Endoscopic Eustachian Tube Balloon Dilatation

What is the Eustachian Tube and Why Does it Matter?

The Eustachian tube is a narrow channel connecting the middle ear to the back of the nose and throat (nasopharynx). Its primary functions are to:

• Equalise pressure between the middle ear and the surrounding environment
• Drain secretions away from the middle ear
• Protect the middle ear from pathogens and nasopharyngeal pressure fluctuations

When the Eustachian tube does not open and close normally, pressure regulation fails, fluid may accumulate in the middle ear and a range of distressing ear symptoms can develop.

Why is Eustachian Tube Balloon Dilatation Performed?

1. Chronic Eustachian Tube Dysfunction

• Persistent blocked ear sensation, pressure, muffled hearing or aural fullness that does not resolve with conservative management.
• Symptoms are typically worse with altitude changes (flying, driving in the mountains) or during upper respiratory tract infections.

2. Chronic Otitis Media with Effusion (Glue Ear) in Adults

• When fluid repeatedly accumulates in the middle ear in adults due to underlying Eustachian tube dysfunction, dilatation of the tube addresses the root cause rather than simply treating the consequence with a grommet.

3. Recurrent Acute Otitis Media

• Patients who suffer from frequent middle ear infections attributable to poor Eustachian tube function may benefit from dilatation as part of their management.

4. Eardrum Retraction

• Chronic negative middle ear pressure caused by a poorly functioning Eustachian tube can cause the eardrum to be progressively drawn inward (retracted). Addressing the underlying tube dysfunction can halt or slow this process.

5. Poor CPAP Tolerance due to Ear Symptoms

• Some patients on CPAP therapy for obstructive sleep apnoea develop or worsen Eustachian tube symptoms due to positive airway pressure. Balloon dilatation may form part of their management.

What Happens During the Operation?

1. The procedure is performed under general anaesthesia as a day-case procedure.
2. A rigid nasal endoscope is passed through the nose to visualise the nasopharyngeal opening of the Eustachian tube.
3. A specially designed balloon catheter is carefully introduced into the cartilaginous portion of the Eustachian tube under direct endoscopic vision.
4. The balloon is inflated for approximately 2 minutes at a controlled pressure, gently dilating and remodelling the Eustachian tube lumen.
5. The balloon is then deflated and removed. No tissue is cut or removed and no sutures are required.

Typical duration: 15-20 minutes and can be performed on one or both sides in the same sitting.

What are the Advantages of this Technique?

• Minimally invasive — no external incisions, no tissue removal
• Performed entirely through the nose under endoscopic vision
• No nasal packing or splints required
• Can be combined with other nasal or sinus procedures (e.g. septoplasty, FESS) in the same anaesthetic if indicated
• Evidence supports durable improvement in Eustachian tube function and symptom relief in appropriately selected patients

Expected Recovery

• Almost all patients are discharged on the same day as the procedure.
• Mild ear discomfort, a sensation of fullness or slight pressure changes in the ear are common in the first few days and settle quickly.
• Popping or crackling sounds in the ear during the early recovery period are normal and indicate the tube beginning to function.
• A nasal saline rinse may be recommended in the early postoperative period.
• Patients are advised to avoid forceful nose blowing for one to two weeks.
• Flying is generally safe after a short recovery period — your surgeon will advise based on your individual circumstances.
• Follow-up is arranged to assess symptom improvement and middle ear status, including a repeat tympanogram (a simple painless test of middle ear pressure) to confirm improved Eustachian tube function.