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. 2022 Jun 24;7(4):1120-1128.
doi: 10.1002/lio2.842. eCollection 2022 Aug.

Comparison of outcomes for balloon dilation of the Eustachian tube under local vs general anesthesia

Joonas Toivonen  1   2 , Marc Dean  3 , Kosuke Kawai  1 , Dennis Poe  1
Affiliations

Comparison of outcomes for balloon dilation of the Eustachian tube under local vs general anesthesia

Joonas Toivonen et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: To compare the effectiveness of balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia in the treatment of obstructive Eustachian tube dysfunction (OETD).

Study design: Retrospective review.

Methods: Consecutive patients ages ≥18 with persistent OETD having failed adequate medical therapy underwent BDET between 2013 and 2018 under local or general anesthesia. Inclusion criteria were persistent type B or C tympanograms with symptoms or type A with symptoms upon barochallenge. Objective outcome measures were tympanometry, otoscopy and the need for additional subsequent intervention (revision dilation and tympanostomy tube). Primary outcome (failure) was defined as no change or worse in tympanogram.

Results: The 191 patients (332 ETs), ages 18-88 years (mean 58.0) underwent BDET. The 112 patients (59%) were female. The 107 procedures (32%) were performed under local anesthesia. Mean duration of follow-up was 3.1 years (SD 1.9). Tympanograms improved to type A in 88% for BDET under local and 74% for general anesthesia at 12 months. Probability of being failure-free at 5 years was 70% (95% confidence interval [CI]: 52%-82%) in the local anesthesia group versus 65% (95% CI: 55%-73%) in the general anesthesia group. Risk of failure did not significantly differ between the groups (HR = 0.60; 95% CI: 0.27-1.31; p = .20).

Conclusion: BDET under local anesthesia is effective in treating OETD and results in sustained improvements over 2 years. The procedure was successfully performed in all but one case utilizing a precise anesthesia protocol, and results are comparable with the procedure performed under general anesthesia.

Level of evidence: 4.

Keywords: Eustachian tube; balloon dilation; in‐office balloon dilation; local anesthesia.

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Conflict of interest statement

Dr. Marc Dean is a consultant for Acclarent, Aerin Medical, Biosense Webster, Immertec, Stryker, and STStent. Dr. Dennis Poe is a consultant for Acclarent.

Figures

FIGURE 1
FIGURE 1
Percentage of patients with type A tympanogram preoperatively and during follow‐up.
FIGURE 2
FIGURE 2
Kaplan Meier curve for failure‐free probability comparing patients who underwent balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia. Risk of failure was defined as no change or worse in tympanogram. Patients who had type B or C tympanogram preoperatively included.
FIGURE 3
FIGURE 3
Failure‐free probability comparing balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia in groups with and without adjunctive procedures.
See this image and copyright information in PMC

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