Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis

Abstract

Possible causes for the development of these postinterventional emphysemas are considered to be mucosal injuries of the ET during manipulations for the correct position of the insertion instrument, through a "kinking" of the balloon catheter or even due to the relative rigid catheter itself, although its form is regarded to be atraumatic. The complication rate of postoperative emphysema was 0.27% (95% CI 0.13-0.50%). The above facts in addition to only minor and transient overall complications after BET reported in literature, can label this procedure as a safe treatment with a low risk profile.

A Rare Case of Pneumomediastinum after Eustachian Tube Dilation

“…In their review of 2,272 patients undergoing balloon dilation in Germany, Skevas et al[3] reported 10 cases of subcutaneous emphysema and 3 cases of pneumomediastinum. Many of these events occurred after maneuvers such as sneezing or nose blowing, and all occurred no later than the third postoperative day [2].…”

“…It is performed by inserting a balloon catheter endonasally into the orifice of the eustachian tube until the bony-cartilaginous junction is reached. The balloon is then inflated inside the cartilaginous portion of the eustachian tube for up to 2 min before removal [2, 3].…”

Balloon Eustachian tuboplasty for Eustachian tube dysfunction: report of long-term outcomes in a UK population

“…A comprehensive investigation into cervicofacial emphysema following balloon Eustachian tuboplasty demonstrated 10 cases in 3670 procedures – an incidence of only 0.27 per cent, 16 which settled in all cases once the Valsalva manoeuvre had been discontinued for a period of time. This rare complication is thought to arise as a result of small tears in the Eustachian tube caused by the dilatation, which allow gas to escape into the tissue around the parotid area on Valsalva manoeuvres.…”

“…is their recommendation for the use of oral or intravenous antibiotic therapy in cervicofacial emphysema patients, in addition to discontinuation of the Valsalva manoeuvre for a period of at least two weeks. 16 This recommendation is based on a recent study examining the bacterial species found on balloon Eustachian tuboplasty catheter tips post-operatively. 17 That study found several bacterial species in high concentrations, including corynebacterium, Staphylococcus hominis, Proteus mirabilis , Escherichia coli , Staphylococcus aureus , Staphylococcus epidermidis , Streptococcus pyogenes and Klebsiella oxytoca , 17 which have the potential to create significant deep tissue infection in the event of rupture of the Eustachian tube mucosa and subsequent surgical emphysema.…”

Sensorineural Hearing Loss After Balloon Eustachian Tube Dilatation

“…Concerning the occurrence of minor complications, transient adverse events are reported with a rate of 3% (11), including nose bleeding and hematotympanum. The rate of cervicofacial and mediastinal emphysema as major complications was calculated as 0.27% in a multicenter study with 3,670 BET procedures (12). The information of a negative effect on the inner ear function is of central importance for a procedure which is focussed on improving the middle ventilation and function.…”