Computed Tomography Before Balloon Eustachian Tuboplasty–A True Necessity?

Abstract

Preoperative high-resolution CT scan of the temporal bone does not seem to be suitable to predict intraoperative or postoperative difficulties of balloon Eustachian tuboplasty. Being extremely cautious during balloon catheter insertion into the Eustachian tube and using a device that is designed with a built-in stop mechanism preventing too deep insertion, the data presented suggest that fear of injury to the internal carotid artery during balloon dilatation might be disproportionate. Nevertheless, for inexperienced surgeons, HR-CT scans of the temporal bone may help to understand the relation between internal carotid artery and the Eustachian tube.

Balloon Eustachian tuboplasty: a retrospective cohort study

“…In three patients (four Eustachian tubes, 1.1% of patients, 0.8% of Eustachian tubes), balloon dilation could not be performed due to difficulties advancing the balloon catheter. In the light of current literature, our data suggest that fear of internal carotid injury during balloon dilation is disproportionate . This conclusion was corroborated by Tisch et al ., who evaluated head CT scans of 1000 patients and found no dehiscence of the carotid canal.…”

Imaging of the Eustachian tube and its function: a systematic review

“…BET is an ET dilatation technique using a high-pressure balloon catheter, similar to those employed in angioplasty. CT provides the best structural resolution [ 37 – 39 ], and CT angiography can provide further detail if required [ 36 ]. Some institutions routinely request CT imaging prior to performing BET to look for arterial dehiscence adjacent to the ET, as this may put the artery at risk.…”

“…However, many surgeons consider this unnecessary, as commercially available ET balloon catheters introduced via the nasopharynx do not reach this far. Abdel Aziz et al found carotid canal dehiscence in 6.3 % patients undergoing BET, all of whom went on to have the procedure without complication [ 37 ]. In contrast, Tisch et al found no dehiscence in a total of 2000 scans, with a mean thickness of the carotid canal wall of 1.02 ± 0.29 mm [ 38 ].…”

In Vivo Measurement of Middle Ear Pressure Changes during Balloon Eustachian Tuboplasty

“…Although not representative related to the small sample size, the rate (1 out of 5 patients) of internal carotid artery dehiscences observed in our study should be considered when handling the Eustachian tube. This finding underlines the close relationship between the Eustachian tube and the internal carotid artery [ 16 , 17 ].…”