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Balloon treatment for eustachian tube dysfunction, tinnitus relief alcohol - Review

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The development of balloon catheters used, for example, in the dilatation of coronary arteries led to revolutionary treatment concepts, previously deemed unthinkable.
In a practical clinical study, Professor Holger Sudhoff has proved that the Eustachian tube can be treated by means of a modified PTA catheter which is introduced into the tube with the aid of a special microendoscope specifi cally developed for this purpose.
A preoperative tubomanometry (TMM) is performed on the patients for a detailed assessment of tube function and in order to decide whether dilatation should be performed. The treatment principle is similar to that of balloon dilation in vascular stenosis and has recently also been established in the treatment of chronic obstructive sinusitis. During the clinical part of the study, balloon dilation was performed on subjects with obstructive tube dysfunction.
First of all, under transnasal endoscopic vision of the lateral wall of the epipharynx, a suitably modifi ed catheter is placed adjacent to the pharyngeal ostium of the Eustachian tube.
In order to investigate the functional changes of Eustachian tube dilation by balloon catheter, the intervention was performed on a total of eight patients (aged 20 and above) treating a total of 13 ears. The success of other treatment procedures was mainly assessed using examination methods that only allowed indirect conclusions regarding tube function. The results of this study show that dilation of the Eustachian tube is a safe and uncomplicated procedure. A balloon that’s inserted through the nose and into the ear could help tackle hearing problems, including tinnitus.Once it’s in the ear, the balloon is inflated with salt water which helps widen and unblock the Eustachian tube — the narrow passage which connects the middle ear to the back of the nose. Treatments for Eustachian tube dysfunction include decongestants, oral and nasal steroids, and antihistamines. Around 200 patients suffering from long-term Eustachian tube dysfunction will have the deflated balloon treatment in one ear The patient will then have a grommet inserted into the other ear and be monitored for up to two years. Bilateral middle ear effusions for more than 3 months, accompanied by a moderate to severe conductive hearing loss, and or evidence of speech or language delay.

During the observation period it is worthwhile to treat with one full course of appropriate oral antibiotics and encourage exercises to improve eustachian tube function.
Indications for more prompt insertion are those rare effusions causing a significant conductive hearing loss, those with a pre-existing hearing loss, significant learning and speech delay and those with anatomical abnormalities such as cleft palate. The microendoscope is constructed in such a way that the catheter may be advanced into the tube in a carefully controlled manner without injuring any critical structures. Thereafter, histological examinations were performed on the petrosal bone to record the direct effects that balloon dilation has on the Eustachian tube and its surrounding structures.
This catheter, with a balloon at its distal tip, is pushed through the working channel of the microendoscope and carefully advanced into the tube while avoiding any resistance.
Pre and postoperative results were compared using a specially developed Eustachian tube score (ETS) of subjective and objective parameters. This study, however, used tubomanometry as a method of directly measuring tube function by assessing the tube‘s gas transfer capability. The tube sits just behind the ear drum and is normally closed, but opens during swallowing, yawning and chewing to equalise air pressure on both sides of the drum. A tympanostomy tube, or grommet, can also be inserted through a small incision in the ear drum which allows air and mucus to pass through the Eustachian tube.In a new planned trial at Southmead NHS Hospital, Bristol, around 200 patients suffering from long-term Eustachian tube dysfunction will have the deflated balloon treatment in one ear (the balloon is inserted up the nose and then steered into the Eustachian tube under general anaesthetic). The treatment, which is being evaluated by the National Institute for Health and Clinical Excellence (NICE), has previously been tested in a small trial with 11 adults at the University of Tampere Medical School, Finland. Those with only mild hearing loss, and without a history of recurrent acute otitis media can be safely observed for 6-12 months in terms of long term language development. These include the blowing up of balloons, bubbling water through a straw and valsalva manoevres if able. It requires an anaesthetic, and otorrhoea is a common but rarely persistent problem during the period of tympanostomy tube patency.

Full assessment is required once the tympanostomy tubes have extruded to ensure persisting middle ear ventilation.
A comparison of outcomes following tympanostomy tube placement or conservative measures for management of otitis media with effusion. Once the balloon is positioned inside the tube, a saline solution is used to apply the dilation up to a pressure of 10 bar. Two months after the treatment, ten cases showed evidence of tube opening in all three TMM measurements (30, 40, 50 millibar). Once an effusion has been present for 3 months, however, only 30% will resolve over the ensuing year.
Only patients with chronic obstructive Eustachian tube dysfunction were included in the study. Then the solution is aspirated from the balloon and the catheter is carefully removed with the endoscope to complete the procedure. The Eustachian tube score showed a signifi cant improvement in tube function in the clinical part of the study. There was not a single case where tube opening did not occur in one of the three measurements. 12 Very rarely tympanostomy tubes may need to be removed if they remain in situ for greater than 2 years.

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