Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model
To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model.
A total of 12 separate sessions were performed on both sides of the Eustachian tube (ET) in six human cadavers. Cadavers were positioned for the submentovertical view on a fluoroscopy table. Endoscopy-guided ET selection was used in the first three cadavers, whereas fluoroscopy-guided ET selection was used in the remaining three. Eustachian tubography was performed by injecting 2 ml of contrast media through a 5-Fr catheter. We recorded the success of ET selection, number of attempts, procedure time, and tubography quality using native and subtraction images (range, 0–3).
Both endoscopy- and fluoroscopy-guided selections were successfully performed in five of six sessions (83.3%). There were no statistically significant differences between the endoscopy- and fluoroscopy-guided procedures in terms of the number of attempts, procedure time, rate of immediate contrast leak to the middle ear cavity, and quality of tubography (p > 0.05). An excellent quality of tubography was obtained in 83.3% (10 of 12 sessions) of subtraction images and in 33.3% (4 of 12 sessions) of native images. The tubography quality score was significantly higher for the subtraction images than for the native images (p = 0.04).
Subtraction Eustachian tubography using direct catheterisation seems to be technically feasible. The entire ET can be well visualised; thus, this technique can be used as a simple tool for assessment of ET function and anatomy.
• Direct catheterisation of the Eustachian tube is technically feasible.
• The entire Eustachian tube could be well visualised by direct Eustachian tubography.
• Subtraction Eustachian tubography images have better image quality than native images.
• Subtraction Eustachian tubography can provide objective assessment of ET function and anatomy.
KeywordsEustachian tube Radiography, interventional Otitis media with effusion Dilatation Constriction, pathological
This study has received funding by Korea Health Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (HI17C0881).
Compliance with ethical standards
The scientific guarantor of this publication is Ho-Young Song.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required for this study because this study is cadaveric experimental study.
Institutional Review Board approval was not required because this study is a cadaveric experimental study.
• Experimental study
• Performed at one institution
- 10.Kim KY, Tsauo J, Song HY et al (2017) Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction. Eur Radiol. https://doi.org/10.1007/s00330-017-5040-4
- 11.Wittenborg MH, Neuhauser EB (1963) Simple roentgeno-graphic demonstration of Eustachian tubes and abnormalities. Am J Roentgenol Radium Therapy, Nucl Med 89:1194–1200Google Scholar
- 13.Bluestone CD (1971) Eustachian tube obstruction in the infant with cleft palate. Ann Otol Rhinol Laryngol 80(Suppl 2):1–30Google Scholar
- 14.Gaafar H, el Deeb AK, Abdel-Baki F, el-Henawi D (1988) Flexible endoscopy and radiologic evaluation of the eustachian tube in adults with Eustachian tube dysfunction. Am J Otolaryngol 9:357–362Google Scholar