Advertisement

European Radiology

, Volume 28, Issue 9, pp 3685–3691 | Cite as

Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model

  • Kun Yung Kim
  • Woo Seok Kang
  • Jung-Hoon Park
  • Byung-Chul Kang
  • Jun Woo Park
  • Min Tae Kim
  • Nader G. Bekheet
  • Seung Jun Hwang
  • Joonmyeong Choi
  • Kyu-Jin Cho
  • Hong Ju Park
  • Ho-Young Song
Vascular-Interventional
  • 118 Downloads

Abstract

Objectives

To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model.

Methods

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).

Results

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).

Conclusion

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.

Key Points

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.

Keywords

Eustachian tube Radiography, interventional Otitis media with effusion Dilatation Constriction, pathological 

Abbreviations

ET

Eustachian tube

Notes

Funding

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

Guarantor

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.

Informed consent

Written informed consent was not required for this study because this study is cadaveric experimental study.

Ethical approval

Institutional Review Board approval was not required because this study is a cadaveric experimental study.

Methodology

• Experimental study

• Performed at one institution

References

  1. 1.
    Alper CM, Swarts JD, Singla A, Banks J, Doyle WJ (2012) Relationship between the electromyographic activity of the paratubal muscles and Eustachian tube opening assessed by sonotubometry and videoendoscopy. Arch Otolaryngol Head Neck Surg 138:741–746CrossRefPubMedGoogle Scholar
  2. 2.
    Schilder AG, Bhutta MF, Butler CC et al (2015) Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol 40:407–411CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hwang SY, Kok S, Walton J (2016) Balloon dilation for Eustachian tube dysfunction: systematic review. J Laryngol Otol 130(Suppl 4):S2–S6CrossRefPubMedGoogle Scholar
  4. 4.
    Huisman JML, Verdam FJ, Stegeman I, de Ru JA (2018) Treatment of Eustachian tube dysfunction with balloon dilation: a systematic review. Laryngoscope 128:237–247CrossRefPubMedGoogle Scholar
  5. 5.
    McCoul ED, Anand VK (2012) Eustachian tube balloon dilation surgery. Int Forum Allergy Rhinol 2:191–198CrossRefPubMedGoogle Scholar
  6. 6.
    McCoul ED, Anand VK, Christos PJ (2012) Validating the clinical assessment of eustachian tube dysfunction: the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Laryngoscope 122:1137–1141CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Schroder S, Lehmann M, Sudhoff H, Ebmeyer J (2014) Assessment of chronic obstructive Eustachian tube dysfunction: evaluation of the German version of the Eustachian Tube Dysfunction Questionnaire. HNO 62:160 162-164CrossRefPubMedGoogle Scholar
  8. 8.
    Van Roeyen S, Van de Heyning P, Van Rompaey V (2015) Value and discriminative power of the seven-item Eustachian Tube Dysfunction Questionnaire. Laryngoscope 125:2553–2556CrossRefPubMedGoogle Scholar
  9. 9.
    Schroder S, Lehmann M, Korbmacher D, Sauzet O, Sudhoff H, Ebmeyer J (2015) Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction. Clin Otolaryngol 40:691–697CrossRefPubMedGoogle Scholar
  10. 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. 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
  12. 12.
    Parisier SC, Khilnani MT (1970) The roentgenographic evaluation of Eustachian tubal function. Laryngoscope 80:1201–1211CrossRefPubMedGoogle Scholar
  13. 13.
    Bluestone CD (1971) Eustachian tube obstruction in the infant with cleft palate. Ann Otol Rhinol Laryngol 80(Suppl 2):1–30Google Scholar
  14. 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

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Biomedical Engineering Research Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Anatomy and Cell Biology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.School of Mechanical and Aerospace EngineeringSeoul National UniversitySeoulKorea

Personalised recommendations