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

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Balloon Eustachian tuboplasty (BET) is a new treatment modality addressing chronic obstructive dysfunction of the Eustachian tube (ET). So far, BET has been deemed a safe procedure under general anesthesia with only minor adverse effects. However, individual cases of postoperative emphysema have been reported. In the present retrospective multicenter analysis we determined the incidence rate of this potentially life threatening complication after BET.

Methods

In total we collected data from 3,670 BET procedures performed on 2,272 patients in four tertiary care ENT departments.

Results

Ten cases of postoperative cervicofacial emphysema were documented, whereas only in 3 of them a pneumomediastinum was developed. None of the affected patients developed at any time serious clinical signs or symptoms besides cutaneous crepitations. A complete resolution and recovery of the emphysema occurred in all patients under antibiotic prophylaxis and abstinence from Valsalva maneuver within the first 2–6 postoperative days.

Conclusions

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.

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References

  1. Holger Sudhoff in collaboration with Bernard Ars CD, Martino Di E, Ikeda R, Jumah MD, Kikuchi T, Kobayashi T, Lehnerdt G, Leuwer R, Mudry A, Skevas T, Theis D, Tisch M, Tysome J (2017) Eustachian tube dysfunction, 2nd edn. UNI-MED Verlag AG

  2. Schröder S, Lehmann M, Ebmeyer J, Upile T, Sudhoff H (2015) Balloon Eustachian tuboplasty: a retrospective cohort study. Clin Otolaryngol 40(6):629–638. https://doi.org/10.1111/coa.12429

    Article  PubMed  Google Scholar 

  3. Poe DS, Silvola J, Pyykko I (2011) Balloon dilation of the cartilaginous eustachian tube. Otolaryngol Head Neck Surg 144(4):563–569. https://doi.org/10.1177/0194599811399866

    Article  PubMed  Google Scholar 

  4. Browning GG, Gatehouse S (1992) The prevalence of middle ear disease in the adult British population. Clin Otolaryngol Allied Sci 17(4):317–321

    Article  CAS  PubMed  Google Scholar 

  5. Choi SH, Han JH, Chung JW (2009) Pre-operative evaluation of eustachian tube function using a modified pressure equilibration test is predictive of good postoperative hearing and middle ear aeration in type 1 tympanoplasty patients. Clin Exp Otorhinolaryngol 2(2):61–65. https://doi.org/10.3342/ceo.2009.2.2.61

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schröder S, Lehmann M, Sauzet O, Ebmeyer J, Sudhoff H (2015) A novel diagnostic tool for chronic obstructive eustachian tube dysfunction—the eustachian tube score. Laryngoscope 125(3):703–708. https://doi.org/10.1002/lary.24922

    Article  PubMed  Google Scholar 

  7. Hwang SY, Kok S, Walton J (2016) Balloon dilation for eustachian tube dysfunction: systematic review. J Laryngol Otol 130(Suppl 4):S2–S6. https://doi.org/10.1017/S0022215116008252

    Article  PubMed  Google Scholar 

  8. Leuwer R, Koch U (1999) Anatomy and physiology of the auditory tube. Therapeutic possibilities in chronic disorders of tubal function. HNO 47(5):514–523

    Article  CAS  PubMed  Google Scholar 

  9. McCoul ED, Lucente FE, Anand VK (2011) Evolution of eustachian tube surgery. Laryngoscope 121(3):661–666. https://doi.org/10.1002/lary.21453

    Article  PubMed  Google Scholar 

  10. Cummings CW (2005) Cummings otolaryngology—head and neck surgery, 4th edn. Elsevier Mosby, Philadelphia

    Google Scholar 

  11. Poe DS, Pyykko I, Valtonen H, Silvola J (2000) Analysis of eustachian tube function by video endoscopy. Am J Otol 21(5):602–607

    CAS  PubMed  Google Scholar 

  12. Chays A, Cohen JM, Magnan J (1995) Microfibroendoscopy of the eustachian tube. Presse Med 24(16):773–774

    CAS  PubMed  Google Scholar 

  13. Hopf J, Linnarz M, Gundlach P, Schafer E, Leege N, Scherer H, Scholz C, Muller G (1991) Microendoscopy of the eustachian tube and the middle ear. Indications and clinical application]. Laryngorhinootologie 70(8):391–394. https://doi.org/10.1055/s-2007-998060

    Article  CAS  PubMed  Google Scholar 

  14. Lehnerdt G, Winterhoff S, Heusgen L, Jahnke J, Hoffmann TK, Lang S (2013) Tubal dilatation. Laryngorhinootologie 92(3):154–157

    Article  CAS  PubMed  Google Scholar 

  15. McCoul ED, Anand VK (2012) Eustachian tube balloon dilation surgery. Int Forum Allergy Rhinol 2(3):191–198. https://doi.org/10.1002/alr.21007

    Article  PubMed  Google Scholar 

  16. Sudhoff H, Schroder S, Reineke U, Lehmann M, Korbmacher D, Ebmeyer J (2013) Therapy of chronic obstructive eustachian tube dysfunction: evolution of applied therapies. HNO 61(6):477–482. https://doi.org/10.1007/s00106-013-2691-6

    Article  CAS  PubMed  Google Scholar 

  17. Schröder S, Abdel-Aziz T, Lehmann M, Ebmeyer J, Sudhoff H (2015) Bacteriologic investigation of the eustachian tube and the implications of perioperative antibiotics before balloon dilation]. HNO 63(9):629–633. https://doi.org/10.1007/s00106-015-0048-z

    Article  PubMed  Google Scholar 

  18. Ockermann T, Reineke U, Upile T, Ebmeyer J, Sudhoff HH (2010) Balloon dilation eustachian tuboplasty: a feasibility study. Otol Neurotol 31(7):1100–1103. https://doi.org/10.1097/MAO.0b013e3181e8cc6d

    Article  PubMed  Google Scholar 

  19. Silvola J, Kivekas I, Poe DS (2014) Balloon dilation of the cartilaginous portion of the eustachian tube. Otolaryngol Head Neck Surg 151(1):125–130. https://doi.org/10.1177/0194599814529538

    Article  PubMed  Google Scholar 

  20. Kivekas I, Chao WC, Faquin W, Hollowell M, Silvola J, Rasooly T, Poe D (2015) Histopathology of balloon-dilation eustachian tuboplasty. Laryngoscope 125 (2):436–441. https://doi.org/10.1002/lary.24894

    Article  PubMed  Google Scholar 

  21. Miller BJ, Elhassan HA (2013) Balloon dilatation of the Eustachian tube: an evidence-based review of case series for those considering its use. Clin Otolaryngol 38(6):525–532. https://doi.org/10.1111/coa.12195

    Article  CAS  PubMed  Google Scholar 

  22. Ockermann T, Reineke U, Upile T, Ebmeyer J, Sudhoff HH (2010) Balloon dilatation eustachian tuboplasty: a clinical study. Laryngoscope 120(7):1411–1416. https://doi.org/10.1002/lary.20950

    Article  PubMed  Google Scholar 

  23. Catalano PJ, Jonnalagadda S, Yu VM (2012) Balloon catheter dilatation of Eustachian tube: a preliminary study. Otol Neurotol 33(9):1549–1552. https://doi.org/10.1097/MAO.0b013e31826a50c3

    Article  PubMed  Google Scholar 

  24. Tisch M, Maier S, Maier H (2013) Eustachian tube dilation using the bielefeld balloon catheter: clinical experience with 320 interventions. HNO 61(6):483–487. https://doi.org/10.1007/s00106-013-2711-6

    Article  CAS  PubMed  Google Scholar 

  25. Gurtler N, Husner A, Flurin H (2015) Balloon dilation of the eustachian tube: early outcome analysis. Otol Neurotol 36(3):437–443. https://doi.org/10.1097/MAO.0000000000000631

    Article  PubMed  Google Scholar 

  26. Randrup TS, Ovesen T (2015) Balloon eustachian tuboplasty: a systematic review. Otolaryngol Head Neck Surg 152(3):383–392. https://doi.org/10.1177/0194599814567105

    Article  PubMed  Google Scholar 

  27. Norman G, Llewellyn A, Harden M, Coatesworth A, Kimberling D, Schilder A, McDaid C (2015) Systematic review of the limited evidence base for treatments of eustachian tube dysfunction: a health technology assessment. Clin Otolaryngol 39(1):6–21. https://doi.org/10.1111/coa.12220

    Article  Google Scholar 

  28. Wanscher JH, Svane-Knudsen V (2014) Promising results after balloon dilatation of the eustachian tube for obstructive dysfunction. Dan Med J 61 (4):A4818

    PubMed  Google Scholar 

  29. McCoul ED, Singh A, Anand VK, Tabaee A (2012) Balloon dilation of the eustachian tube in a cadaver model: technical considerations, learning curve, and potential barriers. Laryngoscope 122(4):718–723. https://doi.org/10.1002/lary.23181

    Article  PubMed  Google Scholar 

  30. Poe DS, Hanna BM (2012) Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model. Am J Otolaryngol 32(2):115–123. https://doi.org/10.1016/j.amjoto.2009.11.008

    Article  Google Scholar 

  31. Pau HW (2015) Does balloon dilatation represent a breakthrough for eustachian tube disorders—even in children? HNO 63(10):681–682. https://doi.org/10.1007/s00106-015-0047-0 (684–685)

    Article  CAS  PubMed  Google Scholar 

  32. Okutani D, Aoe M, Yamane M, Hatoh S, Toyooka S, Sano Y, Date H (2007) Extensive traumatic pneumomediastinum without injuries of organs in the thorax: report of a case. Kyobu Geka 60(10):942–945

    CAS  PubMed  Google Scholar 

  33. Perna V, Vila E, Guelbenzu JJ, Amat I (2010) Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 37(3):573–575. https://doi.org/10.1016/j.ejcts.2009.08.002

    Article  PubMed  Google Scholar 

  34. Khalid MS, Ahmad N, Moin S, El-Faedy O, Gaffney P (2008) Spontaneous pneumomediastinum: a rare complication of acute asthma. Ir J Med Sci 177(4):393–396. https://doi.org/10.1007/s11845-007-0039-5

    Article  CAS  PubMed  Google Scholar 

  35. Aslaner MA, Kasap GN, Demir C, Akkas M, Aksu NM (2015) Occurrence of pneumomediastinum due to dental procedures. Am J Emerg Med 33(1):125. https://doi.org/10.1016/j.ajem.2014.05.055 (e121–123)

    Article  PubMed  Google Scholar 

  36. Heyman SN, Babayof I (1995) Emphysematous complications in dentistry, 1960–1993: an illustrative case and review of the literature. Quintessence Int 26(8):535–543

    CAS  PubMed  Google Scholar 

  37. Arai I, Aoki T, Yamazaki H, Ota Y, Kaneko A (2009) Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107(4):e33–e38. https://doi.org/10.1016/j.tripleo.2008.12.019

    Article  PubMed  Google Scholar 

  38. Picard M, Pham Dang N, Mondie JM, Barthelemy I (2015) Cervicothoracic subcutaneous emphysema and pneumomediastinum after third molar extraction. J Oral Maxillofac Surg 73 (12):2286. https://doi.org/10.1016/j.joms.2015.07.030 (e2281–2283)

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, St. Anna Hospital, Academic Teaching Hospital of the Heinrich-Heine University of Düsseldorf, Vogelsangstrasse 106, 42109, Wuppertal, Germany

    Theodoros Skevas & Götz Lehnerdt

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Frankfurt Höchst, Gotenstrasse 6-8, 65929, Frankfurt a. M., Germany

    Carsten V. Dalchow

  3. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Sara Euteneuer

  4. Department of Otorhinolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, University of Münster, Teutoburger Str. 50, 33604, Bielefeld, Germany

    Holger Sudhoff

Authors
  1. Theodoros Skevas
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Corresponding author

Correspondence to Theodoros Skevas.

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See detailed information in the paragraph “Study design and data collection”.

Conflict of interest

The author Theodoros Skevas declares that he has no conflict of interest. The rest of the authors received reimbursement of travel expenses by the manufacturer of the Bielefeld BET catheter (Spiggle & Theis Medizintechnik GmbH, Overath, Germany). In addition, the author Sara Euteneuer received financial support for a CME training course from Spiggle & Theis. Holger Sudhoff further received financial support for a meeting and royalties from Spiggle & Theis.

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Skevas, T., Dalchow, C.V., Euteneuer, S. et al. Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis. Eur Arch Otorhinolaryngol 275, 81–87 (2018). https://doi.org/10.1007/s00405-017-4805-3

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  • DOI: https://doi.org/10.1007/s00405-017-4805-3

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