All About the Innovative Treatment Options for Ear Infections

Looking for chronic ear infection relief? Join us on We Nose Noses as Dr. Reddy, Dr. Smith, and Dr. Undavia guide you through this revolutionary procedure for treating eustachian tube dysfunction through the use of balloon dilation. We’ll cover everything from how the eustachian tubes work to the latest in treatment options, so you can find the relief you deserve.

What you’ll learn

What you’ll learn:

  • Learn about eustachian tubes and why they’re crucial for keeping your ears healthy and infection-free.
  • Understand the symptoms and causes of eustachian tube dysfunction, and why traditional treatments may fall short.
  • How a balloon eustachian tube dilation can be a less invasive, more effective alternative for long-term relief.

If you are in need of ear support or other ENT services, schedule a consultation today at our Marlton, New Jersey location by visiting NJENT.com or call 609-710-NOES (6673).

Listen to the audio version below.

Audio Transcript:

Dr. Reddy:

Hey guys, welcome back to the show. Today we will be discussing balloon eustachian tube dilation. This is a newer procedure that we offer here at NJENT, and it’s used to treat eustachian tube dysfunction. So first, let’s just go over what are your eustachian tubes. Dr. Undavia, do you wanna go over that?

Dr. Undavia:

Sure. The eustachian tube is, it is a tube, and it connects your nose to the middle ear. And what it does is it allows the space in the middle ear to have the same atmospheric pressure on the inside and outside of the eardrum, so that your eardrum can easily move back.

Dr. Reddy:

Correct. Perfect. And what is eustachian tube dysfunction?

Dr. Smith:

Sure. So eustachian tube dysfunction or ETD is a problem with allowing that ventilation cycle to occur between the back of the nose and the middle ear space. And so the middle ear is a sinus as Dr. Undavia was alluding to. And so that middle ear is a warm, dark environment. So it’s a setup for infections and inflammation if it doesn’t get adequate ventilation into and so if that eustachian tube isn’t letting adequate ventilation in there, you can start to get symptoms of negative pressure within the ear or kind of pain, pressure, difficulty equalizing that, that pressure gradient across the eardrum to the outside world. Some people will even develop fluid within their ear from eustachian tube dysfunction or inflammation around the eustachian tube that cause of eustachian tube dysfunction can be pretty variable. Sometimes in little kids, which are the most common, it’s just due to the immaturity of the eustachian tube. So the eustachian tube is a little more narrow, a little more flat. And so it’s more susceptible to kind of sinus issues or nasal issues with nasal congestion, viruses, allergies, and it’s more susceptible to reflux coming up into the back of the nasopharynx as well. So gastroesophageal contents can come up and spill up into the nasopharynx and trigger inflammation and swelling around that eustachian tube opening. And so anytime you get inadequate opening in the back of the nose, that can trigger then inflammation kind of upstream going into the middle ear and decrease the ventilation there.

Dr. Reddy:

Yep, and Dr. Undavia, do you wanna go over any common treatment options?

Dr. Unavia:

Yeah, I mean, we always start with the least invasive. So we always start with just either control of your environment or medications. So if you know you’re allergic to something that’s giving you nasal congestion, like Dr. Smith was talking about, we can try and avoid that. But if that’s not really an option, we can do allergy medication, like Claritin, Zyrtec, the Ligbarra, Zizal, and the generic forms of those. You can do nasal sprays, like Flo Nase or Fluticasone.

There’s other brands like Nasacore, Rhinochor, and then there’s other nasal sprays like Azolastine. Azolastine is a topical antihistamine. Typically tastes bad, but those all can kind of help to take some of the inflammation away from the nose and get a little bit more space in the nose and hopefully translate to more space in the eustachian tube. Sometimes we can do antibiotics if we see fluid in the ear we can do some oral steroids. If we see a lot of inflammation and fluid in the ear, even things like Sudafed can help or Afrin. If it’s Afrin, we can do for a couple of days, it can decongest the nose pretty quickly. Yeah, oral and nasal decongestants as well. Those are the main things.

Dr. Reddy:

And what if that doesn’t work? Then what do you do?

Dr. Undavia:

Well, that’s when I would talk to you both.

Dr. Smith:

Well, traditionally, you know, most people have gotten ear tubes or pressure equalization tubes are kind of the real term for PET or pressure equalization tubes. Um, you know, talk more about.

Dr. Reddy:

Yeah. So ear tubes, uh, it’s an artificial eustachian tube. So you’re putting, you’re making a tiny little incision in your eardrum and you’re putting a little plastic, um, tube there typically and that tube equalizes pressure behind your eardrum and it acts as an artificial eustachian tube so that you no longer have to rely on your natural eustachian tube to equalize pressure. What are some downsides to tubes?

Dr. Smith:

Yeah, so one downside is that you’re putting something artificial in there. So whether it’s plastic or a metal substance, it can be a nidus for bacterial growth and so infections from those.

When you make a hole in the eardrum and we put that tube in there as a spacer to keep that small hole open, sometimes that tube can fall out and the hole may not close. So sometimes we have issues where the tubes fall out too soon and somebody may need another tube or the tube may fall out and the hole may not close, which isn’t common, but it does happen requiring another procedure sometimes if the hole gets larger to close it. So that’s usually the most common thing. But even some small changes, you know, kids don’t typically notice the hearing changes that much from ear tubes, but you know, especially in adults, if you put one in one side versus the other side, you’ll typically notice a little bit of a difference in the hearing when those equalization tubes are in. They do have some extra weight, which, you know, puts, you know, extra weight against the movement of the drum, but it also allows some of the air pressure in.

And so your job of the eardrum is to take and conduct sound into the middle and then through the middle into the inner ear so that you can hear. And if you put a hole in that eardrum, sound is actually just air pressure movement. And so as those sound waves, so the air pressure comes and hits the drum, some of it will actually go through the ear tube. So sometimes even just where on the eardrum that tube sits sometimes can change the hearing kind of dynamics.

And so sound dynamics can change with the ear tubes as well.

Dr. Undavia:

Sometimes you get like that noise cancellation where the sound wave goes through the tube and it’s right across from the round window and it cancels out the sound, so you actually feel worse sometimes.

Dr. Smith:

And true. And some people feel like a hollowness from ear tubes as well, that, that a lot of people get used to it and don’t, and aren’t bothered by it because they don’t have the pressure and the congestion pain anymore, but sometimes that hollowness feeling can be problematic for patients as well. Most of us if we have issues equalizing our ears, we start to do things like balsalva or like pincher nose and blow air. We can kind of strain or try to like pull air up from the nasopharynx into the middle ear as well. And people get used to being able to pop their ears like as if they were on an airplane. But if you no longer have that ability to feel that air pop and the drum move.

Some people kind of miss that feeling, so they don’t really like that tube because they don’t have that feeling that their ear’s popping and they’re relieving that pressure. So there are some downsides to tubes, but there are significant upsides to them as well.

Dr. Reddy:

And the biggest complaint is really, you can’t get water in your ears. Yeah. So swimming is a problem. You’re at a high risk of getting an infection if you’re exposed to lake water or beach water.

So you have to wear earplugs. So dirt you can dominate or water is an issue. So that’s probably the biggest complaint. Now up until very recently, all the options that you guys were going over were really the only options for treating eustachian tube issues. And the only procedural option was really ear tubes. Now recently the FDA has approved a new procedure called balloon eustachian tube dilation, which is trying to treat the underlying eustachian tube make that work more, your natural eustachian tube, to try to make that work more effectively to make you feel better. And do you guys want to go over the procedure at all, just broadly speaking, what that looks like?

Dr. Smith:

Sure. Well, we can go over who’s a candidate for that type of a procedure. Sure. Typically, someone who’s a candidate for that procedure would be someone who has either failed multiple sets of tubes or at least they got improvement with the tubes, they continue to need tubes in the future. So if it’s an acute problem, you probably don’t need eustachian tube dilation. But if it’s a chronic problem, it’s typically the gist. So you’ve had multiple sets of tubes maybe in the past, you show signs of negative pressure in the ear, whether it’s a retracted drum, where you get what’s called a tympanogram, which shows that ear drum pressure, kind of the peak compliance of that ear drum is at a negative pressure, as opposed to more neutral or positive type pressure. So people who experience significant barotrauma. So you go up in an airplane and you always are getting pain and pressure in the ears, or if you try to go under the water. So we think of scuba divers, but some people can’t even get five feet underwater without significant pressure against the eardrum and not able to equalize. So those people are typically good candidates for eustachian tube dilation.

And sometimes even just people with like a chronic hole in their eardrum because years and years and years of Eustachian tube dysfunction led to chronic middle ear disease or sinus disease within their middle ear. And maybe they’ve had their eardrum reconstructed or they’ve had the bone and the sinus operated on as well. Those patients are actually good Eustachian tube balloon candidates as well to try to prevent recurrence or progression further of that disease process.

Dr. Undavia:

Well, that’s also one of the risks of putting a tube in is that you’d have a permanent hole afterwards. And it has happened even though it’s not a common complication, but it can happen.

Dr. Reddy:

Yep. So just broadly speaking, any person with eustachian tube dysfunction where conservative medical management doesn’t work is basically a candidate for balloon eustachian tube dilation.

Sometimes the insurance criteria is a little bit more specific or complicated than that, but anyone that just doesn’t want ear tubes is basically a candidate for eustachian tube dilation.

Dr. Smith:

Do you want to go over kind of what the, like a brief kind of overview of what the procedure would be like and what the patient might experience getting that done?

Dr. Reddy:

Sure. So first we numb up, this is done typically in the office. You don’t need to go to the operating room. You don’t need to undergo general anesthesia for this.

It’s a very simple procedure. Arguably, it’s less invasive than ear tubes, right? Because there’s no incisions, there’s no cuts, there’s no removal of tissue. Essentially what we’re doing is we’re numbing up your nose with some cotton balls and maybe some numbing injections and a little catheter is inserted through your nose and on that catheter there is a deflated balloon and that deflated balloon along with the catheter is inserted into the eustachian tube orifice and then that’s dilated with the balloon is undilated and that balloon remains dilated for typically about two minutes and then the balloon is deflated and then the entire apparatus and catheter is removed. So there’s nothing that stays in your nose, the balloon doesn’t stay in your nose, the dilation is for about two minutes and then everything is removed and you’re done.

So there’s no artificial tube or anything. The way that it’s thought to work, or the studies have shown, is that it’s not just dilating the orifice of the tube, it’s also changing the lining of your Eustachian tube canal. So what happens is the dilation of the balloon leads to a little bit of a pressure necrosis of the surrounding Eustachian tube where the lining of your nose, the lining is actually kind of sloughed off. And then that new lining that’s formed hopefully functions better and is able to equalize pressure in your ears. And you know, there’s some decent long-term data of over three, four years now that shows that this lasts for a long time.

And the nice thing about it, worst-case scenario, if it doesn’t work you still have ear tubes as a backup.

Dr. Smith:

Right. Now we used to, when we used to start these and do these, most of us would put ear tubes in at the same time of doing a dilation, or only do them in patients who had contemporary ear tubes placed to try to prevent any pressure after the dilation, because you may get some swelling that makes the pressure equalization a little bit more difficult for the first couple weeks until things improve.

But now more and more I think, you know, at least I’m getting away. I think you are as well getting away from doing tubes at that same time. I find that most patients are used to the, those types of pressure equalization problems when they’re in here and the symptoms after that type of dilation aren’t that bad. Um, and most people do really, really well after these. So, and don’t need that, that tube necessarily. And it’s always there as a fail safe, just in case.

Dr. Undavia:

Well, purpose is to not have the tube. Yeah.

Dr. Reddy:

How about complications? I mean, is there any risks or complications associated with the procedure? Have you guys seen anything, any issues?

Dr. Smith:

Sure, I mean, none personal, but I will say we all were imaging prior to doing these types of procedures, so we all get a CAT scan of kind of the bony anatomy around the eustachian tube, just making sure there’s no major vessels coming close to the eustachian tube that may be put in harm’s way the, it’s soft tissue and you’re going into that area with a, with a probe. And so, you know, theoretically you can dilate and cause, um, a small tear in the lining, which then can lead to air getting trapped underneath of the soft tissue around there. So there are reports of people getting what’s called subcutaneous emphysema or air trapped around the side, kind of the soft tissues in the, in the face and skin around the sinuses.

Those are pretty rare and uncommon to happen. And self-resolvent. Yeah. And self-resolvent.

Dr. Reddy:

Yeah. I mean, I think overall the risks from ear tubes are far greater than the risks from the eustachian tube dilation.

Dr. Undavia:

The main risk is like from some of the injections and noticeably temporarily for like a day off. Yep. Yeah. So anything else to add?

Dr. Smith:

No, I think that’s great.

Dr. Undavia:

You can do a eustachian tube dilation more than once if you needed to.

Dr. Reddy:

You can. Um, I don’t think there’s any contraindication to doing that. Now I’ve never had a patient where I’ve done that for, but I’m sure as time goes on, we may have more patients that have had these done maybe in their early infancy and may need it redone again. And actually the interesting thing, recent development with balloon eustachian tube dilation is that up until very recently, it’s for ages 18 and up. And recently the FDA has approved it for ages up to 13 and up, I believe.

And I could foresee in the future where the FDA starts approving this procedure for even the pediatric population, younger kids, and eventually you could envision a time where right now the most common procedure done in the United States for kids is ear tubes. So we can envision a time where potentially the most common procedure done in the United States for kids is balloon eustachian tube dilation.

Dr. Undavia:

I mean this is a nice procedure. Insurance has made it difficult to get it authorized, but we can still do this procedure on our patients. The best thing about this is it allows our patients, especially the adults, to maintain the activities that they’d like to pursue without any restrictions.

Dr. Reddy:

All right, very good. Well thank you for joining us. We’ll see you guys next time.

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