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European Archives of Oto-Rhino-Laryngology

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01-01-2018 | Otology

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

Authors: Theodoros Skevas, Carsten V. Dalchow, Sara Euteneuer, Holger Sudhoff, Götz Lehnerdt

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2018

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.

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

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 CrossRefPubMed

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 CrossRefPubMed

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

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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

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

10.

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

11.

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

12.

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

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 CrossRefPubMed

14.

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

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRef

28.

Wanscher JH, Svane-Knudsen V (2014) Promising results after balloon dilatation of the eustachian tube for obstructive dysfunction. Dan Med J 61 (4):A4818PubMed

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 CrossRefPubMed

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 CrossRef

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) CrossRefPubMed

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):942–945PubMed

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 CrossRefPubMed

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 CrossRefPubMed

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) CrossRefPubMed

36.

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

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 CrossRefPubMed

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) CrossRefPubMed

Title: Cervicofacial and mediastinal emphysema after balloon eustachian tuboplasty (BET): a retrospective multicenter analysis
Authors: Theodoros Skevas
Carsten V. Dalchow
Sara Euteneuer
Holger Sudhoff
Götz Lehnerdt
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 1/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-017-4805-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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