In-Office Eustachian Tube Solutions

When Metro Sinus Can Help

The Eustachian tube is a partially collapsable, membranous tube that connects the back of the nasal airway to the air-filled space behind the eardrum (known as the middle ear space). Normally the tube opens temporarily with swallows and yawns, equalizing pressure behind the eardrum with that of the outside world.

When the Eustachian tube orifice (its opening in the back of the nose) becomes inflamed, it can swell fully shut for days, weeks or months. Negative pressure then builds up behind the eardrum, creating a vacuum effect that can pull fluid into the middle ear space from the surrounding tissue. Patients with middle ear effusions (fluid behind the eardrum) experience muffled hearing and pressure, and severe pain can result if the fluid becomes infected.

Eustachian tube dysfunction (ETD) is usually treated with nasal sprays and steroids to reduce swelling around the tube’s opening to the back of the nasal cavity. When medical treatment fails to improve the pressure and/or hearing loss caused by ETD, the physicians of Metro Sinus can help you find lasting relief.

What Is Balloon Dilation of the Eustachian Tube?

Balloon dilation of the Eustachian tube (BDET) is a bloodless endoscopic in-office procedure designed to re-establish normal Eustachian tube function. It utilizes a thin, flexible balloon catheter (similar to what is used during BSD) to dilate and permanently remodel the obstructed portion of the Eustachian tube where it arises from the back of the nasal cavity.

BDET is performed under local anesthesia via a numbing gel applied to the nasal cavity and ET opening. No needles or injections are necessary. The catheter is then gently advanced into the first portion of the Eustachian tube, the balloon is inflated for 2 minutes, then deflated and removed. There is mild pressure, little to no pain, and no recovery time or restrictions.

The procedure has a 10+ year history of safety and efficacy. Studies have shown BDET to provide permanent clinical improvement in the large majority of patients with very few risks or downsides.

How Balloon Dilation Works

Eustachian Tube Dilation FAQs

Successful BDET permanently remodels the inside of the membranous Eustachian tube, which is the portion closest to the back of the nasal cavity and the only portion that can swell shut due to ETD. As the dilated tissue heals, the bulky tissue that obstructs the tube thins substantially.

By permanently reducing swelling on the inside of the Eustachian tube, BDET substantially improves the chances the tube will successfully equalize pressure throughout each day. This improved baseline in ET function lessens the likelihood of future fluid accumulation and middle ear infections, and allows the eardrum to vibrate more freely. The end result is a durable reduction in ear fullness, pressure, and muffled hearing–naturally and without tubes.

It is often said by ENT physicians that “the nose rules the ears.” Anti-inflammatory treatments such as nasal sprays, steroids and decongestants are always the first-line treatments when ear fullness and muffled hearing occur due to ETD.

If a fluid effusion develops behind the eardrum, the symptoms can be quite bothersome. If the condition is refractory to medical treatment and lasts weeks-months, sometimes the best option is to drain the fluid directly in an in-office procedure called a myringotomy and tube placement.

A myringotomy is a small incision made in the numbed eardrum under a microscope. Fluid can then easily be suctioned from the middle ear space and fully removed. Left alone, this small hole in the eardrum usually heals within days and the fluid usually returns.

To prevent this, a small tube (also known as a grommet) is typically placed into the eardrum incision, stenting it open. An ear tube equalizes the pressure in the middle ear space (the space behind the eardrum) to that of the outside world. This helps prevent fluid effusion while the tube is in place. Most tubes last about a year before falling out into the ear canal, after which the eardrum usually heals spontaneously.

Tubes are a great option for select patients but come with some disadvantages like muffled, hollow-sounding hearing and a risk of persistent eardrum perforation. It’s sometimes helpful to consider tubes a second-best, backdoor way to equalize ear pressure. Whenever possible, a normally functioning Eustachian tube is always the best-case scenario.

Ear fullness and pressure–and Eustachian tube dysfunction in particular–can be a complex issue to diagnose and treat. In many offices, myringotomy & ear tube placement is the sole recommendation offered to address this issue. Many of these patients will be unhappy with tubes if not selected properly. BDET is a newer frontier in Eustachian tube treatment that has allowed us to offer a different–and often better–way forward.

We invite you to visit us to learn what treatments are most likely to bring you relief. If BDET is a good option for you, be confident in our experience. Dr. Conoyer and Dr. Boone have been performing Eustachian tube dilation procedures comfortably in the office setting since 2013.

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