Tuboplastia con balón en la disfunción tubárica obstructiva. Nuestra experiencia

Abstract

Introduction and objective: Obstructive tube dysfunction consists in ventilatory function fail of Eustachian tube over middle ear on account of an alteration on its opening, conditioning negative pressure in tympanic box. According to its duration it is classificated in acute (<3 months) and chronic (>3 months). Etiology is varied, diagnosis is mainly clinical and initial treatment is medical. However, for those refractary cases that keep to criteria we dispose a surgical treatment that has demonstrated good short and long-term results: balloon Eustachian tuboplasty. Otorhinolaryngology section in Burgos University Hospital (HUBU) has conducted a retrospective study of balloon Eustachian tuboplasty carried out from 2018 to 2021. Method: Monitoring of all of them was made with check-up the first month, the third one and the sixth one from the intervention. We used otoscopy in the sixth month as objective criterion of improvement. We carried out 25 procedures in 22 patients, 11 men and 11 women. 3 of them were younger than 18 years old, 6 were 18-40, and 13 were 41-65 years old. All patients included in the study had tube dysfunction diagnosis; furthermore 11 of them had SOM associated, 8 had COM with tympanic perforation and 3 presented tympanic atelectasis. 69% had required ventilation tubes in more than 2 times. 14 of the 25 interventions were unilateral and 10 bilateral, only 1 of them could not be canalised. Many of them had other associated surgeries in the same surgical intervention (such as 12 ventilation tubes, 11 myringoplasties, 3 radiofrequencies and 1 adenoid resection). As complications, we notified 2 otorrhagia, 2 otorrhea and 1 epistaxis. Results: We used the otoscopy in the sixth month as objective criterion of improvement (improvement refers to the absence of: retractions, atelectasis, indirect signs of mucous occupation in tympanic box, tympanic perforations, etc.). 16% didn´t get improvement in otoscopy. 48% had obvious improvement. 26% was not assessable due to in situ ventilation tube. We observed the best results in balloon Eustachian tuboplasty associated to myringoplasty (used for tympanic perforation closure or as a support to prevent membrane retractions). Discussion/Conclusions: Balloon Eustachian tuboplasty is a simple technique with rare complications. It has demonstrated good results, especially when it is associated to myringoplasty. The main indication is SOM and barotrauma when medical treatment is not effective. An appropriate clinical diagnosis is the most important and complicated aspect, because results depend on it.