Eustachian Tube Balloon Dilation: Who It Helps and What to Expect

01ETD

What Eustachian tube dysfunction is

The Eustachian tube normally opens when you swallow or yawn, letting air into the middle ear. If it stays closed, pressure becomes negative, pulling the eardrum inwards, causing fullness, muffled hearing, discomfort and sometimes fluid build-up.

See Eustachian tube dysfunction and ear fullness.

02Who

Who may benefit

• Adults with symptoms lasting at least 3 months.
• Symptoms not improved by medical treatment such as nasal steroid sprays.
• Ear pressure problems when flying or diving.
• Abnormal pressure tests (tympanometry) or a retracted eardrum.
• No other cause, such as a patulous tube or nasal blockage needing different treatment.

03Before

Before considering surgery

• Treat nasal congestion, allergies and sinusitis.
• Use steroid nasal sprays as directed.
• Try autoinflation, such as gently blowing up a balloon through the nose.
• Practise pressure-equalising techniques.
• Wait, as many cases improve with time.

See ear won’t pop and ear pressure relief.

04Procedure

How the procedure is done

Usually under general anaesthetic, sometimes local, the surgeon uses a thin endoscope to guide a catheter through the nostril to the opening of the Eustachian tube. A small balloon is inserted into the tube and filled with saline for about 1 to 2 minutes, then deflated and removed. The procedure takes about 30 minutes and can be done on one or both sides. It is often a day-case procedure.

05How it works

How it is thought to work

Inflating the balloon is thought to stretch the cartilage part of the tube and reduce inflamed tissue in the lining, allowing it to open more easily. The exact mechanism is still being studied.

06Evidence

What the evidence says

A randomised controlled trial in adults with dilatory dysfunction found that balloon dilation plus medical management led to greater improvement in symptom scores and middle ear pressure than medical management alone at 6 weeks, with benefits maintained over longer follow-up. A US clinical consensus statement supports balloon dilation for carefully selected adults. NICE guidance states that the evidence on efficacy and safety is adequate to support its use with standard arrangements.

07Recovery

Recovery

• Most people go home the same day.
• Mild nasal discomfort or small nosebleeds for a few days.
• Ear popping and crackling as the tube starts to work.
• Avoid blowing the nose hard for a few days.
• Flying is usually avoided for a short period; follow your surgeon’s advice.

08Risks

Risks

• Nosebleeds.
• Temporary ear pain or fullness.
• Air under the skin of the face or neck (rare).
• Failure to improve symptoms.
• Rarely, more serious complications related to nearby structures.

09Alternatives

Alternatives

Ventilation tubes (grommets) in the eardrum bypass the Eustachian tube and relieve pressure, especially when there is fluid behind the eardrum. Grommets work quickly but may fall out and can cause discharge. Balloon dilation treats the tube itself.

See ear tubes and fluid in ear.

10Patulous

When it is not suitable

Balloon dilation is not suitable for a patulous Eustachian tube, which stays open too much and causes hearing your own voice and breathing loudly. It is also not used when symptoms are due to another ear condition.

11Flying

Flying and diving after the procedure

Many people with ETD have trouble with pressure changes when flying or diving. Balloon dilation may make equalising easier. Ask your surgeon when it is safe to fly and whether diving is suitable.

See ear barotrauma.

12Questions

Questions to ask your ENT surgeon

• Is my problem dilatory dysfunction rather than a patulous tube?
• Have I tried all appropriate medical treatments?
• What results do you expect for my symptoms?
• Will one or both sides be treated?
• When can I fly or dive afterwards?

14Summary

Key points to remember

• Balloon dilation treats chronic Eustachian tube dysfunction.
• It is for adults who have not improved with medical treatment.
• A balloon is inflated in the tube through the nose, without cuts.
• Evidence supports it in carefully selected patients.