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7 Tips for a Successful In-Office Balloon Dilation of the Eustachian Tube

New Office Procedures for Otology and Rhinology – Hosted by Acclarent

Saturday, October 10, 12:00 – 1:00 pm (ET)

Industry  Thought Leaders Series


Marc Dean, MD

The first device for Balloon Dilation of the Eustachian Tube (BDET) was approved by the U.S. Food and Drug Administration (FDA) in 2016—but the procedure was required to be performed under general anesthesia in an operating room. In a few short years, though, all FDA-approved eustachian tube dilation devices have indications for use in an office setting under local anesthesia.

“Due to its superior safety profile and durability, BDET has been recommended as an alternative to tympanostomy tubes in the Academy’s 2019 Consensus Statement,” said Marc Dean, MD, of the Ear and Science Institute in Fort Worth. “Performing BDET under local anesthesia offers notable advantages, such as improved patient safety without the risks of general anesthesia, convenience for the patient with less preoperative preparation, and reduced treatment costs.”

Karen Hoffmann, MD

So what does that mean for the otolaryngologist? It means it’s time to enhance those BDET skills. In advance of their session, panelists Dr. Dean and Karen Hoffmann, MD, of Piedmont Ear, Nose, Throat, and Related Allergy in Atlanta, Georgia, provided some tips and tricks for seamlessly performing BDET under local anesthesia in your own office.

  1. Anesthetize an intact tympanic membrane to minimize discomfort resulting from stretching and mobilization of the drum with dilation.
  2. Don’t forget to look at the ear drum of the patient prior to applying topical anesthetic, as they may have developed a new perforation since their last visit.
  3. Utilize a 45-degree scope for improved visibility of the ET opening.
  4. Use an ointment or cream-based anesthetic in the nasopharyngeal opening of the ET, as the gel-based ones have a potential to be wicked up into the middle ear via the ET, potentially causing temporary deafness and vertigo if absorbed into the inner ear.
  5. Inflate the balloon at a speed of < 1 atm/sec to minimize the effect on the reflex arc and decrease discomfort.
  6. Use a vestibular suppressant to avoid triggering vertigo with sudden pressure changes in the middle ear.
  7. If possible avoid any unnecessary tissue trauma as well as any injections of local anesthetic to prevent/minimize any blood running into the field, as it quickly can obscure the view, making the procedure more difficult.

If you miss this live event, it will become available in the on-demand library of education content within 72 hours following the presentation.