By Nancy Melville
Patients undergoing balloon dilation for persistent obstructive Eustachian tube dysfunction who receive local anaesthesia show no significant differences in outcomes compared with those provided general anaesthesia, according to a study presented at the 2020 Virtual Meeting of the American Academy of Otolaryngology-Head & Neck Surgery Foundation (AAO-HNSF).
“Balloon dilation of the Eustachian tube under local anaesthesia is effective in treating obstructive Eustachian tube dysfunction and the results are durable with a mean follow-up of over 2 years,” reported Joonas Toivonen, MD, Boston Children’s Hospital, Boston, Massachusetts.
While balloon dilation of the Eustachian tube may be performed under general or local anesthesia, the latter option provides benefits including being able to be performed in an office setting and therefore significantly reducing costs.
Dr. Toivonen and colleagues evaluated data on patients with persistent obstructive Eustachian tube dysfunction who had failed adequate medical therapy and underwent balloon dilation of the Eustachian tube between 2013 and 2018. Of the patients, 93 underwent local anaesthesia and 173 received general anaesthesia.
The local anaesthesia protocol included diazepam 10 mg 90 minutes preoperatively, oxymetazoline spray for decongestion, otic drops on the ipsilateral tympanic membrane, cottonoids with 2% tetracaine solution in the nose bilaterally for 10 minutes, removal, and then administration of tetracaine/lidocaine cream 0.5 ml into the Eustachian tube orifice, and replacement of the cottonoids in the nasal cavity for another 10 to 15 minutes.
With a mean follow-up of 2.3 years, there were statistically significant improvements in middle ear function in both groups, with the tympanograms improving to type A status in 93% in the local anaesthesia group and 77% in the general anaesthesia group 1 year post-op.
Tympanogram results were normal in 97% of those in the local anaesthesia group at 1 year post-op and in 90% of patients in the general anaesthesia group.
The probability of being failure-free at 5 years was 87% and 84%, respectively.
One patient did not tolerate the balloon dilation procedure and went on to have the dilation performed under general anaesthesia.
“We found significant improvements in both groups with a mean follow-up of 2.3 years, including in otomicroscopic findings, tympanograms, and the ability to perform the Valsalva maneuver,” said Dr. Toivonan said. “When comparing the 2 groups, there was no need for additional interventions.”