“This needs to be distinguished from other types of Eustachian tube dysfunction such as patulous dysfunction, or non-obstructive Eustachian tube inflammation,” he said, adding that as far as the current evidence shows, it’s only patients with obstructive Eustachian tube dysfunction who really benefit from balloon dilation of the Eustachian tube.
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April 2023BDET in Clinical Practice
Steven D. Pletcher, MD, residency program director at the University of California, San Francisco and a head and neck surgeon who specializes in sinus surgery and rhinology, said he currently uses BDET in his practice several times a year. An expert in minimally invasive endoscopic procedures of the paranasal sinuses and skull base, Dr. Pletcher’s practice focuses more on sinus disorders, but he has had patients with comorbid sinus and Eustachian tube disease.
“Sometimes my otology colleagues ask for help with this transnasal procedure due to nasal or sinus disorders that limit access to the Eustachian tube orifice,” he said. “It’s helpful to have an option other than medical management and tympanostomy tubes for these patients, though it’s still hard to know what long-term outcomes will look like.”
James E. Saunders, MD, an associate professor of otology and neurotology at Dartmouth Hitchcock Medical Center in Lebanon, N.H., has been performing the procedure since 2014 and does about one per week, with most of those for patients undergoing middle ear surgery, such as laser myringoplasty or tympanoplasty.
“Patients undergoing BDET are often treated by comprehensive otolaryngologists as an alternative to tympanostomy tubes,” he said. “But I’m interested in determining if this technique can be appropriately used for patients with more severe ear disease.”
Traditionally, Dr. Saunders, who learned this procedure from Dr. Poe, would treat Eustachian tube dysfunction in those patients with tympanostomy tubes, but as these can further weaken the eardrum and lead to perforations, he’s looking for any opportunity to improve function and outcomes. “As an otologist, we’re often at the mercy of the Eustachian tube,” he said.
Dr. Saunders has noticed BDET’s rapidly growing popularity, which he said is often the case when something is fairly easy to perform and carries a relatively low risk. He is concerned, however, that as a specialty, otolaryngologists should be careful about critically evaluating their results and identifying which patients are most likely to benefit.
“We should examine the nasopharynx and Eustachian tube more often when considering middle ear surgery to identify any treatable pathology or potential benefit from BDET,” he said. “We also need to resolve the role of BDET in children and clarify the required pre-op evaluation.”