About this page. Detailed consent for Eustachian Tube Balloon Dilatation (ETBD) — a relatively modern technique that addresses the underlying cause of Eustachian tube dysfunction, in contrast to grommets which simply bypass it.
What the Operation Is
The Eustachian tube is the narrow channel that connects the middle ear to the back of the nose. It normally opens during swallowing and yawning, equalising air pressure between the middle ear and the atmosphere and draining any fluid out of the middle ear into the nasopharynx. When the Eustachian tube does not open properly — Eustachian tube dysfunction (ETD) — patients experience fullness, muffled hearing, ear popping, tinnitus, pressure pain on aeroplanes, or recurrent middle-ear effusions.
In Eustachian Tube Balloon Dilatation, a deflated balloon catheter is passed via a guidewire through the nose into the cartilaginous portion of the Eustachian tube, under general anaesthetic. The balloon is inflated to a defined pressure for a defined time, gently stretching and remodelling the tissues lining the tube. This re-establishes a more normal opening mechanism. The aim is to restore the Eustachian tube's function rather than simply bypass it (as a grommet does).
I have a video of this operation on my YouTube channel:
Expected Results
The recommended quoted success rate for ETBD is around 75%. This figure is partly because Eustachian tube dysfunction is sometimes difficult to diagnose objectively — the more confident I am that ETD is the true underlying problem, the more likely I believe the technique will work for that patient. The technique can take about six weeks to deliver its full effect, although many patients feel better within a few days of surgery. ETBD should be considered an irreversible procedure — once the tube has been remodelled, it cannot be returned to its original state.
Risks & Complications
1. Nosebleed
Because an instrument is passed via the nose, there is a theoretical risk of nosebleed. This has not happened in my practice before.
2. Pain
I do not offer this procedure under local anaesthetic, so post-operative pain is very low. Any sore throat experienced afterwards is usually from the anaesthetic breathing tube rather than the operation itself.
3. Theoretical damage to the carotid artery
The internal carotid artery runs immediately deep to the Eustachian tube. There is a theoretical risk of damage to the carotid artery with this technique. I am not aware of this ever happening globally, but I include the risk because it has concerned doctors in the past. If it occurred, it could conceivably lead to stroke or serious haemorrhage.
4. Patulous Eustachian tube
There is a possibility that the Eustachian tube can be opened too widely, leading to a "patulous" tube that stays open all the time. The result is hearing your own breathing as a hollow rushing sound and potentially more frequent infections. I am not aware of this ever happening globally with the standardised technique.
5. Lack of success
Around 25% of patients do not get the benefit they hoped for. Where the underlying diagnosis is uncertain, or where there is a structural problem beyond simple tubal dysfunction (large adenoids, severe nasal disease, scarring from previous radiotherapy), the success rate is lower.
6. Anaesthetic risks
Standard general-anaesthetic risks apply, which the anaesthetist will discuss separately.
Aftercare
- Painkillers are rarely needed; paracetamol is sufficient if any discomfort.
- Steroid spray may be prescribed for several weeks to reduce inflammation around the Eustachian tube opening.
- Saline rinses can help keep the nose clean.
- Do not fly for approximately three months after this operation — flying too soon can undo the dilatation and cause recurrence of symptoms.
- Avoid forceful nose blowing for at least two weeks.
When to Call the Hospital or Attend A&E
- Heavy or persistent nosebleed.
- Severe headache, neck stiffness, or sudden visual disturbance.
- Sudden hearing loss, vertigo, or fluid discharge from the ear.
- Worsening pain or signs of infection.
Further Videos
Useful additional videos from the YouTube channel:
Booking, Consent and Next Steps
If you are considering Eustachian Tube Balloon Dilatation, the secretarial team can arrange a consultation. See also Eustachian Tube Dysfunction, Grommet Insertion Consent, and Myringotomy Consent.