This protocol applies to adults (18 years or older) with obstructive eustachian tube dysfunction who also have a middle ear effusion present at the time of balloon dilation of the eustachian tube (BDET). Some patients who meet criteria for BDET have concurrent middle ear effusion.
Before escalating to this protocol, medical management of identified treatable causes of obstructive ETD — including allergic rhinitis, rhinosinusitis, and laryngopharyngeal reflux — will have been carried out.
Escalation is indicated when that approach has not achieved symptomatic improvement of associated obstructive ETD. This protocol represents the next step after that failure.
When a middle ear effusion is present at the time of BDET, a concurrent procedural approach to address the effusion may be considered alongside the eustachian tube intervention. The full structured regimen — including the specific procedural options and guidance for this scenario — is available via the link below.
Goals: Better hearing outcomes and normalization of the tympanogram.
DOI: 10.1177/0194599819848423
Some patients who meet criteria for BDET have concurrent middle ear effusion.
Patients with a middle ear effusion at the time of BDET may benefit from concurrent myringotomy with or without tympanostomy tube placement.
Several studies have shown that concomitant placement of tympanostomy tubes at the time of BDET is beneficial.
The panel concluded that placement of the tympanostomy tube may be beneficial in producing better hearing outcomes and normalization of the tympanogram but did not find evidence that it is mandatory.
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