By Dr. Brad Bichey, MD MPH · December 2, 2022

Eustachian Tube Dilation Surgical Procedure

Why Does Someone Need Eustachian Tube Dilation?

The eustachian tubes are small tubes connecting the middle of your ears to the upper portion of your throat, lying just behind the nose. They are responsible for keeping the ears healthy and functioning by equalizing pressure and draining fluids. Eustachian tubes also help protect the body from pathogens that could potentially cause infections.

Most of the time, the eustachian tubes stay closed to protect the ears. However, certain actions such as swallowing, chewing, or yawning cause them to open so that pressure within the ear can be equalized. This is why people often chew gum when flying, as it helps force the eustachian tubes to open, alleviating the added pressure on the ears that is experienced at higher altitudes. Anytime you experience that “pop” in the ears, you’re feeling the eustachian tubes opening to relieve pressure.

When the eustachian tubes stop functioning properly and do not open and close when they are meant to, this is called eustachian tube dysfunction (ETD). ETD usually occurs when the tubes get blocked, which can happen for a variety of reasons, such as a buildup of fluid or mucus from allergies, sinusitis, or upper respiratory tract infections.

However, ETD can also happen due to trauma or an anatomical abnormality. For example, a patulous eustachian tube is an abnormality that causes the eustachian tube to stay open longer than usual.

Symptoms of eustachian tube dysfunction, whether caused by a blockage or abnormality, can include:

• Fullness in the ears
• Pain
• Feeling like the ear are “plugged”
• Hearing difficulties
• Ringing in the ears
• Clicking and popping sounds

Many occurrences of ETD are mild and will resolve on their own, but a doctor may recommend using decongestants, nasal sprays, antihistamines, or antibiotics if the issue is the result of a bacterial infection. For more severe or chronic ETD, the doctor may recommend eustachian tube dilation surgery.

What are the Benefits of Eustachian Tube Dilation Surgery?

For years, severe cases of ETD were treated by inserting artificial tubes into the ears to help with drainage and blockage. But the problem is that these tiny plastic tubes can easily fall out of place, and using them long-term could result in perforation or issues with dry ear. In 2010, a new type of surgery emerged that involved the use of balloon dilation for eustachian tube dysfunction.

Today, balloon dilation eustachian tube surgery is considered the preferred and more effective treatment option. Some of the many benefits include:

• Improved outcomes: Eustachian tube dilation has proven to be more effective than other ETD treatments because it doesn’t stop at treating the blockage issue— it can help address underlying structural problems in the ears, preventing future problems with blockage.
• Safety: Eustachian tube dilation surgery doesn’t require any cutting or removal of bone, making it the safer option. There is a lower risk of infection or something going wrong.
• Quick and efficient: Because the procedure is so simple, it is much easier to perform. It can be done at the doctor’s office using local anesthesia rather than going to the hospital and being put under general anesthesia. This procedure also reduces the need for repeat surgeries, saving time in the long run.
• Reduced recovery times: Again, as there is no cutting involved, there are no wounds that need to heal after surgery, which means recovery time is minimal. Patients can often return to their normal activities on the same day.

If chronic ear pressure or fluid hasn't responded to the usual treatments, chat with us to find an ENT near you who offers eustachian tube dilation and can tell you whether it's a good fit.

Are There Any Risks Involved With Eustachian Tube Dilation Surgery?

Any surgery comes with risks. There is never a guarantee that something won’t go wrong. However, most doctors prefer eustachian tube balloon dilation surgery as there are minimal risks. The majority of patients have no issues whatsoever and experience little to no discomfort.

In most cases, eustachian tube dilation surgery has a 95% of better success rate. However, exceedingly rare issues can lead to infection, mucosal trauma, or carotid artery injury.

What to Expect: What is Eustachian Tube Dilation?

Eustachian tube dilation is a type of surgery that involves the insertion of a special balloon, which is inflated inside to unclog the tubes and help with potential structural problems or anatomic abnormalities. This treatment can prevent future issues, such as ear pain, pressure, and clogging.

How Much Does it Cost?

The biggest downside of eustachian tube dilation surgery is that the costs can vary greatly as it is still considered an experimental treatment by many insurance providers. Some say it can be as expensive as $7,000 to $13,000, while others say it’s $1,800 to $2,500 per ear.

You should check with your specific insurance provider and your physician to know how much the procedure will cost you. Some insurance companies will cover a portion of the cost, and others will not.

What Happens Before Eustachian Tube Dilation Surgery?

Prior to surgery, the doctor will check the inside of the nasal cavity with a small camera and light to determine potential causes of the ETD. They will also look for any anatomical abnormalities. If the issue is mild or minor, they will likely suggest other less invasive treatments first.

However, if other treatments fail or if the issue is determined to be severe, balloon dilation surgery may be suggested. In this case, your doctor should go over the details of the procedure with you, such as what you should do before coming in for the surgery, what they will do during surgery, and the outcomes and risks involved.

As with most surgeries, you may be asked to avoid eating or even drinking anything after midnight the night before. However, office-based treatment requires no change in your eating habit. You may also be asked to stop taking certain medications or supplements to reduce any complications.

What Happens During Eustachian Tube Dilation Surgery?

On the day of the procedure, you will likely go to your doctor’s office, as it is not necessary to have the surgery done in a hospital operating room. However, some doctors do still perform the surgery in a hospital.

You will be numbed using local anesthesia, which means you will still be awake and conscious. The procedure is fairly quick and easy, so there is no need to be fully under using general anesthesia.

Once you are numbed, the doctor will insert the deflated eustachian tube balloon through the nose. It is guided through the nasal cavity until reaching the opening of the eustachian tube at the back of the nose.

Once inside the eustachian tube, the balloon is inflated to dilate the obstructed tube. The balloon is then kept in place for a couple of minutes as it remodels the structure of the eustachian tube cartilage. This also helps flatten out any inflammation.

After the area is unblocked, the balloon is deflated and removed from the eustachian tube and nasal cavity. If both eustachian tubes are blocked, the procedure will then be repeated on the other side.

In most cases, this procedure is performed without any issues. However, it can only be done so long as there are no obstructions through the nasal cavity. If, for some reason, the doctor cannot access the eustachian tube through the nasal cavity, such as a deviated septum or nasal polyps, other treatment options may be required.

Eustachian Tube Dilation Recovery

Though eustachian tube dilation surgery is relatively new compared to other treatment methods for ETD, statistics have shown high success rates and long-lasting results. Overall, it is a very simple, safe, and effective procedure.

Most patients can resume their normal activities within the same day, but a little rest may be suggested. General recovery time is around one to two days, though some doctors may suggest refraining from more intense activities, such as exercising, for a week or two.

Additional post-op instructions may include:

• A day of rest
• Using a saline spray twice per day
• Avoiding intentionally popping your ears for one week

Your doctor may also recommend an exercise called the Valsalva maneuver after surgery to help with recovery. This involves closing your nose and mouth and then blowing out, which forces air through the eustachian tube to help relieve pressure and remodel the newly treated cartilage.

Are There Side Effects?

All surgeries come with risks. With eustachian tube dilation, the side effects are typically minimal. Patients could experience nose bleeds, infection, or some trauma to the eustachian tube.

Some mild discomfort, minimal bleeding, soreness, or congestion may occur immediately after the procedure, but this can easily be remedied using nasal sprays and over-the-counter pain medications or decongestants.

When to Call Your Doctor

Again, minimal bleeding and discomfort are normal after eustachian tube dilation surgery. However, if your symptoms last longer than a week or two and are more severe than what is expected, you should check in with your doctor. You should also schedule a follow-up to make sure the surgery was effective. If your symptoms of ETD do not go away, you may need to have balloon dilation surgery again or try another treatment method.

Signs that you may be experiencing complications and may need to see your doctor include:

• Bleeding that lasts for more than a few days or bleeding that is excessive
• Pain that lasts more than a few days or pain that is unmanageable
• Headache, fever, fatigue, or nausea—these may be signs of an infection
• Difficulty breathing

What is the Goal of Eustachian Tube Dilation?

The overall goal of eustachian tube dilation surgery is to remodel the structure of the eustachian tube to allow it to open and close properly. Additionally, the goal is also to do this in the most minimally invasive way possible while providing long-lasting results.

Other surgeries used to treat eustachian tube dysfunction are more invasive because they involve cutting into tissue and removing bone. Inserting artificial tubes is also not guaranteed to work as the small plastic tubes can easily fall out of place or cause trauma, such as perforation.

Eustachian tube balloon dilation surgery, however, has higher success rates and reduces the risk of complications. There is no cutting involved. The doctor simply inflates a small balloon inside the eustachian tube and holds it in place for a couple of minutes until the tube has been remodeled and unblocked.

Though still a new procedure, many studies have shown eustachian tube dilation to be safer and more effective than other ETD treatment methods.