Theodoros Skevas1, Carsten V Dalchow2, Sara Euteneuer3, Holger Sudhoff4, Götz Lehnerdt5. 1. Department of Otorhinolaryngology, Head and Neck Surgery, St. Anna Hospital, Academic Teaching Hospital of the Heinrich-Heine University of Düsseldorf, Vogelsangstrasse 106, 42109, Wuppertal, Germany. theodoros.skevas@cellitinnen.de. 2. Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Frankfurt Höchst, Gotenstrasse 6-8, 65929, Frankfurt a. M., Germany. 3. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. 4. Department of Otorhinolaryngology, Head and Neck Surgery, Bielefeld Academic Teaching Hospital, University of Münster, Teutoburger Str. 50, 33604, Bielefeld, Germany. 5. Department of Otorhinolaryngology, Head and Neck Surgery, St. Anna Hospital, Academic Teaching Hospital of the Heinrich-Heine University of Düsseldorf, Vogelsangstrasse 106, 42109, Wuppertal, Germany.
Abstract
PURPOSE: Balloon Eustachian tuboplasty (BET) is a new treatment modality addressing chronic obstructive dysfunction of the Eustachian tube (ET). So far, BET has been deemed a safe procedure under general anesthesia with only minor adverse effects. However, individual cases of postoperative emphysema have been reported. In the present retrospective multicenter analysis we determined the incidence rate of this potentially life threatening complication after BET. METHODS: In total we collected data from 3,670 BET procedures performed on 2,272 patients in four tertiary care ENT departments. RESULTS: Ten cases of postoperative cervicofacial emphysema were documented, whereas only in 3 of them a pneumomediastinum was developed. None of the affected patients developed at any time serious clinical signs or symptoms besides cutaneous crepitations. A complete resolution and recovery of the emphysema occurred in all patients under antibiotic prophylaxis and abstinence from Valsalva maneuver within the first 2-6 postoperative days. CONCLUSIONS: Possible causes for the development of these postinterventional emphysemas are considered to be mucosal injuries of the ET during manipulations for the correct position of the insertion instrument, through a "kinking" of the balloon catheter or even due to the relative rigid catheter itself, although its form is regarded to be atraumatic. The complication rate of postoperative emphysema was 0.27% (95% CI 0.13-0.50%). The above facts in addition to only minor and transient overall complications after BET reported in literature, can label this procedure as a safe treatment with a low risk profile.
PURPOSE:Balloon Eustachian tuboplasty (BET) is a new treatment modality addressing chronic obstructive dysfunction of the Eustachian tube (ET). So far, BET has been deemed a safe procedure under general anesthesia with only minor adverse effects. However, individual cases of postoperative emphysema have been reported. In the present retrospective multicenter analysis we determined the incidence rate of this potentially life threatening complication after BET. METHODS: In total we collected data from 3,670 BET procedures performed on 2,272 patients in four tertiary care ENT departments. RESULTS: Ten cases of postoperative cervicofacial emphysema were documented, whereas only in 3 of them a pneumomediastinum was developed. None of the affected patients developed at any time serious clinical signs or symptoms besides cutaneous crepitations. A complete resolution and recovery of the emphysema occurred in all patients under antibiotic prophylaxis and abstinence from Valsalva maneuver within the first 2-6 postoperative days. CONCLUSIONS: Possible causes for the development of these postinterventional emphysemas are considered to be mucosal injuries of the ET during manipulations for the correct position of the insertion instrument, through a "kinking" of the balloon catheter or even due to the relative rigid catheter itself, although its form is regarded to be atraumatic. The complication rate of postoperative emphysema was 0.27% (95% CI 0.13-0.50%). The above facts in addition to only minor and transient overall complications after BET reported in literature, can label this procedure as a safe treatment with a low risk profile.
Entities:
Keywords:
Balloon catheter; Balloon dilation of the ET; Balloon eustachian tuboplasty (BET); Cervicofacial emphysema; Eustachian tube (ET); Pneumomediastinum