Long-term outcomes of balloon dilation of the eustachian tube under local anesthesia

Abstract Purpose To evaluate the long-term outcomes, safety, and feasibility of balloon dilation of the Eustachian tube (BDET) performed under local anesthesia in patients with baro-challenge-induced and obstructive Eustachian tube dysfunction (ETD). Methods This prospective observational cohort study included 65 adult patients (89 ears) undergoing in-office BDET under local anesthesia between May 2020 and June 2023. Symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and a visual analogue scale (VAS). Clinical examination, Valsalva maneuver, tympanometry, and pure-tone audiometry were additionally evaluated when available. Follow-up was performed at 3, 12, and 24 months. Results Thirty-seven patients had baro-challenge-induced ETD and 28 had obstructive ETD (OETD). All 65 patients underwent BDET under local anesthesia, with a mean intraoperative pain score of 5/10. Mean ETDQ-7 scores improved significantly in the overall cohort (p < 0.0001), with improvement maintained at 12 and 24 months. Improvement was significant in baro-challenge-induced ETD but not in OETD. Subjective ability to perform the Valsalva maneuver improved significantly in both groups, while air-conduction thresholds improved significantly in the baro-challenge group. One self-limiting cervicofacial subcutaneous emphysema occurred, with no major complications. Conclusion In-office BDET under local anesthesia is a safe and feasible treatment for ETD, with symptomatic improvement maintained for up to 24 months. Patients with baro-challenge-induced ETD appear to benefit most, whereas outcomes in OETD are more variable. These findings highlight the importance of appropriate patient selection and counseling.