Computed tomography before balloon Eustachian tuboplasty--a true necessity?

Area of Science:

• Otolaryngology
• Medical Imaging
• Surgical Procedures

Background:

• Balloon Eustachian tuboplasty (BET) is a treatment for Eustachian tube dysfunction.
• The necessity of preoperative high-resolution CT (HR-CT) scans for BET remains debated.
• Concerns exist regarding potential intraprocedural injury, particularly to the internal carotid artery (ICA) due to carotid canal dehiscences.

Purpose of the Study:

• To evaluate the predictive value of preoperative HR-CT scans of the temporal bone for BET.
• To assess the association between CT findings and intraoperative/postoperative difficulties and complications.
• To specifically investigate the risk of ICA injury in relation to carotid canal dehiscences.

Main Methods:

• Retrospective study at a tertiary referral center.
• Analysis of 284 patients (510 Eustachian tubes) undergoing BET between 2009 and 2012.
• Review of preoperative HR-CT scans and intraoperative/postoperative outcomes.

Main Results:

• Carotid canal dehiscences were identified in 6.3% of patients.
• Difficulties advancing the balloon catheter occurred in 1.1% of patients, with some having unremarkable CT scans.
• Postoperative complications (emphysema, hypoglossal paresis) occurred in 1.1% of patients, all with unremarkable CT scans and resolving fully.

Conclusions:

• Preoperative HR-CT scans are not effective in predicting intraoperative or postoperative difficulties during BET.
• Cautious technique and appropriate device selection mitigate the risk of ICA injury during BET.
• HR-CT scans may offer educational value for inexperienced surgeons regarding ICA-Eustachian tube anatomy.