Transoral Approach for Balloon Dilation of the Eustachian Tube

Balloon dilation of the Eustachian tube (BDET) is typically performed by advancing a balloon through the nasal cavity into the Eustachian tube orifice using a guide catheter. However, in patients with challenging nasal or Eustachian tube anatomy, this transnasal approach may be unsuccessful. Here, we present a case in which transnasal BDET was not possible due to challenging Eustachian tube anatomy, but a transoral approach provided a successful alternative.

After unsuccessful attempts at BDET through the nasal passages, a Crowe-Davis mouth retractor was placed. With endoscopic visualization through the nasal passage, the guide catheter was advanced into the oral cavity and around the soft palate to the Eustachian tube orifice.

The angle of insertion from the transoral approach enabled easy advancement into the Eustachian tube. After the procedure, the patient was able to ventilate the ears without difficulty.

We describe a transoral technique for BDET that bypasses obstructive nasal anatomy and offers greater flexibility in catheter angulation. This approach may serve as a useful alternative in select cases where standard access is not feasible.