new balloon dilation of the eustachian tubedokse.dk/onewebmedia/dokumenter/blandede foredrag... ·...
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Balloon dilation
of
the Eustachian tube
Afdelingslæge Jens Højberg Wanscher
Overlæge Viggo Svane-Knudsen
ØNH-kir. Afd. F,
OUH
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Treatment (historic) of
Chronic obstructive tuba dysfunction
Jens H. Wanscher
Balloon dilation
Bougie
dilation
Myringotomy/
grommet
Laser/ microdebrider
tuboplasty
Catheterization
of ET
Steroid (and/or antihistamines)
nasal spray
Noninvasive
autoinflation
Drilling of the
bony ET
Alteration of the peritubal
muscles
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Bielefeld Balloon Catheter
Jens H. Wanscher
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Jens H. Wanscher
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Jens H. Wanscher
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- Endonasal approach
- The balloon is applied
to ET guided by a
rigid scope
- Dilation for
2 minutes (10 bar)
- General anesthesia
Jens H. Wanscher
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2012, HNO,
Chronisch obstruktive Tubenfunktionsstörung des Erwachsenen,
Schröder et al. (Tyskland)
120 patients (209 ET)
Bielefeld Balloon Catheter
2009-2011
Classical anamnesis
+
Poor tubafunction
(Tubomanometry (score <5),
Tympanometry, Valsalva maneuver) Combination of questions
and measurements
(Score 0-10)
Bielefelder tubenscore
Jens H. Wanscher
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2012, HNO,
Chronisch obstruktive Tubenfunktionsstörung des Erwachsenen,
Schröder et al. (Tyskland)
2 months postoperative:
80 % had sign. positive
impact on tubafunction
(subj. + obj.)
(66 patients, 115 ET)
81 % normal valsalva
(subjective)
12 months postoperative:
80 % had sign. positive
impact on tubafunction
(subj. + obj.)
(12 patients, 20 ET)
90 % normal valsalva
(subjectivt)
120 patients (209 ET)
Bielefeld Balloon Catheter
2009-2011
3 days postoperative:
20 % had sign. positive
impact on subjectiv
tubafunction
No complications ? ?
Jens H. Wanscher
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OUH experiences
Jens H. Wanscher
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Pre-operative examinations
Jens H. Wanscher
• Anamnesis
• Valsalva/extended valsalva/otomicroscopy
• Tympanometry
• Toynbees test
• Nine-step inflation/deflation test
• Tubomanometer
• Endoscopy, Radiology, Audiometry
• Other…
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5 patients – 7 ET • P1 = 21 y , chronic secr. otitis media sin, myringotomy sin x12
• P2 = 54 y , chronic obstr. tubadysfunction sin/(dxt) in many
years, myringotomy many times
• P3 = 31 y , myringoplasty x2 dxt, myringotomy dxt many
times
• P4 = 26 y , myringoplasty dxt x2, myringoplasty sin x1, slight
retraction bilat, adenotomy x2
• P5 = 20 y , cholesteatoma surgery sin x1, myringotomy sin x5,
atelecasis sin
CT og rhinoskopi:
Normal except P4(a polyp
by the right ET ostium)
Toynbees test/valsalva:
Negative/no function
Audiometry:
P1: minor ABG sin
P2: normal
P3: minor ABG bilat
P4: minor ABG bilat
P5: large ABG sin Jens H. Wanscher
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5 patients – 7 ET
Jens H. Wanscher
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Jens H. Wanscher
Surgery
No complications (except a bit of nosebleed and a case of acute otitis media
2 weeks post-operative)
Technically easy surgery
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Questionnaire/VAS
Jens H. Wanscher
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0
10
20
30
40
50
60
70
80
90
100
Præoperativ At trykudligne Postoperativ At trykudligne
P1
P2
P3
P4
P5
Questionnaire/VAS
Hvor svært har du ved at trykudligne ørerne
(når du holder dig for næsen) ?
Jens H. Wanscher
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0
10
20
30
40
50
60
70
80
90
100
Præoperativ Propfornemmelse Postoperativ Propfornemmelse
P1
P2
P3
P4
P5
Questionnaire/VAS
Hvor tit føler du propfornemmelse i ørerne ?
Jens H. Wanscher
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Jens H. Wanscher
0
10
20
30
40
50
60
70
80
Præoperativ Ømhed/smerter Postoperativ Ømhed/smerter
P1
P2
P3
P4
P5
Questionnaire/VAS
Hvor ofte har du ømhed/smerter i ørerne ?
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Jens H. Wanscher
Questionnaire/VAS
Ubehag ved
operation
Anbefale
operation
0
10
20
30
40
50
60
70
80
90
100
P1
P2
P3
P4
P5
Hvor stort ubehag havde du ved operationen ?
Vil du anbefale operationen til en ven/bekendt med tilsvarende problemer ?
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Jens H. Wanscher
Toynbees test/valsalva
All with a positive test
except P4 (dxt)
(polyp + remnants after adenotomy)
Postoperative findings
Audiometry
No change
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Jens H. Wanscher
BIG SUCCES BY VAS
P2 = 54 y , chronic obstr. tubadysfunction sin/(dxt) in many
years, myringotomy many times
SOME SUCCES BY VAS
P1 = 21 y , chronic secr. otitis media sin, myringotomy sin x12
P4 = 26 y , myringoplasty dxt x2, myringoplasty sin x1, slight
retraction bilat, adenotomy x2
P5 = 20 y , cholesteatoma surgery sin x1, myringotomy sin x5,
atelecasis sin
NO SUCCES BY VAS
P3 = 31 y , myringoplasty x2 dxt, myringotomy dxt many
times
Conclusion
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Jens H. Wanscher
BIG SUCCES BY TOYNBEES TEST/VALSALVA
ALL
Except P4
No change in hearing/audiometry
Conclusion
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Jens H. Wanscher
Questions
By 20 % of the patients, it doesn t work – why?
How long lasting is the effect of the dilation?
Is preoperative CT necessary?
Can it be done in local anesthesia?
How about children?
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Jens H. Wanscher
OUH continues dilation of ET
Further results will be presented at
DSOHH 2013
More research is wanted
Future perspectives
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Thank you
Jens H. Wanscher
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Jens H. Wanscher
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Kort om lasertuboplastik
1997, Kujawski et al: 68 % med normal tympanometri efter 1 år
65 % med normal tympanometri efter 3 år
2003, Poe et al: 36 % med normal tympanometri efter 6 måneder
38 % med normal tympanometri efter 2 år
(ud af kun 13 patienter blev bl.a. set synekier og granulomer i det Eustachiske rør!)
Jens H. Wanscher