Balloon Eustachian Tuboplasty : Systematic Review of Long-term Outcomes and Proposed Indications

Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the long-term outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up >= 12 months). Five additional articles (follow-up, 6-11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET.Peer reviewe

Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging

Object: To investigate the long-term effects of balloon Eustachian tuboplasty (BET) from patient's perspective and to discover which symptoms of Eustachian tube dysfunction (ETD) benefit the most from BET. Method: We designed a retrospective postal questionnaire based on the seven-item ETD questionnaire (ETDQ-7). Our questionnaire covered the severity of present ETD symptoms in comparison with the preoperative situation, the severity of current overall ear symptoms, and possible surgical interventions after BET. Forty-six patients treated in our institution between 2011 and 2013 fulfilled the inclusion criteria and 74% (34 patients; total 52 ears treated with BET) returned the questionnaire with a mean follow-up time of 3.1 years (range 1.8-4.6 years). Results: Pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged had reduced in 75% of the ears that suffered from these symptoms preoperatively. Seventy-seven percent of all the responders felt that their overall ear symptoms were reduced. Altogether, 82% of all the patients stated that they would undergo BET again if their ear symptoms returned to the preoperative level. Conclusion: Patient satisfaction in the long-term effects of BET is encouraging. These results may help clinicians in preoperative patient selection and counselling.Peer reviewe

The feasibility of virtual reality for anatomic training during temporal bone dissection course

Funding Information: The study was funded by the Academy of Finland (AD Grant No. 333525), State Research Funding of the Kuopio University Hospital (TT Grant No. 5551865, AD Grant No. 5551853), The Finnish ORL-HNS Foundation (TT Grant No. 20210002 and No. 20220027), North Savo Regional Fund (TT Grant No. 65202121, AD Grant No. 65202054), Finnish Cultural Foundation (TT Grant No. 00211098), and The Finnish Society of Ear Surgery. Publisher Copyright: Copyright © 2022 Timonen, Iso-Mustajärvi, Linder, Vrzakova, Sinkkonen, Luukkainen, Laitakari, Elomaa and Dietz.Introduction: In recent decades, the lack of educational resources for cadaveric dissections has complicated the hands-on otological surgical training of otorhinolaryngology residents due to the poor availability of cadaver temporal bones, facilities, and limited hours for practice. Since students must gain adequate and patient-safe surgical skills, novel training methods need to be considered. In this proof-of-concept study, a new virtual reality (VR) software is described; this was used during a national temporal bone dissection course where we investigated its feasibility for otological surgical training. Methods: A total of 11 otorhinolaryngology residents attended the annual 2-day hands-on temporal bone dissection course; they were divided into two groups with similar experience levels. Both groups received a lecture on temporal bone anatomy. A total of 22 cadaver temporal bones were harvested for the course; 11 of these bones were imaged by computed tomography. VR software designed for preoperative planning was then used to create 3D models of the imaged temporal bones. Prior to dissection training, the first group underwent a 30-min VR session, where they identified 24 surgically relevant anatomical landmarks on their individual temporal bone. The second group proceeded directly to dissection training. On the second day, the groups were switched. The feasibility of VR training was assessed with three different metrics: surgical performance evaluation using a modified Hopkins objective structured assessment of technical skill (OSATS), time for the surgical exposure of anatomical landmarks, and the user experience collected with a Likert scale questionnaire. Results: No differences were noted in the overall performance between the groups. However, participants with prior VR training had a lower mean time for surgical exposure of anatomical landmarks (antrum 22.09 vs. 27.64 min, p = 0.33; incus 60.00 vs. 76.00, p = 0.03; PSCC 71.83 vs. 88.50, p = 0.17) during dissection training. The participants considered VR beneficial for anatomy teaching, surgery planning, and training. Conclusion: This study demonstrated the feasibility of implementing VR training in a temporal bone dissection course. The VR training demonstrated that even short expert-guided VR sessions are beneficial, and VR training prior to the dissections has a positive effect on the time needed to perform surgical tasks while maintaining comparable performance scores.Peer reviewe

Tutkijan tukipalvelut tehokkaaseen käyttöön

Korva-, nenä- ja kurkkutautien ja foniatrian väitöstutkijat ja vastikään väitelleet lääketieteen tohtorit kokevat hyötyvänsä erityisesti biostatistikon, kielentarkastajan, tutkimushoitajan ja informaatikon palveluista. Niistä pitäisi tiedottaa nykyistä paremmin.</p

Tutkijan tukipalvelut tehokkaaseen käyttöön

Korva-, nenä- ja kurkkutautien ja foniatrian väitöstutkijat ja vastikään väitelleet lääketieteen tohtorit kokevat hyötyvänsä erityisesti biostatistikon, kielentarkastajan, tutkimushoitajan ja informaatikon palveluista. Niistä pitäisi tiedottaa nykyistä paremmin

Balloon Eustachian Tuboplasty : Technique, Outcome, and Indications

Normal middle ear function is based on the air-filled middle ear (ME) cleft. The air in the ME is derived from the nasopharynx through the Eustachian tube (ET) and from the mastoid air cell system through transmucosal gas exchange. In chronic ear diseases, aeration is usually impaired because of ET dysfunction (ETD) or because the aeration routes from the mastoid are blocked or both. Balloon Eustachian tuboplasty (BET) aims at improving the function of the ET, thereby facilitating the prevention and treatment of chronic ear diseases. Only individual reports mention performing BET under local anesthesia (LA). However, BET under LA can offer several advantages, including reduced anesthesia-related risks and decreased time needed in the operation room. Although short-term outcomes of BET are promising, more studies focusing on the long-term outcomes of BET, subjective and objective, are warranted. Establishing accepted indications for BET is also necessary. In Study I, we investigated the feasibility of BET under LA by comparing it with endoscopic sinus surgery (ESS) that is routinely performed under LA. The study focused on safety of the procedure and the patients’ experience. The balloon dilation device was Acclarent Aera (Acclarent Inc., Menlo Park, CA, USA) but its import to the EU ceased and, therefore, in Study II, we decided to examine if BET was feasible under LA with other BET devices (TubaVent and TubaVent Short, Spiggle & Theis Medizintechnik GmbH, Overath, Germany). In Study II, we also compared lidocaine-prilocaine cream and cocaine-adrenaline solution in anesthetizing the ET. No adverse effects occurred among the patients treated with BET under LA. Intraoperatively, those treated with Acclarent Aera and TubaVent Short had similar visual analog scale (VAS) scores for pain to those of the ESS group. Compared with ESS patients, TubaVent patients reported significantly more pain and discomfort during BET. No differences emerged between the effects of lidocaine-prilocaine cream and cocaine-adrenaline solution. In Study III, we examined the long-term outcomes of BET in our institution, focusing on the patients’ perspective. The questionnaire study showed that pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged reduced the most, in 75% or more of the patients who had suffered from these symptoms preoperatively. Of all patients, 77% had milder overall ear symptoms after the mean follow-up of 3.1 years. In Study IV, a systematic literature review revealed that the studies on the long-term outcomes of BET were heterogeneous in definition of ETD, selection of patients, duration of follow-up, additional treatments, and chosen outcome measures. Together, data from the studies suggested that BET has a positive long-term effect on chronic ETD symptoms and objective findings. Study IV also presented national indications for BET in adults as proposed by the Finnish Otosurgical Society: chronic bothersome symptoms referring to ETD, ETD symptoms when atmospheric pressure changes rapidly, or recurring serous otitis media. We conclude that BET is safe and feasible under local anesthesia. In addition to regular nasal nerve block anesthesia, both lidocaine-prilocaine cream and cocaine-adrenaline solution are suitable for local anesthesia although room for improvement regarding the anesthesia method still exists. Pain and discomfort scores were similar between the three different BET devices. However, patients treated with TubaVent experienced significantly more pain and discomfort during the operation than patients undergoing ESS. With the knowledge of which symptoms of chronic ETD respond best to BET and with the national consensus on indications for BET, patient counseling and selection can be enhanced. However, more long-term studies – with uniform criteria – on the effect of BET are still needed.  Välikorvan normaali toiminta perustuu hyvin ilmastoituihin välikorvaonteloon ja kartiolisäkkeen lokerostoon. Ilma pääsee välikorvaan joko korvatorven kautta nenänielusta tai kartiolisäkkeen lokeroston limakalvon läpi tapahtuvan kaasujenvaihdon seurauksena. Kroonisissa korvataudeissa ilmastoituminen on kuitenkin yleensä vaillinaista kartiolisäkkeen lokeroston ja välikorvan välisten ilmastointireittien tukkeutumisen, korvatorven vajaatoiminnan tai molempien vuoksi. Korvatorven pallolaajennus tähtää korvatorven toiminnan parantamiseen ja siten kroonisten korvasairauksien ehkäisyyn ja hoitoon. Vain yksittäisissä julkaisuissa on raportoitu korvatorven pallolaajennuksen suorittamista paikallispuudutuksessa. Paikallispuudutustoimenpiteellä voidaan olettaa olevan kuitenkin useita etuja yleisanestesiatoimenpiteeseen verrattuna. Näitä ovat esimerkiksi nukutukseen liittyvien riskien poistuminen ja lyhyempi leikkaussaliaika. Vaikka lyhytaikaiset seurantatulokset ovat lupaavia, korvatorven pallolaajennuksen subjektiivisiin ja objektiivisiin pitkäaikaishyötyihin keskittyviä tutkimuksia tarvitaan lisää. Myös yhtenevät toimenpideindikaatiot puuttuvat. Ensimmäisessä osatyössä tutkittiin, soveltuuko korvatorven pallolaajennus paikallispuudutuksessa tehtäväksi toimenpiteeksi vertaamalla sitä paikallispuudutuksessa tehtävään poskionteloaukon avarrukseen. Tutkimuksessa selvitettiin toimenpiteen turvallisuutta sekä potilaan kokemusta paikallispuudutustoimenpiteestä. Ensimmäisessä osatyössä korvatorven pallolaajentimena käytetyn Acclarent Aera -laitteiston (Acclarent Inc, Menlo Park, CA, USA) maahantuonti kuitenkin loppui, ja sen vuoksi päätimme toisessa osatyössä selvittää, sopivatko muut saatavilla olevan korvatorven pallolaajentimet – TubaVent ja TubaVent short (Spiggle & Theis Medizintechnik GmbH, Overath, Saksa) – paikallispuudutustoimenpiteessä käytettäviksi. Lisäksi vertailimme lidokaiiniprilokaiinivoidetta ja kokaiiniadrenaliiniliuosta korvatorven puuduttamisessa. Paikallispuudutuksessa tehdyissä korvatorven pallolaajennuksissa ei ilmaantunut haittavaikutuksia. Acclarent Aeralla ja TubaVent Shortilla hoidettujen potilaiden arvio toimenpiteen aikaisesta kivusta vastasi poskionteloaukon avarruksella hoidettujen potilaiden kokemuksia. Sen sijaan TubaVentillä hoidetut potilaat kokivat merkitsevästi enemmän kipua ja epämukavuutta toimenpiteen aikana kuin poskionteloaukon avarrusleikkauksella hoidetut potilaat. Lidokaiiniprilokaiinivoiteen ja kokaiiniadrenaliiniliuoksen puudutustehossa ei havaittu eroja. Kolmannessa osatyössä selvitimme korvatorven pallolaajennuksen pitkäaikaistuloksia klinikassamme keskittyen erityisesti potilaan kokemukseen hoidon tehosta. Kyselytutkimuksen perusteella korvatorven pallolaajennus helpotti eniten korvakipua, paineen tunnetta korvassa sekä korvien lukkoisuutta. Nämä oireet lievittyivät vähintään 75 %:lla niistä, jotka olivat kärsineet kyseisestä oireesta ennen toimenpidettä. Kaiken kaikkiaan korvaoireet olivat nyt leikkausta edeltäneeseen tilanteeseen verrattuna vähäisempiä 77 %:lla kaikista tutkimukseen osallistuneista potilaista. Seuranta-aika oli keskimäärin 3,1 vuotta. Neljännessä osatyössä tehtiin systemaattinen kirjallisuuskatsaus, jossa todettiin korvatorven pallolaajennuksen pitkäaikaistuloksia selvittävien tutkimusten olevan kovin heterogeenisiä potilasvalinnan ja käytettyjen mittareiden suhteen. Tutkimukset kuitenkin osoittavat, että korvatorven pallolaajennuksella on hyvä pitkäaikaisteho kroonisen korvatorven vajaatoiminnan hoidossa. Lisäksi osatyössä esitettiin Suomen Korvakirurgiyhdistyksen muodostamat kansalliset indikaatiosuositukset korvatorven pallolaajennukselle aikuispotilailla: pitkäaikaiset korvatorven vajaatoiminnan oireet ja löydökset, nopeisiin paineenvaihteluihin liittyvät paineentasausongelmat sekä toistuva liimakorva. Korvatorven pallolaajennus on turvallinen myös paikallispuudutuksessa tehtynä. Nenän johtopuudutuksen lisänä sekä lidokaiiniprilokaiinivoide että kokaiiniadrenaliiniliuos ovat sopivia korvatorven puudutukseen, vaikka paikallispuudutusmenetelmän lisäkehittely on vielä tarpeen. Korvatorven pallolaajentimista Acclarent Aera ja TubaVent Short sopivat käyttöön paikallispuudutustoimenpiteissä. Tämän tutkimuksen perusteella tiedämme, mitkä korvatorven vaajatoiminnan oireista lievittyvät parhaiten korvatorven pallolaajennuksella. Lisäksi on luotu korvatorven pallolaajennuksen kansalliset indikaatiot. Nämä tiedot ovat tärkeitä potilasohjauksessa ja potilaiden valinnassa toimenpiteeseen. Silti tarvitaan vielä lisää yhtenäisillä kriteereillä tehtyjä pitkäaikaistutkimuksia korvatorven pallolaajennuksen tehosta

Balloon eustachian tuboplasty: Systematic review of long-term outcomes and proposed indications

Balloon Eustachian tuboplasty (BET) aims to improve the function of the Eustachian tube (ET). The objective of this study was to review the longterm outcome of BET and present the process and results of outlining indications for BET by the Finnish Otosurgical Society. The literature review is based on a database search performed in May 2017. The search resulted in 100 individual articles, which were screened for relevance. Five articles fulfilled the inclusion criteria (follow-up ≥12 months). Five additional articles (follow-up, 6–11 months) were analyzed to obtain supportive information. The proposed BET indications were constituted in the 2016 annual meeting of the Finnish Otosurgical Society. The workshop included a review of the Eustachian tube physiology, middle ear aeration mechanisms, and BET outcome studies. Thereafter, the members of the Society first voted and then discussed 14 cases in order to conclude whether BET was indicated in each case, and subsequently, a consensus statement on the indications for BET was outlined. The long-term follow-up studies were heterogeneous regarding the Eustachian tube dysfunction (ETD) definition, patient selection, follow-up duration, additional treatments, and outcome measures. The current, but limited, evidence suggests that BET is effective in the long-term. However, more long-term studies with uniform criteria and outcome measures as well as placebo-controlled studies are needed. The proposed indications for BET by the Finnish Otosurgical Society include chronic bothersome symptoms referring to ETD, ETD-related symptoms when pressure changes rapidly, or recurring serous otitis media. With the current evidence, we suggest treating only adults with BET

Table2_The feasibility of virtual reality for anatomic training during temporal bone dissection course.DOCX

Introduction: In recent decades, the lack of educational resources for cadaveric dissections has complicated the hands-on otological surgical training of otorhinolaryngology residents due to the poor availability of cadaver temporal bones, facilities, and limited hours for practice. Since students must gain adequate and patient-safe surgical skills, novel training methods need to be considered. In this proof-of-concept study, a new virtual reality (VR) software is described; this was used during a national temporal bone dissection course where we investigated its feasibility for otological surgical training.Methods: A total of 11 otorhinolaryngology residents attended the annual 2-day hands-on temporal bone dissection course; they were divided into two groups with similar experience levels. Both groups received a lecture on temporal bone anatomy. A total of 22 cadaver temporal bones were harvested for the course; 11 of these bones were imaged by computed tomography. VR software designed for preoperative planning was then used to create 3D models of the imaged temporal bones. Prior to dissection training, the first group underwent a 30-min VR session, where they identified 24 surgically relevant anatomical landmarks on their individual temporal bone. The second group proceeded directly to dissection training. On the second day, the groups were switched. The feasibility of VR training was assessed with three different metrics: surgical performance evaluation using a modified Hopkins objective structured assessment of technical skill (OSATS), time for the surgical exposure of anatomical landmarks, and the user experience collected with a Likert scale questionnaire.Results: No differences were noted in the overall performance between the groups. However, participants with prior VR training had a lower mean time for surgical exposure of anatomical landmarks (antrum 22.09 vs. 27.64 min, p = 0.33; incus 60.00 vs. 76.00, p = 0.03; PSCC 71.83 vs. 88.50, p = 0.17) during dissection training. The participants considered VR beneficial for anatomy teaching, surgery planning, and training.Conclusion: This study demonstrated the feasibility of implementing VR training in a temporal bone dissection course. The VR training demonstrated that even short expert-guided VR sessions are beneficial, and VR training prior to the dissections has a positive effect on the time needed to perform surgical tasks while maintaining comparable performance scores.</p

Table3_The feasibility of virtual reality for anatomic training during temporal bone dissection course.DOCX

Introduction: In recent decades, the lack of educational resources for cadaveric dissections has complicated the hands-on otological surgical training of otorhinolaryngology residents due to the poor availability of cadaver temporal bones, facilities, and limited hours for practice. Since students must gain adequate and patient-safe surgical skills, novel training methods need to be considered. In this proof-of-concept study, a new virtual reality (VR) software is described; this was used during a national temporal bone dissection course where we investigated its feasibility for otological surgical training.Methods: A total of 11 otorhinolaryngology residents attended the annual 2-day hands-on temporal bone dissection course; they were divided into two groups with similar experience levels. Both groups received a lecture on temporal bone anatomy. A total of 22 cadaver temporal bones were harvested for the course; 11 of these bones were imaged by computed tomography. VR software designed for preoperative planning was then used to create 3D models of the imaged temporal bones. Prior to dissection training, the first group underwent a 30-min VR session, where they identified 24 surgically relevant anatomical landmarks on their individual temporal bone. The second group proceeded directly to dissection training. On the second day, the groups were switched. The feasibility of VR training was assessed with three different metrics: surgical performance evaluation using a modified Hopkins objective structured assessment of technical skill (OSATS), time for the surgical exposure of anatomical landmarks, and the user experience collected with a Likert scale questionnaire.Results: No differences were noted in the overall performance between the groups. However, participants with prior VR training had a lower mean time for surgical exposure of anatomical landmarks (antrum 22.09 vs. 27.64 min, p = 0.33; incus 60.00 vs. 76.00, p = 0.03; PSCC 71.83 vs. 88.50, p = 0.17) during dissection training. The participants considered VR beneficial for anatomy teaching, surgery planning, and training.Conclusion: This study demonstrated the feasibility of implementing VR training in a temporal bone dissection course. The VR training demonstrated that even short expert-guided VR sessions are beneficial, and VR training prior to the dissections has a positive effect on the time needed to perform surgical tasks while maintaining comparable performance scores.</p