Balloon Dilatation of the Eustachian Tube as a Treatment for Pulsatile Tinnitus with Associated Chronic Eustachian Tube Dysfunction

By June 7, 2019

Geukens, Sven1
1 Deptartement of Otolaryngology, OLV Hospital, Aalst, East-Flanders, Belgium

15% of pulsatile tinnitus is diagnosed as idiopatic (1). Balloon dilatation of the Eustachian tube (BET) is successfully used as a treatment for pulsatile tinnitus in a patient with chronic Eustachian tube dysfunction, diagnosed by Eustachian Tube Score-7 (ETS-7) (2). BET is considered to be a safe and effective treatment for chronic Eustachian tube dysfunction (3) and was applied successfully.

Study Design : retrospective case review.
Setting : Dept of ENT, OLV Hospital Aalst
Patient : 49-year old female with a two year ongoing continuous pulsatile unilateral tinnitus. Normal imaging on CT, MRI showed a neurovascular conflict that led to an initial misdiagnosis. A ventilation tube had been placed without result.
Intervention :
* diagnostic : ETS-7 score
* therapeutic : BET

Main outcome Measure : – ETS-7 score
Results : one week posrtoperatively, there was a type A tympanometry with Valsalva being successful sometimes, but no improvement on tinnitus was noticed. Tubomanometry was negative at 50 mbar, resulting in a ETS-7 score of 7. The patient was given the advice to frequently perform Valsalva manoeuvre.
After 4 weeks, there was an improvement upon pulsatile tinnitus, the latter only being present during physical exercise. Otoscopy was normal, Valsalva possible with normal audiometry and closure of the excisting air-bone gap. There was a type A tympanometry and normal tubomanometry at 50 mbar pressure applied. This resulted in a ETS-7 score of 9, no longer diagnosed as chronic Eustachian tube dysfunction.

Before pulsatile tinnitus is diagnosed as being idiopathic, chronic Eustachian tube dysfunction should be ruled out as a possible cause. When chronic Eustachian tube dysfunction is present, balloon dilatation of the Eustachian tube can be used as a valid treatment (3).