Balloon dilation of the Eustachian tube: definitions, consensus and trial data

Published 12 October 2026 · IN OFFICE Course editorial team

Balloon dilation of the Eustachian tube (BDET) is used in adults with chronic obstructive Eustachian tube dysfunction that persists despite medical treatment. It is increasingly performed under local anaesthesia, which makes it relevant to office-based ENT practice. This article summarises the definitions, guidance and trial data.

Defining Eustachian tube dysfunction

The 2015 international consensus statement (Schilder et al., Clinical Otolaryngology) describes Eustachian tube dysfunction as a syndrome with a constellation of signs and symptoms, and distinguishes three subtypes: dilatory, baro-challenge induced and patulous. It notes that there is no universally accepted set of symptom scores, functional tests or scoring systems, and that the ETDQ-7 is the only patient-reported outcome tool to have undergone initial validation.

Guidance and consensus

NICE interventional procedures guidance IPG665 (2019, replacing IPG409) states that the evidence on safety and efficacy is adequate to support the procedure provided standard arrangements are in place, and that it can be done under local or general anaesthesia.
The AAO-HNSF Clinical Consensus Statement on balloon dilation of the Eustachian tube (Tucci et al., 2019) reached consensus on 28 statements for adults aged 18 or over with obstructive dysfunction. Among them: tympanostomy tube placement is not a mandatory prerequisite, allergic rhinitis, rhinosinusitis and laryngopharyngeal reflux should be treated first, and the ETDQ-7 is the most reliable outcome measure.

Randomised trial data

In a multicentre randomised controlled trial (Poe et al., Laryngoscope 2018), tympanogram normalisation at six weeks was 51.8% after balloon dilation versus 13.9% in the control group, and ETDQ-7 normalisation was 56.2% versus 8.5%. No device or procedure related serious adverse events were reported. The 12-month follow-up (Anand et al., 2019) reported benefits that remained clinically relevant through 52 weeks.

Balloon dilation under local anaesthesia

Sheppard et al. (Frontiers in Surgery, 2023) performed 47 dilations in 30 patients in the office under local anaesthesia. One attempt was stopped because of anxiety, mean discomfort was 4.7 on a 1 to 10 scale, the procedure took 5.7 minutes per tube, there was one self-limiting subcutaneous emphysema and all patients were discharged immediately.
Balai et al. (Journal of Laryngology and Otology, 2025) reported 40 dilations in 31 patients under local anaesthesia in the UK. All were well tolerated with no adverse events, and the ETDQ-7 score fell by 6.75 points in the short term and 7.58 points in the long term.

Limits of the evidence

Office data come mostly from single-centre case series, and the consensus statement itself left 28 statements without agreement. Careful patient selection, treating nasal and reflux disease first and using a validated outcome measure such as the ETDQ-7 remain the common ground across sources.

How the IN OFFICE 2026 course covers this topic

The International IN OFFICE Breathing Disorders Surgery Course runs from 10 to 12 December 2026 at Hospital Dr. Nélio Mendonça in Funchal, Madeira, with lectures, live surgery and supervised hands-on training in groups of 4. The programme lists the sessions on this topic with the course day and the speaker.

Programme sessions on this topic · Registration and fees

Sources

Written for healthcare professionals. This summary does not replace the original publications or clinical judgement.