I'm also following this procedure with a lot of interest. Here's my take on it at present...
I’m a pediatric ENT doc, and there simply isn’t much data on this in kids. Furthermore, pediatric Eustachian tube (ET) dysfunction is usually a transient condition of early childhood, and it tends to improve on it’s own, so hard to justify this for most patients. The technique has been used successfully in some adult populations, but the numbers are small, and there have been studies with both laser tuboplasty and balloon dilation. This is a procedure early on in it’s evolution, but hopefully more data will be forthcoming.
Here are some other things to consider. The ET isn’t just a clogged pipe that needs to be opened. This is the case with the coronary arteries, where balloon dilation or stents can restore flow into a compromised pathway. The ET is a complex passageway where malfunction is often related to problems with the muscles that actively dilate the tube or the structure of the tube walls. In most cases of divers having problem equalizing, it’s a technique issue. There is also a lot if misunderstanding of the anatomy, where people think that improving nasal issues like a deviated septum will help the ET work better.
Now there are some patients that do have a problem of simple stenosis of the tube that can be treated by dilation. This is sometimes seen in people who have ET scarring from radiation therapy. But most people with ET issues aren’t in that situation.
I have been watching the data come in on this procedure, and it’s still not clear to me that this should be done on every diver with trouble equalizing. And there are potential risks too. Remember, the ET runs right next to the internal carotid artery, the big pipe that supplies most of the blood to the brain. I would want to be very sure that any pressure treatment didn’t have a chance of causing cerebrovascular issues. There is some limited evidence that this is safe, but those numbers are small - it’s possible that there will be more concern if this becomes a common procedure. And there are reports of other significant injuries from the operation. What happens if there is plaque or other abnormalities of the internal carotid artery? Would that make an injury more likely.
For selected divers who have adequately addressed technique issues, it may be a viable option in experienced hands. What remains to be seen is good evidence that it works, and that any effect of the surgery isn't just temporary. It's a very hard thing to study. The outcome measure that you are monitoring is something that is subjective and self reported (pain on equalization). You could try to follow objective things like tympanometry data (measures middle ear pressure in the office), but that doesn't necessarily correlate with the ability to equalize underwater.
To really get this answer, you would need to do a randomized blinded study - you would have to get a bunch of divers and have them volunteer to be randomized into either a surgical group or a group that had "sham" surgery. That is, you would have to put them to sleep and wake them up without doing any dilation, and there are obviously ethical issues with that.
Hopefully, you will get some long term benefit here!
