Eustachian tube balloon procedure for diving

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Yesterday I went through the bilateral Eustachian tube balloon surgery
PLEASE post back with your eventual results! I'm an anesthesiologist who has taken care of several balloon patients now with Eustachian issues, and am really excited about the prospects for divers. In a good ENT's hands, it's a short procedure, easy to recover from.
Whatever you tell us will be a scientific series of just one, but all the same, I'm anxious to hear from a diver who's actually had it.

Thanks!

Diving Doc
 
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!
 
Just wrote a really long and dreary post detailing my ear woes, but deleted it because honestly, not seeking any advice on any of that - there really isn't anything else I can do/try in that arena. I know that some people just can't dive due to their ears, but hoping I do not fall into that category!

My real question is - has anyone here had the Eustachian tube balloon procedure and had it help their ears while diving? My otolaryngologist suggested it might help, as it would stretch my tubes and potentially make equalizing easier and more effective. Wondering if anyone else here has any experience with it? I have a consult next week with the doctor who performs the procedure. Also, my insurance likely wouldn't cover it since I do not have "official" Eustachian tube dysfunction, but willing to pay out of pocket if it'll help.

Your profile shows you have over 200 dives under your belt, so is this an issue that’s developed more recently or have you always had problems?
I’ve had some problems with equalising both ears (at different times) recently, with sudden severe squeeze developing at around 10m I believe, even after consciously equalising regularly up to that point. I’m a bit perplexed why this is happening, and whether there are possible solutions if the issues persist, so I’m interested in your story. So far I’ve only seen my GP but will look for ENT specialist with diving knowledge.
 
My real question is - has anyone here had the Eustachian tube balloon procedure and had it help their ears while diving? My otolaryngologist suggested it might help, as it would stretch my tubes and potentially make equalizing easier and more effective. Wondering if anyone else here has any experience with it? I have a consult next week with the doctor who performs the procedure.

I am currently scheduled for this balloon procedure in January 2019. My 2 issues are difficulty equalizing and sea sickness.

I never had issues with sea sickness until I moved to Hawaii and started diving every weekend. It takes me forever to get down to 110'. I nearly always have a bloody nose at the end of my dive, no matter how slow and gently I equalize. I will consistently have water in my ears for 3 to 6 weeks after a dive. It's been a couple years since I've been diving now. My eardrums look good, and he doesn't see any scarring, but I do have some hearing loss in one ear. As for technique, I almost always dove with friends that are instructors and a couple course directors. They have monitored my technique and can't think of anything else for me to do. I've tried earplugs with no success.

I also race sailboats. Any inter-island sailing and I get violently sick unless I'm on the tiller. I'm originally from Alaska and I never got seasick there, so I'm thinking the issues with my ears may be a factor in my sudden onset of seasickness. I do not experience true vertigo.

The inner ear specialist I saw, thinks so as well since seasickness is typically a lifelong pattern rather than late onset, or so he says. I want to be able to do some live-a-board dive trips.

There is only one specialist/surgeon for this in all of Hawaii. He did say a possible risk would be echoing in my ears for the rest of my life. I'm nervous and would really like to hear about anyone's experience with this procedure.

Did you get the procedure done?
 
Results are in
Had the ballooning in September along with adnoid removal.
Due to schedule conflicts and a bout of bronchitis, couldn’t get in the pool until recently.
The surgery went well and was really only out of commission for about a week. Healing wasn’t bad and nothing compared to getting tonsils removed.
As for equalization?....
Since the procedure, my ENT tasked me with “practicing” equalizing my ears (after about week two of recovery). I continued to be able to pop my right ear, but had to use a different technique to pressurize the left ear.
When I began descending in the pool, I found the left ear still didn’t “pop”, but was able to slowly pressurize. I had grand visions of performing the valsalva maneuver and both ears popping simultaneously. This wasn’t the case. I found having to essentially yawn and tilt my head to get left ear to go. Regardless, I was still able to descend to the bottom of the pool in half the time as before, and with NO PAIN. Moreover, I was able to reasscend without the complications or reverse squeeze that I used to have.
The next day, my left ear was a little sore. Not sure if it was due to slight barotrauma or like when a muscle isn’t used very often and it’s sore the next day.
All in all, it was a success.
 
Thanks for the follow up! Gotta watch this space closely...
 
I had septoplasty, removal of two bone spurs, reduction of inferior turbonates, and balloon dilation of eustachian tubes bilateral on September 10, 2014. Before the operation I had a lot of trouble clearing my ears, always had to use a descent line, and usually got otitis media during every dive trip which then had me sitting out dives while my wife did the dives and she got ahead of me in our log books. After the operation, I can clear my ears without any problem whether down line or free descent and am now doing a lot better than my wife. Tomorrow, we are going to San Diego to see Dr. Brian Weeks who is one of the originators of this method, and my wife is going to tell him whatever he did to me, she wants it done to her! (In reality, they will need to check her out and she will probably not have everything that I had). I have a previous post on Scuba Board that I made after the surgery so you can read that one if you want. (I do not know how to find it otherwise I would have referred you to that). I found out about the doctor and the procedure on scubaboard which I find remarkable given that I have had 8 allergists and 5 ENT docs in my life and none of them every mentioned it. Dr. Weeks is a diver who dove in Australia among other places so he knew exactly what I was talking about when I saw him originally. I now know what my trainer was trying to tell me in the gym after each exercise when he would tell me to breath through my nose. Now I can actually breathe through my nose. I assume that you are not a screwed up as I was so you will probably not need all of the stuff I had. I strongly endorse this balloon dilation of eustachian tube at least as practiced by Dr. Brian weeks in San Diego. Good luck.
 
***If I go through with this, I will likely be diving again at the end of July - so I'll report back to everyone here on whether it made a difference or not. Again, I'll also write a quick summary on what they say in my consult next week.***

Alas, no report as promised.
Sad. :(
 
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