Cape doctor introduces ‘game-changing’ surgery

For people with Eustachian tube dysfunction, diving, flying and even day-to-day life can be painful. But a new surgery, approved by the FDA last September, can offer relief – and the surgery is now available on Cape Cod.

“For the patients who have gone through the surgery, it’s been very helpful,” said otolaryngologist Craig Jones, MD, who has offices in Mashpee and Harwich. Dr. Jones is the first doctor to perform the surgery in Southeastern Massachusetts.

The new procedure, called Eustachian tube dilation, uses a small balloon to open the Eustachian tubes, allowing them to function properly.

The Eustachian tube connects the back of the nose to the middle ear. “It really acts more as a valve,” said Dr. Jones. “It’s supposed to stay closed most of the time. What’s supposed to happen is when you swallow or yawn, the Eustachian tube will open and close. That little brief opening allows air into the middle ear, so the air pressure there is the same as the outside world.”

When that doesn’t happen, you may suffer from pain in the ear, dizziness or muffled hearing.

In some cases, people with Eustachian tube dysfunction experience a regular build-up of fluid in their ears. That may require the use of tympanostomy tubes, which may have to be replaced every 12 to 24 months. For other people, symptoms only occur when they experience pressure changes from diving or flying.

“Patients become afraid of flying because they never know when they’re going to have pain during the flight,” said Dr. Jones. “A lot of times patients who have issues with flight will come in to see us before the flight and make sure they have tubes or make sure their Eustachian tubes are working. If you have somebody who’s a business person and has to fly all the time, this surgery could be a game-changer for them.”

Minimally Invasive

Eustachian tube dilation is a minimally invasive procedure, requiring no incisions. It’s a hospital procedure done under a general anesthetic.

The surgeon uses an endoscope to maneuver a catheter from the nose to the Eustachian tube.

“Once it’s in place, we blow up the balloon for about two minutes,” he said. “It crushes lymphoid patches. You make the opening bigger by shrinking the excess lymphoid tissue within the Eustachian tube.

“It’s all done by trying to dilate the natural opening of the Eustachian tube, not unlike doing angioplasty to dilate the coronary vessels. It’s basically been applied to a new part of the body, and thus far, there have been promising results.”

Patients don’t get instant improvement, he said.

“They get slow improvement for about two months after the procedure, but it’s a way of getting their body to do what it’s not been doing. It gets the Eustachian tube to allow air in the middle ear.”

Specially Designed Catheter

The procedure was developed by Dennis Poe, MD, PhD of Boston Children’s Hospital.

“He basically took the concept of balloon sinus surgery and thought, what happens if I try that on the Eustachian tube? He did quite a few years of research using different types of balloons,” said Dr. Jones.

The catheter for Eustachian tube dilation was specifically designed for this particular procedure, he said.

“They started doing research with the sinus balloon, but they modified it to make it a safer procedure for the Eustachian tube.”

The procedure was approved by the FDA for patients 22 and older. Research on its use in younger patients is continuing.

Relief is “permanent, as far as we know,” said Dr. Jones. “Right now we have 10 years of data, but we don’t yet have decades of results.”

Dr. Jones was trained in the procedure last fall during the annual meeting of the American Academy of Otolaryngology – Head and Neck Surgery. After getting approval from Cape Cod Hospital to introduce the new technology, he performed the first surgery of its kind on Cape Cod in March.

“I think it’s going to change the way we manage things in people who have chronic ear disease,” he said.

“It’s always better to have your own Eustachian tube work for you than to have to rely on a surgically placed tube.”