European Radiology

, Volume 28, Issue 9, pp 3685–3691 | Cite as

Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model

  • Kun Yung Kim
  • Woo Seok Kang
  • Jung-Hoon Park
  • Byung-Chul Kang
  • Jun Woo Park
  • Min Tae Kim
  • Nader G. Bekheet
  • Seung Jun Hwang
  • Joonmyeong Choi
  • Kyu-Jin Cho
  • Hong Ju ParkEmail author
  • Ho-Young SongEmail author



To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model.


A total of 12 separate sessions were performed on both sides of the Eustachian tube (ET) in six human cadavers. Cadavers were positioned for the submentovertical view on a fluoroscopy table. Endoscopy-guided ET selection was used in the first three cadavers, whereas fluoroscopy-guided ET selection was used in the remaining three. Eustachian tubography was performed by injecting 2 ml of contrast media through a 5-Fr catheter. We recorded the success of ET selection, number of attempts, procedure time, and tubography quality using native and subtraction images (range, 0–3).


Both endoscopy- and fluoroscopy-guided selections were successfully performed in five of six sessions (83.3%). There were no statistically significant differences between the endoscopy- and fluoroscopy-guided procedures in terms of the number of attempts, procedure time, rate of immediate contrast leak to the middle ear cavity, and quality of tubography (p > 0.05). An excellent quality of tubography was obtained in 83.3% (10 of 12 sessions) of subtraction images and in 33.3% (4 of 12 sessions) of native images. The tubography quality score was significantly higher for the subtraction images than for the native images (p = 0.04).


Subtraction Eustachian tubography using direct catheterisation seems to be technically feasible. The entire ET can be well visualised; thus, this technique can be used as a simple tool for assessment of ET function and anatomy.

Key Points

Direct catheterisation of the Eustachian tube is technically feasible.

The entire Eustachian tube could be well visualised by direct Eustachian tubography.

Subtraction Eustachian tubography images have better image quality than native images.

Subtraction Eustachian tubography can provide objective assessment of ET function and anatomy.


Eustachian tube Radiography, interventional Otitis media with effusion Dilatation Constriction, pathological 



Eustachian tube



This study has received funding by Korea Health Technology R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (HI17C0881).

Compliance with ethical standards


The scientific guarantor of this publication is Ho-Young Song.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this study is cadaveric experimental study.

Ethical approval

Institutional Review Board approval was not required because this study is a cadaveric experimental study.


• Experimental study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Biomedical Engineering Research Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Anatomy and Cell Biology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.School of Mechanical and Aerospace EngineeringSeoul National UniversitySeoulKorea

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