Skip to main content
SpringerLink
Log in

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

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

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

Methods

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).

Results

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

Abbreviations

ET:

Eustachian tube

References

  1. Alper CM, Swarts JD, Singla A, Banks J, Doyle WJ (2012) Relationship between the electromyographic activity of the paratubal muscles and Eustachian tube opening assessed by sonotubometry and videoendoscopy. Arch Otolaryngol Head Neck Surg 138:741–746

    Article  PubMed  Google Scholar 

  2. Schilder AG, Bhutta MF, Butler CC et al (2015) Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin Otolaryngol 40:407–411

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Hwang SY, Kok S, Walton J (2016) Balloon dilation for Eustachian tube dysfunction: systematic review. J Laryngol Otol 130(Suppl 4):S2–S6

    Article  PubMed  Google Scholar 

  4. Huisman JML, Verdam FJ, Stegeman I, de Ru JA (2018) Treatment of Eustachian tube dysfunction with balloon dilation: a systematic review. Laryngoscope 128:237–247

    Article  PubMed  Google Scholar 

  5. McCoul ED, Anand VK (2012) Eustachian tube balloon dilation surgery. Int Forum Allergy Rhinol 2:191–198

    Article  PubMed  Google Scholar 

  6. McCoul ED, Anand VK, Christos PJ (2012) Validating the clinical assessment of eustachian tube dysfunction: the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Laryngoscope 122:1137–1141

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schroder S, Lehmann M, Sudhoff H, Ebmeyer J (2014) Assessment of chronic obstructive Eustachian tube dysfunction: evaluation of the German version of the Eustachian Tube Dysfunction Questionnaire. HNO 62:160 162-164

    Article  PubMed  CAS  Google Scholar 

  8. Van Roeyen S, Van de Heyning P, Van Rompaey V (2015) Value and discriminative power of the seven-item Eustachian Tube Dysfunction Questionnaire. Laryngoscope 125:2553–2556

    Article  PubMed  Google Scholar 

  9. Schroder S, Lehmann M, Korbmacher D, Sauzet O, Sudhoff H, Ebmeyer J (2015) Evaluation of tubomanometry as a routine diagnostic tool for chronic obstructive Eustachian tube dysfunction. Clin Otolaryngol 40:691–697

    Article  PubMed  CAS  Google Scholar 

  10. Kim KY, Tsauo J, Song HY et al (2017) Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction. Eur Radiol. https://doi.org/10.1007/s00330-017-5040-4

  11. Wittenborg MH, Neuhauser EB (1963) Simple roentgeno-graphic demonstration of Eustachian tubes and abnormalities. Am J Roentgenol Radium Therapy, Nucl Med 89:1194–1200

    CAS  Google Scholar 

  12. Parisier SC, Khilnani MT (1970) The roentgenographic evaluation of Eustachian tubal function. Laryngoscope 80:1201–1211

    Article  PubMed  CAS  Google Scholar 

  13. Bluestone CD (1971) Eustachian tube obstruction in the infant with cleft palate. Ann Otol Rhinol Laryngol 80(Suppl 2):1–30

    Google Scholar 

  14. Gaafar H, el Deeb AK, Abdel-Baki F, el-Henawi D (1988) Flexible endoscopy and radiologic evaluation of the eustachian tube in adults with Eustachian tube dysfunction. Am J Otolaryngol 9:357–362

    CAS  Google Scholar 

Download references

Funding

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

Author information

Author notes

  1. Kun Yung Kim and Woo Seok Kang contributed equally to this work and are co-first authors.

  2. Hong Ju Park and Ho-Young Song contributed equally to this work and are co-corresponding authors.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Kun Yung Kim, Jung-Hoon Park, Min Tae Kim, Nader G. Bekheet & Ho-Young Song

  2. Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Woo Seok Kang, Byung-Chul Kang, Jun Woo Park & Hong Ju Park

  3. Department of Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jung-Hoon Park

  4. Department of Anatomy and Cell Biology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seung Jun Hwang

  5. School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, Korea

    Joonmyeong Choi & Kyu-Jin Cho

Authors
  1. Kun Yung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Woo Seok Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung-Hoon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung-Chul Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Woo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Min Tae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nader G. Bekheet
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Seung Jun Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joonmyeong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kyu-Jin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hong Ju Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ho-Young Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hong Ju Park or Ho-Young Song.

Ethics declarations

Guarantor

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.

Methodology

• Experimental study

• Performed at one institution

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, K.Y., Kang, W.S., Park, JH. et al. Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model. Eur Radiol 28, 3685–3691 (2018). https://doi.org/10.1007/s00330-018-5392-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5392-4

Keywords

Search

Navigation