Long-term Assessment of Balloon Eustachian Tuboplasty for Obstructive Eustachian Tube Disease

To date, more than 130 000 Balloon Eustachian Tuboplasty (BET) procedures have been performed worldwide. This procedure is proposed in case of Obstructive Eustachian Tube Dysfunction (OETD) with or without chronic otitis media. However, the effectiveness of this procedure is still discussed amongst otolaryngologist. Most of studies,were open label prospective studies comparing Eustachian tube function before and after surgical treatment. A recent meta-analysis suggests that BET procedure improves postoperative Eustachian tube function, but high-level evidence is still lacking. In this project, the investigators propose to perform the first blinded randomized controlled trial procedure to assess the changes of Eustachian tube function after BET in a population of subjects with chronic OETD with or without chronic otitis. Prognosis factors of efficacy will be also investigated during the study.

Obstructive Eustachian Tube Dysfunction (OETD) is a common medical condition whose prevalence is estimated to be 4.6% in the general population. Subjects suffering from OETD display various symptoms such as ear fullness, hearing loss, muffled hearing, pain, especially during pressure changes (airplane, diving, mountain experience...), tinnitus, ticking or popping sounds, autophony, or balance disorders. Failure to treat OETD can lead to chronic otitis media with cholesteatoma which is a severe medical condition requiring multiple surgeries and frequently associated with a permanent hearing loss and several major complications including meningitis, facial palsy and labyrinthitis. OETD medical management (pressure equalization device, in addition to medical treatment of rhinosinusitis and GERD) can be used in adults. However, high level evidence of effectiveness of such a treatment is still lacking and the success rates are unknown.

Surgical treatment such as grommets (tympanostomy tube) is only a temporary solution that might work in children, but is less effective in adults, requiring multiple surgeries during the patients lifetime for their repeated. Grommets are treating only the consequences but not the cause of OETD.

In 2010, the team of Prof. Sudhoff in Bielefeld, Germany, proposed for the first time the Balloon Dilatation of the Eustachian tube as an alternative treatment of OETD. To date, more than 75 000 Balloon Eustachian Tuboplasty (BET) procedures have been performed worldwide. However, the effectiveness of this procedure is still discussed amongst ENT physicians. Indeed, no blinded controlled randomized clinical trial was performed to address the effects of BET on Eustachian tube function. Only one randomized clinical trial using objective measures as outcomes was published so far and compared the effect of BET in addition to medical management versus medical management alone in an open label study. Knowing that the success rates of medical management are not clearly established and probably depend on the medical treatment used, the effect of the surgical procedure remains uncertain with this design of study. Another randomized controlled study used a quality-of-life questionnaire as main outcome measure 6 weeks after surgery. No objective assessment was performed as major outcome and follow-up was not sufficient for the main outcome measure. Most of published studies so far were open label prospective studies comparing Eustachian tube function before and after surgical treatment.

In this project, the investigators propose to perform the first blinded randomized controlled trial versus control procedure to assess the changes of Eustachian tube function after BET in a population of subjects with chronic OETD with or without chronic otitis, and after medical treatment failure. Prognosis factors of efficacy will be also investigated during the study. The control procedure will consist in the insertion of an Eustachian tube catheter, causing no dilation of the Eustachian tube. This procedure will allow to evaluate the effect of the balloon inflation itself on tubal function, compared to the insertion of catheter tube for probing and flushing in the Eustachian tube only. The literature reports very low rates of complication of BET surgery making this control procedure acceptable in terms of risks. The use of this type of control procedure is justified by the fact that no other reference treatment can be proposed as a reference group, and blinding the patient to the investigational arm is needed to ensure the methodological validity of the study.

Simplified study calender:

Visit 0: Selection Visit During this visit, investigators will inform patients of the study.

Visit 1: Inclusion Visit (14 days - 3 months after V0):

The subject consent will be obtained. Medical and demographic data will be collected and study examinations will be performed. Patients will be also received for an anesthesiology consultation and after randomized the in the intervention or the control group arm.

Visit 2: 2 days-3 months after V1 Intervention under general anaesthesia: ETD or control procedure.

Visit 3: 2 months (±15 days) after V2 Medical data collection and study examinations as well as ETDQ-7 questionary (Eustachian Tube Dysfunction Questionary).

Visit 4: Final Visit - 6 months (±15 days) after V2 Medical data collection and study examinations as well as ETDQ-7 questionary. End of the study for the participant.

Unscheduled visits If subject gets in contact with the site between regular visits due to acute disorders, an unscheduled visit will promptly be performed at the site. During this additional visit a physical examination, a systematic interview for recording of Adverse Event should be performed.

Eligibility Criteria:
Inclusion Criteria:

* Aged between 18 and 85 years
* Clinical symptoms of OETD with Eustachian tubal score less or equal to 7/14
* Failure of well conducted medical treatment (GERD, allergy, rhinosinusitis) including pressure equalization device used for 1 month or more
* ASA score 1 or 2 (ASA : American Society of Anesthesiologists)

Exclusion Criteria:

* Palatal cleft
* Anatomical anomaly of pharyngeal Eustachian tube ostium on the treated side
* Medical history of nasopharyngeal radiotherapy
* Medical history of middle ear surgery (except myringotomy and/or tympanostomy tube)
* Eardrum perforation in the treated side
* Contraindication of general anesthesia, or major risk of general anesthesia including ASA scores of 3 and 4
* Major nasal obstruction ipsilateral to the Eustachian tube to treat
* Medical history of previous Eustachian Tube Dilation
* Pregnant or nursing woman, or in childbearing age and not willing to use contraception
* Inclusion in another interventional clinical trial
* Protected and vulnerable adult
* Not covered by Health insurance
* Refusal to sign informed consent form
* Subjects unable to attend all scheduled visits or to comply with all trial procedures