title: Computed tomography before balloon Eustachian tuboplasty--a true necessity?
abstract: OBJECTIVE
  Since the introduction of balloon Eustachian tuboplasty the necessity of preoperative high-resolution CT scans of the temporal bone has been a topic of debate. This study investigated the informative value of preoperative CT scanning in predicting intraoperative or postoperative difficulties and complications. Special focus was laid on the existence of carotid canal dehiscences for fear of intraprocedural injury.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Approximately 284 patients (510 Eustachian tubes) with intractable Eustachian tube dysfunction undergoing unilateral or bilateral balloon Eustachian tuboplasty with preoperative high-resolution CT scans of the temporal bone from January 1, 2009, to December 31, 2012.
  
  
  RESULTS
  Carotid canal dehiscences were found in 18 patients (6.3%). In 3 patients (4 Eustachian tubes, 1.1% of patients) balloon dilatation could not be performed because of difficulties advancing the balloon catheter. Of these 3 patients, one had bilateral carotid canal dehiscences, whereas the other two had unremarkable CT scans. Postoperative complications occurred in 3 patients (1.1%): 2 soft tissue emphysemas and 1 unilateral hypoglossal paresis. All 3 patients had unremarkable CT scans, and all complications resolved completely without further sequelae.
  
  
  CONCLUSIONS
  Preoperative high-resolution CT scan of the temporal bone does not seem to be suitable to predict intraoperative or postoperative difficulties of balloon Eustachian tuboplasty. Being extremely cautious during balloon catheter insertion into the Eustachian tube and using a device that is designed with a built-in stop mechanism preventing too deep insertion, the data presented suggest that fear of injury to the internal carotid artery during balloon dilatation might be disproportionate. Nevertheless, for inexperienced surgeons, HR-CT scans of the temporal bone may help to understand the relation between internal carotid artery and the Eustachian tube.
authors.affiliation: *Department of Otorhinolaryngology, Head and Neck Surgery, and †Department of Radiology, Klinikum Bielefeld, Academic Teaching Hospital University of Münster University, Bielefeld, Germany.
authors.forename: Tarek
authors.initials: T
authors.lastname: Abdel-Aziz
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schröder
authors.forename: Martin
authors.initials: M
authors.lastname: Lehmann
authors.forename: Hans-Björn
authors.initials: HB
authors.lastname: Gehl
authors.forename: Jörg
authors.initials: J
authors.lastname: Ebmeyer
authors.forename: Holger
authors.initials: H
authors.lastname: Sudhoff
mesh_terms: D021721:Balloon Occlusion; D005064:Eustachian Tube / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D013506:Otologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017211:Treatment Failure