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Delayed extensive surgical emphysema after Valsalva manoeuvre post Eustachian tuboplasty

Published online by Cambridge University Press:  17 May 2023

S Z M Hussain Open the ORCID record for S Z M Hussain [Opens in a new window] ,
S Hashmi  and
A Qayyum
S Z M Hussain*
Affiliation:
ENT Department, Peterborough City Hospital, Peterborough, UK
S Hashmi
Affiliation:
ENT Department, Peterborough City Hospital, Peterborough, UK
A Qayyum
Affiliation:
ENT Department, Peterborough City Hospital, Peterborough, UK
*
Corresponding author: Syed Zohaib Maroof Hussain; Email: syedzohaibmaroof@hotmail.com
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Abstract

Objective

This paper reports a case of balloon Eustachian tuboplasty with delayed presentation of extensive surgical emphysema.

Methods

This is a clinical case report with a review of literature.

Results

Eustachian tube dysfunction is a functional disorder that results in inadequate middle-ear ventilation, causing aural fullness and tinnitus. A 36-year-old male presented with the sudden onset of an isolated, painful, left-sided neck swelling. The patient underwent balloon Eustachian tuboplasty, which was uneventful, but subsequently developed a sudden onset of isolated left-sided neck swelling on the 5th post-operative day during Valsalva manoeuvre. Neck examination revealed extensive crepitus on the left side of the neck. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home.

Conclusion

Balloon Eustachian tuboplasty is a safe procedure; however, extra care must be taken to avoid possible complications. Patients should be counselled against Valsalva manoeuvre and heavy weightlifting. They also should be instructed to sneeze with an open mouth and consider the use of stool softeners.

Keywords

Subcutaneous emphysemaValsalva maneuverEustachian tuboplastyballoon dilatation of Eustachian tube
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1293 - 1296
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr S Z M Hussain takes responsibility for the integrity of the content of the paper

References

Adil, E, Poe, D. What is the full range of medical and surgical treatments available for patients with Eustachian tube dysfunction? Curr Opin Otolaryngol Head Neck Surg 2014;22:8–15CrossRefGoogle ScholarPubMed
Martino, E, Di Thaden, R, Krombach, GA, Westhofen, M. Function tests for the Eustachian tube. Current knowledge [in German]. HNO 2004;52:1029–39Google ScholarPubMed
Norman, G, Llewellyn, A, Harden, M, Coatesworth, A, Kimberling, D, Schilder, A et al. Systematic review of the limited evidence base for treatments of Eustachian tube dysfunction: a health technology assessment. Clin Otolaryngol 2014;39:6–21CrossRefGoogle ScholarPubMed
Catalano, PJ, Jonnalagadda, S, Yu, VM. Balloon catheter dilatation of Eustachian tube: a preliminary study. Otol Neurotol 2012;33:1549–52CrossRefGoogle ScholarPubMed
Ockermann, T, Reineke, U, Upile, T, Ebmeyer, J, Sudhoff, HH. Balloon dilation Eustachian tuboplasty: a feasibility study. Otol Neurotol 2010;31:1100–3CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE). Balloon dilation for chronic eustachian tube dysfunction. Interventional procedures guidance [IPG665]. In: https://www.nice.org.uk/guidance/ipg665 [1 January 2023]Google Scholar
Kivekäs, I, Chao, WC, Faquin, W, Hollowell, M, Silvola, J, Rasooly, T et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope 2015;125:436–41CrossRefGoogle ScholarPubMed
Meyer, TA, O'Malley, EM, Schlosser, RJ, Soler, ZM, Cai, J, Hoy, MJ et al. A randomized controlled trial of balloon dilation as a treatment for persistent Eustachian tube dysfunction with 1-year follow-up. Otol Neurotol 2018;39:894–902CrossRefGoogle ScholarPubMed
Ramakrishnan, N, D'Souza, R, Kadambi, P. A systematic literature review of the safety and efficacy of Eustachian balloon tuboplasty in patients with chronic Eustachian tube dysfunction. Indian J Otolaryngol Head Neck Surg 2019;71:406–12CrossRefGoogle ScholarPubMed
Long, S, Obayemi, A, Rameau, A. A rare case of pneumomediastinum after Eustachian tube dilation. ORL J Otorhinolaryngol Relat Spec 2021;83:127–9CrossRefGoogle ScholarPubMed
Shah, RR, Thomas, WW, Naples, JG, Ruckenstein, MJ. Subcutaneous emphysema and pneumomediastinum after Eustachian tube balloon dilation. Otolaryngol Head Neck Surg 2018;159:203–5CrossRefGoogle ScholarPubMed
Chung, MY, Shin, MJ, Cha, SH, Lee, JY. Transient asystole during balloon dilation of the Eustachian tube: a case report. Medicine (Baltimore) 2022;101:e31720CrossRefGoogle ScholarPubMed
Jang, IJH, Yuen, HW. Extensive cervicofacial emphysema after Eustachian tube balloon tuboplasty. Otol Neurotol 2022;43:e1056–e1057CrossRefGoogle ScholarPubMed
McMurran, AEL, Hogg, GE, Gordon, S, Spielmann, PM, Jones, SE. Balloon Eustachian tuboplasty for Eustachian tube dysfunction: report of long-term outcomes in a UK population. J Laryngol Otol 2020;134:34–40CrossRefGoogle Scholar
Perna, V, Vilà, E, Guelbenzu, JJ, Amat, I. Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 2010;37:573–5CrossRefGoogle ScholarPubMed
Schröder, S, Abdel-Aziz, T, Lehmann, M, Ebmeyer, J, Sudhoff, H. Bacteriologic investigation of the Eustachian tube and the implications of perioperative antibiotics before balloon dilation [in German]. HNO 2015;63:629–33CrossRefGoogle ScholarPubMed
Skevas, T, Dalchow, CV, Euteneuer, S, Sudhoff, H, Lehnerdt, G. Cervicofacial and mediastinal emphysema after balloon Eustachian tuboplasty (BET): a retrospective multicenter analysis. Eur Arch Otorhinolaryngol 2018;275:81–7CrossRefGoogle Scholar
Luukkainen, V, Kivekäs, I, Silvola, J, Jero, J, Sinkkonen, ST. Balloon Eustachian tuboplasty: systematic review of long-term outcomes and proposed indications. J Int Adv Otol 2018;14:112–26CrossRefGoogle ScholarPubMed
Howard, A, Babu, S, Haupert, M, Thottam, PJ. Balloon Eustachian tuboplasty in paediatric patients: is it safe? Laryngoscope 2021;131:1657–62CrossRefGoogle ScholarPubMed