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      In-office balloon dilation of the Eustachian tube under local anesthesia: A retrospective review

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          Abstract

          Objective

          To study the effectiveness and feasibility of in office balloon dilation of the Eustachian tube (BDET) utilizing a novel anesthetic protocol. Study design: retrospective review.

          Methods

          Retrospective chart review looking at the tolerability and effectiveness of stand-alone BDET in an office setting utilizing a novel topical anesthesia protocol in 33 patients with Eustachian tube dysfunction as defined by an ETDQ-7 score greater than 2.2 and type B or C tympanograms for greater than 3 months despite maximal medical management, including at least 4 weeks of nasal steroids.

          Results

          BDET in the office was well tolerated with 94% (31/33) of patients completing the procedure as planned. No adverse effects or complications were reported; however, the planned dilation time was cut short in one case due to significant discomfort and aborted prior to dilation in another due significant coughing. Tympanograms normalized at six weeks in 87.1% (27/31) of patients who underwent dilation.

          Conclusion

          This study demonstrates that performing BDET in an office setting utilizing a local anesthesia protocol is feasible and effective when the unique barometric considerations of BDET are addressed.

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          Most cited references18

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          Balloon dilatation eustachian tuboplasty: a clinical study.

          To assess the feasibility of balloon dilatation eustachian tuboplasty (BET) as an option for treatment of patients with eustachian tube (ET) dysfunction. Ethics approved case controlled interventional study. Eight patients were identified with poor ET function using a ET score and were assigned to the study. The endoscopic procedure involved the dilatation of the cartilaginous and bony portion of 13 ETs with a balloon catheter. Pre- and postinterventional computed tomography was performed. All patients were reassessed 1, 2, and 8 weeks after BET. BET was technically easy to perform. No damage to essential structures, particularly the carotid canal, was found in the human study. Patients revealed a significant improvement of the ET score comparing pre- and the 2-month post-treatment results. Improvement was found to be time dependent. This newly introduced method of BET was found to be a feasible and safe procedure to inflate the ET. It significantly helped to improve ET function in our study group. However, larger long-term studies are necessary to fully evaluate the clinical value of BET.
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            Trigeminal Cardiac Reflex: New Thinking Model About the Definition Based on a Literature Review

            Abstract Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context. Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response. The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex. In this review, we highlighted criteria for proper definition and classification of the TCR in the light of increased knowledge and present a thinking model to overcome this complexity. Further we separately discussed the role of HR and MABP and their variation in this context. As another subtopic we gave attention to is the chronic TCR; a variant that is rarely seen in clinical medicine.
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              The strange case of the ear and the heart: The auricular vagus nerve and its influence on cardiac control.

              The human ear seems an unlikely candidate for therapies aimed at improving cardiac function, but the ear and the heart share a common connection: the vagus nerve. In recent years there has been increasing interest in the auricular branch of the vagus nerve (ABVN), a unique cutaneous subdivision of the vagus distributed to the external ear. Non-invasive electrical stimulation of this nerve through the skin may offer a simple, cost-effective alternative to the established method of vagus nerve stimulation (VNS), which requires a surgical procedure and has generated mixed results in a number of clinical trials for heart failure. This review discusses the available evidence in support of modulating cardiac activity using this strange auricular nerve.
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                Author and article information

                Contributors
                Journal
                World J Otorhinolaryngol Head Neck Surg
                World J Otorhinolaryngol Head Neck Surg
                World Journal of Otorhinolaryngology - Head and Neck Surgery
                KeAi Publishing
                2095-8811
                2589-1081
                12 October 2019
                September 2019
                12 October 2019
                : 5
                : 3
                : 143-147
                Affiliations
                [1]Texas Tech University Health Science Center, Lubbock, TX, USA
                [2]Vitruvio Institute of Medical Advancement, Dallas, TX, USA
                Article
                S2095-8811(19)30092-7
                10.1016/j.wjorl.2019.08.001
                6849361
                31750426
                f78d26e3-7200-43dc-bed1-f3940c3b9cb0
                © 2019 The Author

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 May 2019
                : 22 August 2019
                Categories
                Article

                balloon dilatation,eustachian tube,local anesthesia,in office,topical

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