Role of imaging before Eustachian tube dilation using the Bielefeld balloon catheter

Balloon dilation is a novel method in the management of chronic Eustachian tube dysfunction. Routine preoperative CT has been recommended in order to rule out possible bone dehiscence in the region of the carotid canal or aneurysms of the internal carotid artery which can lead to vascular injuries and life-threatening bleeding or brain damage during the dilation procedure. We evaluated head CT scans of 1000 patients to assess the occurrence of carotid canal dehiscence, aneurysms or other vascular malformations and to measure the osseous part of the carotid canal. No dehiscence was noted in a total of 2000 boney carotid canals. The mean thickness of the carotid canal wall was 1.02 +/- 0.29 mm. No aneurysms or vascular malformations were detected. The necessity of routine CT scans before balloon dilation should be critically discussed with a view to protecting patients from unnecessary radiation exposure and saving costs in the health care system.