The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) has released a position statement on paediatric Eustachian tube balloon dilation (ETBD) stating it is appropriate, efficacious and safe in a select group of children.
The statement said the academy considers the balloon dilation procedure as an “appropriate treatment for paediatric patients with obstructive Eustachian tube dysfunction resulting in chronic otitis media which is refractory to standard surgical interventions such as tympanostomy tube placement and adenoidectomy”.
“Multiple studies have demonstrated the efficacy and safety of ETBD in the paediatric population, with evidence showing improvements in hearing, tympanogram, quality of life, and decreased likelihood for additional surgery,” it states.
It said the procedure could be completed safely, as a stand-alone procedure or in combination with other procedures.
“The American Academy of Otolaryngology-Head and Neck Surgery thus considers ETBD as a proven and effective therapeutic option in a select group of paediatric patients,” it stated. “The recommendation for ETBD should be determined by a qualified Otolaryngology-Head and Neck surgeon.”
A CT scan was not required preoperatively unless determined to be clinically indicated by the performing physicians, the statement added.
It said otolaryngologists should use devices that were approved by the Food and Drug Administration (FDA) for these indications, and their use should adhere to restrictions and guidelines specified by the appropriate governing agency, such as the FDA in the United States.
The academy approved the statement in July 2025.
It said that while it was an official position statement, it did not represent a standard of care.
“The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient,” it stated.
While there isn’t a specific Australian guideline solely for eustachian tube balloon dilation, the Therapeutic Goods Administration approved the procedure in 2016.
An Australian study in 2021 of the procedure, called BDET in Australia or balloon dilation Eustachian tuboplasty, was mainly in adults.
A Queensland Children’s Hospital Department of Otolaryngology systematic review and meta-analysis of outcomes after balloon dilation of the Eustachian tube in children was published in the Australian Journal of Otolaryngology on 15 March 2024.
Reviewers said there was hesitancy in performing it in children due to their shorter and more horizontal eustachian tube.
However the review concluded balloon dilation of the Eustachian tube was “a safe and potentially effective procedure for the treatment of obstructive Eustachian tube dysfunction” but prospective cohort studies and randomised controlled trials were needed before it could be recommended as evidence-based management.
Danish ENT surgeon, Dr Martin Nue Møller told HPA earlier this year that Eustachian tube balloon dilation could be a first line tool in the treatment of chronic otitis media in children. He is undertaking a multi-national clinically controlled, randomised, patient blinded, prospective trial of the therapy.
Dr Nue Møller has just launched a new platform, ENTBalloon.com, dedicated to minimally invasive ENT procedures using balloon technology in-office. The hands-on, evidence-based course is designed for ENT specialists who want to expand their expertise in BDET and balloon sinuplasty.
Click here to read the academy’s position statement and journal references.
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