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Otology & Neurotology : Official... Dec 2012Eustachian tube dysfunction is a common problem and transnasal endoscopic balloon dilation of the Eustachian tube (ET) is a new surgical technique. The goal of this...
OBJECTIVE
Eustachian tube dysfunction is a common problem and transnasal endoscopic balloon dilation of the Eustachian tube (ET) is a new surgical technique. The goal of this study is to review the evolution of this novel technique and study the preliminary outcomes.
SUBJECTS AND METHODS
Balloon catheter dilation of the 100 Eustachian tubes in 70 adults was performed at a tertiary medical center from January 2009 to January 2011. A 5-mm sinus balloon catheter was endoscopically placed transnasally into the proximal ET to dilate the cartilaginous ET. Cases were reviewed with respect to indications, outcomes, and complications.
RESULTS
Of the 100 ETs, ear fullness and pressure were improved in 71% of patients studied for 26.3 weeks (± 3.6). Of 8 patients followed for a minimum of 34 months, 87% reported persistent improvement. One complication is reported.
CONCLUSION
Endoscopic transnasal ET balloon dilation is a novel approach to treating ET dysfunction. Benefits can be durable up to 3 years. This technique holds much promise and merits further investigation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Dilatation; Endoscopy; Eustachian Tube; Female; Humans; Labyrinth Diseases; Male; Middle Aged; Nasal Cavity; Otologic Surgical Procedures; Pharynx; Treatment Outcome; Young Adult
PubMed: 23047259
DOI: 10.1097/MAO.0b013e31826a50c3 -
Gut Oct 1994Forceful dilatation under endoscopic control is a well established treatment of achalasia; several different types of dilators can be used. This study prospectively... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Forceful dilatation under endoscopic control is a well established treatment of achalasia; several different types of dilators can be used. This study prospectively compared the clinical and manometric efficacy of a single dilatation using two different dilators. Forty one patients were randomly assigned to forceful dilatation under endoscopic control with either a pneumatic dilator (n = 17) or a metallic dilator (n = 24). Thereafter, the patients received periodic clinical and manometric evaluation for one year (before and one, six, and 12 months after dilatation). One month after dilatation all but one of the subjects in each group had experienced good to excellent results and their clinical improvement persisted for the one year follow up. Two patients (one in each group) were perforated during the procedure and required surgical treatment. Recovery was uneventful in both cases. Resting lower oesophageal sphincter pressure (mean (SEM)) significantly and similarly decreased after both methods of dilatation (pneumatic dilator: before dilatation 37 (3) mm Hg, one year after dilatation 18 (3) mm Hg; metallic dilator: before dilatation 34 (2) mm Hg, one year after dilatation 17 (3) mm Hg; p < 0.05 for both). It is concluded that in the treatment of achalasia a single dilatation under endoscopic control with either pneumatic or metallic dilator yield comparable clinical and manometric results and similar complication rates. The use of one or other dilator should depend more on the preference and experience of the endoscopist than on the type of device.
Topics: Catheterization; Dilatation; Esophageal Achalasia; Esophagus; Female; Follow-Up Studies; Humans; Male; Manometry; Middle Aged; Prospective Studies
PubMed: 7959186
DOI: 10.1136/gut.35.10.1360 -
Sexual Medicine Reviews Apr 2021Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual... (Review)
Review
INTRODUCTION
Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual intercourse among populations of women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with a wide variety of pelvic floor disorders who experience genito-pelvic pain/penetration disorder (GPPPD) are often advised to incorporate vaginal dilators into their pelvic floor rehabilitation program and treatment regimens to enable penetrative intercourse with less pain. However, little is known about the behaviors of dilator users, what treatment protocols are most effective, how patients are currently using their dilators, and how effective are clinicians in helping their patients achieve success with their dilation therapy.
METHODS
A recent PubMed literature search was performed using the key words vaginal dilator, vaginal dilator therapy, sexual quality of life, vaginal stenosis, vaginal dilation, vaginismus. A total of 29 English articles were reviewed and summarized. Articles were excluded for the following reasons: not in English and unrelated to dilator therapy.
MAIN OUTCOME MEASURE
This article will summarize the current research on vaginal dilators and discuss needs for future research to maximize patients' compliance and success with this treatment. Much of the summary data regarding user behavior will come from the early survey data with Milli, a novel, patient-controlled electronic dilator that slowly expands 1 mm at a time from its smallest diameter, 15 mm to a maximum diameter of 40 mm. Milli is currently being used by more than 1,000 women, and 3-month follow-up data were recorded on 335 of those patients.
RESULTS
Dilators exist in multiple forms (plastic, latex, and medical grade material), may come individually or in sets, and many have special features such as vibration or the ability to be heated or cooled before use. Little is known about patients' use of dilators and the Milli's 3-month survey serves as an insight to patient dilator behavior. The most common medical goals for patients undergoing dilation treatment were return to penetrative intercourse and pain reduction during coitus. Patients were dilated on average 2.72 days/week; 56.8% of patients had suffered from sexual pain for 2 or more years and 36.3% had previously used static dilators. More than 70% of Milli users purchased Milli and are using Milli without the direct guidance of a clinician. The most common emotions patients used to describe their treatment were not only "anxious," "frustrated," but also "empowered" and "optimistic." The most common dilatory session duration was 6-10 minutes, mostly in the evening/bedtime (68.3%), located in the bedroom (96.8%). Adjunctive treatment included the following: vaginal moisturizers, local estrogen products, coital lubricants, and genital pelvic floor physical therapy. During the dilation sessions, women most often watched TV/videos, practiced mindfulness, or listened to soothing music. Factors that showed trends toward improved patient outcomes were length of dilation treatment (greater than 3 months) and use of meditation and soothing music. Factors not associated with improvement trends were as follows: when/where patients dilated and patient demographics including age, race, or religious preferences.
CONCLUSION
Patients who purchase dilators have often suffered with their condition for a long time and had difficulty finding a competent health-care clinician well versed in sexual pain syndromes that can help them. When patients did find a clinician, there were no clinically proven standardized protocols or formalized guidelines to give to patients about how to best use their dilators. Larger long-term interventions investigating a standardized dilation protocol are planned in future studies to better elucidate the effective and optimal dilation treatment plans. Liu M, Juravic M, Mazza G, et al. Vaginal Dilators: Issues and Answers. Sex Med Rev 2021;9:212-220.
Topics: Constriction, Pathologic; Dilatation; Female; Humans; Quality of Life; Vagina; Vaginismus
PubMed: 32014450
DOI: 10.1016/j.sxmr.2019.11.005 -
Journal of Laparoendoscopic & Advanced... Feb 2020Esophageal dilatations are commonly performed in pediatric patients who have undergone an esophageal atresia/tracheoesophageal fistula (EA/TEF) repair or following... (Comparative Study)
Comparative Study
Esophageal dilatations are commonly performed in pediatric patients who have undergone an esophageal atresia/tracheoesophageal fistula (EA/TEF) repair or following caustic injury. We sought to compare the practice of esophageal dilatation across different specialties. We analyzed all patients who had an esophageal dilatation at our center between April 2014 and December 2018. Patients were identified via prospectively maintained databases and clinical coding records. Patients had a combination of dilatations under each specialty: interventional radiology (IR), surgery, and gastroenterology. Thirty-five individual patients underwent 226 dilatations, median dilatations per patient was 3 (1-40). The median age at first dilatation was 18 months (1-194 months). Sixty-eight percent of patients had a previous EA/TEF repair. IR performed 59% of dilatations, surgeons 26%, and 15% by gastroenterologists. Surgeons more frequently were performing initial dilatations ( < .05) and performed more dilatations in EA/TEF patients ( < .0001). There was a significant difference between the time from a surgical dilatation until the next dilatation, 3.7 months, compared with an IR dilatation, 1.8 months (ANOVA, < .05). Surgeons more frequently increased the size of balloon used (57% versus 33% versus 39%, < .01). There was no significant difference in balloon size between specialties or in the incremental increase in size between subsequent dilatations. There was one postprocedure perforation, managed conservatively (complication rate = 0.4%). We have demonstrated that on average, patients wait longer after a surgical dilatation until their next procedure, and surgical teams are more likely to increase the size of the dilating balloon. Surgeons tend to be more involved in their postoperative patients in the initial phases of stricture management. Our results suggest the feasibility and safety of a multispecialty approach for these patients.
Topics: Adolescent; Burns, Chemical; Child; Child, Preschool; Dilatation; Esophageal Atresia; Esophageal Stenosis; Gastroenterology; General Surgery; Humans; Infant; Infant, Newborn; Postoperative Complications; Radiology, Interventional; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 31794681
DOI: 10.1089/lap.2019.0592 -
The Laryngoscope Nov 2021To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes. (Observational Study)
Observational Study
OBJECTIVES/HYPOTHESIS
To better assess rates of postoperative complications and mortality following esophageal dilation, and to identify factors associated with adverse outcomes.
STUDY DESIGN
Observational, retrospective cohort study.
METHODS
We queried a national database of insurance claims for Current Procedural Terminology (CPT) codes representing esophageal dilation performed between 2011 and 2017. Patients aged 18 to 100 who were continuously enrolled with their insurance provider were included. Demographic information, additional CPT codes, concomitant diagnoses, and anticoagulant medication data were collected for all patients included. Postoperative mortality was assessed and International Classification of Diseases (ICD)9/10 codes for complications, including esophageal perforation, hemorrhage, mediastinitis, and sepsis were flagged.
RESULTS
We identified 202,965 encounters for esophageal dilation. Of these procedures, 193 were performed on a patient who underwent percutaneous endoscopic gastrostomy (PEG) during the study period and was analyzed separately. Another 244 dilations were excluded due to repeat entries. Of the remaining 202,528 procedures remaining, 42,310 were repeat dilations in the same patient. Data analysis was confined to each patient's initial dilation. 160,218 initial dilations remained. Of these, 62,107 were performed on male patients and 98,111 were performed on female patients. The average age was 57.7 years. There were 12 mortalities within 30 days postoperatively, representing 0.0075% of all dilations. Esophageal perforation and esophageal hemorrhage were the most common reported complications, with 139 and 110 occurrences, respectively. The overall per-dilation complication rate was 0.215%.
CONCLUSIONS
Evidence from a national insurance claim database suggests that esophageal dilation is a safe procedure with a low rate of serious complications and a 30-day all-cause mortality rate of less than 1 per 10,000 dilations.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2436-2440, 2021.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Current Procedural Terminology; Databases, Factual; Deglutition Disorders; Dilatation; Esophageal Diseases; Esophageal Perforation; Esophagus; Female; Gastrostomy; Hemorrhage; Humans; International Classification of Diseases; Male; Mediastinitis; Middle Aged; Postoperative Complications; Retrospective Studies; Sepsis
PubMed: 33305828
DOI: 10.1002/lary.29322 -
The British Journal of Surgery Oct 1984Maloney's mercury weighted dilators have been used to dilate benign oesophageal strictures in 109 patients in the outpatient department. A total of 524 dilatations have...
Maloney's mercury weighted dilators have been used to dilate benign oesophageal strictures in 109 patients in the outpatient department. A total of 524 dilatations have been performed. Following dilatation two patients had a small haematemesis but there have been no oesophageal perforations. Maloney's dilators can be used in the outpatient department effectively to dilate benign oesophageal strictures and the risk of complications is low.
Topics: Adult; Aged; Dilatation; Esophageal Stenosis; Female; Humans; Male; Middle Aged; Outpatient Clinics, Hospital; Recurrence
PubMed: 6487972
DOI: 10.1002/bjs.1800711005 -
Endoscopy Nov 1977A low risk procedure for dilation of esophageal strictures is peroral bougienage under direct endoscopic vision with a flexible fiberscope. First the stricture is...
A low risk procedure for dilation of esophageal strictures is peroral bougienage under direct endoscopic vision with a flexible fiberscope. First the stricture is inspected using the foreward lens of the fiberscope, and then dilated with conventional bougies according to its nature and size under direct visual control. In this paper we report on the treatment of 16 patients with inoperable advanced benign stenosis. In a total of 86 sittings an average of three bougienages each were performed without complication.
Topics: Dilatation; Esophageal Stenosis; Esophagoscopy; Fiber Optic Technology; Humans
PubMed: 590210
DOI: 10.1055/s-0028-1098518 -
Clinical Obstetrics and Gynecology Jun 2009Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of... (Review)
Review
Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of complications such as cervical laceration or uterine perforation. The cervix may be prepared with osmotic dilators such as laminaria, Lamicel, or Dilapan-S, or with pharmacologic agents such as misoprostol. Dilapan-S and Lamicel achieve their maximum dilation faster than laminaria, making same-day procedures possible. Misoprostol has limited data supporting its use in this setting. Decisions regarding which method is best are clinician-dependent, and factors such as gestational age and time allowed for preparation should be considered.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Biocompatible Materials; Cervix Uteri; Device Removal; Dilatation; Female; Humans; Laminaria; Magnesium Sulfate; Misoprostol; Polymers; Polyvinyl Alcohol; Pregnancy; Pregnancy Trimester, Second
PubMed: 19407523
DOI: 10.1097/GRF.0b013e3181a2b3cd -
The Journal of Laryngology and Otology Jul 2016Eustachian tube dysfunction is a disorder for which there are limited medical and surgical treatments. Recently, eustachian tube balloon dilation has been proposed as a... (Review)
Review
BACKGROUND
Eustachian tube dysfunction is a disorder for which there are limited medical and surgical treatments. Recently, eustachian tube balloon dilation has been proposed as a potential solution.
METHOD
A systematic literature review was performed. Abstracts were selected for relevance, and pooled data analysis and qualitative analysis was conducted.
RESULTS
Nine prospective studies, describing 713 eustachian tube balloon dilations in 474 patients (aged 18-86 years), were identified. Follow-up duration ranged from 1.5 to 18 months. Ability to perform a Valsalva manoeuvre improved from 20 to 177 out of 245 ears following eustachian tube balloon dilation and, where data were reported in terms of patient numbers, from 15 to 189 out of 210 patients. Tympanograms were classified as type A in 7 out of 141 ears pre-operatively and in 86 out of 141 ears post-operatively.
CONCLUSION
Prospective case series can confirm the safety of eustachian tube balloon dilation. As a potential solution for chronic eustachian tube dysfunction, further investigations are warranted to establish a higher level of evidence of efficacy.
Topics: Dilatation; Ear Diseases; Eustachian Tube; Humans; Treatment Outcome
PubMed: 27488333
DOI: 10.1017/S0022215116008252 -
The Laryngoscope Nov 2023Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management....
OBJECTIVE
Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors.
METHODS
Consecutive patients at three academic centers undergoing BDET (January 2014-November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures.
RESULTS
BDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7-78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio [RR] = 3.26; 95% confidence interval [CI]: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent.
CONCLUSION
BDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:3152-3157, 2023.
Topics: Adolescent; Adult; Female; Humans; Male; Catheterization; Dilatation; Ear Diseases; Endoscopy; Eustachian Tube; Inflammation; Otitis Media; Child; Young Adult; Middle Aged; Aged
PubMed: 36929856
DOI: 10.1002/lary.30659