Balloon Dilation of the Eustachian Tube (BDET)

What this page is about

This page explains a newer procedure called balloon dilation of the Eustachian tube. It is for adults and children in general above the age of 8 (where eustachian tube maturity would have been reached by the majority of children). Appropriate patients have ongoing Eustachian tube dysfunction (ETD) that has not improved with medicines such as nasal steroid sprays or allergy treatment.

1. What is BDET?

Your middle ear needs air to get in and out through a small passage called the Eustachian tube. When that tube keeps sticking shut, you can feel blocked, full, unable to “pop” the ear, or you can get fluid behind the eardrum. Balloon dilation is an endoscopic procedure performed through the nose and or mouth, that gently widens the soft (cartilaginous) part of the tube from the nose side. The idea is to help the tube open more normally so the ear can equalise pressure again.

2. Who is it for?

BDET is mainly for older children and adults who have:

• Symptoms for 3 months or more
• Signs on testing, such as negative middle ear pressure or fluid
• Already tried medical treatment (allergy/nasal treatment)
• Have a type of eustachian tube problem called obstructive ETD (the tube does not open)
• It is not for the “too open” tube (patulous ETD) because that would make things worse.

3. How is it done?

• A small camera is passed into the nose along with a balloon introducer
• A thin balloon is guided into the opening of the Eustachian tube
• The balloon is inflated for a short time to stretch/remodel the tube
• The balloon is removed

It can be done under general anaesthetic in theatre, or in selected patients under local anaesthetic. Technical success in large studies was essentially 100%, meaning surgeons were able to get the balloon into the right place and inflate it. This does not mean it works every time to relieve symptoms.

4. Does it work?

Symptom relief
The short answer is sometimes, especially for well selected patients. A major randomised trial showed patients’ symptom scores (ETDQ-7) went from about 4.6 (quite bothered) to about 2.1 (mild/low symptoms) by 6 weeks, and this improvement was still there at 24 months. That is a significant change in medical research conducted in such a rigorous way.

How many people improve?
When you put the better-quality studies together, a realistic message is:

• About 6 out of 10 adults feel clearly better after balloon dilation
• About 6 out of 10 can clear or “pop” the ear more easily after the procedure
• In one trial, the eardrum looked normal in more than 80% of patients after treatment

So it is not perfect, but the majority do improve. This is why we still treat the nose and allergy first, and then offer BDET to the group that stays blocked.

In ear surgery patients
A small randomised 2025 study showed that if you are already having ear surgery (for chronic middle ear disease) and you also have ETD, adding balloon dilation did not show meaningful differences in graft success. More research is needed here.

5. How safe is it?

This has been one of the reassuring parts of the research.

• Large reviews report low complication rates, around 2%
• Most problems were minor and got better on their own (small nose bleed, brief pain, short-lived swelling or crackling in the tissues of the face)
• Serious complications are very rare, especially when scans and nasal endoscopy have ruled out things like a carotid canal problem or a mass near the opening of the tube
• It is not done in people with patulous ETD

So for the average adult with confirmed obstructive ETD, BDET is considered a low-risk ENT procedure.

6. Things to know before deciding

• It treats the tube, not every cause of ear fullness
• If allergy or a blocked nose is driving the problem, that must be treated first
• Results are good on average but not guaranteed for every person
• At present it is usually done once per side, because the results in most people last at least 6–12 months in the studies

7. When to talk to us

You should book or discuss BDET with your ENT surgeon if you have:

• Ongoing ear pressure or fullness for more than 3 months
• Difficulty flying, diving or changing altitude because the ears won’t clear
• Objective tests (tympanogram, hearing, endoscopy) already showing obstructive ETD
• Had a good response to a grommet in the past but don’t want repeated grommets

Your surgeon will confirm that it is obstructive ETD, check your nose and nasopharynx, review your scans if needed, and then discuss BDET alongside other options.