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<p>Balloon Eustachian tuboplasty (BET) has emerged as an established intervention for obstructive Eustachian tube dysfunction; however, the high cost of proprietary balloon systems limits widespread accessibility. Standard endovascular balloons represent a low-cost alternative, yet their tissue-level effects remain insufficiently characterized, particularly in pediatric populations. This study aimed to evaluate histopathological changes of the Eustachian tube (ET) mucosa before and after BET using a standard endovascular balloon. Twenty-two Eustachian tubes (ETs) from eleven children with bilateral obstructive dysfunction refractory to medical and prior surgical management underwent BET. Mucosal biopsies were obtained immediately before and after dilation in all cases. In addition, follow-up biopsies at 16 weeks were obtained from two ETs in a single patient to explore short-term histopathological changes. Specimens were independently analyzed by two blinded pathologists using light microscopy, focusing on epithelial integrity, inflammatory infiltration, lymphoid tissue architecture, and fibrosis. Pre-dilation specimens demonstrated epithelial inflammation with dense submucosal lymphocytic infiltration. Immediately following dilation, mucosal thinning, partial epithelial disruption, and compression of lymphoid tissue were observed, while the basal epithelial layer remained largely preserved. At 16 weeks, limited follow-up specimens demonstrated partial re-epithelialization with restoration toward pseudostratified ciliated columnar epithelium and reduction in inflammatory infiltrates, without histological evidence of tissue necrosis or marked fibrosis in the sampled specimens. BET using a standard endovascular balloon was associated with immediate epithelial and submucosal injury-related histopathological alterations while preserving the basal epithelial layer. Limited follow-up histological observations from a single case demonstrated partial re-epithelialization with reduced inflammatory infiltrates. However, these findings should be considered preliminary and do not permit definitive conclusions regarding reparative response, clinical tolerability, safety, feasibility, or long-term tissue remodeling, which require validation in larger prospective longitudinal studies.</p>

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Histopathological changes of the Eustachian tube mucosa following balloon Eustachian tuboplasty in children: insights from standard endovascular balloon application

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Abdelrahman Mostafa Hassan,
  • Hani Farouk Elgarem,
  • Eman Sheta,
  • Yasser Gaber Sheweal,
  • Yehia Mohammed Ashry,
  • Abdelrahman Mostafa Hassan

摘要

Balloon Eustachian tuboplasty (BET) has emerged as an established intervention for obstructive Eustachian tube dysfunction; however, the high cost of proprietary balloon systems limits widespread accessibility. Standard endovascular balloons represent a low-cost alternative, yet their tissue-level effects remain insufficiently characterized, particularly in pediatric populations. This study aimed to evaluate histopathological changes of the Eustachian tube (ET) mucosa before and after BET using a standard endovascular balloon. Twenty-two Eustachian tubes (ETs) from eleven children with bilateral obstructive dysfunction refractory to medical and prior surgical management underwent BET. Mucosal biopsies were obtained immediately before and after dilation in all cases. In addition, follow-up biopsies at 16 weeks were obtained from two ETs in a single patient to explore short-term histopathological changes. Specimens were independently analyzed by two blinded pathologists using light microscopy, focusing on epithelial integrity, inflammatory infiltration, lymphoid tissue architecture, and fibrosis. Pre-dilation specimens demonstrated epithelial inflammation with dense submucosal lymphocytic infiltration. Immediately following dilation, mucosal thinning, partial epithelial disruption, and compression of lymphoid tissue were observed, while the basal epithelial layer remained largely preserved. At 16 weeks, limited follow-up specimens demonstrated partial re-epithelialization with restoration toward pseudostratified ciliated columnar epithelium and reduction in inflammatory infiltrates, without histological evidence of tissue necrosis or marked fibrosis in the sampled specimens. BET using a standard endovascular balloon was associated with immediate epithelial and submucosal injury-related histopathological alterations while preserving the basal epithelial layer. Limited follow-up histological observations from a single case demonstrated partial re-epithelialization with reduced inflammatory infiltrates. However, these findings should be considered preliminary and do not permit definitive conclusions regarding reparative response, clinical tolerability, safety, feasibility, or long-term tissue remodeling, which require validation in larger prospective longitudinal studies.