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New ear tube dilation system may keep aircrew airborne

  • Published
  • By Merrie Schilter-Lowe
  • 60th Air Mobility Wing Public Affairs

TRAVIS AIR FORCE BASE, Calif. - When the U.S. Food and Drug Administration approved a dilation system to treat chronic Eustachian Tube Dysfunction in September 2016, Maj. (Dr.) Scott McCusker immediately understood the application.

“This new technology will keep pilots and crew members flying, which is ultimately why we are here in Air Force medicine,” said McCusker, 60th Surgical Operations Squadron at Travis Air Force Base, California.

In 2013, the Air Force disqualified 15 of 38 pilots and 73 of 103 enlisted aircrew members with ETD, said Maj. (Dr.) Brian Davis, 6th Air Refueling Squadron flight surgeon. Additionally, five of seven pilot applicants were disqualified.

The Eustachian tube connects the middle ear to the back of the throat. During flight, or situations where altitude or pressure changes rapidly, the Eustachian tube allows people to “pop” their ears.

If the tube does not function properly, a person may feel a sense of fullness or clogging in the ear. They also may experience earache, ear infection or hearing loss, said McCusker.

Doctors aren’t sure what causes ETD.

“In some patients, it’s related to allergies and inflammation around the opening of the Eustachian tube,” said McCusker.

Some patients may have a mass or tumor in front of the Eustachian tube, which must be treated or removed, he said.

“Most of us, at some time, will have ETD, like when you have a bad cold and can’t clear your ears,” said McCusker. “You may feel like you’re underwater.”

Before the FDA approved the new rigid plastic balloon dilation device for ETD, doctors prescribed nasal steroids as a first course of action to help drain the ear.

“If that didn’t work, we had to think about other options,” said McCusker.

The traditional option was an ear tube placed through the eardrum to bypass the Eustachian tube and equalize the pressure, he said.

“Ear tubes are safe and they don’t cause a lot of complications for patients,” said McCusker. “It’s an easy surgery.”

Traditional tubes fall out in about a year and must be replaced, said McCusker.

“People who need an ear tube, need it long term,” he said.

Doctors perform about 100,000 ear tube surgeries annually in the United States. Travis ear, nose and throat surgeons perform 50 to 100 of these surgeries, mostly in children, said McCusker.

Although getting an ear tube is not a big deal for most patients, aircrew who require a tube ultimately lose their pilot qualifications, said McCusker.

“I think this is really going to benefit (the Air Force),” said McCusker of the new treatment. “Pilots and enlisted crew members spend a lot of time in a plane. We’ve spent a lot of money for their training. It’s awful to have to say, ‘You can’t fly anymore’.”

After hearing about the dilation device at an otolaryngology scientific conference last year, McCusker began researching the technology. In February, he became one of only two Air Force physicians certified to perform the delicate operation.

During the surgery, a doctor uses a catheter to insert a small rigid balloon through the patient’s nose and into the Eustachian tube. Once inflated, the balloon opens up a pathway for mucus and air to flow through the tube, which may help restore proper function. After the Eustachian tube is dilated, the doctor deflates and removes the balloon.

Although the procedure itself takes about five minutes, McCusker was required by the company that manufactures the device to complete an eight-hour course, which included hands-on cadaver dissections.

“The procedure is minimally invasive and patients recover very quickly - most are back to normal the next day,” said McCusker. “There’s no external incisions or scars because everything is done with cameras through the nose.”

However, the surgery does require the patient to be under a general anesthesia, he said.

“The data says that once the patient heals, 50 to 70 percent are completely cured with this one simple treatment,” said McCusker. “Of the 30 to 50 percent who are not cured, almost all improve. Now, for people who had no other option, like pilots, this makes a huge difference.”

From all indications, the treatment is permanent and patients only need one treatment. But the technology is new, said McCusker. Patients may need another surgery in five to 10 years.

David Grant USAF Medical Center has three otolaryngology surgeons who can treat patients with ETD. Adults who have had traditional treatments and are still suffering can get evaluated for the dilation procedure with a referral from their primary care provider.

“This is a way to address the issue instead of bypassing it,” said McCusker. “I think this is going to be a big part of our business when word gets out and people realize how powerful this technology is.”

DGMC has everything needed to perform the new procedure.

“We just need a qualified patient,” said McCusker.