ModifiedCignaPolicy 0480

Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation

This Cigna medical coverage policy governs when balloon sinus ostial dilation (balloon sinuplasty) and Eustachian tube balloon dilation are considered medically necessary or not, and provides coding guidance for providers submitting claims under Cigna-administered health plans.

Policy Summary

PayerCigna

PolicyBalloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation

Policy CodePolicy 0480

Change TypeModified (added pediatric languagerevised sinuplasty criteriaremoved adult nasal endoscopy requirement)

Effective DateApr 15, 2026

Next Review DateApr 15, 2027

Key ActionSubmit prior authorization with documentation of failed medical therapy and required objective testing (CT/endoscopy or tympanometry and audiometry) when requesting balloon sinuplasty or Eustachian tube balloon dilation.

SourceLink

POLICY UPDATE CHANGES

Removed policy statement for prior evaluation with nasal endoscopy in adults undergoing Eustachian tube balloon dilation.

Added policy statements for pediatric Eustachian tube balloon dilation.

Revised policy statements for sinuplasty regarding mucosal thickening and antibiotics.

31295-31298, 69705-69706CPT codes considered medically necessary

≥8 weeksMin. medical therapy before sinuplasty

≥6 monthsAdult ETBD symptom duration

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One lifetimeETBD allowed

July 2025AAO-HNS pediatric statement

4/15/2026Policy effective/review

Coverage Criteria for Balloon Sinuplasty and Eustachian Tube Dilation

inv-01: Balloon sinus ostial dilation — Chronic rhinosinusitis (per sinus)

Covered when ALL of the following are met for each sinus being considered:

Duration and symptoms: Presence of two or more of the following signs/symptoms for more than three consecutive months: nasal obstruction; anterior or posterior mucopurulent (foul) drainage; facial pain, pressure and/or fullness over the affected sinus; decreased sense of smell.>3 months

Radiologic evidence: Evidence of chronic rhinosinusitis on computerized tomography (CT) scan in each sinus being considered for treatment, including any of: mucosal thickening; air fluid levels; opacification; nasal polyposis.CT evidence

Medical management failure: Failure, intolerance or contraindication of medical management when ALL the following have been tried during at least eight (8) consecutive weeks: antibiotic therapy; steroid spray; antihistamine nasal spray and/or decongestant; nasal saline irrigation.>=8 weeks

inv-02: Balloon sinus ostial dilation — Recurrent acute rhinosinusitis (per sinus)

Covered when ALL of the following are met:

Episode frequency: Four or more episodes per year of acute rhinosinusitis.>=4/year

Endoscopy: Nasal endoscopy findings suggestive of significant disease (abnormal mucosal status, fluid, or infection).endoscopy abnormal

CT evidence: CT scan evidence of ostial occlusion and mucosal thickening in each paranasal sinus being considered for treatment.CT ostial occlusion

inv-05: Balloon sinus ostial dilation (SOD/BSD) — Appropriate use

Covered when ALL of the following are met:

SOD candidate: Adult (≥18 years) with chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS) who have failed appropriate medical therapy.

Supported by AAO-HNSF and ARS statements

Objective evidence: Objective documentation of sinonasal inflammation by nasal endoscopy or CT (CT required before surgical intervention).

AAO-HNSF: CT required before balloon dilation; diagnosis should not be made by symptoms alone

Procedure selection: SOD may be used alone or adjunctively with FESS for limited CRS without polyposis or for RARS with ostial occlusion/mucosal thickening.

AAO-HNSF consensus supports appropriate use in selected patients

inv-06: Eustachian tube balloon dilation (ETBD) — Appropriate use

Covered when ALL of the following are met:

Age and diagnosis: Adults aged ≥18 years with chronic obstructive Eustachian tube dysfunction (ETD) with persistent symptoms and objective evidence of ETD.

Objective evidence may include abnormal tympanometry (Type B or C) or abnormal tympanic membrane findings

Prior management: Contributing conditions (e.g., allergic rhinitis, rhinosinusitis, middle ear effusion) have been identified and managed prior to ETBD and conservative therapies attempted.

Tympanostomy tubes may relieve symptoms but do not correct ET pathology; improvement during tube patency supports diagnosis

Safety screening: Exclude patulous ETD, internal carotid artery dehiscence into the ET lumen, active otitis media, tympanic membrane perforation or tympanostomy tube when contraindicated; consider CT to rule out ICA dehiscence when indicated.

FDA contraindication: ipsilateral carotid artery dehiscence and history of ipsilateral patulous ET; many trials required CT confirmation

inv-07: Adult coverage criteria

Covered when ALL of the following are met

Adult candidate criteria: Age ≥18 years; symptoms of obstructive ETD for >3 months affecting quality of life or functional status; failed appropriate medical therapy for identified treatable causes; objective confirmation with abnormal tympanometry and supportive measures (e.g., ETDQ-7) and nasal endoscopy to assess ET lumen and access; absence of exclusion conditions (e.g., patulous ETD, internal carotid artery dehiscence, active otitis media, tympanic membrane perforation).

Drawn from AAO-HNSF consensus and trial inclusion criteria

inv-03: Eustachian tube balloon dilation — Adults — Unilateral or bilateral ETBD is covered once per lifetime for chronic obstructive Eustachian tube dysfunction when ALL of the following are met:

Unilateral or bilateral ETBD is covered once per lifetime for chronic obstructive Eustachian tube dysfunction when ALL of the following are met:

Age 18 years or older.>=18

Symptoms duration and type: Any of the following symptoms continuously for at least six months: aural fullness; aural pressure; hearing loss; autophony; or history of chronic ear disease or intolerance to barometric changes greater than six months.>=6 months

Objective tests: Both of the following prior to ETBD: two abnormal tympanograms (Type B or C) and two abnormal tympanic membrane examinations (e.g., retracted membrane, effusion, perforation).2 abnormal tests

inv-04: Eustachian tube balloon dilation — Pediatrics (ages 8-17)

Covered when ALL of the following are met:

Age: Patient is 8 to 17 years of age and device used is FDA-approved/cleared for pediatric use.8-17 years

Objective signs of persistent ETD resulting in chronic otitis media with effusion, evidenced by middle ear effusion persisting for ≥3 months or tympanic membrane retraction with associated hearing loss.>=3 months effusion

Prior surgery: Refractory to at least one surgical intervention (e.g., tympanostomy tubes, adenoidectomy) for persistent Eustachian tube dysfunction.>=1 prior surgical intervention

inv-08: Pediatric coverage stance — Pediatric use — coverage rationale and limitations

Pediatric use — coverage rationale and limitations

Pediatric considerations: Evidence is primarily retrospective and observational; ETBD may be considered in select pediatric patients with chronic otitis media with effusion (COME) or recurrent acute otitis media (RAOM) after failure of standard treatments (e.g., tympanostomy tube history, recurrent symptoms), with careful attention to device sizing and anatomical differences; providers should document rationale and prior treatments.

Studies report improvements in tympanometry and failure-free survival but lack RCT evidence; devices often off-label for younger children

inv-09: AAO-HNSF consensus-derived candidate criteria for BDET (adult)

Covered when ALL of the following are met

Adult BDET candidate criteria: 1) Obstructive ETD present in one or both ears for >3 months affecting quality of life or functional health status; 2) Comprehensive history and physical including otoscopy performed; 3) Nasal endoscopy performed to assess ET lumen and transnasal access feasibility; 4) Tympanometry and comprehensive audiometry included in evaluation; 5) Other causes of aural fullness (patulous ETD, TMJ disorders, extrinsic obstruction, superior semicircular canal dehiscence, endolymphatic hydrops) are ruled out; 6) Patient has failed medical therapy for identified treatable causes (e.g., allergic rhinitis, rhinosinusitis, laryngopharyngeal reflux).all

AAO-HNSF consensus-derived candidate criteria

inv-10: Procedure adjuncts and contraindications — Providers should consider the following when planning BDET

Providers should consider the following when planning BDET

Adjuncts and contraindications: BDET is contraindicated for patients with patulous ETD. Myringotomy with or without tympanostomy tube placement is not mandatory prior to BDET; patients with middle ear effusion at the time of BDET may benefit from concurrent myringotomy/tympanostomy. A dehiscent carotid artery on imaging is a contraindication to using devices without a depth marker. Potential risks include bleeding, scarring, infection, development of patulous ETD, and need for additional procedures.all

inv-11: Pediatric BDET (AAO-HNS position statement)

Covered when ALL of the following are met for selected pediatric patients

Pediatric BDET criteria: Pediatric patient with obstructive ETD resulting in chronic otitis media refractory to standard surgical interventions (e.g., tympanostomy tube placement and adenoidectomy). Treatment decision made by a qualified otolaryngology-head and neck surgeon. Use of FDA-approved devices for the indication and adherence to device-specific guidelines. Preoperative CT imaging is not routinely required unless clinically indicated.all

AAO-HNS pediatric position statement

Balloon sinus ostial dilation (balloon sinuplasty) and Eustachian tube balloon dilation (ETBD) are covered only for the specific indications and criteria listed in this policy. Balloon sinus ostial dilation is considered not medically necessary for all indications beyond chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS) when the documented clinical and objective criteria for CRS or RARS are not met. Similarly, ETBD is not medically necessary for indications that do not meet the applicable adult or pediatric ETBD criteria described in this policy.

Balloon dilation of the paranasal sinuses should only be performed when the patient has sinonasal symptoms and objective confirmation of disease on CT or endoscopy. Per AAO‑HNSF guidance and the policy criteria, balloon dilation is not appropriate for patients without both sinonasal symptoms and positive CT findings, and should not be used solely for management of headache or sleep apnea in the absence of documented sinus disease.

Explicit exclusions and contraindications include conditions that increase procedural risk or indicate an alternative diagnosis. The policy excludes patients with patulous Eustachian tube dysfunction, an ipsilateral internal carotid artery dehiscent into the Eustachian tube lumen, active primary inflammatory disorders, and situations where a tympanic membrane perforation or an in situ tympanostomy tube would preclude standard evaluation or safe performance of ETBD.

Per the AAO‑HNSF consensus statements incorporated into this policy, candidates for balloon dilation of the Eustachian tube should not include patients with patulous ETD, those with extrinsic obstruction of the Eustachian tube, or patients with active primary inflammatory disorders. These conditions must be identified and excluded during preprocedural evaluation before considering BDET.

Balloon sinuplasty (balloon sinus ostial dilation) is considered not medically necessary for any indication that does not meet the specific CRS or RARS criteria in this policy. The policy requires documented symptom duration, objective CT or endoscopic findings, and prior medical management before considering sinuplasty; absent those criteria, the procedure is not supported.

Eustachian tube balloon dilation (ETBD) is considered not medically necessary for indications that do not meet the detailed adult or pediatric coverage criteria in this policy. ETBD is limited to patients who fulfill the documented age, symptom duration, objective testing, and prior management requirements described for adults or for select pediatric patients.

Balloon sinuplasty performed without objective evidence of sinonasal disease is considered inappropriate and may be noncovered. The AAO‑HNSF and ARS guidance cited in this policy state that the diagnosis of CRS or RARS should not be made on symptoms alone; CT imaging or nasal endoscopy demonstrating sinonasal inflammation is required before balloon dilation is performed.

Pooled evidence does not support using intranasal corticosteroid therapy alone as a basis for ETBD. Meta‑analysis of tympanometry outcomes found no significant improvement with intranasal corticosteroids versus control; therefore intranasal corticosteroid use alone, without documented failed medical therapy and objective testing (e.g., tympanometry), is insufficient justification for ETBD.

Patient‑reported symptom scores alone are insufficient to establish the diagnosis of obstructive Eustachian tube dysfunction or to justify BDET. The AAO‑HNSF statements emphasize that objective testing (e.g., tympanometry, audiometry, nasal endoscopy) and comprehensive clinical evaluation are essential components of the diagnostic workup prior to considering balloon dilation of the Eustachian tube.

Provider Documentation, Prior Authorization, and Billing Guidance

Prior Authorization

Prior authorization / covered CPT codes

CPT codes 31295, 31296, 31297, 31298, 69705, and 69706 are listed as considered medically necessary when the applicable policy criteria are met; providers must submit appropriate supporting documentation with claims or prior authorization requests.

31295, 31296, 31297, 31298 — balloon sinus ostial dilation CPT codes
69705, 69706 — eustachian tube balloon dilation CPT codes

Prior Authorization

Prior authorization recommended when criteria must be shown

Payers may require prior authorization demonstrating documented failure of medical therapy and objective findings (CT or nasal endoscopy for sinonasal disease; tympanometry/tympanic membrane exam for ETD) before approving balloon sinuplasty or ETBD.

Procedural selection should be based on failure of medical therapy and objective confirmation (CT/endoscopy or tympanometry).
CT scanning of the sinuses is required before balloon dilation per AAO-HNSF statements.

Codes and Coding Guidance

Covered CPT Codes - Balloon sinus ostial dilationCPTCovered

31295	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa.
31296	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium.
31297	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium.
31298	Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia.

Covered CPT Codes - Eustachian tube dilationCPTCovered

69705	Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral.
69706	Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral.

FDA 510(k) device identifiers mentionedmixed

K230742	ACCLARENT AERA™ Eustachian Tube Balloon Dilation System identifier (FDA 510k)
K230065	VenSure™ Balloon Dilation System identifier (FDA 510k)
K223542	TubaVent™ Balloon Dilatation System identifier (FDA 510k)
K210841	NuVent™ Eustachian Tube Dilation Balloon identifier (FDA 510k)
K171761	XprESS™ ENT Dilation System identifier (FDA 510k)

FDA product codes referencedmixed

LRC, PGW, PNZ

Product code(s): LRC, PGW, PNZ

Mucosal thickening — threshold

Mucosal thickening threshold> 3 millimeters

Radiologic finding contextListed among CT characteristics used to document sinusitis (air fluid levels, opacification, nasal polyposis, bony remodeling)

Imaging modalityCT scan is the standard radiologic examination when endoscopic sinus surgery is being considered

Key Definitions

Recurrent acute rhinosinusitis (RARS) — definition

RARS episode frequencyFour or more episodes of acute rhinosinusitis in the past 12 months

Inter-episode symptom statusNo signs or symptoms of rhinosinusitis between episodes

Diagnostic supportDiagnosis supported by endoscopy and CT findings per AAO-HNSF guidance

Lund-Mackay Score — CT-based scoring system

Score range0 to 24 total

Scoring regionsRight and left sides each divided into six regions: maxillary, anterior ethmoid, posterior ethmoid, sphenoid, frontal, and ostiomeatal complex

Per-region scoring

Background and Evidence Summary

Chronic rhinosinusitis (CRS) is inflammation of the paranasal sinuses lasting longer than 12 weeks and may present with ≥2 symptoms such as mucopurulent drainage, nasal obstruction, facial pain/pressure, or decreased sense of smell. Balloon sinus ostial dilation (balloon sinuplasty) is a minimally invasive option to dilate sinus ostia and improve ventilation, and is considered medically necessary only when the policy's symptom duration, objective imaging or endoscopic findings, and documented failure of appropriate medical therapy are met.

Policy Revision History

2026-04-15annual_reviewLatest

Removed policy statement requiring prior evaluation with nasal endoscopy in adults undergoing Eustachian tube balloon dilation; added pediatric-specific policy statements referencing AAO-HNS pediatric guidance.

2025-05-15annual_review

Revised policy statements for sinuplasty regarding mucosal thickening and antibiotic management.

2024-04-15annual_review

Policy Summary

PayerCigna

PolicyBalloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation

Policy CodePolicy 0480

Change TypeModified (added pediatric languagerevised sinuplasty criteriaremoved adult nasal endoscopy requirement)

Effective DateApr 15, 2026

Next Review DateApr 15, 2027

SourceLink

On This Page

Sinonasal symptoms such as pain, pressure, drainage, or reduced sense of smell.

Medical management: Failure, intolerance or contraindication to appropriate medical management including at least four weeks of a nasal topical spray.>=4 weeks

Improvement with tubes: If history of tympanostomy tube placement, symptoms of Eustachian tube obstruction improved while tubes were patent.improvement with tubes

Prior Authorization

Prior authorization: failed medical therapy and objective confirmation

Document prior medical management failure using trial examples from clinical trials (e.g., at least four weeks of daily intranasal steroid or a completed course of oral steroid) and include objective confirmatory tests such as abnormal tympanometry and symptom questionnaires where applicable.

Trials defined failed medical management as ≥4 weeks intranasal steroid or a completed course of oral steroid within the specified pre-enrollment period.
Prior authorization should include objective indicators (abnormal tympanometry, ETDQ-7 or similar) when applicable.

Prior Authorization

Prior authorization evidence required

Include diagnostic evaluation documentation with prior authorization: comprehensive history and physical including otoscopy; nasal endoscopy findings; tympanometry results; and audiometry when applicable; for sinonasal procedures, include CT imaging reports.

Comprehensive history and physical exam including otoscopy.
Nasal endoscopy findings to document sinonasal abnormality or to assess ET lumen/transnasal access.
Tympanometry and comprehensive audiometry results for ETBD authorization.
CT imaging for sinus procedures or when required to exclude contraindications (e.g., ICA dehiscence).

Step Therapy

Medical therapy required prior to procedure

Providers must document that appropriate medical therapy was attempted and failed prior to requesting authorization for balloon procedures; for CRS this includes at least eight consecutive weeks of combined therapies.

CRS: at least eight consecutive weeks including antibiotic therapy, steroid spray, antihistamine nasal spray and/or decongestant, and nasal saline irrigation.
Adult ETBD: failure, intolerance or contraindication to appropriate medical management including at least four weeks of a nasal topical spray.

Step Therapy

Require prior medical management trial

Document a trial of initial medical management (e.g., antibiotics, intranasal steroids, saline irrigation); balloon procedures are considered only after appropriate medical therapy has failed.

Medical management is the usual initial therapy; balloon dilation is considered after failure of appropriate medical therapy.
Document specific therapies tried and duration.

Step Therapy

Step therapy requirement

Candidates for BDET must have attempted and failed appropriate medical management for identifiable treatable causes (e.g., allergic rhinitis, rhinosinusitis, laryngopharyngeal reflux) prior to authorization.

Document identification and management of contributing conditions prior to ETBD.
Authorization should include evidence of failed medical therapies for those conditions.

Step Therapy

Step therapy prior to BDET

BDET is appropriate only after failure of medical therapy for identified treatable causes; providers should document specific conservative treatments attempted and their durations.

Document trials of treatments targeting allergic rhinitis, rhinosinusitis, or reflux when relevant.
Include duration and response to those therapies in the record.

Documentation Required

Imaging documentation

Obtain and document a CT scan when endoscopic sinus surgery or balloon sinus ostial dilation is being considered; report radiologic characteristics such as mucosal thickening, air-fluid levels, opacification, or nasal polyposis.

CT is the standard radiologic exam and is required before surgical intervention.
Report mucosal thickening (>3 mm), air-fluid levels, opacification, or polyposis.

Documentation Required

Required objective documentation for CRS/RARS

Before surgical intervention for CRS/RARS, include CT imaging of the paranasal sinuses demonstrating ostial occlusion or mucosal thickening and/or nasal endoscopy documenting sinonasal inflammation.

CT imaging is indicated when endoscopic sinus surgery is being considered.
Diagnosis should be supported by nasal endoscopy or CT showing inflammation prior to balloon dilation.

Documentation Required

Required documentation for ETBD

For ETBD, document objective evidence of obstructive ETD such as abnormal tympanometry (Type B or Type C) and abnormal tympanic membrane findings; also document prior management of contributing conditions.

Two abnormal tympanograms (Type B or C) and two abnormal tympanic membrane examinations are required per adult criteria.
Document management of contributing conditions (allergic rhinitis, rhinosinusitis, middle ear effusion) prior to ETBD.

Documentation Required

Required pre-procedure documentation

Prior to the procedure document a comprehensive history and physical including otoscopy, and nasal endoscopy findings assessing ET lumen and feasibility of transnasal access.

Include otoscopy and nasal endoscopy assessing the ET lumen and transnasal access.
Record findings that support feasibility and safety of the planned approach.

Documentation Required

Pre-procedure diagnostic documentation

Document comprehensive history and physical including otoscopy; include nasal endoscopy findings that assess ET lumen and transnasal access feasibility, plus tympanometry and comprehensive audiometry when evaluating BDET candidacy.

Nasal endoscopy is necessary to assess ET lumen and rule out extrinsic causes.
Tympanometry and audiometry are essential components of the diagnostic evaluation.

Documentation Required

Pediatric-specific documentation

For pediatric BDET, document failure of standard surgical interventions (e.g., prior tympanostomy tube placement and adenoidectomy) when pertinent and that treatment decisions were made by a qualified otolaryngology-head and neck surgeon.

Document prior surgical interventions and refractoriness (e.g., persistent middle ear effusion ≥3 months or tympanic membrane retraction with hearing loss).
State device used is FDA‑approved/cleared for pediatric use when applicable.

Denial Risk

Denial for non-covered codes

Claims for services not accompanied by covered procedure codes under this Coverage Policy will be denied as not covered; submit only the CPT codes listed as considered medically necessary when criteria are met.

Claims for non-covered codes or services not meeting policy criteria will be denied as not covered.

Denial Risk

Lack of objective documentation risks denial

Performing balloon dilation based solely on symptoms without objective confirmation (CT or nasal endoscopy for sinus disease; tympanometry/nasal endoscopy for ETD) or proceeding without required CT prior to surgery risks denial for lack of objective documentation.

AAO-HNSF: diagnosis should not be made on symptoms alone; CT or endoscopy confirmation is required before balloon dilation.
Balloon sinuplasty without objective CT or endoscopic evidence is considered inappropriate/not medically necessary.

Denial Risk

Denial triggers

Procedures performed when exclusion criteria or contraindications are present (for example internal carotid artery dehiscence into the ET lumen, patulous ETD, tympanic membrane perforation, active otitis media) may be denied.

Exclude procedures when ICA dehiscence into the ET lumen or patulous ETD are present.
Active otitis media, tympanic membrane perforation, or presence of tympanostomy tube (per some trial exclusions) are listed contraindications.

Documentation Required

Documentation/diagnostic evaluation expectations

Failure to document essential diagnostic evaluation elements (comprehensive history and physical including otoscopy, nasal endoscopy, tympanometry, and audiometry) prior to BDET may trigger coverage denial if medical necessity cannot be established.

Document otoscopy, nasal endoscopy, tympanometry, and comprehensive audiometry as part of the pre-procedure evaluation.
Patient-reported symptom scores alone are insufficient to establish diagnosis or medical necessity.

Each sinus scored 0 (no abnormality), 1 (partial opacification), or 2 (total opacification); ostiomeatal complex scored 0 or 2

Chronic rhinosinusitis (CRS) — definition

Duration requirementSymptoms lasting 12 weeks or longer

Symptom criteriaTwo or more: mucopurulent drainage, nasal obstruction, facial pain/pressure/fullness, or decreased sense of smell

Objective inflammationPlus documented inflammation by purulence/edema on endoscopy, nasal polyps, and/or radiographic imaging showing paranasal sinus inflammation

Recurrent acute rhinosinusitis (RARS) — four or more/year

Episode frequencyFour or more episodes per year of acute bacterial rhinosinusitis

Episode duration and featuresEach episode up to 4 weeks with purulent nasal drainage plus nasal obstruction or facial pain/pressure

Between-episode requirementNo signs or symptoms of rhinosinusitis between episodes

Obstructive Eustachian tube dysfunction (ETD) — definition & symptoms

DefinitionFailure of the Eustachian tube to open adequately causing impaired middle ear ventilation and abnormal pressure regulation

Typical symptomsAural pressure or fullness, sensation of a heavy ear, fluctuating hearing loss, popping/snapping/buzzing sounds, possible vertigo

Objective supportMay be supported by Type B (flat) or Type C (negative pressure) tympanogram and abnormal tympanic membrane findings

Balloon dilation of the Eustachian tube (BDET/ETBD) — procedural definition

Procedural definitionInsertion of a catheter with a balloon into the cartilaginous portion of the Eustachian tube and inflation of the balloon to alleviate obstructive ETD

PurposeAimed to relieve obstruction and improve middle ear ventilation and pressure regulation

Device classificationDescribed as a balloon dilation procedure in AAO-HNSF consensus statements

Failed medical therapy — examples from trials

Trial-based examples of failed medical therapyAt least four weeks of daily intranasal steroid spray or a completed course of oral steroid within the specified pre-enrollment period

Other medical therapies referencedSystemic decongestants, antihistamines, nasal irrigation, topical nasal decongestants and corticosteroid sprays used before enrollment in trials

Role in eligibilityDocumentation of failed medical therapy is required prior to considering BDET in trials and clinical criteria

Balloon dilation of the Eustachian tube (BDET) — procedural definition (duplicate)

Procedural definition (duplicate)Inserting a catheter with a balloon temporarily into the cartilaginous portion of the Eustachian tube and inflating the balloon to alleviate obstructive ETD

Consensus sourceDefinition provided in AAO-HNSF (2019) clinical consensus statement

Intended effectAlleviation of obstructive ETD symptoms such as aural fullness and pressure

Obstructive Eustachian tube dysfunction (ETD) — symptoms & definition (duplicate)

Symptoms listAural fullness, aural pressure, hearing loss, otalgia (ear pain), fluctuating hearing, popping/snapping sounds

Definition restatedObstructive ETD results from failure of the Eustachian tube to ventilate the middle ear, often due to inflammation/remodeling of cartilaginous ET

Diagnostic considerationsRequires ruling out patulous ETD and other causes; tympanometry and nasal endoscopy are essential parts of evaluation

Annual review with no coverage changes recorded.