Two Cases of Intra-Operative Cardiac Arrhythmia During Balloon Eustachian Tuboplasty: The Mechanism and Treatment

Balloon eustachian tuboplasty (BET), a surgical technique to expand the cartilaginous portion of the eustachian tube by ballooning via opening at the nasopharynx, has been introduced as a useful surgical modality for eustachian tube dysfunction patients. Although BET is known as a relatively safe procedure, we recently have experienced two cases of cardiac complications during balloon inflation. In one case, an asystole occurred for 13 seconds during this procedure; the heart rate was recovered after balloon deflation with an intravenous injection of glycopyrrolate and atropine. In the other case, bradycardia occurred and continued during BET. Heart rate was recovered immediately after deflation of balloon without drug injection. As far as we know, this is the first report of cardiac complications during BET, probably related with trigemino-cardiac reflex. In both cases, no other sequelae remained after the surgery. We report these two cases of cardiac complications that occurred during BET along with a review of literature.