Fluoroscopic subtraction Eustachian tubography: initial feasibility test in a cadaver model

Kun Yung Kim, Woo Seok Kang, Jung Hoon Park, Byung Chul Kang, Jun Woo Park, Min Tae Kim, Nader G. Bekheet, Seung Jun Hwang, Joonmyeong Choi, Kyu Jin Cho, Hong Ju Park, Ho Young Song

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: To evaluate the technical feasibility of direct Eustachian tube catheterisation and subtraction Eustachian tubography in a cadaver model. Methods: A total of 12 separate sessions were performed on both sides of the Eustachian tube (ET) in six human cadavers. Cadavers were positioned for the submentovertical view on a fluoroscopy table. Endoscopy-guided ET selection was used in the first three cadavers, whereas fluoroscopy-guided ET selection was used in the remaining three. Eustachian tubography was performed by injecting 2 ml of contrast media through a 5-Fr catheter. We recorded the success of ET selection, number of attempts, procedure time, and tubography quality using native and subtraction images (range, 0–3). Results: Both endoscopy- and fluoroscopy-guided selections were successfully performed in five of six sessions (83.3%). There were no statistically significant differences between the endoscopy- and fluoroscopy-guided procedures in terms of the number of attempts, procedure time, rate of immediate contrast leak to the middle ear cavity, and quality of tubography (p > 0.05). An excellent quality of tubography was obtained in 83.3% (10 of 12 sessions) of subtraction images and in 33.3% (4 of 12 sessions) of native images. The tubography quality score was significantly higher for the subtraction images than for the native images (p = 0.04). Conclusion: Subtraction Eustachian tubography using direct catheterisation seems to be technically feasible. The entire ET can be well visualised; thus, this technique can be used as a simple tool for assessment of ET function and anatomy. Key Points: • Direct catheterisation of the Eustachian tube is technically feasible. • The entire Eustachian tube could be well visualised by direct Eustachian tubography. • Subtraction Eustachian tubography images have better image quality than native images. • Subtraction Eustachian tubography can provide objective assessment of ET function and anatomy.

Original languageEnglish (US)
Pages (from-to)3685-3691
Number of pages7
JournalEuropean Radiology
Issue number9
StatePublished - Sep 1 2018
Externally publishedYes


  • Constriction, pathological
  • Dilatation
  • Eustachian tube
  • Otitis media with effusion
  • Radiography, interventional

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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