{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:50:44Z","timestamp":1792785044724,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Alexandria University","id":[{"id":"https:\/\/ror.org\/00mzz1w90","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats: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.<\/jats:p>","DOI":"10.1038\/s41598-026-57118-9","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:24:31Z","timestamp":1784640271000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Histopathological changes of the Eustachian tube mucosa following balloon Eustachian tuboplasty in children: insights from standard endovascular balloon application"],"prefix":"10.1038","volume":"16","author":[{"given":"Abdelrahman Mostafa","family":"Hassan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani Farouk","family":"Elgarem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Sheta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser Gaber","family":"Sheweal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehia Mohammed","family":"Ashry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"57118_CR1","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1111\/coa.12475","volume":"40","author":"AG Schilder","year":"2015","unstructured":"Schilder, A. G. et al. Eustachian tube dysfunction: consensus statement on definition, types, clinical presentation and diagnosis. Clin. Otolaryngol. 40, 407\u2013411 (2015).","journal-title":"Clin. Otolaryngol."},{"key":"57118_CR2","unstructured":"Bluestone, C. D. Eustachian tube: structure, function, role in otitis media (PMPH-USA, 2005)."},{"key":"57118_CR3","unstructured":"Hamrang-Yousefi, S., Ng, J. & Andaloro, C. Eustachian Tube Dysfunction (StatPearls Publishing, 2025)."},{"key":"57118_CR4","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/s00106-012-2573-3","volume":"61","author":"S Schr\u00f6der","year":"2013","unstructured":"Schr\u00f6der, S., Reineke, U., Lehmann, M., Ebmeyer, J. & Sudhoff, H. Chronic obstructive eustachian tube dysfunction in adults: long-term results of balloon eustachian tuboplasty. HNO 61, 142\u2013151 (2013).","journal-title":"HNO"},{"key":"57118_CR5","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s00106-013-2711-6","volume":"61","author":"M Tisch","year":"2013","unstructured":"Tisch, M., Maier, S. & Maier, H. Eustachian tube dilation using the Bielefeld balloon catheter: clinical experience with 320 interventions. HNO 61, 483\u2013487 (2013).","journal-title":"HNO"},{"key":"57118_CR6","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1002\/alr.21007","volume":"2","author":"ED McCoul","year":"2012","unstructured":"McCoul, E. D. & Anand, V. K. Eustachian tube balloon dilation surgery. Int. Forum Allergy Rhinol. 2, 191\u2013198 (2012).","journal-title":"Int. Forum Allergy Rhinol"},{"key":"57118_CR7","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1177\/0194599814529538","volume":"151","author":"J Silvola","year":"2014","unstructured":"Silvola, J., Kivek\u00e4s, I. & Poe, D. S. Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube. Otolaryngol. Head Neck Surg. 151, 125\u2013130 (2014).","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"57118_CR8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1177\/0194599811399866","volume":"144","author":"DS Poe","year":"2011","unstructured":"Poe, D. S., Silvola, J. & Pyykk\u00f6, I. Balloon dilation of the cartilaginous eustachian tube. Otolaryngol. Head Neck Surg. 144, 563\u2013569 (2011).","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"57118_CR9","doi-asserted-by":"crossref","unstructured":"Hassan, A., Elgarem, H., Elsawy, E. S., Sheweal, Y. & Ashry, Y. Eustachian Tube Balloon Dilation in Children: Prospective Clinical Outcomes of a Low-Cost Endovascular Balloon. Otol Neurotol, 10\u20131097 (2026).","DOI":"10.1097\/MAO.0000000000004903"},{"key":"57118_CR10","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1097\/MAO.0b013e3181e8cc6d","volume":"31","author":"T Ockermann","year":"2010","unstructured":"Ockermann, T., Reineke, U., Upile, T., Ebmeyer, J. & Sudhoff, H. H. Balloon dilation eustachian tuboplasty: a feasibility study. Otol Neurotol. 31, 1100\u20131103 (2010).","journal-title":"Otol Neurotol"},{"key":"57118_CR11","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1002\/lary.24894","volume":"125","author":"I Kivek\u00e4s","year":"2015","unstructured":"Kivek\u00e4s, I. et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope 125, 436\u2013441 (2015).","journal-title":"Laryngoscope"},{"key":"57118_CR12","doi-asserted-by":"publisher","first-page":"3152","DOI":"10.1002\/lary.30659","volume":"133","author":"RD Hubbell","year":"2023","unstructured":"Hubbell, R. D. et al. Patulous Eustachian Tube Dysfunction Symptoms Following Balloon Dilation. Laryngoscope 133, 3152\u20133157 (2023).","journal-title":"Laryngoscope"},{"key":"57118_CR13","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1177\/0003489418796648","volume":"127","author":"F Christov","year":"2018","unstructured":"Christov, F. & Gluth, M. B. Histopathology of the Mucosa of Eustachian Tube Orifice at the Middle Ear in Chronic Otitis Media With Effusion: Possible Insight Into Tuboplasty Failure. Ann. Otol Rhinol Laryngol. 127, 817\u2013822 (2018).","journal-title":"Ann. Otol Rhinol Laryngol"},{"key":"57118_CR14","unstructured":"De Novo Summary (DEN150056. ). De novo classification request for acclarent aera\u2122 eustachian tube balloon dilation system. https:\/\/www.accessdata.fda.gov\/cdrh_docs\/reviews\/den150056.pdf"},{"key":"57118_CR15","doi-asserted-by":"publisher","first-page":"104208","DOI":"10.1016\/j.amjoto.2023.104208","volume":"45","author":"J Gurberg","year":"2024","unstructured":"Gurberg, J., Dean, M., Kawai, K., Toivonen, J. & Poe, D. Long-term efficacy of balloon dilation of the pediatric Eustachian tube: A six-year matched cohort study. Am. J. Otolaryngol. 45, 104208 (2024).","journal-title":"Am. J. Otolaryngol."},{"key":"57118_CR16","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1177\/00034894211041340","volume":"131","author":"J Saniasiaya","year":"2022","unstructured":"Saniasiaya, J., Kulasegarah, J. & Narayanan, P. Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review. Ann. Otol Rhinol Laryngol. 131, 797\u2013804 (2022).","journal-title":"Ann. Otol Rhinol Laryngol"},{"key":"57118_CR17","doi-asserted-by":"crossref","unstructured":"Howard, A., Babu, S., Haupert, M. & Thottam, P.J. Balloon Eustachian Tuboplasty in Pediatric Patients: Is it Safe? Laryngoscope 131, 1657\u20131662 (2021).","DOI":"10.1002\/lary.29241"},{"key":"57118_CR18","doi-asserted-by":"publisher","first-page":"509","DOI":"10.14639\/0392-100X-1690","volume":"37","author":"M Tisch","year":"2017","unstructured":"Tisch, M., Maier, H. & Sudhoff, H. Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children. Acta Otorhinolaryngol. Ital. 37, 509\u2013512 (2017).","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"57118_CR19","first-page":"e27193","volume":"14","author":"AK Goulioumis","year":"2022","unstructured":"Goulioumis, A. K., Gkorpa, M., Athanasopoulos, M., Athanasopoulos, I. & Gyftopoulos, K. The Eustachian Tube Dysfunction in Children: Anatomical Considerations and Current Trends in Invasive Therapeutic Approaches. Cureus 14, e27193 (2022).","journal-title":"Cureus"},{"key":"57118_CR20","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/00016489.2020.1714077","volume":"140","author":"B Demir","year":"2020","unstructured":"Demir, B. & Batman, C. Efficacy of balloon Eustachian tuboplasty on the quality of life in children with Eustachian tube dysfunction. Acta Otolaryngol. 140, 297\u2013301 (2020).","journal-title":"Acta Otolaryngol."},{"key":"57118_CR21","doi-asserted-by":"crossref","unstructured":"Demir, B. & Batman, C. Efficacy of balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children. J. Laryngol. Otol. 134, 1018\u20131021 (2020).","DOI":"10.1017\/S0022215120002340"},{"key":"57118_CR22","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s11517-020-02121-z","volume":"58","author":"ME Smith","year":"2020","unstructured":"Smith, M. E. et al. The mechanism of balloon Eustachian tuboplasty: a biomechanical study. Med. Biol. Eng. Comput. 58, 689\u2013699 (2020).","journal-title":"Med. Biol. Eng. Comput."},{"key":"57118_CR23","doi-asserted-by":"publisher","first-page":"e0268763","DOI":"10.1371\/journal.pone.0268763","volume":"17","author":"Y Kim","year":"2022","unstructured":"Kim, Y. et al. Serial histological changes in the cartilaginous eustachian tube in the rat following balloon dilation. PLoS One. 17, e0268763 (2022).","journal-title":"PLoS One"},{"key":"57118_CR24","doi-asserted-by":"publisher","first-page":"2574","DOI":"10.1002\/lary.32101","volume":"135","author":"J Jia","year":"2025","unstructured":"Jia, J. et al. Mechanism of Eustachian Tube Balloon Dilation in Minipigs. Laryngoscope 135, 2574\u20132589 (2025).","journal-title":"Laryngoscope"},{"key":"57118_CR25","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1097\/MAO.0000000000003009","volume":"42","author":"J Toivonen","year":"2021","unstructured":"Toivonen, J., Kawai, K., Gurberg, J. & Poe, D. Balloon Dilation for Obstructive Eustachian Tube Dysfunction in Children. Otol Neurotol. 42, 566\u2013572 (2021).","journal-title":"Otol Neurotol"},{"key":"57118_CR26","doi-asserted-by":"publisher","first-page":"e921","DOI":"10.1097\/MAO.0000000000002789","volume":"41","author":"M Tisch","year":"2020","unstructured":"Tisch, M. et al. Balloon Eustachian Tuboplasty (BET) in Children: A Retrospective Multicenter Analysis. Otol Neurotol. 41, e921\u2013e933 (2020).","journal-title":"Otol Neurotol"},{"key":"57118_CR27","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1002\/ohn.913","volume":"171","author":"S Mukerji","year":"2024","unstructured":"Mukerji, S., Rosas Herrera, A. M., Rochat, R., Hosek, K. & Liu, Y. C. Outcomes and Complications of Pediatric Eustachian Tube Dilation Surgery. Otolaryngol. Head Neck Surg. 171, 1530\u20131534 (2024).","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"57118_CR28","doi-asserted-by":"publisher","first-page":"1271248","DOI":"10.3389\/fsurg.2024.1271248","volume":"11","author":"OJ Ungar","year":"2024","unstructured":"Ungar, O. J. et al. Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review. Front. Surg. 11, 1271248 (2024).","journal-title":"Front. Surg."}],"updated-by":[{"DOI":"10.1038\/s41598-026-69301-z","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000}}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57118-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57118-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57118-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:32:31Z","timestamp":1789572751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-57118-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["57118"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-57118-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 September 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1038\/s41598-026-69301-z","URL":"https:\/\/doi.org\/10.1038\/s41598-026-69301-z","order":9,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approved by the Institutional Review Board of the Faculty of Medicine, Alexandria University, Egypt (Approval No.\n                      00012098\n                      ). All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all patients or their legal guardians prior to inclusion in the study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"22821"}}