Extensive Subcutaneous Emphysema and Pneumomediastinum Following Eustachian Tube Dilation and PET Insertion: A Rare Complication

Introduction: Eustachian tube dilation (ETD) is an increasingly popular and seemingly safe method of treating ETD. We present a rare case of subcutaneous emphysema and pneumomediastinum following ETD. Methods: Retrospective chart review. Patient consent was obtained for data collection, analysis, drafting, and publication of information. Results: A 33-year-old male presented to the emergency department with acute facial swelling 1 day after treatment for bilateral eustachian tube dysfunction with bilateral ETD and pressure equalization tube (PET) insertion by an otolaryngologist at an outside facility. Symptoms began after he tried to pop his ears. He had extensive crepitus throughout his face, neck, and chest bilaterally with intact and patent PETs. Flexible laryngoscopy revealed a patent airway and no evidence of mucosal injury. Computed tomography demonstrated extensive subcutaneous emphysema extending from the chest to the skull base along with pneumomediastinum. The patient was admitted for observation given these findings and ultimately discharged without requiring any surgical intervention. No recurrent symptoms were noted in the subsequent post-operative period. Discussion: This case illustrates a rare but important complication of ETD, where mucosal injury within the Eustachian tube likely facilitated air dissection into deep cervical and mediastinal fascial planes. While subcutaneous emphysema and pneumomediastinum are typically self-limiting, awareness of anatomical pathways, appropriate imaging, and conservative management strategies are essential for optimal patient care. As ETD gains wider acceptance, further research is needed to characterize risk factors and preventative measures for these complications.