Balloon eustachian tuboplasty (BET) is a safe procedure for chronic obstructive eustachian tube dysfunction. Simultaneous subcutaneous emphysema and pneumomediastinum are rare and potentially life-threatening. We report the first case of iatrogenic subcutaneous emphysema and pneumomediastinum after BET in the literature. A 49-year-old woman presenting with chronic rhinitis, nasal septum deviation and obstructive eustachian tube dysfunction was admitted for septomeatoplasty and balloon eustachian tuboplasty (BET). Acute facial swelling with neck crepitus developed after the operation. Computed tomography (CT) revealed subcutaneous emphysema and pneumomediastinum. Iatrogenic eustachian tube mucosal laceration caused by balloon barotrauma and multiple dilatations (5 in total) was observed. The symptoms subsided within 3 days after conservative treatment with parenteral antibiotics, and follow-up CT one month later revealed complete remission of the subcutaneous emphysema and pneumomediastinum. (J Taiwan Otolaryngol Head Neck Surg 2024; 59:40-43)
