Balloting the ETT cuff refers to exerting gentle bouncing pressure over the suprasternal notch while palpating the ETT pilot balloon.  If the ETT is in a good position, pressure variation over the suprasternal notch should be transmitted to the ETT cuff, and thence transmitted further to the pilot balloon (where it may be palpated).  If the ETT isn’t easily balloted, this may be used to adjust tube position (e.g. advance or withdraw the ETT until ballottement improves).


Unfortunately, inability to ballot the ETT has only a 26% specificity for indicating incorrect ETT placement (Ledrick 2008).  Thus, in some cases (e.g. morbid obesity), this technique may incorrectly suggest that the ETT is misplaced.  This could lead to repositioning of a correctly positioned ETT, running the risk of actually causing ETT misplacement (6).


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