Medical advances over the past several decades have been remarkable. In the mid 1980’s, a revolution changed the way surgeons treated sinus disease. At that time, it was common practice to cut the skin of the face or the tissue above the upper teeth to gain access to sinus disease. That method has given way with few exceptions to “FESS.”
FESS (Function Endoscopic Sinus Surgery) is a surgical procedure that is performed on the inside of the nose. The surgeon uses a thin, flexible, lighted telescope and special instruments to assist in the examination and operation of the sinuses. There is no cutting of the skin.
Another innovative procedure started to gain favor among ENT specialists about ten years ago — to alleviate the pressure, pain and discomfort associated with chronic sinusitis. Balloon Sinuplasty uses a balloon dilating catheter to widen the natural openings of the sinus (ostia) and restore normal sinus drainage. ENT specialists have adopted the experience of cardiologists, who used such catheters to free up blocked blood vessels around the heart and re-establish more normal blood flow to the heart (angioplasties).
Procedure
Balloon sinuplasty uses the concept of dilating the openings of the sinuses with balloons. After appropriate anesthesia, a lighted wire-guided balloon catheter is place through the nose into the involved sinus. Once the surgeon confirms that he/she is in the sinus, the balloon is passed over the blocked sinus opening (ostia). It is briefly inflated and this pressure widens the sinus passageway leaving the mucosa lining intact. It’s an outpatient procedure that can be done in the office or hospital. Most patients return to work in a day or two.
Major Indications:
Chronic sinusitis
Recurrent sinusitis
Sinuplasty is especially useful in patients with chronic or recurrent sinusitis that has not improved with antibiotics, topical steroids or allergy treatment. This procedure is also useful in patients who pose an anesthesia risk and bleeding risk. CT scans often demonstrate abnormal findings in this group of patients.
Major Contraindications:
Ethmoid disease
Nasal polyps (polyposis)
Sinuplasty is not recommended in patients with ethmoid disease because of the high risk for eye complications. Some of the other contraindications are nasal polyps, fungal sinusitis, mucocele (cyst-like structure in the sinus) and patients with cystic fibrosis.
Conclusion
Every year sinusitis affects millions of people. If you have been diagnosed with chronic or recurrent rhinosinusitis without polyposis and medication has not improved your condition, you may be a candidate for sinus surgery. Balloon sinuplasty is not a substitute for FESS, but an alternative for you and your surgeon to consider for relief of sinus congestion, pain and discomfort.
Messerrklinger, Walter; Endoscopy of the Sinus; Springer-Vertag, 1983.
Waldir Carreirao Neto, et al; Balloon Sinuplasty; International Archives of Oto.; 2008
Weiss RL, Church CA, et al. Long-term outcome analysis of balloon catheter sinusotomy: two-year follow up. Otolaryngol Head Neck Surg 2008.