Alabama Nasal & Sinus Center
Balloon Sinuplasty - Part II
Today, I will continue discussion of one of the newest technologies introduced to the armamentarium of the sinus surgeon, balloon sinuplasty.
A reminder, the balloon sinus dilator is a tool that utilizes a small wire catheter that can be placed into a sinus opening and then the balloon attached to the catheter inflated to widen the sinus opening.
Dr. Sillers and I were involved in the initial testing of this new technology in 2002. Dr. Sillers was much more instrumental than I, as he was the Chair of the Rhinology Division of the Department of Otolaryngology – Head and Neck Surgery at the University of Alabama - Birmingham at the time and I was but a lowly resident.
Dr. Sillers gave me the opportunity to utilize the balloon on one of his first patients to undergo the balloon procedure, much to the chagrin of the research team from the company that made the balloon and was conducting the initial study.
Seriously, you could feel the tension in the room skyrocket as Dr. Sillers handed me the instruments. Pencil leads were snapping like so many twigs in a windstorm. I'm quite certain that the data point that was that patient was likely excluded from the study, though the patient did very well. We have since treated numerous patients with chronic rhinosinusitis ("sinus" for those here in the South) both medically and surgically. Some of our surgical patients have been good candidates for use of the balloon. Most, however, do not need just a balloon, but more complete dissection of the paranasal sinus cavity, especially the ethmoid sinuses, which lie in the area between the eyes. The majority of chronic sinusitis patients have ethmoid sinus disease. The balloon is ineffective in this region. Balloon sinuplasty can only dilate the natural ostium of the maxillary, frontal, and sphenoid sinuses. For patients who have isolated disease in the aforementioned sinuses, balloon sinuplasty may be a good option. In a few select cases, the balloon may be used in conjunction with other instruments to open the sinuses. Currently, most of our balloon-worthy patients are treated in the office. This keeps costs down and is usually more convenient for the patient. In addition, some patients cannot undergo anesthesia and an in-office procedure done under topical/local anesthetic only is a great option.
In patients with recurrent acute rhinosinusitis, which is a condition of recurring sinus infections that last less than twelve weeks and are interspersed with periods of health, anatomical variations including Haller cells, nasal polyps, septal deviation, and choanal obstruction by benign adenoid tissue, or odontogenic sources of infections should be considered. These patients, also, rarely need balloon sinuplasty.
In part three, I will briefly discuss some of the controversy surrounding balloon sinuplasty and hopefully answer all your questions about this technology.