What is Balloon Sinuplasty

Balloon sinuplasty is an endoscopic surgical procedure for the treatment of blocked nasal sinuses. Patients diagnosed with chronic sinusitis but not responding well to medications may be candidates for some type of sinus surgery. Two options are balloon sinuplasty and functional endoscopic sinus surgery (FESS).

Balloon sinuplasty is an endoscopic, catheter-based system for patients suffering from sinusitis. The procedure has been cleared by the U.S. Food and Drug Administration.It uses a small, flexible balloon catheter to enlarge sinus passageways. When the balloon is inflated, it restructures and widens the walls of the sinus passageway, with the goal of restoring normal sinus drainage without damaging the sinus lining.

The Procedure

Sinus surgery with balloon sinuplasty may be performed as an outpatient procedure. Because the procedure involves the insertion into the nose of balloon catheters, guide wires and other devices such as irrigation catheters, illumination systems and navigation systems, individuals might become uncomfortable and find it difficult to remain still. Thus either local or general anesthesia is usually administered.

The physician inserts the sinus guide catheter into the nostril to gain access to the sinus ostia (passage) under endoscopic visualization. An endoscope allows the physician to see through the nasal passages to the sinus cavities to ensure that he/she is inserting the catheter into the proper location. A sinus guide wire or sinus illumination system is then introduced into the targeted sinus via the sinus guide catheter. The sinus illumination system provides a targeted fiber optic light transmission that helps the physician place the sinus guide catheter in the correct place.

Once access to the intended location has been confirmed by light or x-ray exposure, a balloon inside a catheter is introduced into the sinus cavity via the sinus guide wire or sinus illumination system and positioned in the blocked ostium for inflation. Once the position has been confirmed visually, the balloon is opened to unblock and reshape the narrow or blocked ostium. The balloon is then deflated and removed. Next, an irrigation catheter may be advanced over the sinus guide wire or sinus illumination system to flush out the sinus of any mucus or pus. Finally, the sinus irrigation catheter is removed from the sinus to allow the sinus cavity to drain any mucus and/or pus.

 

 

History

Balloon sinuplasty technology was developed by Acclarent, Inc., and was brought to market in 2005, after FDA approval. It does not involve the cutting or removal of bone or tissue, and some patients return to normal activities quicker. Not all patients qualify for the sinus balloon procedure. Balloon sinuplasty is not able to treat sinus disease located between the eyes (one of the most common locations for sinus infections). There are other severe limitations of balloon sinuplasty (as compared to the more conventional and still standard endoscopic sinus surgery). 

Balloon procedures alone do not offer the surgeon the ability to obtain material for culture (test for specific bacteria or yeast). Balloon procedures alone do not offer the surgeon the ability to send biopsy material for examination under the pathologist's microscope in order to rule out cancer or other important diseases that may be found in the sinuses. Where biopsy or culture is needed, the balloon procedure has to be combined with standard practice (a so-called hybrid procedure), thus increasing effort, increasing surgical time and increasing costs for two systems used together. During balloon sinuplasty, as with other invasive sinus procedures, there is a small risk of damage to the brain and eyes, which are located in close proximity to the sinuses.

Controversy around the balloon procedure involves the question of whether leaving bone in an attempt to improve drainage from the sinuses is a good idea or not. Balloon sinuplasty does not guarantee an easier recovery than standard endoscopic sinus surgery, particularly because most of the "recovery" comes from associated procedures such as straightening a deviated septum and/or reducing the nasal turbinates. There is little medical research that would permit surgeons to fully understand the consequences of leaving bone after balloon sinuplasty. After balloon sinuplasty, patients may still need to undergo traditional surgical procedures, or may repeat the balloon procedure if problems persist or recur.