NSIBR |Procedures | October 4, 2020
Balloon sinuplasty began in the early part of this century by biomedical engineers from the balloon angioplasty field. They reasoned that just as a surgeon could thread a balloon into a blocked heart artery and dilate it to increase blood flow, you could modify the technology to enable sinus surgeons to dilate the blocked outflow tracks of the paranasal sinuses.
The medical theory behind balloon sinuplasty dates back to the beginning of minimally invasive sinus surgery. Minimally invasive sinus surgery (aka functional endoscopic sinus surgery) began over three decades ago when sinus surgeons from Austria reported that long standing sinus sufferers could achieve permanent relief without having to undergo radical sinus surgery. The theory behind minimally invasive sinus surgery is that if you open the outflow tracts of the diseased sinuses, then in most cases the affected sinuses will return to normal. The efficacy of minimally invasive sinus surgery is well established, as it has been standard of care since the 1980s. Balloon Sinuplasty is an outgrowth of that. In balloon sinuplasty, the outflow tracts are still opened to relieve blockage. This procedure is unique in that it is a quick, in office procedure and patients usually return to full activity within days
Balloon sinuplasty is an in office procedure for patients with chronic sinusitis. It can replace more involved sinus procedures in carefully selected patients. The patient is fully dressed and sits in a procedure chair that is comfortable and that reclines a bit. The balloon sinuplasty procedure involves guiding a thin wire into previously numbed sinuses, passing a balloon over the wire until it is in the precise blocked outflow tract of the sinus, then inflating, deflating, and removing the balloon. This is repeated for all involved sinuses. The procedure takes approximately 20 minutes, and is performed in our facility with a light anesthesia so that the patient feels no discomfort.
Chronic sinusitis is the most prevalent chronic disease in the United States. It affects approximately 30,000,000 Americans. Symptoms may include nasal congestion, pressure around the eyes, facial pain, drainage, nasal obstruction, decreased sense of smell, and headaches. Recurrent sinus infections may or may not be a feature. Other symptoms such as chronic cough may also be related to the sinuses. The differential diagnosis of many of these symptoms include issues which can also cause pressure or pain around the face such as a dental issue, fibromyalgia, or temporomandibular joint syndrome. Your sinus physician performs an evaluation including an endoscopic look into the outflow areas of the sinuses and a CAT scan of the sinuses to most accurately determine the diagnosis. Once the diagnosis of chronic sinusitis is established, further evaluation elucidating the etiology usually includes allergy testing. Treatment is directed to the underlying allergies and to reduce the inflammation of the sinuses.
Simply stated, balloon sinuplasty is a valuable option for patients suffering from chronic sinusitis who have not responded to allergic and/or medical management. It does not replace medical management and does not cure allergies. It is a mechanical opening of blocked sinuses that cause the symptoms described previously. Your sinus physician will evaluate you by doing a careful endoscopic look into the nose and sinuses, obtaining a CAT scan of the sinuses, and performing or reviewing allergy testing. Again, it is important to keep underlying allergies under control in order to maximize the chance of lifelong relief.
Patients leave the office within 20 minutes following the completion of the balloon sinuplasty procedure. They resume their normal diet immediately and full activity within one or two days. The most frequently reported symptom in the immediate postoperative period is nasal congestion or a mild headache. These are almost always self limited and resolve within a few days. Your physician may prescribe antibiotics for the period around the procedure. Antiinflammatories such as ibuprofen or prednisone may also be prescribed. A gentle rinse to facilitate healing is begun shortly after the procedure.
Clinical studies performed to date suggest the effects of the balloon sinuplasty are permanent. Most patients realize the benefit shortly after the procedure and continue to enjoy its effects indefinintely. The caveat must always be mentioned however that the long lasting effect is predicated upon maintaining good allergy control in patients with environmental allergies. If this is not done, then thickening of the linings of the sinuses can recur and the obstructive symptoms may return.
Similar to elective surgery of any kind, the choice of surgeon should be made based on several factors. A surgeon who is board certified in otolaryngology is the starting point. If there is consideration of work done at the same time to improve the appearance of the nose, then the surgeon should also be board certified in facial plastic surgery or plastic surgery. Next is choosing a surgeon who specializes in balloon sinuplasty. Even though it is a fairly quick in office procedure, results are related to the skill and experience of the surgeon in placing the balloon easily and efficiently. The office setting where this procedure is performed should be evaluated. You may ask about registration of the operators with the state or certification of the operatory. It is appropriate to ask the surgeon how many balloon sinuplasties he or she performs on a weekly or monthly basis. Lastly, patients often post their experiences both good and bad on the internet. Much insight can often be gained from that.
The Nose and Sinus Institute of Boca Raton has been caring for patients in Florida and surrounding regions for over three decades. Drs Nachlas and Hancock specialize in medical, allergic, and surgical care of the nose, sinuses and face. Both surgeons are double board certified – otolaryngology as well as facial plastic surgery. Many state of the art procedures for the minimally invasive treatment of these areas were pioneered at the NSIBR, including minimally invasive sinus surgery, in office computer assisted balloon sinuplasty (first in the United States, performed in 2014 at NSIBR), balloon septoplasty and noninvasive sculpting of the nose for breathing relief. Patients undergoing any or all of these procedures at the Institute can elect to have these performed under local anesthesia or under light anesthesia. For more information, please contact Sandy Friedman, our Director of Patient Relations, at 561-939-0909.
