When treating sinusitis, ENT doctors use a variety of approaches to clear the blocked sinuses and help the patient breathe normally again. Medical therapy and Functional Endoscopic Sinus Surgery (FESS) are two very common techniques used to provide relief for patients suffering from sinus infections.
A newer approach is endoscopic sinus surgery with balloon catheters, also known as balloon sinuplasty. This procedure is an option for select patients who have not responded well to medical treatment and continue to experience sinus infections. Balloon sinuplasty was approved by the U.S. FDA in 2005 and involves dilating any or all of the 3 of the larger sinus passages: frontal, maxillary and sphenoid sinuses. A wire catheter is inserted into the sinus and a small balloon is advanced over the wire. Once this balloon is inflated, the walls inside the sinus passages are pressed open to enlarge the sinus opening and help restore normal sinus function.
Read below for a more in-depth discussion of balloon sinuplasty and find out if you are a candidate.
Perhaps the most widely-accepted benefit of balloon sinuplasty is the fact that is it minimally invasive. Unlike the more popular method of treatment, FESS, the sinus tissue is not removed, but rather, simply widened. This creates less trauma to the general sinus area, reducing post-operative pain, scarring, bleeding and overall recovery time. As a result, balloon sinuplasty is viewed by many doctors as a useful alternative to FESS, specifically with regard to the treatment of limited sinusitis.
Since balloon sinuplasty can be performed as an in-office procedure, under local anesthesia and recovery can be as rapid as 24 hours, it is a good option for those with minimal sinus issues who do not wish to undergo a long recovery time. It is also a good option for those who are averse to surgery under general anesthesia, or patients with health problems or those have encountered complications with regard to general anesthesia.
The speedier recovery time is another benefit, leading many patients to choose balloon sinuplasty for treatment of their sinus issues. No one enjoys missing out on the pleasures of life, so the sooner one can get back to their normal, daily lives, the better.
There are several disadvantages to balloon sinuplasty that your doctor should discuss with your before moving ahead with the procedure.
The first involves patients with nasal polyps. If polyps are blocking the sinuses and causing difficulty breathing, then, unfortunately, unlike FESS, balloon sinuplasty is an ineffective treatment to adequately treat the polyps.
Secondly, balloon sinuplasty is unable to treat all of the four sinuses that may become blocked. Specifically, if a patient’s ethmoid sinus is blocked, balloon sinuplasty cannot adequately facilitate drainage. This is due to the fact that the openings to the sinus passages cannot be easily located or reached via the catheter and guide wire. Balloon sinuplasty can be effective in patients with blockages in the frontal, sphenoid, or maxillary sinuses.
Third, balloon sinuplasty is sometimes not the most effective means to treat sinus issues, especially chronic sinusitis. Functional endoscopic sinus surgery, or FESS, is seen as the procedure that offers the ability to clear up multiple sinus problems. For example, while balloon sinuplasty merely dilates the sinus, FESS allows for removal of the actual tissue creating the blockage. It also permits the surgeon to fine-tune other nasal issues that may be contributing to sinus problems. In addition, although FESS is more invasive than balloon sinuplasty, is it still in many ways considered the “gold standard” of chronic sinusitis and recurrent acute sinusitis treatment and has a lower rate of patients who complain of recurring sinus troubles compared to those who elect balloon sinuplasty.
Additionally, some surgeons and medical researchers have taken the position that balloon sinuplasty is unable to offer a solution to the underlying causes of a sinus infection. Scholars have noted that chronic sinusitis consists of more facets than mere drainage and that using a balloon to dilate the sinus may not adequately treat a patient with severe sinus issues.
Further, balloon sinuplasty is often more expensive than FESS, despite its minimally invasive nature. The procedure calls for more disposable equipment, meaning a higher cost to be passed on to patients. Many insurances will not pay for the equipment in balloon sinuplasty.
Lastly, because the procedure is still considered new in the medical community, the long-term efficacy is not yet known. Although patients have shown improvements for up to two years following surgery, more research is needed in order to determine whether the procedure is a permanently viable treatment for chronic sinusitis.
Dr. Bennett individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your balloon sinuplasty in detail to make sure all of your questions are answered. Depending on whether you have functional/breathing issues insurance may cover part of your surgery.
Balloon sinuplasty may be performed in either a hospital, the office, or an outpatient ambulatory center. It is typically performed under general anesthesia. Sometimes, your doctor might suggest that the procedure is performed in his or her office under local anesthesia.
The location of your surgery and the type of anesthesia used are decisions that are to be made by both you and your doctor. Your doctor will likely make a recommendation based on such factors as your medical history, which sinuses are affected, personal preferences and history of anesthesia complications.
A balloon sinuplasty procedure begins when your surgeon inserts an instrument called a guide catheter into your nostril until it reaches the sinus opening. Your surgeon will be able to see inside your sinus cavity to guide the catheter via an endoscopic visualization system, which is a small high-definition endoscope.
After the guide catheter reaches the sinus opening, your surgeon then advances the guide wire into the blocked sinus. The guide wire has a small light at the end, or an image guidance probe, that allows your surgeon to accurately place it into the correct sinus.
Next, your doctor will carefully place a balloon catheter over the guide wire and slide it into the opening of the blocked sinus. The balloon is slowly inflated, removing the blockages in the sinus and facilitating drainage. After, the balloon is deflated and removed, along with the guide wire and catheter. The theory is that the procedure allows for the continuous drainage of the once-blocked sinus.
After the procedure, patients notice a negligible amount of bleeding, and most are able to return to work and their daily routine within one day.
The exact duration of a balloon sinuplasty varies depending on the severity of the blocked sinuses and the individual patient. However, on average, the procedure takes roughly one hour to complete, which includes anesthesia, the actual surgery, and the post-anesthesia recovery.
If the procedure is performed at a hospital or ambulatory care center, it is unlikely that you will be required to spend the night. Balloon sinuplasty is typically an outpatient procedure for most people.
A balloon sinuplasty is considered a relatively non-invasive procedure, meaning that it does not cause much trauma to the nasal area. As a result, recovery time is usually minimal. You will be able to return to work after 24 hours of rest, as well as resume any extracurricular or recreational activities you regularly enjoyed before surgery.
Note that recovery is different from patient to patient. It largely depends on how you respond to anesthesia, and whether the procedure was performed under general or local anesthesia. General anesthesia usually has a longer recovery period than local anesthesia.
Yes. If you have previously undergone balloon sinuplasty and received less than desirable results, it is still possible to choose one of the other types of treatment to solve your sinus issues. Think of balloon sinuplasty as a limited procedure – as in it does not prevent you from having a more comprehensive surgery in the future.
Whether your insurance carrier will assist in the costs related to a balloon sinuplasty largely depends on your type of coverage in addition to the extent of your sinus issues. Check with your health care provider and your doctor’s office to obtain a complete summary of your benefits. Our office will check your benefits for you to make sure you get the coverage you need and deserve.
The risks involved with balloon sinuplasty are much lower than with FESS. Unlike FESS, balloon sinuplasty does not involve cutting or removing any tissue inside the nasal area. As a result, there is less risk of damage to the eyes and brain, making for a relatively safe surgery.
Additionally, there is a very low complication rate associated with balloon sinuplasty. However, like all procedures, you should talk with your doctor about the normal risks you may encounter – including infection and mucosal trauma.
With upcoming clinic investigations and research, balloon sinuplasty has the potential for advancement in the future. Pending patient demand and the advent of new technology, it is very possible that many patients will benefit from the new advantages that the procedure will one day provide. In the meantime, chronic sinus infection sufferers should still discuss all three main treatments with their doctor to determine which procedure is the best fit with the highest likelihood of permanent success.