Balloon Sinuplasty: An Alternative to Surgery for Chronic Sinusitis
Chronic sinusitis - inflammation of the sinuses that persists for 8 weeks or more or that recurs frequently - is a common medical problem in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 30 million people in the United States, roughly 10 percent of the population, are affected by chronic sinusitis each year.
The sinuses are cavities around the nasal passages. Located in the cheeks (maxillary), forehead (frontal) and between the eyes (ethmoid), the sinuses can become inflamed and swollen because of a cold, allergies, bacterial infections or fungal infections. When this "acute" sinusitis persists or keeps coming back, it is considered chronic sinusitis.
"Most cases of acute sinusitis can be treated with decongestants, antihistamines for allergies, nasal saline sprays and nasal steroid sprays," says Dr. Jason Van Tassel, an otolaryngologist (ear, nose and throat physician) on the medical staff at Washington Hospital. "Some cases of acute sinusitis may be caused by a bacterial infection that can be treated with antibiotics, but antibiotics won't help with sinusitis caused by a viral infection like the common cold, a fungal infection or allergies."
When medical treatments do not resolve obstruction of the sinuses or sinusitis recurs frequently, surgical treatment is considered an option.
"Since the 1980s, most sinus-related surgeries have been performed endoscopically, which is far less invasive than traditional open surgery," Dr. Van Tassel notes. "Even with endoscopic techniques, though, sinus surgery failed to preserve the anatomy or function of the sinuses. Endoscopic sinus surgery also requires nasal packing, and there may be scar tissue or other conditions that require subsequent additional surgeries. The long-term success rate for endoscopic sinus surgery is about 70 percent."
The need to improve treatment for chronic sinusitis has led to new research and innovation, including balloon sinuplasty, which was first proposed in 2006. Similar to balloon angioplasty that is used to open coronary arteries and avoid bypass surgery, balloon sinuplasty uses a small, flexible balloon catheter that is inserted through the nose to reach the sinuses. The sinus balloon catheter is gradually inflated to gently restructure the previously blocked sinus passage. Once the sinus passage is re-opened, the balloon catheter is deflated and removed.
"Balloon sinuplasty maintains the integrity of the sinus structure and lining, and it restores normal sinus function," Dr. Van Tassel says. "The success rate for balloon sinuplasty is better than for endoscopic surgery. Clinical research studies show that 92 percent of sinuses treated with balloon sinuplasty remained clear after two years, and 80 percent of patients remained free of symptoms of sinusitis after two years."
Balloon sinuplasty is an outpatient procedure that sometimes can be performed in the physician's office, using local anesthetics and perhaps a mild sedative such as Valium. For some more complicated cases, the procedure can be performed under general anesthesia in a facility such as the Washington Outpatient Surgery Center. The procedure doesn't involve removing any bone or sinus tissue, so there is minimal bleeding and the sinuses don't need time to heal. Many patients are able to return to their normal activities within 24 hours.
Dr. Van Tassel, who is board-certified in both otolaryngology and plastic surgery, went through specialized training in balloon angioplasty. He has performed the procedure on more than 100 patients over the past five years.
"Not everyone who has chronic sinusitis is a candidate for balloon sinuplasty," he cautions. "For example, balloon sinuplasty is used only for the maxillary and frontal sinuses. It is not considered appropriate for the ethmoid sinuses between the eyes. Some data, however, indicate that opening up the maxillary and frontal sinuses with balloon sinuplasty can sometimes help to alleviate blockages of the ethmoid sinuses, too."
Other patients who would not be considered candidates for balloon sinuplasty might include those with sinus polyps, extensive fungal disease or advanced connective tissue disease. People with opacification of a sinus - which means that the sinus appears black on a CT scan because it is completely blocked by inflammation or infection - may not be candidates for balloon sinuplasty because the opacification blocks the physician's view of and access to the affected sinus.
"The procedure doesn't change the fact that some people have allergies," says Dr. Van Tassel. "Balloon sinuplasty can help open up chronically blocked sinuses for people with allergies, but they may still need to continue using nasal sprays and antihistamines to maintain proper sinus function.
"For many patients with chronic sinusitis, balloon sinuplasty is a valuable minimally invasive alternative to sinus surgery," he adds. "Clinical research has proven that it is a safe and effective tool for dilating blocked sinuses that have not responded to medications."