Balloon Sinuplasty to Treat Chronic Sinusitis

by , last modified on 9/13/16
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Introduction

In a human being, there are 4 sinus cavities that come in pairs (1: frontal, 2: ethmoid, 3: sphenoid, 4: maxillary). Each of these sinus cavities drain through a small opening into the nose. However, problems occur when the openings clog shut resulting in recurrent and even chronic sinus infections. Watch video explaining this further.

sinuses
Image by Wikipedia


Balloon sinuplasty is a relatively new, minimally invasive technique to open up the openings into the sinus cavities without the need for any tissue cutting or bony removal. When compared to the more traditional endoscopic sinus surgery which does involve tissue cutting and removal, balloon sinuplasty causes less trauma to surrounding sinus and nasal tissues thereby:

  • minimizing risk of CSF leak as well as damage to surrounding important structures including the eye, artery, optic nerve
  • decreased pain
  • faster recovery
  • decreased risk of post-operative nosebleeds (thereby minimizing need for nasal packing)
  • decreased chance of scar formation which may require repeated sinus surgery in the future


The balloon sinuplasty technique uses a balloon catheter system similar to that used in coronary artery angioplasty whereby a deflated balloon is inserted into the opening of the sinus cavity and inflated. When the balloon inflates, it opens up the sinus opening into a much larger diameter which than allows for drainage. Watch the video animation below to see exactly how this works (an actual video is shown here). Click here to read the differences between balloon sinuplasty versus traditonal endoscopic sinus surgery.


Steps to the procedure are illustrated below:

Step 1

Under endoscopic guidance, the balloon catheter is introduced into the nasal cavity and guided towards the target sinus cavity opening. Depending on the system used, a sinus guidewire or sinus illumination may be used to help with the guidance.

sinuplasty

Step 2

Once the sinus balloon catheter is correctly positioned across the blocked sinus opening, the balloon is gradually inflated to stretch open the ostia.

sinuplasty

Step 3

After several seconds, the sinus balloon catheter is then deflated and removed leaving an enlarged sinus opening allowing for the return of sinus drainage. There is little to no disruption to mucosal lining.

sinuplasty

Simply put, no "tissue" is removed from the sinus cavity in order to open them up with balloon sinuplasty. However, it is up to the surgeon's discretion whether any further steps are required including sinus flushing or obtaining biopsies of any suspicious masses. If the aim is to "clean out" the sinuses of all masses or diseased mucosa including nasal polyps, balloon sinuplasty may not necessarily be the right thing for you. However, if the sinuses are "blocked" causing problems with recurrent infections, than this techinque will work just fine.

Balloon Sinuplasty versus Traditional Sinus Surgery

 
Balloon Sinuplasty
Traditional Endoscopic Sinus Surgery
Instruments Used Balloon Catheter System and Camera Endoscopes Forceps, Curettes, Biting Type Instruments and Camera Endoscopes
Method of "Opening" Up the Sinus Cavities Balloon Inflation Tissue and Bone Removal
Best Patient Sinus disease (no masses) involving the frontal and sphenoid sinus cavities. In some select patients, the maxillary sinus as well. No tissue sample is able to be obtained with this method. Sinus disease involving any of the sinus cavities. Able to obtain tissue samples for pathologic analysis to see if any cancer or worrisome tumor characteristics are present.
Sinus Cavities that can be Addresed Frontal sinus, sphenoid sinus, and maxillary sinus cavities. The ethmoid sinus cavities can NOT be addressed with this technique. All sinus cavities can be addressed.
Anesthesia Local Anesthesia without Sedation Possible General Anesthesia
Workup for Surgical Consideration
  • CT Scan
  • Allergy Evaluation
  • Medication Failure
  • CT Scan
  • Allergy Evaluation
  • Medication Failure


Patients should be aware that a "hybrid" type of sinus surgery can be performed whereby the approach may be via balloon sinuplasty technique followed by a more traditional approach with tissue removal if biopsies required. If the ethmoid sinuses need to be addressed, a traditional approach can be used for this sinus cavity whereby the other sinus cavities (frontals, sphenoids, and maxillaries) can be addressed by balloon sinuplasty.

Regardless of the technique used, either method can utilize image guidance for increased accuracy.

Please note that with non-sedated balloon sinuplasty, it is possible to perform in the office using only local anesthesia without need for any general anesthesia. However, not all patients are candidates.

Watch an actual video of the balloon sinuplasty technique below:


Conclusion

The goal of sinus surgery whether it is performed traditionally or via balloon sinuplasty is to make the small drainage openings of the sinuses into the nose larger. That's it! By making the sinus openings big enough, the sinuses can't get obstructed as easily and therefore allow for good sinus drainage no matter how much swelling or inflammation may be present. Good sinus drainage prevents/minimizes sinus infections. Paradoxically, be aware that sinus surgery may make your allergy symptoms worse (easier for allergens to gain access into your nose and sinuses since things are opened up), so it's very important to get your allergies under good control before sinus surgery is performed. For those with asthma, having sinus surgery has been shown to markedly improve lung function resulting in decreased number of asthma attacks and use of inhalers overall.

When investigating what may be causing a given person's sinus pressure/pain, a CT scan of the sinus is often ordered. The reason for the CT scan is to first of all, see if the symptoms are indeed truly coming from an infection as well as to see if there are any anatomic causes of sinus obstruction including a deviated septum or large adenoids that makes a person more prone to sinus infections.

Please contact our office for an appointment.


Normal CT Sinus: Note the air within the sinus cavities denoted by black (just like the black surrounding the head). White is bone. Grey is soft tissue.

ct scan normal

 

Abnormal CT Sinus: Note the grey coloration within the sinus cavity, especially the right side. This person has right greater than left maxillary sinusitis along with severe bilateral ethmoid sinusitis. Entirely possible that nasal polyps are present in these same locations as well. This person also has a deviated septum.
ct scan

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