Definition & Overview
Balloon sinuplasty, also referred to as balloon sinus dilation (BSD), is a relatively new minimally invasive endoscopic procedure used in the treatment of chronic rhinosinusitis. Even though the procedure has only been used for just over a decade, it has helped thousands of people worldwide suffering from the condition.
Chronic sinusitis is one of the most common health concerns as it affects hundreds of millions of people around the world. In the United States alone, it is estimated that around 30 million people suffer from the condition. Around 800,000 choose to undergo surgical treatment every year.
Initial treatment for chronic sinusitis is limited to a variety of medications. However, if this treatment method fails to provide the desired results, surgery is considered.
Prior to the introduction of balloon sinuplasty, another minimally invasive surgical procedure called functional endoscopic sinus surgery (FESS) was the best surgical option. Although highly effective, the procedure was associated with a number of complications.
The risks of complications developing after a balloon sinuplasty are significantly lower than FESS. But it is important to understand that not all chronic sinusitis patients are good candidates for a balloon sinuplasty. There are certain situations wherein FESS would need to be performed.
Generally, surgeons believe that the anatomy of the sinuses needs to be kept intact or returned to its normal condition as much as possible. It is difficult to accomplish this through any type of surgical procedure, but balloon sinuplasty offers the best solution.
The concept of balloon sinuplasty is simple. Chronic sinusitis results in a blockage of the nasal ostia and passageway. To remove the blockage and open up the passageway, a balloon catheter is guided to the area and inflated. The inflation process is repeated a few times until the opening has been freed of any debris.
Who Should Undergo & Expected Results
Balloon sinuplasty is reserved for patients suffering from chronic sinusitis that has failed to respond to medications. In most cases, the condition has significantly reduced their quality of life or has affected their ability to perform their jobs.
To qualify for the procedure, the patient must not have a complication of the condition that would necessitate the FESS procedure. Such conditions include diseases of the ethmoid sinus, conditions that require the removal of bone, the presence of tumours or polyps, and conditions that could place the patient at risk of developing meningitis or cerebrospinal fluid leakage.
Patients who are diagnosed with chronic sinusitis are those that display the following minor and major symptoms:
- Frequent pain in the ears
- Frequent headaches
- Blocked nasal passages
- Pain in the face and nasal region
It is important to note that the condition is only described as chronic sinusitis if the symptoms have been present for over 12 weeks.
Other than the symptoms, the patient will need to undergo a series of examinations to identify the exact cause or causes of the problem. If the cause warrants the use of a balloon sinuplasty, the patient will be scheduled for surgery.
Patients who undergo the procedure usually experience an almost immediate improvement of the symptoms. However, since the procedure only involves opening the nasal passageway, medications will likely need to be continued.
How is the Procedure Performed?
After the patient has undergone laboratory and imaging examinations, such as a CT (computed tomography) scan and has been classified as a good candidate for a balloon sinuplasty, he or she is prepared for surgery. The procedure is minimally invasive and can be performed in a hospital’s operating theatre or at a doctor’s clinic.
In most cases, only local anaesthetic is required, but general anaesthesia may also be used if needed. Once the anaesthetic has taken effect, the doctor will insert a guide catheter up the patient’s nostrils towards the ostia. A guide wire fitted with a light source is inserted through the catheter to help the doctor easily find the target area.
Upon reaching the target area, the doctor will insert a balloon catheter to widen the passageway. A saline mixture will then be sprayed into the cavity to remove mucus and pus if any. The device will then be removed thus completing the procedure.
As mentioned earlier, the objective of the procedure is to treat the symptoms of chronic sinusitis. It does not provide a cure for the cause of the condition. The patient may need to continue taking medications after the surgery.
Possible Risks and Complications
Balloon sinuplasty is considered to be safe and highly reliable. However, there are still risks associated with the procedure. Moreover, it is still possible for complications to develop. Complications include:
- Bleeding after the operation
- Pain and swelling in the affected area
- Adverse reaction to the anaesthetic or medications used during the procedure
Since balloon sinuplasty is minimally invasive, the risk of developing such complications has reduced significantly. In fact, studies show that less than 1% of patients who have undergone the procedure developed any type of complication.
Brown CL, Bolger WE. Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation. Ann Otol Rhinol Laryngol. 2006 Apr. 115(4):293-9; discussion 300-1.
Raghunandhan S, Bansal T, Natarajan K, Kameswaran M. Efficacy & outcomes of balloon sinuplasty in chronic rhinosinusitis: a prospective study. Indian J Otolaryngol Head Neck Surg. 2013 Aug. 65:314-9.