Sinusitis: New Treatment
with Balloon Sinuplasty

Richard Crane, MD, FACS
Otolaryngology
Western Wisconsin
Ear, Nose & Throat Center
Eau Claire

Sinusitis affects 37 million Americans annually. Sinusitis (sinus infection) is the result of inflammation in the sinuses around the nose and eyes. Symptoms include facial pain, thick nasal drainage, congestion, tooth pain and loss of smell. Fever and headache are not common symptoms of sinusitis. In fact, studies have found that headaches are frequently mistaken for sinusitis. One-sided headache (or facial pain), even with mild nasal stuffiness, is more likely to be a migraine headache than sinusitis.

Acute sinusitis is inflammation lasting 3-4 weeks. Chronic sinusitis is sinus inflammation lasting three months or longer, or four or more acute episodes per year. A sinus x-ray or CT scan is frequently necessary to confirm sinusitis, as well as show some of the anatomical abnormalities that are causing the problem.

Contributing factors for both acute and chronic sinusitis include: airborne allergies, irritants like cigarette smoke, viral infection and structural problems in the nose. Treatment usually begins with medical measures such as saline nasal rinses, decongestants, mucus thinners and antibiotics.

BALLOON SINUPLASTY TECHNIQUE IS DONE IN THREE STEPS:

1. The otolaryngologist gains access to the target sinus with a sinus guide catheter and a flexible sinus guidewire. Then a sinus balloon catheter is advanced over the sinus guidewire.
2. The sinus balloon catheter is positioned across the blocked
   ostium and gently inflated.
3. The balloon catheter and guidewire are removed, leaving an open sinus ostium and restoring normal sinus drainage and function.

When sinusitis does not clear up with medical treatment, surgery is usually required. Surgeries prior to 1985 were designed to open, drain, clean, remove diseased mucus membrane, or possibly obliterate (fill in) the sinus. Functional endoscopic sinus surgery (FESS) was introduced in the mid 1980s. Endoscopic sinus surgery is performed through the nostrils. The surgeon uses a long, 1/6 inch diameter, fiberoptic scope to view the inside of the nose and its structures. Small instruments are used to remove tissue and bone from around the sinus ostia (openings) to make them larger. This allows the surgeon to look into the sinus and remove diseased tissue, if necessary. The enlarged sinus opening enables the sinus to drain and,
in most cases, restore itself to healthy function.

In 2005, balloon sinuplasty was introduced. This new FESS technique uses a narrow flexible tube with a balloon attached to the end. The surgeon looks through an optical endoscope to position a “guide catheter” or tube. He/she then uses an x-ray fluoroscope to advance a very flexible guide wire into the sinus. A balloon catheter is then threaded over the guide wire and gently pushed into the sinus ostium. It is then inflated with a diluted x-ray dye (so that the process can be watched on the fluoroscope) to ten to fifteen times atmospheric pressure. This pressure stretches the bone and mucous membrane of the ostium to enlarge the opening. After a few seconds, the balloon is deflated and all instruments are removed.

BALLOON SINUPLASTY IS A MINIMALLY INVASIVE TREATMENT OPTION. THE TECHNOLOGY USES A SMALL, SOFT FLEXIBLE DEVICE INTRODUCED THROUGH THE NOSTRILS.

For most sinuses the procedure takes only five to fifteen minutes.

Balloon sinuplasty can be done on the maxillary (cheek), frontal (forehead) and sphenoid sinuses because they are large sinuses with single ostia, but is not suitable for the smaller multiple ethmoid sinuses located between the eyes. Balloon sinuplasty is suggested for patients with less severe sinus disease who have tried medical treatment, but are hesitant to undergo a “big” surgery. Balloon sinuplasty may not be possible when the patient has extensive sinus disease, many polyps, or has had prior standard FESS on the same sinus.

All surgeries carry some risk. Unlike standard FESS, in which bone and tissue are cut away, balloon sinuplasty simply stretches the sinus opening. Because no tissue is removed, there is typically much less bleeding, less need for uncomfortable packing in the nose, less post-operative pain and faster healing. So far, over 10,000 balloon sinuplasty operations have been done world-wide with no serious complications reported.

For information or to schedule an appointment with Dr. Crane,
Western Wisconsin Ear Nose & Throat Center, call 715.831.0289
or visit www.oakleafmedical.com. Dr. Crane sees patients in Eau Claire.