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Balloon sinuplasty is a type of endoscopic sinus surgery. A balloon catheter is used to dilate the sinus drainage doorways. Balloon sinuplasty was designed based on angioplasty heart procedure where balloons are used to dilate blocked blood vessels. Balloon sinuplasty is one of the mucosal preservation surgeries approved by the US FDA in 2005 for use in the nose and sinuses. It is relatively new surgery. The nasal mucosal lining has millions of microscopic hair-like cilia which beat in one direction.
This mechanism helps in clearing the mucous produced in the nose and sinuses, pushing mucus to the back of the nose. This mucosal lining is damaged or removed during conventional nose and sinus surgery, leading to loss of natural mucous drainage mechanisms of the nose and sinuses. Balloon sinuplasty does minimum damage and near-zero removal of the mucosal lining and is thus very safe and effective.
What does Balloon Sinuplasty treat?
Balloon sinuplasty is used for the treatment of following nose and sinus conditions.
- Patients having chronic sinusitis, i.e., patients suffering from sinusitis symptoms for more than twelve weeks. These patients get only partial relief with medication or get complete relief when using medicines. Still, symptoms recur once the medication is stopped.
- Patients having repeated attacks of acute sinusitis. Acute sinusitis symptoms do not last for more than one week to ten days. These patients have recurrent episodes of acute sinusitis with severe symptoms such as thick yellowish to greenish discharge from the nose, severe nose block, pain, heaviness and swelling around eyes, cheek and forehead.
- Patients having to get admitted to ICU because of fevers arising from a sinus infection.
- Sinusitis patients having bleeding and clotting disorders such as haemophilia, liver and kidney disease etc. Balloon sinuplasty causes minimal damage to the nasal mucosal lining reducing the chances of bleeding arising from it.
- Balloon sinuplasty is a good option for treating children having chronic sinusitis not responding well to medication, as it is minimally invasive.
- In patients having nasal polyps, fungal sinusitis, ethmoidal sinusitis, balloon sinuplasty can be used as a part of the hybrid procedure. In the hybrid procedure, balloon sinuplasty can be used to dilate the sinus drainage openings of maxillary, frontal and sphenoid sinuses, and conventional instrumentation or micro-shaver can be used for tissue removal.
What does Balloon Sinuplasty do?
In the Balloon sinuplasty procedure, the sinus drainage openings are widened atraumatically with the help of the Balloon. There are five pairs of sinuses situated around the nose and eyes – Maxillary sinuses located below the eyes and behind the cheekbone; Frontal sinuses are located above the eyes and behind the eyebrows in the forehead; Anterior ethmoid sinuses are situated between the eyes in the front; Posterior ethmoid sinuses are located between the eyes a little behind and Sphenoid sinuses are located very much in the back of the nose immediately behind the posterior ethmoid sinuses.
All these sinuses are lined by a special lining called mucosa, which produces a slimy liquid called mucus. This mucus traps the bacteria, virus and debris from the air we breathe and forms the first line of defence protecting our body. This mucus is continuously produced and cleared from the sinuses by hair-like cilia.
In sinusitis patients, the mucosal lining of the sinuses is inflamed and thickened, blocking the sinus drainage pathways. Due to the blocked sinus drainage pathways, the mucus produced in the sinuses cannot drain out of them, leading to stasis and eventually causing the mucus to turn into pus.
In balloon sinuplasty surgical procedure, the sinus drainage openings are widened by pushing the Balloon through the sinus ostium (sinus drainage opening) under endoscopic guidance. The Balloon is inflated by pushing saline into it. This inflation causes micro-fractures in the bone encircling the sinus ostium, permanently widening it. This widening does not cause any damage to the mucosal lining present over the bone surrounding the sinus ostium.
What is the procedure of Balloon Sinuplasty?
The balloon Sinuplasty procedure is done in the following five steps.
- During the balloon sinuplasty procedure, a guidewire capable of emitting light is passed through the sinus ostium opening into the sinus. Once the guidewire is correctly positioned in the sinus, the illuminated sinus can be visualised from outside.
- Once the position of the guidewire is confirmed, the balloon catheter is passed over the guidewire a little beyond the sinus opening. A marking on the balloon catheter indicates correct positioning
- The balloon catheter is injected with saline, and the Balloon starts getting inflated. The Balloon is inflated until the pressure inside it reaches 10 -12 atmospheres. It is held in position for 10 – 15 seconds.
- The Balloon is then deflated and withdrawn along with the guidewire. In the case of sinuses like the frontal sinuses, which have longer openings, Multiple balloon inflation/ dilations are done at different levels to ensure the entire sinus opening is widely enlarged.
- Through the widened ostium, multiple saline washes can be given to remove pus and debris from it.
Is Balloon Sinuplasty effective?
Balloon sinuplasty is a very safe and effective endoscopic sinus surgical procedure. Patients undergoing Balloon sinuplasty recover faster, have fewer complications and need fewer postoperative medications and follow-ups after surgery.
There are multiple research articles published in indexed journals proving the effectiveness of Balloon sinuplasty over conventional sinus surgery. I have done more than 2000 sinus dilations to date, and I am one of the very few surgeons in India to have reached this number. All of my patients who have undergone balloon sinuplasty are doing very well.
Is Balloon Sinuplasty safe?
Balloon sinuplasty is a very safe procedure. Like any other surgery, it does carry few risks, although very rare. Following are the benefits of Balloon sinuplasty over conventional FESS aka. Functional Endoscopic Sinus Surgery –
- There is a reduced risk of scarring and replacement of functional nasal mucosal lining with another tissue.
- There is a reduced risk of unwanted tissue or structural damage
- There is lesser blood loss during Balloon sinuplasty procedure in comparison to conventional sinus surgery
- Patients undergoing Balloon sinuplasty recover faster and have shorter hospital stays as there is no cutting or removal of tissue
- Number of post operative visits and follow-ups are lesser in Balloon sinuplasty patients
- Balloon sinuplasty patients have lesser nasal crust formation after surgery. So, these patients require fewer nasal endoscopic cleaning visits after surgery.
- Balloon sinuplasty patients require lesser pain relief medications and nasal washes after surgery
- They are at lower risk of getting post operative infections
What are the risks of Balloon Sinuplasty?
These are risks associated with balloon sinuplasty procedure, although very rare.
- Bloody nasal discharge from the front and back of the nose. This can be significant in the first two days after surgery.
- Pain around the nose, eyes and in the forehead region. This can be controlled well with pain relief medications given usually after surgery.
- Patients can have swelling of eyes, nose temporarily
- Nose block and congestion, especially in patients undergoing Balloon sinuplasty along with nasal septal surgery or turbinate surgery
- Infection of sinuses can occur in patients not performing nasal saline douches as recommended
Very rarely the patients undergoing Balloon sinuplasty can have brain fluid leaking from the nose because of the damage to the thin wall separating the brain from the nose.
Even more rarely, balloon sinuplasty can affect the persons sense of smell and the shape of the nose. The chances of occurrence of both the above complications are 0.01.
Is Balloon Sinuplasty a permanent solution?
Yes, Balloon Sinuplasty gives promising results in patients having chronic sinusitis and recurrent attacks of acute sinusitis. A single balloon dilation of affected sinus openings will help in maintaining the sinus drainage pathway. Patients having co-existing nasal mucosal disease conditions like allergy, nasal polyposis etc., should get adequately treated medically for long lasting relief.
What is the success rate of Balloon Sinuplasty?
Balloon Sinuplasty when performed on indicated patients, has a success rate exponentially better than conventional sinus surgery. Apart from the high success rate, it provides long lasting relief, faster recovery, lesser complications and a reduced number of visits postoperatively. The above mentioned advantages make Balloon Sinuplasty the treatment of choice in indicated patients and preferred adjunct therapy in the hybrid nose and sinus surgeries where sinus openings require enlargement.
What is the recovery time of Balloon Sinuplasty?
The patients undergoing Balloon Sinuplasty will be discharged 18-24 hours after surgery. After discharge from the hospital, patient can return back to his desk work. He will experience nasal congestion, bloody nasal discharge and mild discomfort around the nose in the immediate postoperative period.
Following is the advice giving to a patient undergoing Balloon sinuplasty
- Do not blow your nose or forcefully clear the nasal congestion.
- Do not undertake heavy workouts or strenuous activities for at least ten days post-surgery.
- Take the post operative medications given to you by your ENT doctor. He will be prescribed an antibiotic, antihistamine, and pain medications.
- Rinse your nose with nasal saline washes 2 – 4 times a day as advised by your doctor
Balloon Sinuplasty follow-up
Following the Balloon Sinuplasty procedure, your ENT doctor will advise a review in his outpatient department or operation theatre after ten days. During this visit, your nose will be locally anaesthetised by packing. He will examine your nose and sinuses with an endoscope. Any crusting which has formed in your nose and nasal discharge will be removed.
This procedure will not take more than half an hour. Once this procedure is completed, you will be kept under observation for an hour and later discharged. You will be asked to come for review in the outpatient department twice after your first visit with ten days apart. Your ENT doctor will examine your nose with a headlight or an endoscope during both these review visits.