A Less Invasive Option for Patients
Sinusitis is one of the most common health problems in the United States, affecting 37 million people each year. A relatively new procedure, balloon sinuplastyTM, can relieve the accompanying congestion and fatigue that can impact a patient's quality of life. That procedure, previously done only in the operating room, is now being performed in a physician's office.
Chris Davis, MD, an otolaryngologist at Brookwood Medical Center, is one of the few ENT specialists in Birmingham doing the in-office surgery. "This new technology is not for every patient, but there definitely are patients who can benefit from this minimally invasive procedure," he says. "It's exciting that we can open a patient's sinus in the office and watch him or her walk out to the parking lot when it's over. Most will resume normal activity within a day."
Davis has been doing the in-office balloon sinuplasty for just over two months. "The eight patients I have treated have all done well," he says. “Being able to do the procedure outside the operating room under local anesthesia offers a potential option for patients who fail medical management, but decline or are ineligible for traditional surgery. International clinical studies show a 91.6 percent functional patency rate at one year post-surgery and 85 percent of patients noted improvement of symptoms over a two year period.”
Traditionally, physicians have had two options for treating patients with chronic sinusitis - medical therapy (antibiotics and steroids) and sinus surgery. Medical therapy generally alleviates symptoms in 80 percent of patients, but the other 20 percent require some kind of surgery. "Sinus surgery has a bad reputation,” Davis says. “Patients are concerned about packing, which I feel is not necessary even with traditional surgery, and the recovery from general anesthesia. Each year, 900,000 patients elect to live with the problem to avoid traditional sinus surgery.”
Selecting the right patients is key to the success of the in-office procedure. Davis says that someone with a significant polyp burden, a deviated septum, or ethmoid sinus disease would not be a candidate. He does a nasal endoscopy exam and a CT scan on all of his patients prior to scheduling surgery to check for such problems.
Balloon sinuplasty is endoscopic surgery that is catheter-based. After the patient receives local anesthesia in the sinus cavity, the surgeon guides a catheter into the target sinus using endoscopic visualization. The sinus balloon catheter tracks over a flexible guide wire and is positioned across the blocked ostium. The balloon is inflated gradually to gently restructure the blocked ostium. When the balloon system is removed, the ostium remains open, allowing the return of normal sinus drainage and function with little to no disruption to the mucosal lining. Unlike traditional sinus surgery, the procedure requires no cutting and no removal of bone and tissue.
"With this system, we can dilate blocked maxillary frontal or sphenoid sinuses through their natural openings using the balloon device to enlarge the ostium. It's the same concept as a cardiologist opening blocked arteries during balloon angioplasty," Davis says. "Another plus for the balloon system is the irrigation tip on the catheter. Once we dilate the sinus, we can irrigate the sinus cavity with saline and clean it out before the patient leaves the office."
Davis feels that there is a drive for physicians to perform more in-office procedures where possible. "With the new health care law, there will be more of a push to save money. If you do procedures in-office, the patient's recovery is quicker and it costs the insurance companies less money," he says.
Davis adds that this new technology is still trying to find its place. "It's a hot topic among ENT physicians right now. There are those who firmly believe in balloon surgery while others say it never should be used. The reality is somewhere in between. We must select patients who will benefit from the surgery because there is a subset of patients that has been neglected, and those patients can be helped with this technology."