by Cynthia Davis, M.D.
If you suffer from frequent sinus infections, you’ve probably wished you could just stick something up your nose, into your sinuses, and clear them out.
Well, a new technique being performed in San Diego does something quite similar — and so far, the results have been promising.
This alternative to traditional sinus surgery, first introduced in the fall of 2005, is called balloon sinuplasty. You may be familiar with cardiac angioplasty, which uses a catheter with a balloon on the tip to clear blocked arteries in the heart. We use the same technique in sinuplasty.
First, we thread a small guide wire through the nostril into the sinus. Then, a catheter with a balloon over its tip is placed over the guide wire. We use a type of X-ray called a fluoroscopy to help us guide the catheter and make sure it is in the correct location where the sinuses are constricted.
Then we inflate the balloon, which stretches the sinus tissues and opens the constricted area. We can then go in and flush out infected material through a catheter.
Unlike conventional sinus surgery, in which we go in and cut away the affected tissue, balloon sinuplasty simply stretches it.
Because there is no cutting involved, there is less likelihood that scar tissue will form and re-block the opening — which is one of the problems we encounter with conventional surgery. As a result, we anticipate better long-term outcomes with sinuplasty.
Recovery also is faster with sinuplasty. I caution patients to plan a few days to recover, but many patients report going back to work the next day. With traditional sinus surgery, patients are often out of work for a week, and full recovery can take four to six weeks.
Sinuplasty is an outpatient procedure done under general anesthesia. The length of the procedure ranges from one to two hours, depending on how many sinuses we’re treating.
There are eight in all; six can be treated with sinuplasty, while the other two, known as the ethmoid sinuses, must be treated with traditional surgery.
If necessary, we can perform a hybrid procedure that is a combination of the two. In my experience, even though we still have to do some cutting in a hybrid treatment, it is less than with traditional surgery and so the recovery is still faster.
Because sinuplasty was just introduced last year, we don’t yet have reliable long-term data on its effectiveness. Physicians are required to complete a special training course in order to perform it, and so far, only about 500 patients have undergone this procedure.
Overall, patients have been very pleased, and the six-month results are quite promising. Only about five percent of treated sinuses have re-closed, compared to about a 15 to 25 percent re-closure rate with traditional surgery.
Even if the sinuses do re-close, the “worst case” scenario is that we repeat the procedure or perform traditional sinus surgery.
It also appears to be extremely safe. There have been no reported complications to date, and we have not seen the problems with bleeding that we sometimes see in traditional surgery patients.
Although the balloon causes microfractures of the bone as it enlarges the sinus opening, we have had no reports of this causing a problem.
Sinuplasty appears to be a promising treatment for people who suffer from chronic sinus infections that have not been helped by medication. It is not generally recommended for someone who has an acute infection, or who has very advanced disease with nasal polyps.
The jury is still out on whether this treatment is recommended for patients who have previously had traditional sinus surgery.
Currently, Scripps Memorial Hospital La Jolla is the only health care facility in San Diego where sinuplasty is performed. As it becomes more widespread, we will continue to identify the best patient populations for this procedure.
This Scripps Health and Wellness information was provided by Cynthia Davis, M.D., an ENT at Scripps Memorial Hospital La Jolla.