Rhinology (Allergy & Sinus) : Rhinology Procedures and Treatments

Sinuplasty

WHAT IS SINUPLASTY (AKA balloon sinuplasty or balloon dilation)?

INTRODUCTION

Over the last several decades, there have been many changes in technology that have improved our lives. Rhinology, or the sub-specialty of ENT that deals with nasal and sinus disease, has dramatically benefited from these advances. In the mid 1980s, small telescopes called endoscopes allowed surgeons to visualize the inside of the nasal and sinus passages and revolutionized nasal and sinus surgery. These advances continue as technology allows rhinologists to do more, to be more accurate, to be less traumatic, and to be more precise. Once such advancement was the development of the balloon dilating catheter and its adaptation to sinus surgery.
In the 1980s, the field of cardiology drastically changed with the use of angioplasty. This well-known procedure uses a balloon dilating catheter to open up diseased and blocked blood vessels around the heart. This was the first surgery of its kind that could treat this type of heart disease in a minimally invasive fashion. Millions of patients have benefited from this technology and had had their heart disease managed without “open heart surgery.”
This technology has been adapted into the field of Rhinology and Sinus Surgery. Long before the balloon was used in the nose and sinuses, the concept of “functional endoscopic sinus surgery” (commonly known as FESS) was introduced. It is based upon the principle that surgeons can restore the natural drainage pathway of the sinuses by relieving obstruction or blockages that contribute to the disease process. This is commonly done in a conservative fashion in order to preserve the function of the sinuses without damaging natural structures that surround them. In general, standard instrumentation is used to remove tissue including bone and its surrounding mucous membrane (the lining of the nose and sinuses) from the area of the natural openings of the sinuses. Doing this helps to treat disease and to restore the sinuses’ normal drainage pathways.

Sinuplasty refers to a procedure, or specifically a surgical device. This device is similar to balloon angioplasty, which expands the blood vessels in someone’s heart to relieve blockage. In balloon sinuplasty, balloons are placed into the opening of a patient’s sinuses. Expanding the balloon in the narrowed sinus openings allows the openings to become wider. Sinuplasty may also be used along with traditional endoscopic sinus surgery as well.
Like all medical treatments, the information in the popular media may not reflect reality. Although useful, balloon sinuplasty is not for everyone. In many cases standard endoscopic sinus surgery or medical therapy may be the best treatment. However, in some people balloon sinuplasty may be the best option, and may decrease recovery time. Only with a thorough evaluation, along with a CT scan, can your surgeon decide what is the best treatment for your sinuses.

WHAT ARE THE POTENTIAL COMPLICATIONS OF ENDOSCOPIC SINUS SURGERY?

Complications of sinus surgery are rare but include bleeding, damage to the eye or vision, anesthesia complications, and intracranial complications (brain injury, brain fluid leak, infection of the brain). However, it is important to realize that the sinuses are located next to the orbits (eye sockets) and directly beneath the bottom of the brain. Failure to treat chronic rhinosinusitis itself may lead to severe problems, such as infection of the eye or brain. If you are uncomfortable with the risks of sinus surgery, it is important that you discuss this with your surgeon.

WHAT ARE THE ALTERNATIVES TO ENDOSCOPIC SINUS SURGERY?

Continuing medical therapy alone and avoiding surgery is always an alternative. Medical therapy is chiefly antibiotics and/or steroids along with other medications. As with any surgery, you should feel more than comfortable seeking a second opinion from another surgeon.

WHAT IS ENDOSCOPIC SKULL BASE SURGERY?

Over the course of the last ten to fifteen years, abnormalities that involve the areas of the bone at the bottom of the brain and brain itself that are next to the nose and sinuses have been removed via the nostril, without facial incisions. Using cameras and video equipment similar to those used for sinus surgery, these tumors can be removed without facial incisions. Because this technique may be significantly less painful, requires less traction on the brain and necessitates a shorter hospital stay, it is an attractive option for some patients and tumors. However, it must be emphasized that this technique is not for all patients or tumors.