Sinus

Ever know anyone who reached the end of their rope with sinus problems? I encounter them everyday and until recently I could offer either more aggressive medical therapy or surgery. Now, there's a middle ground to bridge the gap for patients who aren't getting adequate relief with medicine, but don't need (or aren't ready for) full blown sinus surgery. 

Traditional Treatment options 
The most frequently used treatments are medications and/or Functional Endoscopic Sinus Surgery (FESS). Treatment with antibiotics or topical nasal steroid spray is often successful in reducing mucosal swelling and relieving obstructions within the sinus openings. However, an estimated 20-25% of patients do not respond adequately to medications.

For these patients, surgery is often their next step toward finding relief. The goals of sinus surgery are to clear blocked sinuses, restore normal sinus drainage and function, while preserving normal anatomy and mucosal tissue. Currently with FESS, specialized probes are used to cannulate closed openings, and small forceps are used to remove bone and tissue to enlarge the sinus opening. Removal of bone and tissue may lead to post-operative pain, scarring, and bleeding. Modern, packless sinus surgery usually provides an 80-90% success rate in relieving symptoms.

Sinus surgery has also evolved from open to less invasive surgical techniques. With the advent of FESS in the 1980s, surgery took an evolutionary leap forward with the elimination of open surgery, the introduction of endoscopic tools, and the discovery that blocked sinus openings may be the primary culprit of this disease. If you have ever known anyone who's had traditional sinus surgery, they will tell you nightmare stories about packing and pack removal.

Achieving the Goals of Sinus Surgery 
Balloon Sinuplasty technology extends the sinus surgery evolution by meeting the goals of clearing blocked sinuses, restoring normal sinus drainage and function, and preserving normal anatomy and mucosal tissue. 

Dr. Keith Forwith was the first otolaryngologist in Louisville trained to use the Balloon SinuplastyTM system and has the most experience with this technology. 

To gain initial sinus access, a catheter is introduced into the target sinus under endoscopic visualization. A flexible guidewire is introduced through the catheter and gently advanced into the target sinus. The Balloon Catheter tracks smoothly over the guidewire and positioned across the blocked opening. It is gradually inflated to gently restructure the blocked passageway. 

The balloon is removed, leaving the ostium open and allowing the return of normal sinus drainage and function. There is little to no disruption to mucosal lining. The opening attained by the Balloon Sinuplasty system is durable and achieves the goals of sinus surgery. 

Applications 
The Balloon Sinuplasty devices are effective endoscopic tools and may be used with other medical therapies or FESS techniques. Additionally, using these devices should not limit future treatment options for patients with progressive disease. The best part of this is that patients recover very quickly, usually less than 24 hours with minimal bleeding and very little discomfort!

Clinical Safety 
Studies revealed that sinus ostial dilation was achieved without damage to surrounding structures. Importantly, the orbital bone and skull base, which are adjacent to the paranasal sinuses, were not affected by Sinus Balloon Catheter dilation of the sinus ostia. Endoscopy and CT scans also revealed that the sinus ostial size achieved by the Sinus Balloon Catheter was comparable to the maximum balloon diameter. Following CT and endoscopic analysis, gross anatomic dissection was performed to further validate the endoscopic and CT scan analysis used to verify device safety. No evidence of damage to the surrounding structures was noted from Sinus Balloon Catheter ostial dilation. This study was published in May of 2006 in the American Journal of Rhinology. 

Initial Clinical Safety and Feasibility Study 

Tissue trauma and bleeding with sinus balloon dilation was observed to be less than what normally is seen during standard sinus surgery. No post-surgical nasal packing was required.Post-operative examinations revealed that all patients tolerated Sinus Balloon Catheter dilation and no post-operative complications occurred. The ostial dilations achieved in surgery were maintained post-operatively. All patients healed well and observed sinus ostia remained patent. This study was published in April of 2006 in the Annals of Otology, Rhinology, and Laryngology.