Sinuplasty Research Articles

Current state and potential of Balloon Sinuplasty

Current state and potential of Balloon Sinuplasty

The role of balloon sinuplasty in the treatment of sinus headache

Introduction: Headache attributed to rhinosinusitis, commonly called sinus headache (SH), is probably one of the most prevalent secondary headaches. The purpose of our study was to examine further sinus headache comparing the effect of conventional functional endoscopic sinus surgery and the balloon sinuplasty. Material and methods: Eighty-three consecutive patients were enrolled from 2009 to 2012, who were diagnosed sinus headache according the diagnostic criteria of AAO-HNS and of HIS. 40 patients were randomized to Conventional Endoscopy Sinus Surgery for frontal sinus (ESS Group), 35 to balloon sinuplasty of frontal sinus (BS Group). Results: The mean operative time was 65±15min for ESS group patients and 32±7min for 23 patients (BS1 Group) and 55±18min for 12 treated with hybrid technique (BS2 Group). The preoperative mean of SNOT-22 scores improved from 28.6±1.2 in ESS group and 27.3±0.8 in BS group to a 1-month postoperative scores of 14.5±0.6 in ESS group and 10.3±0.5 in BS group and to a 6-month postoperative scores of 7.8±0.6 and 5.3±0.3, respectively (p<0.0001). The headache scores base on analog visual scale improved from a preoperative mean of 6.5±0.3 in ESS group and 7.1±0.4 in Bs group to a 1-month postoperative scores of 5.4±0.4 in ESS group and 5.5±0.4 in BS group and to a 6-month postoperative scores of 2.7±0.5 and 1.2±0.1, respectively, representing a statistically significant reduction in headache score in both group. Conclusion: Our data prove that improvement in headache can be expected in patients treated with balloon catheter.

FESS versus Balloon Sinuplasty as Long‐term Treatment for Pediatric Chronic Rhinosinusitis: A 2‐Year Postoperative Analysis

Objectives: Chronic rhinosinusitis (CRS) is a common pediatric disease. For those affected, functional endoscopic sinus surgery (FESS) and balloon sinuplasty are surgical options for long-term relief. Our objective was to examine the efficacy of these treatments in overall symptom improvement &gt;2-years post-operatively. Methods: A 2-group prospective blinded survey was conducted with 10 pediatric patients who underwent FESS and 11 treated with balloon sinuplasty from 2007-2010. All had previously been reviewed in a 6-month post-operative comparative study and were diagnosed with CRS through CT scans and symptomatology. At &gt;2-years post-surgery, symptoms and medications were compared using 1-tailed independent t-tests. Results: Mean age at time of procedure was 9.9 years (range 4.1 – 16.0); 65% were male. Both groups had similar Lund-Mackay scores (FESS: Mean = 12.63; Balloon: Mean = 12.27) and overall symptoms prior to procedure (FESS: Mean = 4.78, SD = 2.73; Balloon: Mean = 4.60, SD = 1.26). Greater than 2-year post-operative follow-up surveys demonstrated a statistically significant long-term decrease in symptoms for balloon and FESS treatments (t = 4.34, P = &lt;0.001). Balloon demonstrated a significant decrease in individual sinus symptoms (t=4.80, P = 0.001) when compared to FESS. Overall, a reduction in antibiotics and topical nasal spray was identified in both groups. Conclusions: FESS and balloon are both effective long-term options in the treatment of pediatric CRS. Both procedures can be performed with minimal short- and long-term complications. At &gt;2-years post-sinus surgery, individuals who underwent balloon sinuplasty reported a greater decrease in overall sinus complaints when compared to FESS.

Feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience

Background: Balloon sinuplasty (BSP) is a catheter-based technique to dilate sinus ostia and drainage pathways to create ventilation and drainage. The aim of this study was to evaluate the feasibility of BSP in routine treatment of patients suffering from chronic rhinosinusitis (CRS). Methodology: Patients with CRS refractory to medical therapy who had been scheduled for endoscopic sinus surgery between 2009 and 2011 were included in this study. Results: Forty-five consecutive patients were included in this study, in whom 112 sinuses were approached by BSP. Of the 112 sinuses, 68 (60%) were planned as a "Balloon-Only" procedure and 44 (40%) were planned as a "Hybrid" procedure. Of the 68 sinuses in the "Balloon-Only" group, in 44 sinuses BSP failed, equating to a failure rate of 65%. Forty-four sinuses were planned for "Hybrid" procedures. In 29 of these sinuses BSP failed, giving a failure rate of 66%. Conclusion: According to literature, BSP can be a useful adjunct technique to standard FESS. In our experience, however, a failure rate of 65% for "Balloon-Only" and of 66% for "Hybrid" procedures occurred, which was regarded as unacceptable by the study group. Therefore, the study initially scheduled for 200 consecutive patients, was abandoned.

Feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience

Balloon sinuplasty (BSP) is a catheter-based technique to dilate sinus ostia and drainage pathways to create ventilation and drainage. The aim of this study was to evaluate the feasibility of BSP in routine treatment of patients suffering from chronic rhinosinusitis (CRS). Patients with CRS refractory to medical therapy who had been scheduled for endoscopic sinus surgery between 2009 and 2011 were included in this study. Forty-five consecutive patients were included in this study, in whom 112 sinuses were approached by BSP. Of the 112 sinuses, 68 (60%) were planned as a "Balloon-Only" procedure and 44 (40%) were planned as a "Hybrid" procedure. Of the 68 sinuses in the "Balloon-Only" group, in 44 sinuses BSP failed, equating to a failure rate of 65%. Forty-four sinuses were planned for "Hybrid" procedures. In 29 of these sinuses BSP failed, giving a failure rate of 66%. According to literature, BSP can be a useful adjunct technique to standard FESS. In our experience, however, a failure rate of 65% for "Balloon-Only" and of 66% for "Hybrid" procedures occurred, which was regarded as unacceptable by the study group. Therefore, the study initially scheduled for 200 consecutive patients, was abandoned.

Balloon Dilation Technology: Let the Truth Be Told

Balloon dilation technology (BDT), also known as balloon sinuplasty, has been in clinical use since September, 2005. Prior to BDT, surgeons performed a procedure called FESS, or functional endoscopic sinus surgery, for patients with chronic sinusitis. As is true with any new technology or procedure in medicine, a debate often ensues between early adopters and mainstream practitioners. Over the past 7years, much has been discussed, debated, and learned about BDT. What follows is a review of the origins of the BDT: the theory, technology, indications and applications; and a review of the pertinent outcomes literature. Independent of how one feels about BDT, the evidence strongly supports its safety, efficacy, and growing popularity among patients and physicians alike.

Treatment of Pott’s Puffy tumor with balloon sinuplasty: report of three cases

Pott's Puffy tumor (PPT) is a rare entity characterized by subperiosteal abscess associated with osteomyelitis of the frontal bone. It is usually managed by surgical curettage of the osteomyelitic bone and long-term antibiotic therapy. Balloon catheter dilatation is a new technique which was recently introduced for the treatment of chronic rhinosinusitis. In this article, we present three PPT cases (two of them were secondary to endoscopic sinus surgery) who were successfully treated with balloon catheter dilatation and long-term antibiotherapy.

Endoscopic Sinus Surgery Might Reduce Exacerbations and Symptoms More than Balloon Sinuplasty

Endoscopic sinus surgery (ESS) is considered after medical therapy failure of chronic rhinosinusitis (CRS). The balloon sinuplasty dilates the natural ostium without moving mucosa or bone. It still lacks evidence from randomized controlled trials. The aim of this retrospective controlled study was to compare the symptom outcomes after maxillary sinus surgery with either the ESS or the balloon sinuplasty technique. No previous or additional sinonasal operations were accepted. Two hundred eight patients with CRS without nasal polyps underwent either balloon sinuplasty or ESS. The patients who met with the inclusion criteria (n = 45 in ESS group and n = 40 in balloon group) replied to a questionnaire of history factors, exacerbations, and a visual analog scale (VAS) scoring of the change in symptoms, on average 28 ± 6 (mean ± SD) months postoperatively. The groups were identical in the response rate (64%), patient characteristics, and the improvement in all of the asked symptoms. Patients with CRS-related comorbidity and/or present occupational exposure had a statistically significantly better symptom reduction after ESS than after balloon sinusotomy. Moreover, the balloon sinusotomy group reported a statistically significant higher number of maxillary sinus punctures and antibiotic courses during the last 12 months. ESS might be superior to balloon sinuplasty, especially in patients with risk factors. There is a need to perform more controlled studies on the treatment choices of CRS.

Quality of Life after Balloon Sinuplasty

Objective: To compare the quality of life of chronic sinusitis patients treated with FESS and those treated by balloon sinuplasty through a randomized prospective study. Method: Study design: prospective cohort. Time frame: August 2009 to December 2011. Disease: Chronic rhinosinusitis. Setting: Tanta University Hospitals. Subjects and methods: Twenty patients suffering from chronic rhinosinusitis were randomly distributed into 2 equal groups: group A treated with FESS and group B treated with balloon sinuplasty. Outcome measurements: Preoperative and postoperative evaluation by SNOT-20 questionnaire, endoscopic examination, and Lund-Mackay CT staging. Results: The balloon catheters dilated all ostia successfully (17 maxillary, 5 sphenoid, and 3 frontal recesses). No adverse effects were recorded. At 12 months, overall patency in 88%, non-patency rate of 4%, and “indeterminate” in 8%. In 2 sinuses, a revision procedure was required (8%) based on clinical and CT findings, compared to 3 sinuses in FESS group. There was a significant improvement over baseline measures in the SNOT-20 in both procedures. As for the patients satisfaction with the interventions; 100% answered “yes, they would undergo the procedure again,” for sinuplasty, against 40% of the patients submitted to FESS. Conclusion: Balloon sinuplasty is safe and effective and improves patients’ quality of life. It may be used as a stand-alone or as a hybrid procedure. Candidates are patients with chronic sinusitis limited mostly to ostial obstruction. Cases of isolated sphenoid, maxillary, and frontal sinusitis are particularly attractive to avoid resection of normal ethmoid sinuses.

Navigational Balloon Sinuplasty

Objective: 1) Use computer navigation to preplan sinuplasty. 2) To evaluate the success rate of cannulation with real time computer guidance. Method: IRB approved prospective study at a community hospital and surgicenter using Paint software with Brainlab computer navigation for 2 years. Patients with recurrent and chronic sinusitis are selected. Balloon sinuplasty is used in conjunction with FESS in a “hybrid” procedure. Sinus ostia on CT scans are colorized. Guides are calibrated then directed to the selected sinus ostia with real time navigation for deployment of the catheter. Cannulation rates, complications, and SNOT scores are measured. Results: We report a 99% cannulation rate for frontal and sphenoid sinuses with no major complications in 200 patients. SNOT scores decreased from over 2 to under 1. Both cases of failure to cannulate were for repeat frontal sinus surgeries. Conclusion: Real time navigation with preop colorization of the sinuses allowed for high success rate of cannulation and increased patient satisfaction according to SNOT scores with no major complications when using balloon sinuplasty in conjunction with FESS.

Stratus Relieva: Treatment for Chronic Rhinosinusitis

Objective: Patients with chronic rhinosinusitis resistant to systemic treatment have as an alternative endoscopic nasal surgery. The Relieva Stratus system has allowed local treatment in paranasal cavities, avoiding an aggressive surgery and high corticoesteroids systemic treatment. We describe our experience with the system in the first six patients. Method: Four patients suffering ethmoid and 2 with frontal chronic rhinosinusitis have been included. The Stratus catheter was implanted endoscopically under general anesthesia in combination with balloon sinuplasty technique for either the maxillary or the frontal sinus. Triamcinolone was used for local delivery. Stratus was removed in office 4 week later. Results: Stratus Relieva was implanted in patients with chronic inflammation of the ethmoid or frontal sinus. No major complications were observed. Four catheters were implanted in the ethmoid bulla and 2 in the frontal sinus. They were removed in office under local anesthesia. Intraoperaory bleeding was minimal. Patients described no foreign object sensation after surgery. We observed good evolution in all patients but one, in which Stratus Relieva was performed. This patient persisted with chronic inflammation of the maxillary and ethmoid sinus and functional endoscopy surgery was performed as alternative for definitive treatment. Conclusion: Results with this device are promising although longer observation period is needed. It is possible that the patient that did not show an improvement of disease may have not been an adequate candidate for this surgery. Therefore, we consider that appropriate selection of patients is necessary for a good outcome.

Functional endoscopic sinus surgery (FESS) alone versus balloon catheter sinuplasty (BCS) and ethmoidectomy: A comparative outcome analysis in pediatric chronic rhinosinusitis

ObjectiveTo evaluate whether the addition of BCS (balloon catheter sinuplasty) would improve the treatment outcome in children with chronic rhinosinusitis (CRS) compared to FESS (functional endoscopic sinus surgery). Study designTwo-group, retrospective cohort with blinded chart review comparison. SettingChildren's Hospital of Michigan, Detroit, MI. Subjects and methodsChart review of 15 pediatric patients who underwent BCS with ethmoidectomy and 16 who underwent FESS from 2008 to 2011 for treatment of CRS in a tertiary care, university affiliated, pediatric institution. Pre-operative CT-scans as well as pre and post-operative sinus symptoms and medications were compared. Post-surgical outcome was examined using chi square analysis. ResultsMean age of children at the time of the procedure was 9.3 (SD=4.19; range=3–17). Both groups had similar pre-surgical Lund–Mackay CT CRS scores (FESS: mean=9.33 and t=0.67; balloon: mean=10.58, t=0.68, and p=0.51). Analyses identified significant post-treatment reductions in overall symptoms and needed interventions in both treatment groups. Side-by-side post-operative comparison of patients who underwent balloon sinuplasty to FESS demonstrated statistically significant post-operative difference between the two groups in antibiotic requirement, sinus congestion and headaches. Though not statistically significant, 62.5% of FESS patients and 80.0% of BCS patients (χ2=1.15) reported improvement in their overall sinus symptoms post-operatively. ConclusionBoth BCS and FESS are suitable treatments for CRS in children. Both treatments significantly reduced CRS complaints post-operatively and had similar overall results. BCS patients required significantly fewer antibiotics post-operatively for CRS related disease when compared to FESS. Larger prospective studies with long-term data are needed to further evaluate.

Management of chronic rhinosinusitis

: Chronic rhinosinusitis (CRS) in children is difficult to treat, with resultant frequent recurrences and failures. There are controversies in the treatment, mirroring the debate over the exact etiology of this disorder. The available medical treatments are antibiotics, topical nasal corticosteroids, and nasal lavage with saline solutions; though, there is no general agreement on the efficacy of the latter. The new technique of balloon sinuplasty allows ventilation to the sinuses to be restored with minimal risk and trauma to the tissues, and initial outcome seems promising, being successful in most treated children. Concerning the surgical approach, adenoidectomy is among the most frequent surgical procedures performed on children, but its therapeutic effect is controversial, because randomized studies have failed to prove that adenoidectomy alone is sufficient in curing CRS. Instead, functional endoscopic sinus surgery is a minimally invasive technique which restores the sinus ostia patency and can re-establish ventilation and drainage through the natural pathways. It is important that the effectiveness of any treatment is also evaluated by patient-reported outcomes (PROs) that refer to all health-related reports coming from the patients, without any involvement or interpretations by physician or others. Among PROs, health-related quality of life (HRQL) is the one most widely known and used. HRQL can be measured by means of validated questionnaires, which provide scores proportional to the degree of well-being perceived by patients. Concerning diseases of the upper airway including RS, there are numerous instruments specifically designed for children and caregivers, which allow to assess the effects of treatments in a more extensive and complete manner.

Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis

Citation: Ahmed J, Pal S, Hopkins C, Jayaraj S. Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD008515. DOI: 10.1002/14651858.CD008515.pub2AbstractBackground Dilation of sinus ostia using a high‐pressure balloon has been introduced as a treatment for chronic rhinosinusitis (CRS) refractory to medical treatment. The efficacy of this technology, however, has not been systematically reviewed.Objectives To assess the effectiveness of balloon sinus ostial dilation as a treatment for patients suffering with CRS refractory to medical treatment.Search strategy We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 20 December 2010.Selection criteria Randomised controlled trials in patients of any age with rhinosinusitis lasting longer than 12 weeks who have failed a prolonged course of medical treatment. Studies compared either balloon sinus ostial dilation or a hybrid procedure [balloon dilation in conjunction with functional endoscopic sinus surgery (FESS)] versus conventional surgery (e.g. FESS) or a waiting list control.Data collection and analysis Two authors independently selected studies for inclusion, extracted data and assessed risk of bias.Main results One study (34 patients) met our inclusion criteria although it was not yet a peer reviewed publication. The study randomised patients with chronic frontal sinusitis who had failed a prolonged course of medical treatment into two groups: balloon dilatation of the frontal recess (plus conventional FESS of other involved sinuses) versus conventional FESS (Draf type 1/2a procedures on the frontal sinuses). At 12‐month follow‐up, there was no statistically significant difference in radiological resolution of frontal sinuses between the two groups. The percentages of directly observed patent frontal recesses at 12 months were 75% in the balloon dilation group versus 63% in the FESS‐only group. The authors state that this was statistically significant but details of the analysis were not presented. Indeed the study as a whole suffers from a bias in the way its outcome measures were reported.No major complications were reported. Three patients in the FESS‐only group required further revision frontal sinus surgery compared to one in the balloon dilation group, although synechiae were more common in the latter.Authors’ conclusions At present, there is no convincing evidence supporting the use of endoscopic balloon sinus ostial dilation compared to conventional surgical modalities in the management of CRS refractory to medical treatment. With the escalating use of balloon sinuplasty, there is an urgent need for more randomised controlled trials to determine its efficacy over conventional surgical treatment modalities.

Endoscopic balloon dilation as an adjunct to extended endoscopic approaches to the skull base

Cholesterol granulomas (CGs) are benign, expanding cystic lesions surrounded by a thick fibrous capsule and filled with fluid, formed by the degradation of blood elements. The goal of surgery is to open the granuloma widely, creating a well-drained cavity. The endonasal endoscopic approach for this extradural lesion is a minimal access method for surgical removal or fenestration. The role of balloon dilation in creating a wide fenestration has not been previously described. The authors describe a patient with a recurrent petrous apex CG who underwent an endoscopic, endonasal, transmaxillary transpterygoid approach to the petrous apex. A balloon sinuplasty catheter was used to dilate the surgical fenestration to maintain continued patency. The authors report on their first experience using balloon dilation combined with endoscopic drainage of the petrous apex. The excellent surgical outcome of this minimally invasive technique holds promise for future endonasal approaches to the middle cranial fossa.

Efficacy &amp; Outcomes of Balloon Sinuplasty in Chronic Rhinosinusitis: A Prospective Study

Balloon Sinuplasty is a new technique which has revolutionized sinus surgery in recent times. Since its introduction in USA in 2004, it has become popular world-wide, due to its sophisticated technology, which uses balloon dilatational systems for dilating the sinus ostia through a minimally invasive approach and has provided satisfactory results in patients with chronic rhinosinusitis. Recent world literature supports the efficacy and outcomes of Balloon Sinuplasty system, with large multi-centric studies proving it to be a very effective tool in the management of various sinus pathologies. We performed this prospective clinical study to assess the efficacy & outcomes of Balloon Sinuplasty among 20 patients at our institution, who were followed up for 12months after surgery. Patients were included as per inclusion criteria formulated for this study & were analyzed with respect to their pre-operative & post-operative symptomatology scores in comparison with their objective Diagnostic Nasal Endoscopy (DNE) & Computerized Tomography Scan of Paranasal Sinuses (CT-PNS) scoring systems. Significant improvements were recorded in patient's symptoms, from the first post-operative week until the end of the study period, and were objectively confirmed by the DNE & CT-PNS scores. The observations & results of our study highlight the efficacy of Balloon Sinuplasty technology in comparison to similar studies reported in recent world literature.

PRS68 A Systematic Review of Chronic Rhinosinusitis in Asia-Pacfic and the Role of Balloon Sinuplasty

PRS68 A Systematic Review of Chronic Rhinosinusitis in Asia-Pacfic and the Role of Balloon Sinuplasty

Functional Endoscopic Sinus Surgery (FESS) Alone vs FESS and Balloon Sinuplasty: A Comparative Outcome Analysis in a Pediatric Population with Chronic Rhinosinusitis

Objective: Chronic rhinosinusitis (CRS) is a common disease afflicting children. For those affected, conventional FESS and balloon sinuplasty are surgical options for those refractory to medical management. Our objective was to evaluate whether the addition of balloon sinuplasty would improve the treatment outcome in children who undergo FESS for CRS. Method: A 2-group, retrospective blinded chart review comparing 11 pediatric patients who underwent balloon sinuplasty to 15 undergoing FESS from 2007 to 2010 at the Detroit Medical Center. Preoperative CT scans as well as pre- and postoperative sinus symptoms and medications were compared. All group data were compared using 1-tailed independent t tests. Results: Mean age at the time of procedure was 8.74 (SD = 4.2 years; range, 2-19 years). Both groups had similar presurgical Lund-Mackay CT CRS scores (FESS: mean = 9.33, SD = 4.7; Balloon: mean = 10.5, t = -.61, p = .55). Analyses identified posttreatment differences in symptom reduction and needed intervention between the 2 groups. Postoperatively patients who underwent balloon sinuplasty reported fewer headaches (t = 2.51, P = .01), less postnasal drip (t = 1.88, P = .04), and reduced sinus congestion (t = 2.05, P = .03). A comparison of the amount of topical steroidal/saline and antibiotic use identified a reduction in the amount of topicals used in children who received balloon treatment (t = 2.66, P = .007) and a reduction of antibiotic use (t = 1.79, P = .04). Conclusion: Balloon sinuplasty directed at the frontal and maxillary sinuses resulted in better outcomes than those with traditional FESS techniques. Balloon sinuplasty patients had less sinus symptoms, required less antibiotics, and required less topical nasal steroids postoperatively. Preservation of the native anatomy in balloon sinuplasty may play a role in these findings.

Evidence‐Based Approach to Treating Chronic Rhinosinusitis

Program Description: The treatment of chronic rhinosinusitis (CRS) requires extensive skill in surgical and medical management strategies. Innovations in this field are constantly evolving. Not uncommonly, payers are hesitant to compensate for technology that is innovated and has not yet stood the test of time. The presentations will provide specific citations for the clinician to effectively communicate with payers, patients, and hospital administrators. The purpose of this miniseminar is to provide a state-of the-art summary of the best scientific evidence available to help clinicians treat patients with CRS. This miniseminar will present the highest level of evidence-based medicine available for: 1) endoscopic sinus surgery, 2) balloon sinuplasty, 3) image-guided sinus surgery, and 4) medical management of CRS. By focusing on strong, well-performed clinical studies, the attendee will learn the research studies that directly impact the surgical and medical treatment of CRS. The miniseminar will conclude with applying this evidence-based research to clinical cases to solidify the applicability and understanding of the research presented. Educational Objectives: 1) Recognize the state-of-the-art evidence-based research for the management of CRS. 2) Apply evidence-based clinical research to improve medical and surgical treatment of CRS. 3) Understand evidence behind recent advances in the treatment of CRS including image-guidance and balloon sinuplasty.

Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis

Dilation of sinus ostia using a high-pressure balloon has been introduced as a treatment for chronic rhinosinusitis (CRS) refractory to medical treatment. The efficacy of this technology, however, has not been systematically reviewed. To assess the effectiveness of balloon sinus ostial dilation as a treatment for patients suffering with CRS refractory to medical treatment. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 20 December 2010. Randomised controlled trials in patients of any age with rhinosinusitis lasting longer than 12 weeks who have failed a prolonged course of medical treatment. Studies compared either balloon sinus ostial dilation or a hybrid procedure (balloon dilation in conjunction with functional endoscopic sinus surgery (FESS)) versus conventional surgery (e.g. FESS) or a waiting list control. Two authors independently selected studies for inclusion, extracted data and assessed risk of bias. One study (34 patients) met our inclusion criteria although it was not yet a peer reviewed publication. The study randomised patients with chronic frontal sinusitis who had failed a prolonged course of medical treatment into two groups: balloon dilatation of the frontal recess (plus conventional FESS of other involved sinuses) versus conventional FESS (Draf type 1/2a procedures on the frontal sinuses). At 12 months follow up there was no statistically significant difference in radiological resolution of frontal sinuses between the two groups. The percentages of directly observed patent frontal recesses at 12 months were 75% in the balloon dilation group versus 63% in the FESS-only group. The authors state that this was statistically significant but details of the analysis were not presented. Indeed the study as a whole suffers from a bias in the way its outcome measures were reported.No major complications were reported. Three patients in the FESS-only group required further revision frontal sinus surgery compared to one in the balloon dilation group, although synechiae were more common in the latter. At present there is no convincing evidence supporting the use of endoscopic balloon sinus ostial dilation compared to conventional surgical modalities in the management of CRS refractory to medical treatment. With the escalating use of balloon sinuplasty, there is an urgent need for more randomised controlled trials to determine its efficacy over conventional surgical treatment modalities.