Sinuplasty Research Articles

Safety and feasibility of balloon sinuplasty for treatment of chronic rhinosinusitis in children

Safety and feasibility of balloon sinuplasty for treatment of chronic rhinosinusitis in children

Limitations of balloon sinuplasty in frontal sinus surgery

Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.

Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis

Rhinosinusitis affects ˜37 million people in the United States and accounts for almost 2% of all primary care office visits. Chronic rhinosinusitis (CRS) is often successfully managed in the primary care setting using antibiotics, topical or oral steroids, and saline nasal irrigation. Surgery is an option when medical management fails. Balloon sinuplasty is a minimally invasive endoscopic treatment, which is often used in combination with surgery. It aims to restore ostial patency with minimal mucosal damage, and it is indicated for dilatation of the paranasal sinuses for diagnostic and therapeutic purposes. The technology gently displaces, microfractures, and molds the bone surrounding the sinus outflow and may be used alone or in combination with conventional endoscopic surgery. Recent uncontrolled retrospective and prospective studies have reported the effectiveness and safety of balloon sinuplasty, including radiographic evidence of sinus patency and improved sinus-related quality of life scores for up to 2 years after balloon dilation. An examination of adverse events during a postmarketing assessment of balloon sinuplasty identified a total of 3 major complications among 28 500 patients, with a total of > 85 000 treated sinuses. While randomized controlled trials comparing balloon sinuplasty with conventional functional endoscopic sinus surgery have not been conducted, existing prospective and retrospective assessments suggest that balloon sinuplasty is a viable option for sinus intervention, either alone or in combination with conventional surgical treatment.

Antral lavage using the luma transilluminaton wire and vortex irrigator—A safe and effective advance in treating pediatric sinusitis

While the treatment of pediatric sinusitis can be controversial, there is evidence that performing antral lavage in combination with adenoidectomy can improve treatment outcomes. We present an "over the wire" technique using new technology that can improve accuracy and reliability when performing antral lavage. The LUMA fiberoptic light wire (Acclarent Inc.) and Vortex sinus irrigation catheter (Acclarent Inc.) were used to perform antral lavage as an adjunct in the treatment of pediatric sinusitis. We found this method to have multiple advantages over other techniques of lavage. These advantages include: 1) confirmation of position in the maxillary sinus by transillumination, 2) improvement of the safety and accuracy of the lavage, 3) ability to balloon dilate the natural ostium and ethmoid infundibulum or to obtain cultures at the time of lavage if clinically warranted or indicated by CT evidence, 4) avoidance of radiation from the use of fluoroscopy associated with other balloon sinuplasty equipment and techniques, and 5) no alteration of normal anatomy. We found this technique to give the surgeon a reliable, safe, versatile, and efficacious alternative before consideration of more invasive procedures in the pediatric population with chronic sinusitis.

Balloon sinuplasty

Balloon sinuplasty is a technique in endoscopic sinus surgery that involves minimally invasive procedures to dilate the obstructed or stenosed anatomical sinus pathways. Procedure is derived from the well-recognized techinique of angioplasty. This article highlights the procedural methods with review of literature and my personal experience in balloon sinupalsty.

Balloon sinuplasty: our first year

Balloon sinuplasty is a new technology which has only recently been introduced in the UK. We review the current literature, and we present our first year's results for the technique together with a description of indications, outcomes and problems. Retrospective case note review of 27 consecutive patients undergoing sinuplasty alone in the first year in which this procedure was performed. The main outcome measures used were subjective improvement and Sino-Nasal Outcome Test (SNOT-22) score. Dilatation was successful in 98 per cent of sinuses in which it was attempted; however, subjective improvement was noted in only 62 per cent of patients thus treated. We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.

In reference to Reformation of Concha Bullosa Following Treatment by Crushing Surgical Technique: Implication for Balloon Sinuplasty

In reference to <i>Reformation of Concha Bullosa Following Treatment by Crushing Surgical Technique: Implication for Balloon Sinuplasty</i>

In response to Reformation of concha bullosa following treatment by crushing surgical technique: Implication for balloon sinuplasty

In response to Reformation of concha bullosa following treatment by crushing surgical technique: Implication for balloon sinuplasty

Ethmoid roof CSF-leak following frontal sinus balloon sinuplasty

Though clear indications for its clinical application are not established yet, balloon sinuplasty technology per se is considered safe and very few severe complications have been mentioned in literature as of today. We report the case of a 36-year-old female patient who presented with right sided rhinorrhea from a CSF-leak in the ethmoidal roof after balloon sinuplasty, aimed at her right frontal sinus. Apparently, the surgeon was unaware of having penetrated the skull base through the lateral lamella of the cribriform plate intraoperatively. CSF rhinorrhea became evident 3 weeks postoperatively only when fever, headaches and moderate nausea developed. Upon revision, diameter, size and shape of the bony defect exactly matched with the tip of a standard sinus balloon catheter device, as could be demonstrated and documented. A small posttraumatic encephalocele had intermittently blocked the leak. Endoscopic surgery and duraplasty were performed under intrathecal fluorescein control, applying CT image-guided navigation. Since two-layer fascia lata closure of the defect, the patient has remained free of symptoms without any evidence of CSF leakage. Balloon sinuplasty per se is considered a safe technique, though in inexperienced hands or wrongly applied, complications may occur, as with any surgical tool rigid enough to breach through skull base.

Unsuccessful Frontal Balloon Sinuplasty for Recurrent Sinus Barotrauma

The standard of care treatment for diffuse recurrent sinus barotrauma (RSB) is an endoscopic sphenoethmoidectomy with a complete frontal dissection. Successful healing leaves the RSB patient with no ethmoid sinuses and endoscopically patent frontal, sphenoid, and maxillary ostia. In persistent cases, patients with small frontal ostia will go on to require a frontal drillout. Patients presenting for surgical management of RSB generally have minimal sinus disease despite significant symptoms during flight and the prospect of extensive surgical management can be unappealing. With the advent of balloon sinuplasty, military otolaryngologists anticipated this technology would permit therapeutic dilation of sinus ostia without the extensive surgical dissection and prolonged recovery typical for standard of care management. This case report is a cautionary note to the wider flight community to recognize a mechanism for recurrence of the underlying pathology when balloon sinuplasty is used that is not possible after properly performed standard of care sinus surgery for RSB.

Balloon Catheter Sinuplasty in Young Children

Background Balloon catheter sinuplasty (BCS) for chronic rhinosinusitis (CRS) was found to be successful in adults. The safety and feasibility of BCS in children has been recently established. The purpose of this study was to study the outcome of this technology in CRS in children. Methods A prospective, multicenter, nonrandomized evaluation was performed on patients with CRS. Thirty-two children between the ages of 2 and 11 years were enrolled. Safety was assessed by rate of adverse events. Effectiveness was assessed using the Sino-Nasal (SN)-5 quality-of-life questionnaire for children with CRS at 52 weeks follow-up. Results Thirty-two children were enrolled of which 24 completed their 52 weeks follow-up. No adverse events were reported because of the procedure. SN-5 score improved from a mean of 4.9 at baseline to a mean of 2.95 at 52 weeks (p &lt; 0.0001). Twelve (50%) children had a significant improvement of their SN-5 (&gt; – 1.5), 7 (29%) had moderate improvement (&gt; –1.0 and &lt; –1.5), 2 (8%) had mild improvement (&gt; –0.5 and &lt; –1.0), 1 (4%) remained the same, and 2 (8%) had worsening scores. Conclusions Balloon catheter dilation of the sinus ostia in children was safe and a significant number showed improvement of their SN-5 at 1 year follow-up. Additional studies comparing balloon sinuplasty to other modalities of treatment in children are needed to determine its efficacy in the treatment of CRS in children.

Balloon catheter sinuplasty in young children.

Balloon catheter sinuplasty (BCS) for chronic rhinosinusitis (CRS) was found to be successful in adults. The safety and feasibility of BCS in children has been recently established. The purpose of this study was to study the outcome of this technology in CRS in children. A prospective, multicenter, nonrandomized evaluation was performed on patients with CRS. Thirty-two children between the ages of 2 and 11 years were enrolled. Safety was assessed by rate of adverse events. Effectiveness was assessed using the Sino-Nasal (SN)-5 quality-of-life questionnaire for children with CRS at 52 weeks follow-up. Thirty-two children were enrolled of which 24 completed their 52 weeks follow-up. No adverse events were reported because of the procedure. SN-5 score improved from a mean of 4.9 at baseline to a mean of 2.95 at 52 weeks (p < 0.0001). Twelve (50%) children had a significant improvement of their SN-5 (>-1.5), 7 (29%) had moderate improvement (>-1.0 and <-1.5), 2 (8%) had mild improvement (>-0.5 and <-1.0), 1 (4%) remained the same, and 2 (8%) had worsening scores. Balloon catheter dilation of the sinus ostia in children was safe and a significant number showed improvement of their SN-5 at 1 year follow-up. Additional studies comparing balloon sinuplasty to other modalities of treatment in children are needed to determine its efficacy in the treatment of CRS in children.

Balloon sinuplasty in acute frontal sinusitis

Balloon sinuplasty has been licensed for the treatment of chronic rhinosinusitis since 2006. Balloon dilation enlarges the sinus ostium by effecting tiny fractures of the surrounding bone and compressing soft tissue such that no mucosa is removed. We believe this to be the ideal technique for achieving drainage of an acutely infected frontal sinus when surgical intervention is required. We report the application of this new technique in a 32-year-old female with acute frontal sinusitis. The frontal sinus was successfully cannulated and drained. Post-operative irrigation was achieved using a modified Vortex catheter.

Reformation of concha bullosa following treatment by crushing surgical technique: Implication for balloon sinuplasty

There are various surgical techniques designed to treat conchae bullosae (CB). These include partial or total resection and crushing. Frontal sinus balloon sinuplasty is thought to work by the crushing/remodeling of the agger nasi and frontal recess air cells. The long-term outcome of sinuplasty in the frontal/ethmoid air cell region is unknown. To date, no study has been done on the reformation of CB after crushing. We report on the long-term outcome of a series of patients who underwent crushing of their CB and suggest implications for frontal sinus balloon sinuplasty. Retrospective case series. Retrospective review of 10 patients who re-presented with CB as a component of their nasal obstructive symptoms despite previously undergoing crushing of their CB. Data analyzed included paranasal sinus computed tomography (CT) scans and operative reports. These 10 patients re-presented with recurrent rhinosinusitis and nasal obstructive symptoms. The patients had previously undergone septoplasty surgery with crushing of the CB and were noted to have reformed the CB on their most recent sinus CT. The previous surgeries were preformed from 2 to 15 years prior to their representation. CB can reform following crushing technique. One may extrapolate that agger nasi and frontal recess air cells may reform following balloon sinuplasty leading to recurrent obstruction of the frontal sinus outflow tract.

Endoscope‐Guided Balloon Sinuplasty of the Equine Nasomaxillary Opening

To describe and evaluate an endoscope-guided balloon sinuplasty technique for dilation of the equine nasomaxillary opening (NMO). Experimental study. Equine cadaver heads (n=5); Quarter Horses (n=4). A custom rigid balloon introducer was passed into position within the NMO at the caudal recess of the middle meatus. Under endoscopic guidance, a balloon catheter was passed via the introducer into the NMO and inflated to 6 atmospheres, for 30 seconds 3 times, to dilate the NMO. Drainage rates after sinuplasty were evaluated for the caudal maxillary sinus in 5 cadaver heads and balloon sinuplasty was performed in 4 live horses. All skulls were examined to assess the efficacy of NMO dilation. Positioning of the balloon catheter was readily achieved in all heads. Dilation was observed endoscopically and confirmed on necropsy in all heads. Drainage rates from the caudal maxillary sinus increased significantly (approximately 1.5 x) in all 5 cadaver heads after sinuplasty (P=.001). Dilation of the NMO improved sinus drainage in all 5 cadaver heads. Endoscopic evaluation of the ostium revealed marked dilation of the NMO in live horses and indicates potential clinical use in standing horses. Balloon sinuplasty of the NMO opening is an easily performed, clinically applicable technique for use in standing horses. Clinical studies will be necessary to evaluate the efficacy of this technique in diseased sinuses.

Outcome of balloon sinuplasty vs adenoidectomy in children

Outcome of balloon sinuplasty vs adenoidectomy in children

A description of the relationship between the nasomaxillary aperture and the paranasal sinus system of horses

Disease of the paranasal sinuses of the horse is common and treatment often involves lavage and sometimes surgery. The development of minimally-invasive, sinus-specific treatments, such as balloon sinuplasty, requires a thorough understanding of this complex anatomical region. To improve this understanding, 10 heads from dead horses of various ages were grossly dissected. The heads were transected sagittally and each half was dissected to expose the left and right nasomaxillary apertures and associated structures which were then photographed and measured. Entrances from the rostral and caudal maxillary sinuses into the maxillary aperture were found that led to a common exit at the middle nasal meatus. The caudal and rostral maxillary sinuses had their own, completely distinct outlets (entrances into the nasomaxillary aperture). There was no significant effect of side on measured variables.

Balloon sinuplasty — the first Indian experience

The surgical management of sinusitis was revolutionized worldwide with the advent of the rigid Hopkins rod nasal endoscopes three decades ago. The traditional Messerklinger technique, was thus propagated worldwide by Prof. Stammberger, from the University of Graz in Austria and has come into vogue as functional endoscopic sinus surgery (FESS). The principal aim behind this procedure was the maximal preservation of the nasal mucosal integrity, while providing optimal disease clearance. Today, the introduction of a new technological innovation called 'balloon sinuplasty', has taken the field of sinus surgery a step further. This new technology is very similar to the principles of balloon angioplasty and today, this system has added an efficient, non-invasive tool in the armamentarium of the innovative endoscopic rhinologist. This FDA approved technique, in recent times has provided excellent results in various centers across the western world. We share our first surgical experience with the introduction of this cutting-edge technology in India.

Balloon sinuplasty for the surgical management of immunocompromised and critically ill patients with acute rhinosinusitis

The purpose of this study was to review use of balloon sinuplasty for surgical treatment in critically ill patients with acute sinusitis. Case series with chart review. Patients who underwent balloon sinuplasty between October 2007 and March 2008 were identified. Medical records of the subset of patients who were immunocompromised or otherwise critically ill were analyzed. Thirty-one patients underwent balloon sinuplasty at our institution between October 2007 and March 2008. We identified five critically ill patients with sinus disease within this group. Patient ages ranged from 15 to 51 years with no sex preponderance. All patients had focal findings on a sinus CT scan. In all cases, purulent drainage was noted intraoperatively. All patients returned to baseline health meeting discharge criteria after treatment. Balloon sinuplasty represents a potentially less invasive surgical option than standard Functional Endoscopic Sinus Surgery (FESS) and should be considered in the treatment of critically ill or immunocompromised patients.

Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children

Balloon sinuplasty is a new technique that was recently introduced for the treatment of chronic rhinosinusitis (CRS). The initial experience in adults has been promising. The technique allows for restoring ventilation to the sinuses with minimal risk and trauma to the tissues. I present our initial experience of its use for treatment of CRS in children. I performed a prospective study of 30 children in whom medical therapy failed and who were scheduled for surgery. They were offered treatment with balloon sinuplasty of selected sinuses. The data collected included age, computed tomography score, and comorbid conditions. The primary outcome was the intraoperative success of dilation of the sinuses and the rate of adverse events due to the procedure. The procedure was successful in 51 of 56 sinuses (91%) in 30 children. Five sinuses, of which 4 were hypoplastic maxillary sinuses and 1 was a frontal sinus, were not amenable to dilation. No complications or side effects were noted. The initial experience with balloon sinuplasty in children seems to be very encouraging. Because there is no bone or tissue removal, the procedure seems to be suitable for use in children. A hypoplastic sinus may not be amenable to balloon sinuplasty.