Dealing with nasal and sinus disease has dramatically benefited from recent technological advances. For example, in the 1980s, small telescopes called endoscopes allowed surgeons to visualize the inside of the nasal and sinus passages which revolutionized nasal and sinus surgery. These advances continued to allow otolaryngologists to do more, to be more accurate, to be more precise and for surgeries to be less traumatic. One 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 surgery that could treat heart disease with a minimally invasive procedure. Millions of patients have benefited from this technology and had their heart disease managed without open heart surgery. This type of technology has been adapted into the field of 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 was based on the principle that surgeons can restore the natural drainage pathway of the sinuses by removing obstructions 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.
Other procedures use standard instrumentation 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 also would help treat sinus disease and to restore the sinuses’ normal drainage pathways.
Balloon Catheters in Sinus Surgery
In 2005, the first commercially available product using balloon dilating catheter technology was released to treat sinus disease. A guidewire is passed from the nasal cavity into the specific sinus that is being addressed. Once it has been confirmed that the guidewire is in the sinus, a balloon dilating catheter is passed over this wire to the narrowest part of the sinus drainage pathway. This high-pressure balloon is briefly inflated, and the pressure of the balloon widens the outflow tract of the sinus by fracturing bone and moving it outwards, along with its mucous membrane. The final result is a dilated, widened outflow tract from the sinus that can be done without actual tissue removal. This technology was met with initial criticism, however, clinical studies confirmed that it was a safe tool in the management of chronic sinusitis. The American Rhinologic Society as well as the American Academy of Otolaryngology-Head and Neck Surgery both currently have favorable position statements concerning this technology. These devices are FDA approved and have been used on tens of thousands of patients. To simplify things, the balloon dilating catheter can be used in two ways. One way is to use it just like any other instrument or tool used during functional endoscopic sinus surgery, it is used as a minimally invasive tool during a procedure where tissue is actually removed. Another way that it can be used is as a stand-alone procedure — that is when only the balloon and no other instrumentation is used to open a sinus. With this technique, no tissue is actually removed from the sinus opening. It has been shown that use of minimally-invasive instruments may result in less postoperative pain, less pain medication use and quicker recovery. It cannot be used in all situations, and it cannot be used in all sinuses. It is one of a vast list of procedure options which an otolaryngologist may choose depending on the patient and different surgical situations.
Over the last several years, there have been advances in balloon technology. Initially, to confirm that a surgeon was in a sinus, an x-ray machine had to be used during surgery to confirm correct placement of the guidewire. This exposed patients to radiation that they would not otherwise get with standard instrumentation. Now, sinus access can be confirmed with a lighted guidewire which has a bright fiber optic light at the end of the flexible guidewire or by using navigational systems that make use of the imaging studies done prior to the surgery as part of the normal diagnostic workup. Irrigation catheters and stents have been developed as an option for the physician to consider.
Regardless of the name of the procedure, the instrument being a balloon or not, the technique is sinus surgery. The indications are no different than the indications for standard endoscopic sinus surgery or FESS. The most common application of this is for chronic sinusitis that has not been able to be controlled after a long duration of medical management that includes courses of antibiotics. The balloon dilating catheter is a tool to be used in endoscopic sinus surgery. It is the adaptation or application of minimally-invasive balloon technology to the field of sinus surgery. All procedures have potential risks and complications, for a full discussion of all of these issues, please contact one of our Otolaryngologists.