“Doc, I got sinus”
How many times have primary care physicians heard the above statement or one very similar. Odds are, many times and frequently.
Sinusitis is one of the most common health problems in the United States, affecting approximately 37 million people each year. According to the National Academy on an Aging Society, sinusitis is more prevalent than arthritis or hypertension and has a greater impact on quality of life than diabetes or congestive heart failure. Symptoms may significantly affect people physically, functionally, and emotionally.
Sinusitis is usually preceded by a viral upper respiratory infection, allergy attack, or irritation from environmental pollutants causing mucosal edema and decreased mucociliary clearance. Usually the resulting symptoms run their course in a few days. However, when a secondary bacterial infection occurs, acute sinusitis may develop. If the condition clears but recurs frequently, recurrent acute sinusitis is the diagnosis. If the condition does not clear and persists for three months or more, it is considered chronic sinusitis.
The first line of therapy for chronic sinusitis remains medical management which includes various combinations of prolonged broad-spectrum antibiotics, intranasal steroid sprays, occasional bursts of oral steroid, decongestants, antihistamines, saline nasal sprays, and antibiotic nasal irrigations. Most people respond to medical management with improvement in their symptoms; however, those who do not improve on medical therapy require surgery to treat their chronic sinusitis.
Approximately 25 years ago, functional endoscopic sinus surgery became available. This was a significant improvement in technology, allowing the surgeon to look directly into the nose and sinuses with an endoscope as opposed to operating solely with a headlight. This resulted in more precise, thorough surgical treatment of sinus disease. More recently CT image-guided technology has served as an adjunct to endoscopic sinus surgery.
Functional endoscopic sinus surgery continues to be a very effective treatment for chronic sinusitis. However, some studies reported that 25% of patients need eventual revision endoscopic sinus surgery.
The newest technology, Balloon Sinuplasty, is a surgical procedure that involves passing a flexible sinus guidewire into the affected sinus. The sinus balloon catheter is then advanced over the sinus guidewire. The sinus balloon catheter is positioned across the blocked sinus opening and gently inflated. The Sinuplasty system is then removed, giving a patent sinus passageway and restoring normal sinus drainage and function. This is all performed using direct visualization with nasal endoscopes as well as transillumination.
Balloon Sinuplasty is most commonly performed on the frontal, maxillary, and sphenoid sinuses. The ethmoid sinuses, if involved with chronic sinusitis, are generally opened using the standard functional endoscopic sinus surgery technique.
Studies have shown that Balloon Sinuplasty is a very effective treatment. To date, over one thousand patients have been tracked in a retrospective patient registry. There have been no serious complications reported at two years. 98% of the sinus ostia remain patent at six months. 0.98% of sinuses and 2.75% of patients required revision dilatation.
In addition to being very safe and effective, the benefits of Balloon Sinuplasty include reduced bleeding due to less removal of tissue and bone and faster recovery time. Many patients are able to return to normal activity within 24 hours.
In conclusion, Balloon Sinuplasty is a safe and effective new surgical procedure now available in the treatment of chronic sinusitis.