Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis

Abstract

The first US Food and Drug Administration-approved dilating balloon catheter system for obstructed paranasal sinus drainage pathways was introduced in September 2005. It was discussed as an alternative treatment option for traditional endoscopic sinus surgery for those suffering from chronic rhinosinusitis. Widespread patient interest has ensued, although controversy regarding application of this device continues. Many otolaryngologists have been trained to use the device, and more than 88,000 patients have had surgery using this device. Like similar dilating catheters used in other specialties to relieve obstruction, it is a minimally invasive tool for mucosal-sparing dilation of sinus ostia or sinus outflow tracts. Although studies have been completed that demonstrate feasibility, safety, and long-term patency of dilated sinuses, the evolving indications for its use remain controversial. Referring physicians and patients can expect a range of opinions on the role of these devices in the treatment of rhinosinusitis for the foreseeable future.

Does balloon catheter sinuplasty have a role in the surgical management of pediatric sinus disease?

“…BCS was particularly limited in hypoplastic maxillary sinuses, in which the successful cannulation and dilation rate was only 60% (6/10). Surgical complications did not occur in any of the children in this case series, consistent with the very low complication rate (0.01% per patient) reported for BCS in adults 1. Radiation exposure during fluoroscopic confirmation of guidewire placement averaged 0.18 mGy per child in this study 2.…”

“…In BCS a guidewire, passed into the target maxillary, sphenoid, or frontal sinus under endoscopic visualization with either fluoroscopic or fiberoptic light confirmation, is used to position a deflated oblong balloon across the natural sinus ostium. This balloon is subsequently inflated to a maximum diameter of 5 to 7 mm, dilating the natural ostium 1. In contrast to FESS, BCS does not involve tissue removal and theoretically is mucosal sparing.…”

“…Purported limitations of BCS include the inability to address alternative predisposing anatomical abnormalities (the uncinate process, for example, is not removed in maxillary procedures) or to treat concurrent ethmoid sinus disease. The efficacy of BCS in adults with frontal, sphenoid and maxillary sinus disease is reported to be on par with FESS,1 suggesting a potential role for BCS in the treatment armamentarium of pediatric rhinosinusitis as well.…”

Sinonasal Manifestations in Cystic Fibrosis

“…Balloon catheter sinuplasty (BCS) was introduced as a new therapeutic modality of chronic rhinosinusitis in otherwise healthy adults around 2006, and has been shown to be equally effective as ESS [46]. More recently, BCS has been evaluated for safety and efficacy of treatment of chronic rhinosinusitis in the pediatric population.…”

Mometasone implant for chronic rhinosinusitis

“…The introduction of balloon dilatation of the sinuses creates potentially interesting future options for the treatment of chronic rhinosinusitis 24. Looking forward, utilization of steroid-eluting stents in combination with balloon dilatation may provide an interesting and minimally invasive option that controls the underlying inflammation in chronic rhinosinusitis that occurs in conjunction with sinus ostial dilatation.…”