Balloon Sinuplasty

What are sinus balloons?

Recently, I have been asked numerous times about balloon sinusplasty. I would like to share what I know. Here is the short history of events. Dr. Messerklinger in Austria in mid 1960’s to 1970’s found out that the vast majority of cases infections of the sinus system are spread from nose. A focus of infection might have remained at the drainage pathway, irritating nasal function and where from infection time and again may spread to the dependent sinuses. By the means of nasal endoscopy these foci can exactly be localized. After clearing the infection foci, which easily can be achieved under endoscopic guidance, mucosal function usually is restored and the dependent larger sinuses heal without having been touched. This was a paradigm change. On their 1990 publication ( doctor’s students mentioned of operating 4500 patient, roughly 450 patients annually. Most their procedures was very limited surgical procedures, diseased ethmoid compartments are operated on (usually ethmoidal bulla), stenotic clefts widened (uncinate process) and prechambers (agar nasi cells) to the frontal and maxillary sinuses freed from disease. However, their definition of chronic sinusitis is mostly based on patient’s symptoms and some minor findings on films or on examination.

Sinus headaches, sinus pressure, stuffiness and drainage can occur in many of allergy or migraine suffers. In that paper by Dr. Messerklinger’s clinic, these issues were not discussed well. To keep the story short this is how endoscopic sinus surgeries started around the world. By early 1990's endoscopic sinus surgery become one of the most popular surgery among the ear nose throat doctors.

In modern medicine, the use of endoscopes for diagnosis and treatment of sinus diseases is standard. Majority of ear nose throat surgeons would not diagnosis of chronic sinusitis solely from patient’s symptoms. Physicians would like to see irreversible tissue damage on nasal or sinus structure. Also patients’ allergies, immune status and virulence of the sinus pathogens are important. Many of “sinus patients” will benefit from simple allergy control, frequent nasal rinsing and migraine treatments, and will never need surgery. In today’s medicine most surgeons did not agree on operating patients unless there is an irreversible damage to nasal and sinus structures.

Sinus balloons are based on Dr. Messerklinger’s teachings, thus solely establishing drainage pathways, but instead of removing the blocking structure, balloons are suggested to inflate the natural sinus opening and improve the drainage of larger sinus cavities. In year 2005 balloon companies received FDA approval for their device. I first become aware of the device in late 2005 and tried the device in 2007.

Function of the sinus cavities is to provide lubrication (mucus) to the inner nose. In addition to creating mucus, the sinuses reduce the skull's weight and make one's voice more resonant their job is lower the weight of head and also save on heating. The results of experimental studies suggested that the natural ventilation rate of a sinus with a single ostium is extremely slow. Indeed, such limited ventilation may be protective for the sinus, as it would help prevent drying of its mucosal surface and maintain a near-sterile environment with high nitrogen concentrations and minimal pathogen access. The air inside to sinuses do not come from air we breathe in but from, diffusion of from small capillaries surrounding the sinuses, so air gas combination inside the sinus cavity close to gas combination on venous blood and outside air.

I think balloons are additional tools to improve patient’s sufferings, help their symptoms. I am glad we have these devices available to use in right patients. But I don’t think, it is such a miracles devices to fix most of the patient’s sinus issues. I think and many of my colleagues also think, most patients will need balloon sinus surgery, would be more cost efficiently treated by allergy control or use of proper antibiotics. Although for balloon surgery patient does not need general anesthesia, it is still a procedure and carries its own risks. In my opinion patients’ headaches and stuffiness of nose is not sign of infection! In reality most of these patient has minor migraines or allergies.