Richmond’s Sinus and Allergy Specialists

Balloon Sinuplasty

80 year old BSD patient
“I’m 80 years old, I had the balloon sinus dilation procedure done by Dr. Armstrong in his office and then went to the University of Richmond basketball game that evening! The procedure is no worse than getting your teeth cleaned. I would recommend Dr. Armstrong to anyone with sinus issues.”

– Dorothy, 80 year old sinus patient

 


Relieve sinus pain now, with Balloon Sinuplasty

Balloon Sinuplasty is a revolutionary office treatment for chronic and recurrent sinusitis. Typically performed under local anesthesia, the surgeon threads a small catheter through the sinus opening and then inflates the balloon with water, dilating the sinus opening to promote drainage and alleviate pain. Most patients return to work the next day, and say that the procedure is no more difficult than having a tooth repaired.

Hear what our patients have to say:

Is Balloon Sinuplasty for me?

If you have exhausted medical management for sinusitis, you may be a candidate for balloon dilation.  Balloon sinus dilation is recommended for patients who have chronic sinusitis that persists despite antibiotics and steroids, or who have recurrent acute sinusitis at least three times each year. The ideal patient has mild disease on CT scan, with primarily bony obstruction as opposed to swelling. Patients with significant nasal polyps are not likely to be cured with balloon dilation alone. The best way to find out is with a sinus CT scan, which can be performed in the office at the time of your consultation.

Sinus CT scan of a 71-year-old man with chronic right maxillary sinusitis.

Sinus CT scan of a 71-year-old man with chronic right maxillary sinusitis. *Mucous membrane swelling is the same or worse after a month of antibiotics (first and middle image). Sinus disease is completely resolved a few months after balloon dilation of the sinus opening (right side image with white arrow pointing to sinus opening)

What can I expect?

On the day of the procedure, we will spray your nose with decongestants and numbing medications. We will place more medication on a cotton ball near the sinus and wait about 20 minutes for maximum anesthesia.  In many cases, additional local anesthetic is injected with a delicate needle until your nose is comfortably numb. Using an endoscope, we will examine your nose and place the catheter in your sinus, using a small light on the end of the device to confirm that it is properly located. Sometimes, we make a small puncture under the lip into the sinus. When we inflate the balloon, you will feel firm pressure and may hear a cracking sound. This is normal. The balloon is inflated for 5-10 seconds and then removed.

Listen to Bob’s testimonial:

How long is recovery?

Most patients are ready to drive home 10-15 minutes after Balloon Sinuplasty, and resume normal activity immediately.  The REMODEL study performed at Richmond ENT and several other community practices randomized 105 patients to balloon sinus dilation or endoscopic sinus surgery and demonstrated 70% faster recovery and significantly better results one week after balloon dilation. Following balloon dilation, our patients took prescription pain pills for less than one day, and returned to normal activity in an average of 1.6 days, compared to 4.8 days following functional endoscopic sinus surgery.[1]

Do I have to be awake?

About half of patients needing Balloon Sinuplasty are treated in the operating room, for reasons that might include anxiety, difficult anatomy or insurance restrictions. The Medarva Stony Point Surgery Center is across the hall from our office and provides excellent care for outpatient surgery.  If you do not feel you need the services of an anesthesiologist, we can premedicate you in the office with oral Valium. You will need a designated driver following any oral sedation or general anesthesia.

Will I need nasal packing?

Light bleeding after any nasal surgery can be expected, but nasal packing after Balloon Sinuplasty is rare.

See postoperative sinus surgery instructions

How long will it last?

Numerous studies have shown that the benefit of balloon dilation lasts at least one to two years in 90-95% of patients, which is as good as or better than functional endoscopic sinus surgery. We have every reason to expect that the improvement is permanent. Dr. Armstrong has been a principle investigator in 3 of these clinical trials demonstrating the long-term benefits of balloon sinus dilation.[1],[2],[3]

What are the risks?

The common risks of any office nasal procedure include pain, nosebleeds, fainting, and fast heartbeat following local anesthesia. Sinus puncture under the lip can cause lip or cheek numbness. Sinus surgery involves the modification of delicate bones that separate the nose and sinuses from the brain and the eye. Injuries to the brain or eye, including meningitis, spinal fluid leak, and blindness have been described in sinus surgery. Balloon dilation is felt to be safer than sinus surgery, but major complications are so rare that it is difficult to perform statistical comparisons. Look for a surgeon with experience.

What if my insurance company won’t pay for Balloon Sinuplasty?

A very few insurance companies, such as Anthem in my market, still consider balloon dilation to be experimental, despite compelling evidence showing that balloon dilation is better than functional endoscopic sinus surgery for selected patients. Anthem does not pay for sinus surgery unless tissue is cut away to make an opening into the sinus. For these patients, I will commonly dilate the sinus first with balloons and then remove the smallest amount of tissue that demonstrates the open sinus while trying to minimize unnecessary tissue damage. Costs are higher when the procedure is performed in the operating room [4] and return to work is delayed by an average of 3.2 days.[1]

What is the FinESS Procedure?

Balloon dilation in the office can be difficult for patients with a nasal septal deviation. With FinESS, the surgeon enters the maxillary sinus through a needle placed under the lip. With a tiny endoscope in the maxillary sinus, we can pass the balloon through the sinus opening under direct vision, without working around or between convoluted or narrow nasal passageways.

    


[1] Cutler J, Bikhazi N, Light J, et al. Standalone balloon dilation versus sinus surgery for chronic rhinosinusitis: A prospective, multicenter, randomized, controlled trial. Am J Rhinol Allergy 27:416-422, 2013.

[2] Brodner D, Nachlas N, Mock P, Truitt T, Armstrong M, Pasha R, Jung C, and Atkins J:  Safety and outcomes following hybrid balloon and balloon-only procedures using a multifunction, multisinus balloon dilation tool.  Int Forum of Allergy & Rhinology 3:652-658, 2013.

[3] Levine SB, Truitt T, Schwartz M, Atkins J: In-Office Stand-Alone Balloon Dilation of Maxillary Sinus Ostia and Ethmoid infundibula in Adults with Chronic or Recurrent Acute Rhinosinusitis: A Prospective, Multi-institutional Study with 1-Year Follow-Up. (Armstrong acknowledged as site principle investigator) Ann Otol Rhinol Laryngol 122(11):665-671, 2013.

[4] Armstrong, M. Office-based Procedures in Rhinosinusitis.  Otolaryngol Clin N Am 38:1327-1338, 2005.