- Documented history of sinusitis;
- Endoscopic exam of the sinuses, demonstrating blockage; and
- History of maximum medical therapy.
Patients with a markedly deviated septum or advanced sinus disease are not candidates for in-office balloon sinuplasty. Neither are children, because children lack the ability to sit still while the surgeon manipulates tools in their sinuses. “I do simpler cases in the office, patients who may have just one or two blocked sinuses without a badly deviated septum and no polyps,” Dr. Setzen said. “If there’s significant sinus disease, I wouldn’t want to do it in an office setting.”
Explore This IssueNovember 2011
In-office balloon sinuplasty may be attractive for some patients and physicians, but Dr. Setzen said that physicians considering the procedure must make sure they’re adequately equipped. “You need more office personnel to assist you if you perform balloon dilatation in office. You may need an assistant, a circulator in the room and additional technology. You also need to have appropriate monitoring and life support. These are all additional risks for the physician and an added liability.” “The good news is that the potential risks following the operation are pretty low,” said Dr. Setzen. Reported complications of balloon sinuplasty include turbinate lateralization or scarring (Am J Rhinol. 2008;22:204-209). To date, no research studies have examined the safety or efficacy of in-office balloon sinuplasty.
Some physicians believe that direct-to-patient marketing is fueling the demand for balloon sinuplasty.
“The economic push with balloon sinuplasty is really greater than any I’ve seen,” Dr. Metson said. “Many of us, the first time we ever heard about balloons was in press releases rather than the medical literature. Our patients were asking us to do it, before any studies were out whatsoever.” The physicians who were interviewed for this article emphasized the importance of establishing realistic expectations. Some patients, based on advertising, come to the physician expecting a minimally invasive, in-office procedure that will cure their chronic rhinosinusitis. The reality, as Dr. Kennedy and others have stated, is often more complicated, and many patients will need traditional sinus surgery in addition to balloon sinuplasty.
That reality has caused some of the initial excitement regarding balloon sinuplasty to wane among physicians.
“At this point in time, a lot of the initial enthusiasm for a strictly balloon approach has dropped off,” Dr. Kennedy said. “Any time a new technology is introduced, there’s this pendulum swing where everyone gets very excited about it and then people become disillusioned and then the technology eventually finds its accurate position. With balloon sinuplasty, we’re just starting to find out what its real position may be.”