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Published on March 01, 2017

Minimally Invasive Sinus Procedure Offers Relief for CRS Patients

Pierre Podrebarac, MD

Pierre Podrebarac, MD

Dr. Podrebarac earned his medical degree from the University of Kansas School of Medicine and completed his residency in otolaryngology-head and neck surgery at Emory University School of Medicine.

When patients with chronic rhinosinusitis or recurrent acute rhinosinusitis fail medical therapy, the next line of treatment typically calls for functional endoscopic sinus surgery. As an alternative therapy, balloon sinus dilation, gives patients another option, which is less invasive with a faster recovery.

Pierre Podrebarac, MD, an otolaryngologist with Meritas Health ENT, has been at the forefront of balloon sinus dilation at North Kansas City Hospital. Currently, he performs dilations on patients who are under general anesthesia in the operating room. Beginning this spring, he and his colleague, Scott L. Knappenberger, MD, will begin offering balloon dilation as an outpatient procedure in office.

FESS Alternative

Often, sinus infections, headaches, facial pain and other symptoms do not abate after protocols for medical management have been exhausted. With 29.4 million adults — 12.3% of the U.S. population — diagnosed with chronic sinusitis, according to the Centers for Disease Control and Prevention, the need for options is paramount.

“These patients are having multiple acute sinus infections or chronic sinus infections and have failed maximum medical therapy. They’ve tried topical and systemic steroids, sinus rinses, extended courses of antibiotics, aggressive allergy treatment and even immunotherapy,” Dr. Podrebarac said.

In lieu of undergoing FESS, balloon sinus dilation gives patients a faster return to normal activity. “Although the recovery is not difficult for traditional sinus surgery, balloon sinus surgery recovery is faster because you’re dilating an opening and not surgically removing tissue and bone. That is obviously a lot less invasive,” Dr. Podrebarac said. “When I do a FESS on a Wednesday, I tell the patient to take the rest of the week off from work. Balloon sinus dilation patients can go back to work the next day.”

A study published in the American Journal of Rhinology & Allergy showed balloon dilation to be equal in symptom improvement to FESS, but superior to traditional sinus surgery for lack of the need for postoperative debridement and follow-up. A follow-up study of one-year outcomes found balloon dilation to be as effective as FESS.

Procedure

Image of balloon sinus dilation.

As the balloon inflates, pressure
on the sinus cavity is released.

After administering an anesthetic to the patient’s sinus tissue, the surgeon inserts a lighted flexible guidewire into the patient’s nostril, endoscopically accessing the blocked sinus cavity and opening the blockage with a balloon dilation.

As the balloon inflates, pressure on the sinus cavity is released. The minimally invasive procedure surgery takes 45 minutes to one hour, depending on the number of sinus sets — frontal, maxillary and sphenoid — involved in the dilation.

Both the American Academy of Otolaryngology and American Rhinologic Society have published position statements on the benefits of this technology.

Candidates

Dr. Podrebarac particularly recommends the procedure for individuals with acute recurrent rhinosinusitis.

“These individuals have multiple — upwards of six a year — sinus infections. They respond to antibiotics, but then they relapse,” he said. “Many of these patients have very narrow sinus openings, but we can improve the situation by dilating them.”

“These patients may be better candidates for the balloon procedure in the sense that if they are critically ill and frail, the risk of anesthesia may outweigh the gains obtained from sinus surgery,” Dr. Podrebarac explained. “If they are anticoagulated on blood thinners, this procedure is a lot less invasive, and oftentimes you don’t have to take them off their blood thinners to dilate a sinus.”

Balloon Sinus Dilation Versus Functional Endoscopic Sinus Surgery

Balloon

FESS

Symptom Improvement After One Week

59%

38%

Symptom Improvement After Six Months

67%

63%

Days Prescription Pain Medicine Needed

< 1

2.8

Days to Return to Normal Activity

1.6

4.8

Require Follow-up Debridements

8%

74%

Source: “Standalone Balloon Dilation Versus Sinus Surgery for Chronic Rhinosinusitis: A Prospective, Multicenter, Randomized, Controlled Trial,” American Journal of Rhinology & Allergy, Vol. 27, No. 5, September/October 2013.