Balloon Sinuplasty (Balloon Sinus Dilation) Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the indications for balloon sinuplasty (balloon dilation of the sinus)?

Sinus infections can have a significant impact on quality of life with loss of productivity at work and school. The majority of patients with sinus infections are successfully treated with conservative methods including rest, topical therapy and oral medications. In general, the decision to proceed with balloon sinuplasty is one that the patient and the ENT surgeon makes together given the complexity of various types of sinus infections and their presentation to the individual patient.

What is balloon sinuplasty?

Balloon sinuplasty is a FDA approved, minimally invasive office-based surgical procedure designed to open up the natural drainage pathways of the paranasal sinuses for better mucous clearance and aeration of the sinuses. The ostiums are dilated using inflatable balloons. With wider openings, topical treatments are more feasible and reduce the need for oral and systemic antibiotics. The procedure is performed using topical anesthetic while the patient is awake.

Is balloon sinuplasty right for you?

Balloon sinuplasty is an effective treatment for chronic sinus infection and recurrent acute sinus infection refractory to medical management. However, long-term outcome is not well studied. Selection for the procedure is strict and the number of patients who are good candidates for the procedure remains low. Patients must be able to tolerate the procedure while awake and must have favorable anatomy. The presence of a septal deviation, concha bullosa, fungal sinusitis, nasal polyposis and other anatomical variation likely prevents adequate access to the paranasal sinuses in a tolerable manner. In patients who are good candidate for balloon sinuplasty, the need for general anesthesia can be avoided. Regardless of the techniques and the instruments used, sinus dilation is a surgical procedure and the risk remains similar to that of minimally invasive functional endoscopic sinus surgery.

Schematic of a left maxillary sinus balloon dilation.

What should I expect before surgery?

• To prepare for your sinus dilation, your physician may prescribe preoperative medications to optimize the condition of your sinuses for the procedure. The medications may include antibiotics and/or oral steroids. Be sure to start any medications on the appropriate day and adhere to the direction.
• DO NOT TAKE THE FOLLOWING MEDICATIONS FOR AT LEAST 14 DAYS PRIOR TO SURGERY: aspirin, ibuprofen (Motrin/Advil), naproxen (Aleve), other non-steroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding. Tylenol is safe and may be taken anytime up to the day of surgery. St. John's wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications. If you take the blood thinner Coumadin or Plavix, you must discuss this with your surgeon so the medication can be discontinued before surgery and restarted appropriately.
• If you smoke, you must stop smoking for at least three weeks prior to surgery, and at least four weeks after surgery. Smoking can contribute to scarring, poor healing, and failure of the procedure. Your primary care physician can direct you to resources for smoking cessation.

What should I expect during the procedure?

Your treatment team will include your surgeon and an assistant. Balloon sinuplasty is typically performed under local anesthesia and can take 1-2 hours. However, this may vary depending on each patient. The extent of your procedure depends on which specific sinus is causing you problem. Initially, your nasal cavity will be anesthetized with nasal spray and a cotton ball. Local anesthetic is then injected into the nasal cavity. You may experience some pain and discomfort during the injection. Once adequate local anesthesia is achieved, the endoscope is inserted into the nasal cavity for visualization and the balloon catheter is inserted into the natural sinus ostium. The assistant will then inflate the balloon with salt water. You may experience some discomfort and pain during the dilation. The sinus is then rinsed with salt water if needed. Typically, nasal packing is not placed with balloon sinuplasty unless significantly bleeding is expected.

Figure 3. The ostium is dilated by the inflatable balloon. Source: acclarent.com & Kennedy et. al. Rhinology: Diseases of the Nose, Sinus, and Skull Base.

What should I expect after balloon sinuplasty?

• After your balloon sinus dilation is completed, you will spend approximately 30 minutes in the office to monitor for bleeding. You should not drive yourself home and you need to arrange for transportation prior to the procedure.
• You can expect mild bleeding for about one day after the procedure. Pain can generally be controlled with over the counter Tylenol; however, narcotic (prescription) medication will be provided for additional control if needed.
• You may eat a regular diet.
• You will have return visits to the ENT clinic at approximately 1, 3, and 6 weeks after balloon sinuplasty. At your first post-operative visit, the doctor will examine your sinuses with an endoscope and may clean your sinuses of dried blood. There may be some mild discomfort and we recommend taking a dose of pain medication about 45 minutes to one hour before this visit (as long as someone can accompany you on your visit). Please write down any questions you may have so that we can answer them at your appointment.
• You should plan on taking one day off from work and ideally have a half-day planned for your first day back.
• Please see the post-operative instructions for additional details.

What are the risks of balloon sinuplasty?

As with any surgical procedure, endoscopic sinus surgery has associated risks. With meticulous planning and appropriate precautions, complications from balloon sinus dilation are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:

• Bleeding: Most sinus surgery involves some degree of blood loss, which is generally well tolerated. Uncommonly, patients may have bleeding in the early post-operative period that could require nasal packing.
• Recurrence of disease: Although balloon sinuplasty provides symptomatic relief for the vast majority of patients, it is not a cure for sinusitis. It would be expected that the frequency and severity of your sinus infections will improve and your requirements for medications should be lessened. However, long-term outcome of balloon sinuplasty is not well studied. In some instances, additional "touch-up" or revision surgery may be necessary to optimize your outcome.
• Spinal fluid leak: Because the sinuses are located near the brain, there is a rare chance of creating a leak of spinal fluid (the fluid lining the brain) or injuring the brain. Should the rare complication of a spinal fluid leak occur, it may create a potential pathway for infection, which could result in meningitis. If a spinal fluid leak were to occur, it would require surgical closure and hospitalization.
• Visual problems: Visual loss has been reported after sinus surgery due to injury to the eye or optic nerve. The potential for recovery in such cases is not good. Fortunately, such a complication is extremely rare. Injury to the eye muscles may result in double vision. Persistent tearing of the eye is another possible complication. Tearing problems usually resolve on their own but occasionally require additional surgery.
• Other risks: Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain; change in the resonance or quality of the voice; and swelling or bruising of the area around the eye.

What restrictions will I have during the postoperative recovery period?

• DO NOT BLOW YOUR NOSE for the first week after surgery. You may sniff back. If you need to sneeze, do not suppress it but instead sneeze with your mouth open. After 1 week, you may blow your nose gently.
• No strenuous activity for one week after surgery. No straining or lifting more than 20 lbs. Light walking and normal household activities are acceptable immediately after surgery. You may resume exercise at 100% intensity after one week. You may drive the day after balloon sinuplasty if you are not requiring narcotic pain medication.
• If you are taking antibiotics and experience stomach upset, active culture yogurt or acidophilus tablets (available at health food stores) on a daily basis may help. If you develop diarrhea, stop your antibiotics and contact our office. Persistent diarrhea may require further medical evaluation.
• You should plan on taking one day off from work.

Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your sinus condition and treatment plan. Please feel free to ask questions about any aspect of your care. Learn more about sinus infection or post-operative care for balloon sinuplasty.