Rhinology - the sub-specialty of ENT that deals with nasal and sinus diseases - has been gaining from recent technological advances. In mid-1980s, tiny telescopes called endoscopes revolutionised nasal and sinus surgery by letting the rhinologists or sinus surgeons ‘observe’ the insides of nasal and sinus passages. Newer advances - such as the balloon dilating catheter and its adaptation to sinus surgery - are improving sinus surgeries’ effectiveness and accuracy more and more.
The balloon dilating catheter revolutionised cardiology by enabling angioplasty through which blocked blood vessels of heart could be opened up to enable blood flow in a minimally invasive procedure unlike the previously required and way more complicated, time-consuming open heart surgery. The very same ballooning technology that has benefited millions of heart patients has now been adapted to rhinology and sinus surgery. Long before ballooning entered nasal domains, functional endoscopic sinus surgery or FESS was introduced through which surgeons widened blocked sinus pathways (contributors to sinus conditions) to restore natural drainage channels of the sinuses. This is a popular procedure, and usually the widening of drainage channels is accomplished by using standard surgical instruments. Now balloon dilating catheters are joining this surgery too.
Balloon catheters in sinus surgery
Balloon dilating catheter technology to treat sinus disease came to mainstream rhinology in 2005. The concept is quite uncomplicated. A guide wire is sent to a specific sinus through the nasal cavity. Once it reached the targeted sinus, a ballooning dilating catheter is sent over it to the most blocked section of the sinus drainage pathway. When inflated briefly, it widens the tract, fractures the bone, and along with the mucous membrane, moves it outwards, leaving behind a dilated outflow sinus pathway accomplished without tissue removal.
Several clinical studies have proven this technique’s safety and efficacy. Tens of thousands of patients have been treated successfully through it. The American Rhinologic Society and the American Academy of Otolaryngology - Head and Neck Surgery favour this technology. Sinus ballooning devices have been approved by FDA, the US government heath safety body.
There are two ways of using the balloon dilating catheter:
- Like any other instrument or tool used during functional endoscopic sinus surgery where it is employed as a minimally invasive tool during a tissue removal procedure.
- Like a stand-alone procedure where only the balloon (no other instrumentation) is used to open a sinus and no tissue is actually removed from the level of the sinus opening.
The benefit is that such minimally-invasive procedures result in reduced postoperative pain, reduced postoperative pain medication use, and quicker recovery for the patient.
Balloon technology’s use in rhinology has been developing rapidly. Earlier, an x-ray machine was employed to verify that the guide wire was at the right place which exposed patients to radiation risk (there is no such risk in conventional surgery). Now the need for this x-ray imaging has been done away through the use of a guide wire with a bright fiberoptic light at the end or by using navigational systems that make use of standard pre-surgery imaging studies.
The most common application of balloon dilating catheters in sinus surgery is in treating chronic sinusitis that has shown insufficient response to long-term medical management including antibiotic courses. As of now, ballooning cannot be used in all sinus-related cases, nor can it be used to unblock all sinuses. The operating surgeon chooses the technique as per the merits of an individual case. Like all other surgical procedures, this procedure too comes with potential risks and complications.