SAN DIEGO—The latest data continue to show an upward trend for the number of balloon dilations performed in the U.S., continuing an explosion of use that’s been seen for the past decade or so. In 2017, 43,936 of the procedures were performed under Medicare Part B, a 4.7% increase from the year before (JAMA Otolaryngol Head Neck Surg [published online ahead of print January 23, 2020] doi: 10.1001/jamaoto.2019.4357).
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April 2020The level of growth is not as sharp as the eye-popping increases seen in the early part of the last decade, when balloon dilations jumped 75% from one year to the next (JAMA Otolaryngol Head Neck Surg [published online ahead of print January 23, 2020] doi: 10.1001/jamaoto.2019.4357). But the cost of the device is still included every time a balloon code is used, generating huge profits, and the procedures are still being performed at extremely high numbers, panelists said in a discussion here in January at the Triological Society Combined Sections Meeting.
And the procedure still faces the scrutiny of some otolaryngologists who are worried it’s being used without regard to best care. Today, in a roomful of otolaryngologists, the mere mention of the words “balloon sinuplasty” can conjure thoughts of misplaced priorities in medicine.
Otolaryngologists on the panel, moderated by Jastin Antisdel, MD, chair of otolaryngology at Saint Louis University in St. Louis, Mo., talked about how the field ended up doing so many balloon dilations—and where it can go from here.
Beginnings of Criticism
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Balloons, which were adapted from cardiac catheters as a way to dilate the sinuses, drew concern as early as 2006 after media reports noted the lack of data showing the procedure’s effectiveness (Abelson, Reed. Too Soon to Breathe Easy? The New York Times, 2016). That same year, a journal commentary piece lamented that “this technology did not go through the proper vetting process in the medical literature before being released in the public media, thereby creating patient expectations that will likely not be realized and potentially damaging the credibility of our specialty in the eyes of the public” (Ann Otol Rhinol Laryngol. 2006;115:789-790).
“This is really the first time, at least in my 18 years in otolaryngology, where we really see this concept of direct-to-consumer marketing, where the physician is bypassed and now we have patients calling our office” about a product, said meeting panelist Pete Batra, MD, chair and professor of otorhinolaryngology at Rush Medical College in Chicago.