“Most people are a little hesitant to go in and perform an endoscopic sinus surgery procedure on kids,” Dr. Ramadan said. “They think it’s maybe a little bit too aggressive, that these kids eventually will outgrow the problem, as their immune system gets better. So, this seemed to me like the perfect fit. Instead of going and doing an endoscopic sinus surgery, you use the balloon, because using the balloon, you’re not taking any tissue out. You’re not disrupting the anatomy.”
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November 2011Balloon sinuplasty may improve the post-surgical care of children who undergo sinus surgery. “In the past, with traditional sinus surgery, we’d have to potentially take them back to the operating room so that we could perform postoperative endoscopy and any manipulation to the wound that was necessary,” Dr. McLaughlin said. “I started using the balloon with children because I saw it as an opportunity to treat a child’s sinuses and not have to take them back to the operating room for postoperative debridement.”
According to Drs. Ramadan and McLaughlin, the use of balloon sinuplasty does not rule out the use of FESS at a later date, should it become necessary.
New research suggests that combining balloon sinuplasty with adenoidectomy, a traditional treatment for chronic rhinosinusitis in children, may improve outcomes. While adenoidectomy typically provides relief to about 50 percent of children who undergo the procedure, a 2010 study by Dr. Ramadan found that 80 percent of children treated with balloon sinuplasty and adenoidectomy experienced an improvement in symptoms (Ann Otol Rhino Laryngol. 2010;119(9):578-582). The improvement persisted 12 months after surgery: 80 percent of children who received the combined treatment experienced significant improvement, compared with 52.6 percent in the group that had undergone adenoidectomy alone.
Appropriate for the Office?
While some physicians are using balloon sinuplasty in conjunction with traditional surgical techniques in the operating room, others are eyeing the technology for use in the office.
“There’s definitely a move towards office-based procedures,” Dr. Setzen said. However, proper patient selection will be essential if office-based balloon sinuplasty is to take off, and research studies that identify proper patient populations are lacking. “I don’t really know exactly who are the best patients for the balloon technology,” Dr. Metson said. “The proper patients and the proper disease are still somewhat unclear.”
Dr. Setzen suggests that all candidates for sinus surgery, whether for balloon sinuplasty or FESS, meet the following criteria:
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