Pros, Cons of In-Office Balloon Sinuplasty, Bilateral Cochlear Implants

In-office balloon sinuplasty and the addition of a second cochlear implant are two procedures that benefit patients, but the proper time to perform them sometimes falls into a gray area. Experts in both areas discussed the topic in debate-style format at the 2015 Triological Society Combined Sections Meeting.

When to Use In-Office Balloon Sinuplasty

Subinoy Das, MD, a head and neck surgeon at Ohio ENT & Allergy in Columbus, said that technology has helped reduce morbidity in sinus surgery, once considered to be the “most dangerous” procedure in otolaryngology, with complication rates in the 30% to 40% range. “As people become comfortable with technology, the complication rate really goes down significantly,” he added. New technologies should be studied and vetted, but “when they are helpful to our patients, we should celebrate that.”

In patients for whom general anesthesia is risky, such as pregnant women or those with high bleeding risks, in-office balloon sinuplasty should be strongly considered, said Dr. Das, who disclosed that he has received speaking fees from Acclarent, which manufactures balloon sinuplasty devices.

He stressed that the procedure should not get a black eye simply because unscrupulous physicians might use it inappropriately. “There are immoral surgeons using in-office balloon for personal gain,” he said. It’s a case of “supplier-induced demand,” he said, presenting figures from a 2013

MarketScan report showing that 1.1% of surgeons perform 21% of all balloon sinuplasties. “My take home point is not to blame a piece of technology for the immoral actions of unethical surgeons,” he said.

Abtin Tabaee, MD, director of rhinology and endoscopic sinus surgery at Mount Sinai Beth Israel Medical Center in New York City, recommended a balanced, evidence-based approach to the use of in-office balloon sinuplasty. One of the primary concerns of overuse of the technology has to do with the very high reimbursement rate potentially leading to patients

undergoing the procedure when they either do not need any surgical procedure, or ultimately need a formal ESS in the operating room. “There has been a significant increase in the number of office balloon procedures being performed in the community without any associated increase in the incidence of chronic sinusitis,” said Dr. Tabaee.

“It’s neither right nor wrong, but we need to understand it better,” so that it can be applied in the correct situations, he said. He reviewed a number of well-performed research studies that support its safety and effectiveness, but cautioned that there has been “heavy industry involvement” in the current literature on the subject. Future, independent studies are necessary to determine its indications, safety and outcomes.