Surgical Approaches to Sinus Disease: The Debate Continues

Dr. Setzen said that balloon technology is a valuable option for sinus surgeons. It’s minimally invasive, it’s safe and effective, and it can be used in conjunction with traditional endoscopic procedures, he noted.

Indications and Contraindications for Balloon Technology

Frederick Kuhn, MD, founder of the Georgia Nasal and Sinus Institute in Savannah, sang the praises of balloon technology, not only how well it works but how it allows for anatomy to be preserved.

The nasal and sinus anatomy and physiology are a really very elegant design, Dr. Kuhn said. We did not design them, and therefore we really do not have free license to destroy the anatomy or function just because we’re able to.

He said he would be inclined to use balloons in primary surgery of patients without polyps; those with moderate disease; those with isolated frontal, maxillary, and sphenoid disease; those with difficult frontal sinusitis; intensive care patients with acute sinusitis; and those with acute frontal sinusitis.

A case in which balloons should not be used, he illustrated, involved a female patient with relatively moderate disease, who got worse after six weeks on antibiotics, then improved after three weeks on prednisone and antibiotics, but became worse again when that treatment was stopped. She was diagnosed with probable chronic eosinophilic sinusitis. A balloon would not work in such a case because it would not address the inflammation, Dr. Kuhn said.

He also presented a case in which a balloon probably should have been used. The patient had no ethmoid disease and no right maxillary sinus disease, only left maxillary sinus disease. The patient, who had a history of pneumonia, was told she needed endoscopic surgery or she would develop pneumonia again within three months. But after the surgery, she suffered severe skull base osteoneogenesis, the left uncinate process was still in place, and she still had maxillary sinus disease.

It’s very clear to me that a left maxillary sinus balloon with extensive sinus irrigation probably would have sufficed for her treatment and protected her from all of the other unnecessary surgery she had, Dr. Kuhn said.

He also mentioned the case of a 76-year-old male with a history of chronic frontal sinusitis. He was treated medically and his condition improved, but three months later it had become worse. Had we done functional endoscopic sinus surgery, it would have required a septoplasty plus an ethmoidectomy in order to perform the frontal sinustomy, Dr. Kuhn said.