By Dr. Anita Krishnan,
Consultant ENT and Balloon Sinuplasty Surgeon
Nova Specialty Surgery, Bangalore
Chronic sinusitis or rhinosinusitis is a condition that affects more than 37 million people in the USA annually. Of the 37 million who have an episode of sinusitis, almost 900,000 patients are not successfully treated. About 7 million patients seek prescriptions, 1.4 million fail medication annually. Only 35% of these patients undergo surgery. The statistics in India is even worse with almost 134 million people suffering from chronic rhinosinusitis, which is like one in eight of us do not have a healthy sinus. The number of affected persons is more in the metros like Bangalore, Mumbai, Delhi etc. thanks to the higher levels of pollution and lesser green spaces and fresh air.
Each of us has four types of sinuses on each side of the face. These are hollow cavities around your cheek bones and eyes. The cavities are covered with a mucus layer and cells that contain a lining of cilia or tiny hair. These work on trapping and pushing out the bacteria and pollutants that enter the cavities. Each sinus has an opening, through which accumulated mucus can drain. A properly draining sinus is a healthy sinus; and when this drainage is blocked, mucus buildup starts to occur. Due to allergic reactions, improper drainage, microbial infections etc. many people suffer from accumulated mucus and/or inflammation of the membrane in their sinuses, which results in chronic sinusitis or for some as acute sinusitis, flaring up only when they have a bad infection. The function of the normal sinuses is to help in cleaning up the air we breathe much like the filter in a carburator for the automobiles.
You would be surprised to know that of the 37 million who have an episode of sinusitis; almost 900,000 patients are not successfully treated. About 7 million patients seek prescriptions, 1.4 million fail medication annually. Only 35% of these patients undergo surgery. Studies show that rhinosinusitis is more common in patients who already suffer from heart disease or asthma.
When a patient comes in with sinusitis, the first course of treatment is usually medication. Most often the prescription will be for antibiotics, often coupled with nasal steroid sprays, depending on the severity of the infection. These help to reduce the mucosal swelling, and also fight infection and help to remove the obstruction of the sinus openings, thus enabling drainage to happen. Very often doctors advise patients to use steam inhalation and/or saline nasal sprays or drops to relive the discomfort and aid in opening up the sinuses and nasal passages. Though most patients will respond positively to these measures, and recover adequately from their infection, about 20% of patients do not respond adequately. These are the ones who will need more help and extra measures to help them recover. The next step is invariably surgical consults.
The most prevalent surgical procedure used for sinus surgery is Functional Endoscopic Sinus Surgery (FESS). However, although FESS is able to clear blocked sinuses and restore drainage it may not necessarily return normal functioning to the sinuses, the removal of the bone and tissue also leads to scarring, bleeding and post operative discomfort to the patient. . After almost two decades of FESS the recurrence and revision rates of about 18% (United States statistics) made the surgeons wonder as to what could be going wrong. Further research identified that the uncinate process and its mucociliary mechanism which is routinely removed in FESS is required for a functioning sinus and also a wide open cavity means less nitric oxide concentration in the sinuses which has bactericidal properties. Also, if a patient has an atypical anatomy, this method is more difficult to use. This is where technology has brought in an even better solution – Balloon Sinuplasty.
Balloon Sinuplasty Technology
Balloon Sinuplasty is the fruit of combining endoscopic techniques with new or emerging technology. It has been in use for more than 7 years with over 6,800 surgeons trained in BSPTM and over 200,070 patients treated and 600,210 sinusotomies performed in the United States.
The technique uses a small, flexible, sinus balloon catheter, which is placed into the nose to reach the sinuses. This is gradually inflated to gently restructure the previously blocked nasal passage, maintaining the integrity of the sinus lining and restoring normal sinus drainage and function. It’s advantages over conventional surgery are many.
- It is safe and effective – research shows that it’s much less riskier than other surgical methods in relieving sinusitis symptoms. Published data in leading ENT journals show that study participants experienced no adverse events and received significant relief from their symptoms at multi-year follow-up.
- Minimally invasive and Patient Friendly – It is less invasive, there is less trauma, less pain, less recovery time (just 24 hours for most patients), less scarring and less follow-up procedures. There is minimal bleeding, and many patients have been able to return to normal activities within 24 hours.
- Does Not Limit Treatment Options – It can safely be used in tandem with other medical therapies or sinus surgery techniques; it does not limit future treatment options.
- Can be used by special case patients – like those who are prone to excessive bleeding or those in the ICU.
It is essential that sinusitis be treated as early as possible. This will ensure than it will not develop into a chronic, and debilitating condition; and will also serve to protect against other complications from arising. Treating early also means that the patient will be able to get relief from simpler measures like medications or Balloon Sinuplasty, and can avoid more radical and invasive measures. Clinical research proves that the Balloon Sinuplasty method of surgically addressing chronic rhinosinusitis is a proven, minimally invasive option for dilating blocked sinuses.