Sinusitis :: New, minimally invasive surgery to treat sinusitis

If drug therapy can’t open blocked sinuses, sufferers now have a novel option. Mayo Clinic ear, nose and throat (ENT) surgeons have taken a page from the book of cardiology in performing a new, outpatient procedure to alleviate acute or chronic symptoms of sinusitis, an inflammation of the sinus cavities usually due to an infection.

They have adapted the angioplasty technique long used to open clogged arteries to help clear the sinuses. The procedure, called balloon sinuplasty, is a minimally invasive solution to the more radical sinus surgery in patients who need more than medicine, says Mayo Clinic otolaryngologist Christopher Garvey, M.D. “It’s innovative. To use this technology in the sinuses is brilliant in a simple way.”

Using the balloon sinuplasty technique, and with the patient under general anesthesia, Garvey inserts a special catheter and guidewire through the patient’s nostril and into the targeted sinus. Under x-ray guidance, Garvey then advances a small, flexible, balloon over the wire to the sinus opening. The balloon is inflated with fluid to a specific pressure. As the balloon expands it causes tiny fractures in the bony opening of the sinus. This enlarges the opening, allowing the sinus to drain normally again. Garvey removes the catheter, guidewire and balloon and may repeat the process again on other blocked sinuses.

Patients recover and typically go home the same day. They may experience immediate symptom relief and resume normal activities within 24 hours.

Individuals have four pairs of sinuses in the skull. Mucus drains from these hollow spaces into the nasal cavity. Sometimes, the linings of the sinuses become inflamed due to a viral or bacterial infection or sometimes, an underlying autoimmune disorder. The sinus openings become blocked, preventing normal drainage of mucus. This leads to symptoms of pain and discomfort for about 30 million Americans each year. A single episode is called acute sinusitis; one that persists longer than about three months is called chronic sinusitis.

If treating the condition with medications fails, doctors may recommend surgery to enlarge the sinus passages. Using a miniaturized camera to see into the sinuses and special, miniature tools, the ENT surgeon will cut away bone and other tissue to open the blocked sinus. This can lead to scarring, which may in time block the sinus opening again. The balloon sinuplasty procedure, however, causes less bleeding, tissue trauma and post operative pain than commonly performed endoscopic surgery.

Garvey selects candidates for the procedure on a case by case basis, and he may combine balloon sinuplasty with customary endoscopic techniques. “Sometimes you do need to remove some of the tissue,” he says. “If the patient has nasal polyps, they have to be removed, and when opening up the inlet into the frontal sinus, there will be some bony fragments that need to be removed. Still, it’s less surgery, less trauma to that tissue and less scarring afterwards.”

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