Curtis Nobles was having a hard time breathing.
“Sometimes, I’d be walking to work, and I’d have to stop to catch my breath,” said the 61-year-old chef at the University at Albany.
Nobles has sinusitis, one of the most common chronic health problems in the United States today, affecting some 37 million Americans each year. Patients suffer headaches, facial pain, congestion, fatigue and other symptoms.
Until recently, sinusitis patients were limited to two treatment options: medical therapy such as antibiotics, topical nasal steroids and allergy management; or conventional sinus surgery such as Functional Endoscopic Sinus Surgery.
Medical therapy can help alleviate symptoms for 75 percent to 80 percent of patients but is inadequate for the rest. For the latter cases, sinus surgery is often the best option, requiring bone and tissue removal to open up blocked sinus passageways.
Now. there is an evolution in endoscopic sinus surgery with balloon sinuplasty.
“Basically, balloon sinuplasty is a new technique that complements existing or standard endoscopic sinus surgery,” explained Dr. Gavin Setzen, an ear, nose and throat specialist with Albany ENT & Allergy Services in Albany, and one of the first physicians in the Capital Region to use the procedure.
Hailed as the middle ground between medication and surgery, balloon sinuplasty is an outpatient surgery done under general anesthesia.
Doctors begin by threading a guide wire catheter into the nostrils and up into the blockage. The catheter is equipped with a tiny balloon that is inflated to about a quarter of an inch once inside the passage. The balloon is inflated just enough to open the passageway. Once the passageway is open, the balloon is deflated and withdrawn.
“For some patients, depending on the nature of the chronic sinusitis, you can access certain sinus cavities more easily, more safely and less invasively with the balloon sinuplasty device,” said Setzen.
The positive side to balloon sinuplasty is that there are no incisions or cutting and, therefore, no bruising or swelling. Instead of cutting, the balloon fractures the soft bones and spreads them apart, allowing the sinuses to be drained.
“Certainly, it’s not a procedure that will replace traditional endoscopic surgery,” said Setzen. “It all depends on the nature of the sinus disease and the extent of the sinus involvement.”
The frontal sinus is particularly challenging to ear, nose and throat surgeons, said Setzen.
“The advantage with this technique is that you can, in a minimally invasive fashion, approach that sinus and dilate the sinus opening in an attempt to restore more normal drainage,” said Setzen. “And the potential risks associated with balloon sinuplasty for the frontal sinus compared with traditional surgery, where one is removing bone or soft tissue, are substantially less.”
Balloon sinuplasty opens sinus cavities the same way doctors open clogged arteries when they do a balloon angioplasty, said Setzen.
“You’re basically widening and stretching the opening that has closed down to restore normal flow or draining,” said Setzen.
Depending on which sinus the physician is working on, the process takes from two to 10 minutes.
“It’s quite fast assuming the catheter passes easily,” said Setzen. “Once you dilate the sinus, you can draw back fluid and do a culture to see what kind of organism or bacteria might be in there, flush out and irrigate that sinus, or introduce antibiotic solutions if you need to.”
Setzen said the number of doctors around the country being trained to perform balloon sinuplasty is increasing.
Balloon sinuplasty can also be done in conjunction with regular sinuplasty sinus surgery.
“For the most part, it allows for a faster healing, potentially less bleeding and less scar formation,” said Setzen.
“Generally speaking there are very limited risks. Bleeding, infection and scar formation have not been shown to be a significant problem.”
While it’s too early to know if the procedure will need to be repeated in some patients, Setzen said if their underlying allergy problems are addressed, it is less likely.
So far, Setzen has used balloon sinuplasty on six patients.
Used as complement
“For a limited number of patients, balloon sinuplasty alone might offer relief without any more extensive surgery,” said Setzen. “But I think for the most part, it will be used as a complement to traditional sinus surgery.”
Nobles had been suffering for about six years when he had balloon sinuplasty last September. He also had polyps removed through traditional endoscopic surgery at the same time.
“After the surgery, it was like night and day,” said Nobles, who is also being treated for allergies. “I could breathe again. All my problems were solved.”
Nobles’ wife, Diane, was also relieved now that her husband, who also had sleep apnea, has stopped snoring.
“At last I can sleep again,” she said with a laugh.
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