Balloon Sinuplasty & Novel Surgery for Nasal Polyps
Balloon Sinuplasty
Symptoms associated with chronic sinusitis can be extremely debilitating and are frequently difficult to control with medications alone. In addition, episodes of sinusitis can recur several times leading to reduced quality of life. Your GP may decide to refer you to an Ear, Nose and Throat (ENT) specialist for further advice and/or treatment. This may involve further medication therapy or surgery to open the sinus drainage pathways.
If you have been diagnosed with chronic sinusitis and are not responding well to medical treatments, you may be a candidate for surgery. Conventional surgery involves removal of the diseased tissue within the sinuses. Inevitably there are risks associated with this procedure particularly owing to how close the sinuses are situated to the eyes and brain.
Balloon Sinuplasty™ technology, developed by Acclarent, is an endoscopic, catheter-based system for patients suffering from sinusitis. The technology, cleared by the FDA in America, uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways, restoring normal sinus drainage. When the sinus balloon is inflated, it gently restructures and widens the walls of the passageway while maintaining the integrity of the sinus lining.
In over 100,000 operations worldwide, the rate of severe adverse events or complications has been shown to be almost zero, and several times lower than for conventional surgery.
If you are suffering from chronic sinusitis and are interested in discussing this procedure in more detail, please contact us.
Novel surgery for nasal polyps
Approximately 1-2% of the population have nasal polyps, with an additional 10000-20000 developing polyps per year.
A nasal polyp is an abnormal growth of tissue projecting
from a mucous membrane. They form due to inflammation in the nose or sinuses, which causes fluid to build up in the cells there. Over time, as gravity pulls on these fluid-filled cells, they can develop into polyps.
They are shaped like teardrops as they grow and look like
grapes on a stem when fully grown. Polyps grow on their own or in clusters and usually affect both nostrils.
It is uncertain what causes this inflammation, but likely
triggers are a bacterial or viral infection, an allergy or an immune system response to a fungus. Some conditions cause nose or sinus inflammation and make it more likely for polyps to form. These include asthma that starts in
adulthood (up to 40 per cent of people with nasal polyps
also have asthma), hayfever and a blocked nose.
Many problems can present themselves caused by polyps, such as headaches, double vision, no sense of smell and taste,breathing and nose problems such as feeling like it is always blocked and running, as if the sufferer has a permanent cold. Because of this many people with polyps have trouble sleeping and might find that they start to snore loudly when they do fall asleep.
Diagnosis is by a CT scan, which uses X-rays and a computer to create detailed images of the inside of your body. This will find out the size and location of any polyps.
Initially a steroid nasal spray, drops or tablets might work as steroids reduce inflammation. It can take several weeks of treatment before any visible improvement is noticed. But if this does not work a patient will require surgery known as a polypectomy under general anaesthetic to remove the polyps.
Using an endoscope – a thin tube that contains a video
camera – to see inside the nose and sinuses, small
surgical instruments are inserted into the nostrils to
remove the polyps. In some cases, small pieces of bone are removed from the nose to reduce the chances of the polyps returning.
It is not as painful as it sounds as polyps have no nerve
endings, but owing to the close proximity of the eyes and brain to the sinuses and polyps, complications can occur.
After the surgery, patients occasionally need dressings or packs inserted into the nose although advancing surgical techniques means that this is becoming less common. In general patients will be able to go home the same day.
However, in approximately three out of four people who have surgery, the polyps grow back after an average of four years.
A new method, known as the ethmoid Stratus Spacer, has been developed by Acclarent and was first used in America last year, having only been in the UK in the last six months. It is usually performed in conjunction with another relatively new procedure, balloon sinuplasty in which the sinus is enlarged
by having a tiny balloon inflated inside. With this
increased space it is then possible to use the new
technique, which involves having a device containing steroid inserted into the ethmoid sinus. The device has multiple fine pores which allow the steroid to seep into the surrounding tissues, causing the polyps to shrink. This lasts for about 4 weeks.
It is based on the principle that steroids reduce
inflammation and so shrink the polyps down. Most patients
will take steroids in the form of a spray or drops in the
nostrils before and after the operation to help firstly
reduce the polyps and then to keep them away. The new operation achieves this on its own, but the additional
steroids are to make undoubtedly sure. The injected steroid during the operation has a slow release and so will continue to work for six weeks by which time the polyps should be gone.
What advantages does it have over conventional surgery?
The new technique is usually conducted in association with either the balloon sinuplasty method or conventional surgery. One advantage is that the procedure is low risk. At present it is not widely available on the NHS (for reasons of cost) but in time the technique will probably gain wider acceptance as has occurred with the balloon sinuplasty.
At present many patients still have some polyps removed by the conventional method as frequently polyps in the nose need to be cleared first to make way in order for the new device to get inside and reach the sinus.
Whilst in theory risks can still occur with the new technique, it is thought to be a safer technique than the traditional one although this is yet to be formally proven.
With the combined surgery for nasal polyps – which typically takes 45-60 minutes and is performed under general anaesthetic – patients feel
better immediately, with a near 100 per cent improvement
which is one of the real strengths as most operations do not have such a positive effect so quickly.
The ideal patient for the combined procedure is someone with longstanding chronic problems of nasal block, sinus congestion and an inability to smell or taste due to extensive nasal polyps.
If you are suffering from chronic sinusitis and are interested in discussing this procedure in more detail, please contact us.