Sinus Infection Treatment

When is balloon sinuplasty preferred over nasal sinus surgery?

by Murray Grossan, M.D.

Seems that more persons have heard about this procedure than about Superman’s Return.

Essentially the procedure is used to open the ostia (opening of the sinus cavity). Some of these ostia have become closed or reduced by repeated infections or swelling. Some have become narrowed by extra bone being laid down.

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Once the ostia is narrowed or closed, a warm humid environment is created for bacteria growth. Cilia are unable to move the bacteria out of the sinus cavity – therefore they multiply. Because of the closure, there are two factors that create pain: the pressure built up by inflammation and fluid material, and the vacuum pressure created by the closure. The vacuum comes from the fact that the oxygen in the cavity is absorbed, so that the inside pressure is 10 pounds, and outside atmospheric pressure is 15 pounds. It’s like having a 5-pound weight on your eye. This vacuum pressure is often much more painful than a bacterial infection.

Once the closed sinus is reopened, healing can take place, even in a badly diseased sinus cavity. The pressures are equalized; the bacteria can be swept out by the cilia.

One method of opening the closed sinus is to enlarge the opening. This is fairly easy to do by using instruments to punch out the opening. This would be like using a chisel to enlarge a wooden doorway.

The balloon method is to place a balloon into the opening and enlarge it. This enlargement pushes the tissue aside gently and is supposed to be less traumatic than the surgical method. The proponents claim there is less chance for re-closure to take place. The technique is too new to know about the permanence.

For the maxillary sinus, or the sphenoid, the techniques for enlarging the openings seem adequate.

For the Frontal Sinus, the balloon method has distinct advantages. This opening is long and tortuous, and simply punching holes to get it open is not easy.

With the Balloon method, a wire stylet is placed through the natural opening. Sometimes you need that just to find the opening. This maneuver is guided by Fluoroscopy, in order to place the guide wire correctly. Once the wire is known to be placed correctly, a flattened balloon is guided over the wire, until it is at the natural opening, and then it is inflated. This inflation pushes aside the blockage, gets air into the closed cavity, and gets the bacteria out.

This method is similar to the method used to open blocked arteries and veins.

Dr Martin Hopp at Tower ENT is pleased with the results he has obtained for Frontal Sinus Disease. The procedure is followed by Pulsatile Irrigation in order to clear disease and to help maintain the opening.

One caveat is that rarely is a single sinus involved in disease. Often the ethmoids may be involved in addition to the frontal or maxillary, so diligent post –op care is necessary, hence the regime of pulsatile irrigation.

Pulsatile irrigation is also tried before sinus surgery of any sort in order to restore nasal cilia function, remove thick mucus that may be blocking the sinus, and reduce edema/swelling that may be a blocking factor. Only when this are other non – surgical techniques fail is surgery recommended.

Dr Murray Grossan's website may be found at Hydromedonline.com

First Published: December 2006
Updated: April 2007

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