Balloon Sinuplasty

Since the Federal Drug Administration (FDA) approval for nasal sinus use in 2005, balloon sinuplasty (BSP) has continued to grow in popularity among otolaryngologists as a minimally invasive way to treat patients suffering from chronic rhinosinusitis (CRS). The idea of using balloon dilation to open an anatomic structure is not a new concept, as cardiac surgeons have used similar techniques in coronary arteries since the late 1970s. In the late 1990s, some otolaryngologists were attempting to use 5-7 french Fogarty catheters to preserve the patency of nasal ostia. This technique offers the ability to dilate sinus ostia and outflow tracts via local microfracture - without destroying the overlying mucosa and maintaining physiologic function. The goal of BSP is to allow for improved mucociliary clearance by minimizing obstruction of the outflow tracts, thus causing symptomatic improvement in patients suffering from CRS.

The description of chronic rhinosinusitis in the literature as the inflammation of nasal mucosa and the surrounding sinuses lasting more than 12 weeks. Patients describe a myriad of symptoms, including congestion, rhinorrhea, facial pressure, hyposmia, but most commonly, nasal obstruction. This condition's etiology is not fully understood, and multiple studies point to various causes, including biofilms, bacterial antigens, fungal infections, or immune dysfunction, among others. The disease is currently broken down into two distinct subgroups: CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP). Approximations are that over 31 million people suffer from CRS, and although medical management is the mainstay treatment in these patients, the literature notes an increasing number of surgical cases. From 2006 to 2011, estimates were that 1 in 3.7 patients with CRS underwent a sinus surgery for treatment. Upwards of 300000 patients elect for sinus surgery annually, which include BSP, functional endoscopic sinus surgery (FESS), or a mix of both called a “hybrid” procedure.

Recently, there has been a push to perform BSP under local sedation in an in-office setting, which avoids the use of general anesthesia in patients with concomitant comorbidities and provides cost savings to the patient and the physician. Holy et al. described that the ratio of sinus surgery per 100,000 patients had remained constant between 2006 and 2011. However, they did note a 7% increase in BSP only procedures during that time frame. One study, which used the Center for Medicare and Medicaid Database, looked at billing codes to compare the number of specific sinus procedures performed from 2012 to 2016. The number of balloon only procedures jumped from 5603 to 25640 in that timeframe. This study found that in-office BSP served as the major reason for this jump in treatment numbers. With the application of in-office BSP, concerns exist regarding the possibility of overutilization of the procedure due to its variety of proposed indications, which this activity will discuss later. In one retrospective cohort study, the authors used one of the largest commercial health insurance program’s database. They noted that 86.53% of BSP procedures studied took place in an in-office setting. With the recent increase in popularity of BSP procedures and the ease of availability in an in-office setting, the authors of this paper hope to provide a general overview of balloon sinuplasty for physicians, healthcare providers, and patients alike.