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Balloon sinuplasty

Posted Oct 28 2008 9:46pm
Checking out the news online today, I couldn't help noticing a little anatomy in the headlines: A balloon instead of a knife: Sinuplasty for ailing sinuses. Here are the first few paragraphs:
It's like an angioplasty to clear out clogged sinuses. A new procedure lets doctors snake a balloon up the noses of chronic sinusitis sufferers, stretching their sinus passages to help them breathe easier with less pain than the standard sinus surgery that 350,000 Americans undergo each year.

No one yet knows if balloon sinuplasty works as well as a surgical fix. Only about 100 doctors around the country are trained to offer it, and research is just beginning to track its effectiveness and determine who is a good candidate.

But if sinuplasty proves itself, it promises a long-awaited middle ground between medications and surgery for thousands of patients seeking relief from the misery of repeated sinus infections.

The accompanying graphic (see below) shows the slender balloon entering a frontal sinus, which is located just above each eye. We also possess a more voluminous maxillary sinus just below each eye, a series of small ethmoidal sinuses between the eyes (not shown here), and a sphenoidal sinus just behind the ethmoidal sinuses (also not shown).

All of these paranasal sinuses are basically air-filled holes in the skull, each one connected via a tiny passageway to the nasal cavity. Each sinus is lined with a wall-to-wall carpet of two major cell types: one cell type that makes mucus that traps bacteria and other unwanted particles, and another cell type with little hair-like projections called cilia that dutifully whisk the mucus towards the nasal cavity.

Unfortunately, those tiny passageways that allow fluid from the sinuses to drain into the nasal cavities really are tiny. Tiny enough that they're very hard to find in cadavers in the gross anatomy lab. Tiny enough that they can easily become blocked when their their walls swell in response to infection or allergens (i.e., inflammation). Add excess mucus production and you have a recipe for sinusitis.

At first glance, performing a "balloon sinuplasty" makes sense: if the drain keeps getting clogged, make the drain a little bigger. But does the drain remain bigger for long? We'll see. Data from a clinical trial involving more than 100 patients should be out later this year. If the results are disappointing, maybe someone should look into developing the next logical step: a sinu- stent. In the meantime, if you have sinusitis and you're thinking about balloon sinuplasty, you might also want to consider another "middle ground between medications and surgery" that the article doesn't mention: nasal irrigation.
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