Sinuplasty is a unique surgical technique using balloons to open the natural pathways of your sinuses. This procedure is less invasive than traditional sinus surgery. By opening the sinuses, the goal is to clear the obstructed passages with little damage to the surrounding tissue. By only enlarging the natural pathways, the healing process is quicker, and there is significantly less postoperative pain. The second goal is to use a minimally invasive technique that allows the procedure to be done in the office under topical anesthesia avoiding the cost of a surgery center, the need for a driver, and thus eliminating the need for narcotic pain medications. Recovery occurs typically within 24 hours.
Balloon sinuplasty is not for everyone or every sinus condition. The decision can only be made after you discuss this with me and we agree this is the best or the first alternative in lieu of traditional functional endoscopic sinus surgery, FESS. Balloon sinuplasty has more than a ten-year history of being performed in the United States with a successful track record and is not considered an experimental procedure.
Balloon sinuplasty risks are the same as any sinus surgery. Though these risks are very uncommon, they are certainly not zero. Discussing these risks with you before the procedure is essential.
Before the procedure
I will schedule your procedure for an hour and a half in the office. The procedure takes about 30 minutes; however, I will spend considerable time making sure you will not experience pain. I will decongest your nose for approximately 45 minutes and administer local anesthesia so you will remain comfortable throughout the visit.
Since the anesthetic is so effective, I can perform in-office sinus surgery as I would offer in the hospital operating room. Our office is equipped with a state of the art CT scanner that provides high-quality images while minimizing the radiation dose to a patient. Typically we use 80 percent less radiation than a standard CT scanner which makes this ideal for children. The CT takes less than a minute and I immediate review the results with you.
Image Guided Sinus Surgery is also an option if needed. Using downloaded images from our CT scanner, I visually navigate and operate in the office as I would in the operating room. Image-guided surgery (IGS) is the use of a real-time correlation of the operative field to a preoperative image that reflects the precise location of a selected surgical instrument to the surrounding anatomic structures. Although first developed for neurosurgery, ENTs use the navigation system for sinus surgery to increase safety and accuracy in the operating room. We offer the same quality treatment in our office.
The In-office Procedure
On the day of the procedure, you are welcome to bring music or any activity, such as knitting, video games, or puzzles to occupy your time while the anesthesia is taking effect. Premedication with antianxiety or pain medication is not prescribed or recommended. It is nice to bring a family member or friend, although it is not necessary since the procedure is performed under local.
After consenting you for the procedure, I start by decongesting your nose with Afrin (oxymetazoline hydrochloride 0.05%) spray. After five minutes, I spray a 50/50 mixture of Afrin and 4% topical lidocaine.
I place two pledgets, sponges for the nose, soaked in the 50/50 mixture of Afrin and 4% topical lidocaine, in the nose for several minutes for the medication to take effect. If the decongestion is adequate, I place 0.25% topical tetracaine gel in the nose. This gel provides additional anesthesia. I reapply or replace the 50/50 mixture of Afrin and topical lidocaine pledgets in the nose and wait for another 5 minutes for the medication to take effect.
Approximately 5 minutes later, I remove the pledgets and inject 1% lidocaine with 1:200,000 epinephrine in the sinus cavity. You will not feel the injection. The “medicine” may drip down the back of your throat and may cause a numb sensation. It is important to understand that even though your throat maybe numb, you can swallow and breathe perfectly normal.
During the procedure, I maintain constant communication with you. I use the video monitor showing the endoscopic procedure to explain what I am doing surgically to you and any family members in the room. I will tell you what I am doing throughout the entire procedure and what to expect before proceeding. For example, I inform you about feelings, sensations, noises, and tastes you may have at each step of the procedure. I create a relaxed and comfortable atmosphere by reinforcing and informing you and your family as I am operating.
After the procedure
You will experience some light bleeding that may last up to three days. There will be some nasal congestion and crusting that can last up to three weeks. It is essential postoperatively you start hypertonic nasal irrigation using the Neil-med saline rinse bottle which we provide or the saline rinse of your choice. Please follow the instructions from the package insert, including using distilled water and the pre-mix saline packages. The sinus rinse will help clear the sinuses of dried mucus and permit you to heal faster. I recommend irrigating at least twice a day.
You may have a mild headache following the procedure that evening. A headache is typically resolved or minimal by the next day. Non-aspirin or non-Motrin medications are recommended, such as Tylenol, to be used as directed by weight. You may eat or drink anything you want after the procedure. You may sleep in any position; however, sleeping with your head elevated always improves nasal breathing
To reduce any potential bleeding, I recommend you do not blow your nose for approximately 48 hours. You may use Afrin or Neo-Synephrine sparingly for the first two days. This may help you breathe better and will also reduce any mucosal bleeding.
Patients return to their regular daily activity the next day. I asked that you do not do any extreme exercising or heavy lifting, but normal exercising can be resumed. Patients do exceptionally well with this procedure. It has been my experience that patients are pleased following balloon sinuplasty. It improves their chronic sinus infections, sinus pressure, headaches and nasal congestion and typically enhances their ability to breathe through their nose.