Balloon Sinuplasty: Everything You Need to Know

Balloon sinuplasty is a relatively newer procedure that treats difficult cases of sinusitis (sinus infection), which is inflammation of the sinuses leading to severe nasal congestion, pain and pressure in the face, headache, sore throat, and excessive mucus, among other symptoms.

Sometimes these infections resolve on their own, and medications are typically attempted as treatment first; however, if these don’t resolve the issue, this procedure may be indicated in select patients.

Unlike many other surgeries, balloon sinuplasty doesn’t require any incisions. Basically, it relies on the use of a special balloon that’s inserted into the problem area and is inflated to essentially open up the drainage pathway or outflow tract of the sinuses. Following this procedure, patients can go home the same day, and this technique is well-tolerated with minimal recovery.

That said, if you’re considering this treatment, it’s important to understand as much as you can about what it is, how it works, how to prepare, as well as the outlook afterward.

What Is Balloon Sinuplasty?

This procedure is performed using minimally-invasive techniques in an operating room, so, barring complications, you won’t need to spend a night in the hospital. A scheduled, rather than emergency procedure, balloon sinuplasty is usually done while you’re asleep on general anesthesia, though sometimes it’s performed using local anesthetic drugs.

It doesn’t rely on incisions to access the affected area; rather, an endoscope—a specialized, adjustable tube with a camera at the end, is run through a nostril to the sinus. Using this imagery to guide the work, a special, surgical balloon is positioned in the affected area and inflated to open up the sinuses. The balloon is then carefully removed.

Contraindications

As with all procedures, there are some contraindications to balloon sinuplasty a poor. These contraindications include:

• Sinusitis with nasal polyposis: There are two predominant types of sinusitis, and in one form—sinusitis with nasal polyposis—the inflammation causes noncancerous growths called polyps to form. While surgical approaches for these do exist, balloon sinuplasty will not be effective.
• Problems within ethmoid sinuses: Many of the sinuses (openings) in the skull are formed by a complicated, unpaired bone called the ethmoid bone. When blockages and inflammation occur within this bone, the procedure will likely not be effective.
• Symptoms without chronic sinusitis: If the source of headache, facial pain, or other discomfort is found not to be related to chronic sinusitis, other treatments will be considered.
• Asymptomatic patients: An absence of severe sinusitis symptoms can also contraindicate this surgery, which is typically reserved for more severe and chronic cases. Alternately, symptoms in absence of a confirmed sinusitis will also call for alternative treatments.
• Allergic fungal sinusitis: This form of sinus inflammation occurs due to allergic reactions to airborne funguses, as opposed to bacterial infection. While treatments are available for it, balloon sinuplasty is not expected to be successful.
• Cystic fibrosis: Patients with this genetic disorder, which affects the lungs and digestive tract, may experience sinusitis symptoms. Taking on this issue requires treatments that target the cystic fibrosis, itself.
• Cancer: When the polyps in the sinuses are cancerous, other treatments are necessary.

Potential Risks

One of the primary benefits of balloon sinuplasty is that it’s a safe procedure and complications are relatively rare. There are, however, a couple of potential risks associated:

• Acute bacterial sinusitis, infection of the sinuses by bacteria
• Excessive bleeding in the affected area
• Affected vision, often due to orbital fracture, in which the bone that holds the eye is broken
• Cerebrospinal fluid leak, in which accidental damage to bone leads to leaking of brain and spine fluids
• Tooth and facial numbness due to nerve damage in the face
• Changes in sense of smell and taste as a result of the procedure
• Injury to the walls of the eye socket or contents of the eye socket

Purpose of Balloon Sinuplasty

As mentioned, the purpose of this procedure is to take on cases of chronic sinusitis—a form of the disease in which symptoms don’t resolve after 12 weeks—that arise without polyps, clinically called “chronic rhinosinusitis without nasal polyposis (CRSsNP)."

Typically, other means of treatment are attempted first, such as the prescription of antibiotics along with steroids. If these other methods don’t yield results, then balloon sinuplasty will be considered.

As with any surgical procedure, proper diagnosis is essential prior to balloon sinuplasty. In particular, your healthcare provider needs to make sure your sinusitis would actually from this treatment as opposed to others. What sorts of tests are needed? Though not all may be applied to every patient, here’s a quick breakdown:

• Fiberoptic nasal endoscopy: This procedure involves running an endoscope through the nostrils to the affected sinuses. The camera at the end transmits high-resolution images allowing medical professionals to assess the extent and causes of sinusitis. 
• Sample testing: To confirm a bacterial infection (as opposed to other reasons for sinus issues), your healthcare provider may draw a sample of mucus or tissue. This sample is tested for the presence of bacteria.
• Allergy testing: For cases of chronic sinusitis suspected to be related to allergies, patients may undergo a panel of blood tests looking for elevated antibody levels. Higher amounts here indicate an allergic reaction.
• Computerized tomography (CT) scan: Imaging will help confirm the diagnosis. This allows the specialists to get a fuller sense of the scope of the infection, as well as the relevant facial anatomy. CT scans employ multiple X-rays to formulate an interactive, 3-D image of the affected area.

How to Prepare

As with all surgeries, but especially those that require general anesthesia, there’s a good deal that goes into preparation for balloon sinuplasty. Making sure that you and your body are ready for this treatment is absolutely essential for success.

This means understanding everything from where the treatment takes place, to what you can do beforehand to ensure success. In the run-up to surgery, you’ll get specific guidelines from your healthcare provider; follow these steps carefully, and be sure to ask any questions you may have.

Location

Balloon sinuplasty typically happens in the surgery ward of a hospital, though some can be performed in outpatient centers. Regardless of where it’s done, you can expect a consistent set of equipment and machinery in the surgical setting, including:

• Endoscope: An endoscope will be used to provide visual guidance for the healthcare provider. This will transmit imagery to monitors in the surgery room.
• Guide catheter and wires: A catheter—essentially a tube—will be used to guide the endoscope, and eventually position wires used to transport the balloon into position.
• Balloon, balloon catheter, and inflation device: Another catheter is used, along with the wires, to position the surgical balloon in the sinus. A special device will then gently inflate this balloon.
• Irrigation catheter: A catheter is run through the nostril, which drains the area of purulent sputum, which is usually yellow or green mucus that contains pus, parts of cells, and dead tissues and is a sign of infection. 
• Monitoring devices: Since the procedure is performed under general anesthesia, you’ll be hooked to machines monitoring important vital signs, such as heart activity and the level of oxygen in the blood, among others.
• Respirator: If performed under general anesthesia, a respirator will help you breathe.

What to Wear

You likely won’t have to plan for a hospital stay, but there are still some recommendations for what to wear:

• Leave home any and all jewelry and remove any piercings.
• Emphasize comfort when deciding on clothing.
• You may need to change into a hospital gown.

Food and Drink

While there’s no specific pre-procedure diet necessary for balloon sinuplasty, there will be some restrictions to diet in the run-up to this procedure:

• No food for at least the two hours prior to the procedure; you can take small sips of water.
• Skip most beverages for two hours before.
• Abstain from excess alcohol consumption for one week before surgery.

Medications

To help prepare for surgery and help ensure better outcomes, your healthcare provider may prescribe certain medications:

• Ativan (lorazepam), an anti-anxiety drug, may be prescribed to help relax you before the procedure. This should be taken about an hour before the operation.
• Oxymetazoline is a prescribed decongestant, usually a nasal spray, that’s taken the morning of and an hour before treatment.
• Antibiotics are sometimes prescribed to prevent re-infection after treatment; these are taken the day before surgery.
• Anti-inflammatory drugs may also be given to prevent inflammation following the procedure.

Even though this procedure doesn’t involve incisions, there is a risk of bleeding. In the two weeks before balloon sinuplasty, your healthcare provider will tell you to steer clear of certain prescription and over-the-counter drugs, as well as some supplements, such as:

• Nonsteroidal anti-inflammatory drugs (Advil, Motrin, Aleve, etc.)
• Vitamin E
• Fish oil
• Gingko biloba
• Ginseng
• Garlic tablets
• St. John’s wort

If you’re taking blood-thinning medications, such as Coumadin (warfarin) and Plavix (clopidogrel), you’ll need to stop taking the drug just before and for some time after balloon sinuplasty. In the consultations prior to this procedure, you’ll need to give your healthcare provider a full accounting of all drugs and supplements you’re taking.

What to Bring

While an overnight stay in the hospital isn’t required, there are some things you’ll need on the day of your balloon sinuplasty:

• A driver: You won’t be able to drive for some time after the procedure, so make sure to arrange for a family member or friend to drive you home.
• Insurance information: Though it will likely be on file, it’s always a good idea to bring your medical insurance information.
• A list of drugs you’re taking: Bring along a complete list of all prescriptions, over-the-counter drugs, vitamins, supplements, and herbal products that are part of your regimen.

Pre-Op Lifestyle Changes

Before any kind of medical procedure, there are significant lifestyle changes that need to be made. Since balloon sinuplasty doesn’t involve incisions or the removal of any bone or tissue, there won’t be too much you have to do to get ready.

However, there are a couple of things to keep in mind. If you’re a smoker, you’ll need to quit tobacco to prevent the risk of complications. This habit can severely impact recovery from the procedure, so you’ll need to stop at least three weeks before your operation, as well as one month afterward.

What to Expect on the Day of Surgery

Taking place either in a hospital’s surgery ward or an outpatient clinic, balloon sinuplasty is a relatively quick procedure. It typically takes between one and two hours to perform, and you’re usually able to recover at home. A great deal happens in this time, and it’s important to have a sense of what you can expect. 

Before the Procedure

The medical team will need to do a final evaluation and screening before treatment starts in earnest. This includes:

• Pre-operative physical: A quick physical evaluation will be performed, checking important signs like heart rate, blood pressure, and others. Lab blood tests may also be performed. In addition, the healthcare provider or nurse will do a final check on medications and supplements you’re taking.
• Anesthesia consultation: If you’re undergoing general anesthesia, you’ll also be assessed by the anesthesiologist to determine the proper dosage. If you’re opting for localized anesthesia, this will also be delivered before treatment.

Once you’re medically cleared for treatment, you will be brought to the operating room.

During the Procedure

Balloon sinuplasty differentiates itself from comparable surgeries because no tissue or bone is removed to treat the sinusitis. How does this procedure work? Here’s a quick breakdown:

• Anesthesia: A majority of these treatments are performed while under general anesthesia—that is, when you’re put asleep—though localized anesthesia may also be considered.
• Endoscopic guiding: Once you’re ready, the endoscope is moved to position near the affected sinuses through a nostril. With the help of that visual guidance, a guiding thread is also moved into the area.
• Balloon placement and inflation: Using the thread to direct it, the uninflated balloon is carefully put into place. At that point, it’s inflated, which opens up the blocked, inflamed sinuses. This restores normal, healthy function.
• Finishing up: After the balloon is inflated and the sinuses are opened, the endoscope and balloon, as well as all other equipment, are removed.

After the Procedure

Initial recovery from this procedure invol a period of monitoring and observation as the medical team needs to ensure that there are no immediate issues or complications. Here’s what happens before you leave the hospital or clinic:

• In the operating room: If the procedure is performed under general anesthesia, you’ll wake up in the operating room. Once the medical team has confirmed that your condition is stable, you’ll be taken to a recovery room.
• In the recovery room: It takes most patients about two hours in the hospital or clinic recover. During this time, your healthcare provider will perform a final assessment of your condition to make sure you’re ready to go home.
• Consultation: Before you go home, you’ll also have a consultation with medical staff to help you understand what goes into recovery and answer any questions you may have.

Recovery

One of the reasons balloon sinuplasty is so well-regarded is that it’s well-tolerated; however, complete recovery takes up to three weeks. Alongside follow-up appointments, there will be some things you’ll have to do at home to promote a successful outcome. Here’s a breakdown:

• Rest: While most patients are able to return to work as soon as 24 hours after the treatment, fatigue is common afterward, and you may want to give yourself more time.
• Nasal saline spray: Over-the-counter saline nasal sprays, such as Ayr, Simply Saline, or others, can be used every two to three hours to ease discomfort.
• Sinus irrigation: You’ll be asked to rinse your sinuses with saline solution several times to help clean them. You’ll be given specialized equipment and instructed on how to do this at home.
• Avoid strain: Lifting objects heavier than 20 pounds and blowing your nose should be avoided for at least 10 days after surgery. These can distress the affected area.
• Skip the NSAIDs: Don’t take Advil, Motrin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) for the two weeks following balloon sinuplasty.
• Return to physical activity: If you’re physically active, most healthcare providers recommend only light exercise—such as walks or cycling—for the first week after the operation. At one week, you can return to a moderate version of your regimen, and by two weeks, you can return to normal.
• Follow-up appointments: Your practitioner will need to ensure that everything has healed correctly, so one or more follow-up appointments may be scheduled in the weeks following the procedure. During these, fluid and blood from the surgery will be drained from your sinus.

Once you’ve recovered from balloon sinuplasty, long term lifestyle changes aren’t necessary. However, as your sinus heals, it’s important to be mindful of signs of complications.

Possible Future Surgeries

While balloon sinuplasty is highly-successful in resolving chronic sinusitis—one large-scale study found 91.6% of patients see successful resolution at one year—it doesn’t always solve the issue. In these cases, sinus surgery is considered. There are two types:

• Endoscopic sinus surgery: Using endoscopic techniques and without making incisions, surgeons use small instruments to remove problematic tissue or polyps. In some cases, portions of bone may also need to be taken out to open up airways.
• Image-guided sinus surgery: In some more complex cases, healthcare providers may recommend an image-guided approach. After uploading a CT scan of the sinus to a computer, the surgeon uses micro-instruments, which transmit exact location data, to perform the surgery. This lets the surgeon work with increased precision.