New Developments in Office Based Balloon Sinus Surgery

Computer Image Guidance comes to Office Sinus Surgery

Balloon Sinus Surgery Alternative

Standalone balloon dilation performed in the office has proven to be an effective and beneficial alternative to the standard Functional Endoscopic Sinus Surgery for patients with certain types of chronic sinusitis that have failed conservative medical antibiotic management.  The benefits of balloon sinus surgery over standard endoscopic sinus surgery are many and include:

1).  Much faster recovery

2).  Less bleeding

3).  Reduction in overall cost

4).  Fewer post-op debridement

5).  Much less use of post-op pain medication

6).  No general anesthesia

These advantages occur with balloon surgery having comparable efficacy to traditional sinus surgery with reduction of symptoms, reduction of episodes of infectious sinusitis, and need for surgical revision at one year.  

One advantage that traditional endoscopic sinus surgery had over balloon surgery in the past was the use of image guidance systems to guide the surgeon during surgery.  Image guided systems uses a very high resolution CT or MRI (between 300 – 500 picture slices per inch) and computer programs to create an extremely precise navigational system to assist the surgeon in locating anatomical structures and precisely navigating instruments during surgery.  Use of image guidance surgery has been shown to reduce complication rates and more precisely perform more complex surgery in standard sinus surgery, skull base surgery, and neurosurgery.

Fiagon is a German medical technology company that has developed a state of the art, electromagnetic based image navigational system which is small, transportable, and accurate.  It can be easily used in the doctor’s office.  In August, 2015, Entellus the manufacturer of the XprESS Multi-sinus Balloon Dilation Systems and Fiagon merged their technologies.  Sinus balloon surgery can now be done in the office with the added safety and precision of computer image guidance.

As an Otolaryngologist with 30 years of experience doing sinus surgery the utility of office balloon surgery using the Entellus balloon dilation system with the Fiagon image guidance system was immediately obvious.  Prior to this technology balloon dilation in the office depended on the technique of transillumination of the skin of the cheek and forehead.  This is essentially putting a flashlight on a wire and determining which sinus you are in.  The technique is good but the Fiagon navigation system is better in my opinion.  I perform ALL my office balloon procedures now with this image navigational system.  I believe this brings the most current, precise, safe, state-of-the-art, (IN-OFFICE) balloon sinus surgery available

To schedule an appointment with the Ear, Nose and Throat Institute, please call 770-406-6587.

Phillip B. Flexon  MD, FACS



1). Bikhazi N, Standalone balloon dilation versus sinus surgery for chronic rhinosinusitis: A prospective, multicenter, randomized, controlled trial with 1-year follow-up. Am J Rhinol & Allergy: 28(4):  323-329 (2014)

2). Chandra K, REMODEL Larger Cohort With Long-Term Outcomes and Meta-Analysis of Standalone Balloon Dilation Studies. Laryngoscope 126: 44-48 (2016)

3). Gould J, In-office, multisinus balloon dilation: 1-year outcomes from a prospective, multicenter, open label trial. Am J Rhinol & Allergy 28(2): 156-163 (2014)

4). Irugu DVK & HR Stammberger. A Note on Technical Aspects and Evaluation of the Role of Navigation System in Endoscopic Endonasal Surgeries. Indian J Otolaryngol Head Neck Surg. 66(Suppl 1): 307-313 (2012)

5). Strauss G, Evaluation of a navigational system for ENT with surgical efficiency criteria. Laryngoscope. 116(4): 564-572 (2006).

What is a Nasal Endoscopy?

What is that thing they put up my nose?

nasal endoscopy

“That thing” is called a nasal endoscope, the procedure titled “nasal endoscopy”. Just think of it as our eyes to see what’s going on past the most anterior part of your nose. When you come in, we always start with a basic exam of your ears, nose, and throat.  When we need more information, we use the endoscope.  The endoscope has a camera lens with a fiberoptic light attached that slides into your nose and sometimes, all the way down to your vocal cords (otherwise known as a laryngoscopy). On occasion, we’ll try to empirically treat you without our “eyes”. That can work but is essentially what you’re doing when you go to your Primary Care Provider. We want to expedite your healing and diagnose you as quickly and accurately as possible. Our endoscope is a tool in our toolbox to do that, and a nasal endoscopy is needed to make you healthy!

So if for example, the reason for your visit is sinus pressure or drainage, we need to have eyes into your nasal passage to evaluate causes of your symptoms: Is it infectious? Is it inflammatory? Could it be related to allergies? Is there anatomic obstruction, masses, polyps? Sometimes, you will come in with ear fullness and we’ll use the endoscope to visualize the back of the nose/top of your throat (nasopharynx) where the Eustachian tube orifice lies.  Many times this opening is blocked from drainage, obstruction, infection and causes your ears to pop, feel full, or even give way to ear infections. By using the endoscope, we can see directly to that site which helps us to narrow down the possibilities and remove the guesswork.

You may notice a “surgical procedure” documented on your bill- that is your insurance company documenting our tools as a procedure.  

To schedule an appointment with the Ear, Nose and Throat Institute, please call 770-406-6587.

What is an ENT Doctor?

Can an ENT doctor help me?


Most people ask this question regularly, because a good portion of the population is not quite sure what an ENT doctor is or what one can do. That is perfectly fine! ENT stands for ear, nose and throat, and ENT doctors are also referred to as otolaryngologists. While this might seem like a scary word, it makes perfect sense if you break down the Latin.

Oto- Ear
Rhino- Nose
Laryngo- Throat
logy- The study of

(See! That wasn’t so bad.)

We will take the time to explore the more common reasons patients go see an ENT specialist, and we will also look into more obscure territories.

  • The Ear: You would see an ENT doctor if you have hearing loss, hearing impairments (such as tinnitus), ear infections, and also hearing issues since birth. ENT doctors also remove excess earwax build-up, which is a dirty job but someone has got to do it.
  • The Nose: The most common nose-related issues that ENT doctors are seen for are sinus related. Most people do not realize that ENT doctors are the sinus experts of the medical field, and they are most likely not getting the expert help they need from general practitioners. ENT doctors also perform cutting-edge procedures to cure sinus conditions; from sinus surgery to balloon sinuplasty, an ENT doctor can improve the lives of sinus sufferers. ENT practices also are known for treating allergy issues. The ENT Institute for instance has in-office allergy testing, and also has many options for allergy treatments that can be picked up right at the office.
  • The Throat: Disorders that affect speech, singing, eating, swallowing, and digestion can also be investigated by an ENT doctor. While it might not be common knowledge, many famous singers have an ENT doctor on speed-dial to help them with their vocal issues when they arise. A more common reason for visiting an ENT doctor is when you are suffering from acid reflux or GERD.
  • Some conditions of the head and neck: ENT doctors can also take care of diseases, tumors, and trauma of the head, neck, and face. Some ENT doctors are even trained to perform cosmetic and reconstructive surgery in these areas.

We hope this helps clear up what an ENT doctor actually does, and also shows that ENT doctors do not get the credit they deserve. Hopefully, next time you have to make a medical decision, you will know when seeing an ENT doctor is the right call.
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Balloon Sinuplasty Center of Excellence

What is a Balloon Sinuplasty Center of Excellence?

The doctors at the ENT Institute are leaders in the country for Balloon Sinuplasty. In fact, The ENT Institute is a Center of Excellence for best practices in performing in office Balloon Sinuplasty. Being a Balloon Sinuplasty Center of Excellence means that doctors from across the country come to the ENT Institute to learn how to perform in office Balloon Sinuplasty from our doctors. We’ve even had doctors from as far away as California and New York come to train under our doctors regularly. The ENT Institute has set the standard nationwide for others to follow.

Balloon Sinuplasty Center

The ENT Institute is even planning to take the ‘Center of excellence’ (as if that was not impressive enough) a step further. So that doctors can get the most from our practice, we are planning to so live streaming sessions of some of the procedures. This way, we can teach even more doctors the correct and expert procedural practices and techniques that we pride ourselves on.

So, what is a Balloon Sinuplasty?

Well, it is a procedure that cures sinus issues without invasive sinus drilling or regiments of medicines. A tiny balloon is dilated inside the sinus cavities to expand them, thus fixing the sinus problems for just as long as the surgical option. A Balloon Sinuplasty can also be performed in your doctor’s office without the need for cutting or tissue removal.

Dr. Jeff Gallups, Founder and Medical Director of the ENT Institute, recruits top doctors from across the county to join our practice and only selects the most highly skilled physicians to join our exceptional team. When you trust your care to our doctors, rest assured that you have the best of the best in the country, and the team that other doctors look to for training and advice. Why trust your health to anyone else?

 Schedule an appointment at The ENT Institute

Balloon sinuplasty can change your life!

Have you heard of balloon sinuplasty?

Are you one of the 37 million Americans who suffer from chronic sinusitis? Balloon sinuplasty may be the answer you are looking for.

Balloon Sinuplasty happy patients

Symptoms of sinusitis include nasal congestion, sinus pressure, facial pain or pressure, headache, swelling around the eyes, and postnasal drip.

Traditionally, treatment for sinusitis was limited to medicines such as decongestants, antibiotics, and antihistamines. Many times, if these medications do not solve the problem, patients would require very invasive sinus surgery.

Today, there is an in office procedure called Balloon Sinuplasty that requires no general anesthesia and has little down time for the patient. During this procedure, an ENT doctor inserts a small, flexible tube into the patient’s nose.

The tube is equipped with a balloon catheter that the doctor inflates inside the sinus cavity, returning sinus function to normal. The procedure is performed while the patient is still awake, drastically reducing procedure costs and recovery time. Patients can usually return to work and normal activities the next day.

Results of balloon sinus dilation are typically very good, and compare equally with traditional sinus surgery, with as many as 95% of patients finding relief and passageways that are open indefinitely.

The doctors at the ENT Institute uses balloons from Entellus Medical, the only balloons indicated to be used on children as young as 2 years old. In a recent clinical study using Entellus Medical balloon sinus dilation, there were 0 complications in 50 patients (157 Sinuses treated)* proving it a safe procedure.

You can have peace of mind knowing this safe procedure may help stop your or your child’s suffering and give you and your child your life back.

The doctors at the ENT Institute are leaders in the country for this in office procedure, in fact, doctors travel to the ENT Institute from across the country to learn best practices for performing office based Balloon Sinuplasty from our doctors.

To schedule an appointment with the Ear, Nose and Throat Institute, please call 770-406-6587 or click here.