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

 

References

1). Bikhazi N, et.al. 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, et.al. REMODEL Larger Cohort With Long-Term Outcomes and Meta-Analysis of Standalone Balloon Dilation Studies. Laryngoscope 126: 44-48 (2016)

3). Gould J, et.al. 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, et.al. Evaluation of a navigational system for ENT with surgical efficiency criteria. Laryngoscope. 116(4): 564-572 (2006).

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