Abstract
Balloon catheter-assisted dilatation is an important tool available for addressing frontal sinus disease. However, a careful selection of candidates is mandatory. An adequate assessment of the underlying disease process and patient anatomy should be done.
Long-term results are good and medical evidence on its efficacy is solid, after several randomized controlled trials and meta-analysis. Technical advancement allows rhinologists to perform frontal balloon sinuplasty under local anesthesia in the office. Frontal balloon sinuplasty may serve as a stand-alone or complementary procedure for treating medically refractory chronic rhinosinusitis.
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Dietz de Loos D, Lourijsen ES, Wildeman MAM, Freling NJM, Wolvers MDJ, Reitsma S, Fokkens WJ. Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology. J Allergy Clin Immunol. 2019;143(3):1207–14. https://doi.org/10.1016/j.jaci.2018.12.986.
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(29):1–464. https://doi.org/10.4193/Rhin20.600.
DeConde AS, Soler ZM. Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy. 2016;30(2):134–9. https://doi.org/10.2500/ajra.2016.30.4297.
Stammberger H. Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part II. Surgical technique. Otolaryngol Head Neck Surg. 1986;94(2):147–56. https://doi.org/10.1177/019459988609400203.
Anali Dadgostar A, Al-Asousi F, Javer AR. Balloon-assisted frontal sinus surgery. In: Lal D, Hwang PH, editors. Frontal sinus surgery. Cham: Springer; 2019. p. 179–85. https://doi.org/10.1007/978-3-319-97022-6_10.
Brown CL, Bolger WE. Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation. Ann Otol Rhinol Laryngol. 2006;115(4):293–9. https://doi.org/10.1177/000348940611500407.
Bolger WE, Vaughan WC. Catheter-based dilation of the sinus ostia: initial safety and feasibility analysis in a cadaver model. Am J Rhinol. 2006;20(3):290–4. https://doi.org/10.2500/ajr.2006.20.2868.
Bolger WE, Brown CL, Church CA, Goldberg AN, Karanfilov B, Kuhn FA, et al. Safety and outcomes of balloon catheter sinusotomy: a multicenter 24-week analysis in 115 patients. Otolaryngol Head Neck Surg. 2007;137(1):10–20. https://doi.org/10.1016/j.otohns.2007.02.006.
Levine HL, Sertich AP, Hoisington DR, Weiss RL, Pritikin J. Multicenter registry of balloon catheter sinusotomy outcomes for 1,036 patients. Ann Otol Rhinol Laryngol. 2008;117(4):263–70. https://doi.org/10.1177/000348940811700405.
Kuhn FA, Church CA, Goldberg AN, Levine HL, Sillers MJ, Vaughan WC, Weiss RL. Balloon catheter sinusotomy: one-year follow-up--outcomes and role in functional endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2008;139(3):27–37. https://doi.org/10.1016/j.otohns.2008.05.010.
Brodner D, Nachlas N, Mock P, Truitt T, Armstrong M, Pasha R, Jung C, Atkins J. Safety and outcomes following hybrid balloon and balloon-only procedures using a multifunction, multisinus balloon dilation tool. Int Forum Allergy Rhinol. 2013;3(8):652–8. https://doi.org/10.1002/alr.21156.
Albritton FD, Casiano RR, Sillers MJ. Feasibility of in-office endoscopic sinus surgery with balloon sinus dilation. Am J Rhinol Allergy. 2012;26(3):243–8. https://doi.org/10.2500/ajra.2012.26.3763.
Karanfilov B, Silvers S, Pasha R, Sikand A, Shikani A, Sillers M. Office-based balloon sinus dilation: a prospective, multicenter study of 203 patients. Int Forum Allergy Rhinol. 2013;3(5):404–11. https://doi.org/10.1002/alr.21112.
Sikand A, Silvers SL, Pasha R, Shikani A, Karanfilov BI, Harfe DT, Sillers MJ, ORIOS 2 Study Investigators. Office-based balloon sinus dilation: 1-year follow-up of a prospective, multicenter study. Ann Otol Rhinol Laryngol. 2015;124(8):630–7. https://doi.org/10.1177/0003489415573830.
Gould J, Alexander I, Tomkin E, Brodner D. In-office, multisinus balloon dilation: 1-year outcomes from a prospective, multicenter, open label trial. Am J Rhinol Allergy. 2014;28(2):156–63. https://doi.org/10.2500/ajra.2014.28.4043.
Kim E, Cutler JL. Balloon dilatation of the paranasal sinuses: a tool in sinus surgery. Otolaryngol Clin N Am. 2009;42(5):847–56. https://doi.org/10.1016/j.otc.2009.07.006.
Cingi C, Bayar Muluk N, Lee JT. Current indications for balloon sinuplasty. Curr Opin Otolaryngol Head Neck Surg. 2019;27(1):7–13. https://doi.org/10.1097/MOO.0000000000000506.
Korban ZR, Casiano RR. Standard endoscopic approaches in frontal sinus surgery: technical pearls and approach selection. Otolaryngol Clin N Am. 2016;49(4):989–1006. https://doi.org/10.1016/j.otc.2016.03.022.
Luong A, Batra PS, Fakhri S, Citardi MJ. Balloon catheter dilatation for frontal sinus ostium stenosis in the office setting. Am J Rhinol. 2008;22(6):621–4. https://doi.org/10.2500/ajr.2008.22.3240.
Catalano PJ, Payne SC. Balloon dilation of the frontal recess in patients with chronic frontal sinusitis and advanced sinus disease: an initial report. Ann Otol Rhinol Laryngol. 2009;118(2):107–12. https://doi.org/10.1177/000348940911800205.
Hopkins C, Noon E, Roberts D. Balloon sinuplasty in acute frontal sinusitis. Rhinology. 2009;47(4):375–8. https://doi.org/10.4193/Rhin08.057.
Tomazic PV, Stammberger H, Koele W, Gerstenberger C. Ethmoid roof CSF-leak following frontal sinus balloon sinuplasty. Rhinology. 2010;48(2):247–50. https://doi.org/10.4193/Rhin09.129.
Heimgartner S, Eckardt J, Simmen D, Briner HR, Leunig A, Caversaccio MD. Limitations of balloon sinuplasty in frontal sinus surgery. Eur Arch Otorhinolaryngol. 2011;268(10):1463–7. https://doi.org/10.1007/s00405-011-1626-7.
Kuhn FA, Bolger WE, Tisdal RG. The agger nasi cell in frontal recess obstruction: an anatomic, radiologic and clinical correlation. Oper Tech Otolaryngol Head Neck Surg. 1991;2:226–31. https://doi.org/10.1016/S1043-1810(10)80085-5.
Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, et al. The International Frontal Sinus Anatomy Classification (IFAC) and classification of the extent of endoscopic frontal sinus surgery (EFSS). Int Forum Allergy Rhinol. 2016;6(7):677–96. https://doi.org/10.1002/alr.21738.
Brodner D, Nachlas N, Mock P, Truitt T, Armstrong M, Pasha R, et al. Safety and outcomes following hybrid balloon and balloon-only procedures using a multifunction, multisinus balloon dilation tool. Int Forum Allergy Rhinol. 2013;3(8):652–8. https://doi.org/10.1002/alr.21156.
Christmas DA, Mirante JP, Yanagisawa E. Hybrid frontal sinus surgery with balloon dilation and microdebrider resection. Ear Nose Throat J. 2015;94(8):304–5. https://doi.org/10.1177/014556131509400801.
Kao R, Rabbani CC, Ting JY, Shipchandler TZ. In-office functional nasal surgery. Otolaryngol Clin N Am. 2019;52(3):485–95. https://doi.org/10.1016/j.otc.2019.02.010.
Lee JT, DelGaudio J, Orlandi RR. Practice patterns in office-based rhinology: survey of the American Rhinologic Society. Am J Rhinol Allergy. 2019;33(1):26–35. https://doi.org/10.1177/1945892418804904.
Chaaban MR, Rana N, Baillargeon J, Baillargeon G, Resto V, Kuo YF. Outcomes and complications of balloon and conventional functional endoscopic sinus surgery. Am J Rhinol Allergy. 2018;32(5):388–96. https://doi.org/10.1177/1945892418782248.
Prince A, Bhattacharyya N. An analysis of adverse event reporting in balloon sinus procedures. Otolaryngol Head Neck Surg. 2016;154(4):748–53. https://doi.org/10.1177/0194599815627779.
Hur K, Ge M, Kim J, Ference EH. Adverse events associated with balloon sinuplasty: a MAUDE database analysis. Otolaryngol Head Neck Surg. 2020;162(1):137–41. https://doi.org/10.1177/0194599819884902.
Abreu CB, Balsalobre L, Pascoto GR, Pozzobon M, Fuchs SC, Stamm AC. Effectiveness of balloon sinuplasty in patients with chronic rhinosinusitis without polyposis. Braz J Otorhinolaryngol. 2014;80(6):470–5. https://doi.org/10.1016/j.bjorl.2014.08.011.
Bikhazi N, Light J, Truitt T, Schwartz M, Cutler J, REMODEL Study Investigators. Standalone balloon dilation versus sinus surgery for chronic rhinosinusitis: a prospective, multicenter, randomized, controlled trial with 1-year follow-up. Am J Rhinol Allergy. 2014;28(4):323–9. https://doi.org/10.2500/ajra.2014.28.4064.
Bizaki AJ, Numminen J, Taulu R, Rautiainen M. Decrease of nasal airway resistance and alleviations of symptoms after balloon sinuplasty in patients with isolated chronic rhinosinusitis: a prospective, randomised clinical study. Clin Otolaryngol. 2016;41(6):673–80. https://doi.org/10.1111/coa.12583.
Bowles PF, Agrawal S, Salam MA. Efficacy of balloon sinuplasty in treatment of frontal rhinosinusitis: a prospective study in sixty patients. Clin Otolaryngol. 2017;42(4):908–11. https://doi.org/10.1111/coa.12814.
Stolovitzky JP, Mehendale N, Matheny KE, Brown WJ, Rieder AA, Liepert DR, et al. Medical therapy versus balloon sinus dilation in adults with chronic rhinosinusitis (MERLOT): 12-month follow-up. Am J Rhinol Allergy. 2018;32(4):294–302. https://doi.org/10.1177/1945892418773623.
Sinnott J, Chisholm E. Balloon sinuplasty: two-year follow up using Sino-Nasal outcome test-22 outcomes. J Laryngol Otol. 2021;135(5):415–9. https://doi.org/10.1017/S0022215121000700.
Levy JM, Marino MJ, McCoul ED. Paranasal sinus balloon catheter dilation for treatment of chronic rhinosinusitis: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2016;154(1):33–40. https://doi.org/10.1177/0194599815613087.
Chandra RK, Kern RC, Cutler JL, Welch KC, Russell PT. REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies. Laryngoscope. 2016;126(1):44–50. https://doi.org/10.1002/lary.25507.
Zhang J, Li Y, Han Z, Wang Y, Ding X, Zhao C. Sinus balloon dilation for treatment of chronic sinusitis: a systematic review and meta-analysis. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;34(5):406–10. https://doi.org/10.13201/j.issn.2096-7993.2020.05.005.
Chan Y, Melroy CT, Kuhn CA, Kuhn FL, Daniel WT, Kuhn FA. Long-term frontal sinus patency after endoscopic frontal sinusotomy. Laryngoscope. 2009;119(6):1229–32. https://doi.org/10.1002/lary.20168.
Ting JY, Wu A, Metson R. Frontal sinus drillout (modified Lothrop procedure): long-term results in 204 patients. Laryngoscope. 2014;124(5):1066–70. https://doi.org/10.1002/lary.24422.
Andrews JN, Weitzel EK, Eller R, McMains CK. Unsuccessful frontal balloon sinuplasty for recurrent sinus barotrauma. Aviat Space Environ Med. 2010;81(5):514–6. https://doi.org/10.3357/asem.2716.2010.
Weitzel EK, McMains KC, Wormald PJ. Comprehensive surgical management of the aerosinusitis patient. Curr Opin Otolaryngol Head Neck Surg. 2009;17(1):11–7. https://doi.org/10.1097/moo.0b013e32831b9caa.
Naidoo Y, Bassiouni A, Keen M, Wormald PJ. Long-term outcomes for the endoscopic modified Lothrop/Draf III procedure: a 10-year review. Laryngoscope. 2014;124(1):43–9. https://doi.org/10.1002/lary.24258.
Minni K, Galusza B, Rapiejko P, Klopotek M, Jurkiewicz D. A six-month analysis of frontal sinus drainage pathway in patients with frontal sinusitis after balloon sinuplasty. Acta Otolaryngol. 2017;137(9):968–74. https://doi.org/10.1080/00016489.2017.1300941.
Yang Y, Ma ZQ, Li Y. Surgical analysis of transnasal frontal sinus balloon dilatation. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020;34(1):23–7. https://doi.org/10.13201/j.issn.1001-1781.2020.01.006.
Bhandarkar ND, Smith TL. Revision frontal sinusotomy using stepwise balloon dilation and powered instrumentation. Laryngoscope. 2010;120(10):2015–7. https://doi.org/10.1002/lary.21110.
Eloy JA, Friedel ME, Eloy JD, Govindaraj S, Folbe AJ. In-office balloon dilation of the failed frontal sinusotomy. Otolaryngol Head Neck Surg. 2012;146(2):320–2. https://doi.org/10.1177/0194599811425885.
Jang DW, Cyr DD, Schulz K, Scher R, Ryan P, Abi Hachem R, Witsell DL. The use of balloon dilation in revision sinus surgery. Int Forum Allergy Rhinol. 2020;10(10):1158–64. https://doi.org/10.1002/alr.22571.
Plaza G, Eisenberg G, Montojo J, Onrubia T, Urbasos M, O’Connor C. Balloon dilation of the frontal recess: a randomized clinical trial. Ann Otol Rhinol Laryngol. 2011;120(8):511–8. https://doi.org/10.1177/000348941112000804.
Hathorn IF, Pace-Asciak P, Habib AR, Sunkaraneni V, Javer AR. Randomized controlled trial: hybrid technique using balloon dilation of the frontal sinus drainage pathway. Int Forum Allergy Rhinol. 2015;5(2):167–73. https://doi.org/10.1002/alr.21432.
Minni A, Dragonetti A, Sciuto A, Rosati D, Cavaliere C, Ralli M, et al. Use of balloon catheter dilation and steroid-eluting stent in light and severe rhinosinusitis of frontal sinus: a multicenter retrospective randomized study. Eur Rev Med Pharmacol Sci. 2018;22(21):7482–91. https://doi.org/10.26355/eurrev_201811_16289.
Ahmed J, Pal S, Hopkins C, Jayaraj S. Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis. Cochrane Database Syst Rev. 2011;7:CD008515. https://doi.org/10.1002/14651858.CD008515.pub2.
Batra PS, Ryan MW, Sindwani R, Marple BF. Balloon catheter technology in rhinology: reviewing the evidence. Laryngoscope. 2011;121(1):226–32. https://doi.org/10.1002/lary.21114.
Tomazic PV, Stammberger H, Braun H, Habermann W, Schmid C, Hammer GP, Koele W. Feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience. Rhinology. 2013;51(2):120–7. https://doi.org/10.4193/Rhino12.194.
Piccirillo JF, Payne SC, Rosenfeld RM, Baroody FM, Batra PS, DelGaudio JM, et al. Clinical consensus statement: balloon dilation of the sinuses. Otolaryngol Head Neck Surg. 2018;158(2):203–14. https://doi.org/10.1177/0194599817750086.
Hanci D, Gürpinar B, Üstün O, Kumral TL, Karaketir S, Uyar Y. Comparison of the olfactory functions in conventional endoscopic sinus surgery to the balloon sinuplasty in frontal sinus surgery. J Craniofac Surg. 2020;31(6):1731–3. https://doi.org/10.1097/SCS.0000000000006482.
Lopez EM, Farzal Z, Norris M, Canfarotta MW, Pappa AK, Santarelli GD, et al. Radiologic analysis of balloon sinuplasty in a human cadaver model: observed effects on sinonasal anatomy. Am J Rhinol Allergy. 2021;35(1):107–13. https://doi.org/10.1177/1945892420939430.
Castro A, Furtado M, Rego Â, Serras D, Plácido M, Martins C. Long term outcomes of balloon sinuplasty for the treatment of chronic rhinosinusitis with and without nasal polyps. Am J Otolaryngol. 2021;42(1):102825. https://doi.org/10.1016/j.amjoto.2020.102825.
Garvey CM. Sinus balloon dilators: one surgeon’s experience and proposed indications for their use. Ear Nose Throat J. 2009;88:12–6.
Friedman M, Schalch P. Functional endoscopic dilatation of the sinuses (FEDS): patient selection and surgical technique. Oper Tech Otolaryngol. 2006;17:126–34.
Friedman M, Schalch P, Lin HC, Mazloom N, Neidich M, Joseph NJ. Functional endoscopic dilatation of the sinuses: patient satisfaction, postoperative pain, and cost. Am J Rhinol. 2008;22:204–9.
Kutluhan A, Bozdemir K, Çetin H, Yalçiner G, Salviz M, Sari N, Değer HM, Bilgen AS. Endoscopic balloon dilation sinuplasty including ethmoidal air cells in chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2009;118:881–6.
Wycherly BJ, Manes RP, Mikula SK. Initial clinical experience with balloon dilation in revision frontal sinus surgery. Ann Otol Rhinol Laryngol. 2010;119:468–71.
Hopkins C, Noon E, Bray D, Roberts D. Balloon sinuplasty: our first year. J Laryngol Otol. 2011;125:43–52.
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Dr. BAPTISTA in office frontal sinus mucocele sinuplasty (Acclarent) (MP4 5196 kb)
Dr. BAPTISTA in office frontal balloon sinuplasty with irrigations (Entellus) (MP4 34622 kb)
PLAZA frontal balloon sinuplasty transillumination (Entellus) (MP4 43332 kb)
PLAZA Frontal balloon sinuplasty left Entellus (MP4 119030 kb)
PLAZA. Balloon does not enter the frontal sinus (MP4 6751 kb)
PLAZA. Balloon does enter the frontal sinus (MP4 2255 kb)
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Plaza, G., Baptista, P., Davies, E. (2022). Frontal Balloon Sinuplasty: Frontal Sinus Surgery Without Tissue Removal. In: Lobo, D.R., Artiles, J.V., Ospina, J.A. (eds) Atlas of Frontal Sinus Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-98128-0_9
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