Efficacy of balloon sinuplasty in treatment of frontal rhinosinusitis: a prospective study in sixty patients

Frontal Sinus Balloon Sinuplasty—Patient Satisfaction and Factors Predicting Reoperation

Objective

To explore predictive factors of postoperative outcome of frontal sinus balloon dilation.

Study Design

Retrospective questionnaire study.

Setting

Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland.

Methods

We reviewed electronic records of all patients who underwent frontal sinus balloon dilatation (successful or attempted) in our clinic from 2008 to 2019. We documented patient characteristics, preoperative imaging results, intraoperative factors, possible complications, and reoperations. Those who underwent frontal sinus balloon sinuplasty were sent a questionnaire regarding their current symptoms and long-term satisfaction with surgery.

Results

In total, 258 operations (404 frontal sinuses) were reviewed, with a technical success rate of 93.6% (n = 378). The revision rate was 15.7% (n = 38). Previous sinonasal surgery predicted a higher revision rate (p = .004, odds ratio [OR] = 3.03, 95% confidence interval [CI] 1.40-6.56). Patients with hybrid surgery had significantly fewer reoperations compared to the balloon only group (p = .002, OR = 0.33, 95% CI 0.16-0.67). The response rate of the questionnaire was 64.5% (n = 156), of which 88.5% (n = 138) reported a long-term benefit from the balloon sinuplasty. Patient satisfaction was higher (p = .02, OR = 8.26, 95% CI 1.06-64.24) among patients using nasal corticosteroids.

Conclusion

Technical success rate and patient satisfaction after frontal sinus balloon sinuplasty are high. Balloon sinuplasty seems insufficient in reoperations. A hybrid approach appears to result in fewer reoperations than a balloon only approach.

Frontal Balloon Sinuplasty in Complicated Acute Pediatric Rhinosinusitis (ARS)

Utilization of frontal balloon sinuplasty in pediatric complicated acute rhinosinusitis (ARS) is demonstrated to be a safe and expedient alternative to other procedures such as trephination or functional endoscopic sinus surgery (FESS) in this case series. We performed a retrospective review of six pediatric cases of frontal balloon sinuplasty for ARS with intracranial complications at a tertiary academic center. Patients underwent unilateral (n = 5) or bilateral dilation (n = 1) in addition to functional endoscopic sinus surgery (FESS) including anterior ethmoidectomy (n = 5) and maxillary antrostomy (n = 6). This technique effectively addressed frontal sinus obstruction and served as an alternative to procedures such as trephination or functional endoscopic sinus surgery. No immediate or short-term complications of balloon dilation were observed in these cases. A larger cohort and extended follow-up are necessary to determine the use and long-term impact of this technique.

Balloon sinuplasty in one-day surgery

Introduction

Balloon sinus dilation is becoming an increasingly common procedure, finding a niche as an invaluable tool in endoscopic sinus surgery.

Aim

To assess the effectiveness of balloon sinus dilation (BSD) in 1-day surgery in patients with chronic rhinosinusitis without polyps based on our own experience.

Material and methods

The study group consisted of 9 patients. The Lund-Mackay scale for computed tomography of the paranasal sinuses was assessed prior to surgery. Endoscopy was performed on the basis of the Lund-Kennedy scale and patients were asked to perform the SNOT-22 survey. Two patients underwent balloon sinuplasty under general and seven under local anaesthesia.

Results

Twelve maxillary and eight frontal sinuses were widened (four attempts were unsuccessful). The SNOT-22 survey was assessed the day after surgery (average of 8 points) and a month after surgery (average of 15.5 points).

Conclusions

BSD only allows widening of the ostia of the maxillary, frontal and sphenoid sinuses. BSD offers shorter post-surgical recovery, and a more rapid return to work because of its less invasive and less traumatic nature.

How to identify the anterior cribriform plate in the medial approach to the frontal sinus

Draf III frontal sinusotomy is one of the most complex surgical procedures on the frontal sinus, designed to limit the risks of restenosis by ensuring unification of the two ostia and resection of the floor of the sinus. This procedure requires a good knowledge of anatomy and sufficient surgical expertise to avoid the risk of CSF leak and to limit the risk of restenosis. The surgeon can use various landmarks, consisting of foramina, bone grooves and arteries located on the anterior part of the cribriform plate to guide the procedure. The purpose of this technical note is to explain the use of these landmarks to ensure safe Draf III frontal sinusotomy via a medial approach.

A Randomized Controlled Trial of Balloon Dilation as a Treatment for Persistent Eustachian Tube Dysfunction With 1-Year Follow-Up

Objective:

Compare Eustachian tube balloon dilation versus continued medical therapy (control) for treating persistent Eustachian tube dysfunction (ETD).

Study Design:

Prospective, multicenter, randomized controlled trial.

Setting:

Tertiary care academic center and private practice.

Patients:

Diagnosed with medically refractory persistent ETD.

Interventions:

1:1 Randomization to balloon dilation or control. After 6 weeks, control participants had the option to undergo balloon dilation if symptoms persisted.

Main Outcome Measures:

Primary efficacy endpoint was the comparison between treatment arms in the mean change from baseline in the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Primary safety endpoint was complication rate.

Results:

Sixty participants were randomized (31 balloon dilation, 29 control). Mean (SD) change in overall ETDQ-7 score at 6 weeks was −2.9 (1.4) for balloon dilation compared with −0.6 (1.0) for control: balloon dilation was superior to control (p < 0.0001). No complications were reported in either study arm. Among participants with abnormal baseline assessments, improvements in tympanogram type (p < 0.006) and tympanic membrane position (p < 0.001) were significantly better for balloon dilation than control. Technical success was 100% (91 successful dilations/91 attempts) and most procedures (72%) were completed in the office under local anesthesia. Improvements in the ETDQ-7 scores were maintained through 12 months after balloon dilation.

Conclusions:

Balloon dilation is a safe and effective treatment for persistent ETD. Based on improved ETDQ-7 scores, balloon dilation is superior to continued medical management for persistent ETD. Symptom improvement is durable through a minimum of 12 months. Procedures are well tolerated in the office setting under local anesthesia.