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Balloon Sinuplasty ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object]
Historical perspectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Balloon technology ,[object Object],[object Object]
ARS position statement on  balloon sinuplasty (2006) ,[object Object]
Manufacturers ,[object Object],[object Object],[object Object],[object Object]
Acclarent, Inc ,[object Object],[object Object],[object Object],[object Object]
Acclarent Relieva sinus catheter
Schematics of Balloon Sinuplasty
Luma Sinus Illumination System (Luma light) Friedman M.Laryngoscope. 2009 Jul;119(7):1399-402.
Comparison of Luma and fluoroscopy Friedman M.Laryngoscope. 2009 Jul;119(7):1399-402.
Initial study 1: Bolger et al. (2006) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Initial study 2: Brown et al. (2006)   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maxillary ostium after balloon dilation Brown C et al. Ann Otol Rhinol Laryngol 2006;115:293–9.
Brown et al. (2006) results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Levine et al (2008) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Measurement of success in balloon sinuplasty ,[object Object],[object Object],[object Object],[object Object]
Sino Nasal Outcome Test (SNOT-20) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SNOT - 20  Weiss RL et al. Otolaryngol Head Neck Surg. 2008 Sep;139(3 Suppl 3):S38-46.
Lund- Mackay scores
Ostial patency Bolger WE et al. Otolaryngol Head Neck Surg 2007;137:10–20.
CLEAR study  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Goals of CLEAR study ,[object Object],[object Object],[object Object],[object Object]
Inclusion & Exclusion criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLEAR study design ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Weiss 2 year study (2008) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLEAR study – SNOT 20 results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SNOT - 20  Weiss RL et al. Otolaryngol Head Neck Surg. 2008 Sep;139(3 Suppl 3):S38-46.
SNOT-20 scores summary
CT sinus: Maxillary  Preop 2 years postop Weiss RL et al. Otolaryngol Head Neck Surg. 2008 Sep;139(3 Suppl 3):S38-46.
CT sinus: Sphenoid Kuhn FA. Otolaryngology–Head and Neck Surgery (2008) 139, S27-S37 Preop 1 year postop
CT sinus: Frontal Kuhn FA. Otolaryngology–Head and Neck Surgery (2008) 139, S27-S37 Preop 1 year postop
CLEAR STUDY-  CT Lund-Mackay scores ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ostia patency: frontal Intraop 9 months postop ANC MT Kuhn FA. Otolaryngology–Head and Neck Surgery (2008) 139, S27-S37
Ostia patency by nasal endoscopy Kuhn FA. Otolaryngology–Head and Neck Surgery (2008) 139, S27-S37
Pediatric population ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LacriCATH by Quest medical (Allen, Tx) ,[object Object],[object Object],[object Object]
LacriCATH study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Entellus Medical, Inc ,[object Object],[object Object]
Radiation exposure in fluoroscopy ,[object Object],[object Object],[object Object],[object Object]
Cost  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Coding ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sinuplasty: A new tool ,[object Object],Raymond Weiss, MD
Conclusions: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you  Thank You

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Balloon sinuplasty-slides-091216

Editor's Notes

  1. Weakness: Retrospective No quality of life information No direct comparison between balloon and standard FESS No statistical analysis Large number of patients in the real world, safety study Levine H, Sertich AP, Hoisington DR, et al. Multicenter registry of balloon catheter sinusotomy outcomes for 1036 patients. Ann Otol Rhinol Laryngol 2008;117(4): 265–70.
  2. Two investigators could not participate in the longer follow-up analysis. One investigator moved and no longer had access to his patients. The other investigator could not reapply to his IRB in time for the 1-year follow-up study.
  3. Hybrid cases have more severe sinus disease and involve ethmoid sinusitis No significant diff between 1-2 years
  4. The left frontal ostium opened by a 7-mm balloon (70° telescope). The medial agger nasi cell wall, which had been lying on the middle turbinate was pushed laterally against medial orbital wall. The frontal sinus roof is visible through the ostium. (B) Left frontal ostium (30° view) 3 weeks after surgery. The medial agger nasi cell wall has moved to a neutral, more medial position, leaving both the frontal drainage pathway and the agger nasi cell open. (C) Left frontal recess (30° view), 9 months after surgery, showing stability of the remodeled medial agger nasi cell wall and durability of the frontal sinus drainage pathway. The frontal ostium, medial to the agger nasi cell, is open and functional. Extensive frontal recess dissection with its attendant risk of mucosal damage and stenosis was avoided.
  5. Ann Otol Rhinol Laryngol. 2009 Mar;118(3):161-5. Safety and feasibility of balloon sinuplasty for treatment of chronic rhinosinusitis in children. Ramadan HH . overall success rate in ail non-hypoplastic sinuses was 98%, compared to 60% for the hypoplastic si
  6. Citardi MJ, Kanowitz SJ. A cadaveric model for balloon-assisted endoscopic paranasal sinus dissection without fluoroscopy. Am J Rhinol 2007;21:579–83. Atkins J. Mechanisms of action for balloon dilation of the ostiomeatal unit in patients with chronic rhinosinusitis. Oral presentation. Rhinology World. April 17, 2009.