Postoperative effects of balloon sinuplasty on chronic rhinosinusitis: a Meta-analysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the postoperative clinical effects of balloon sinuplasty on chronic rhinosinusitis.@*Methods@#PubMed, OVID, Embase, Cochrane Library, Proquest, Web of Science, Sinomed, Wan Fang and CNKI database (from established time to March of 2017) were searched for trials about the chronic rhinosinusitis treated by balloon sinuplasty. The relavent literatures were screened, and the prospective control studies were chosen. Lund-Mackay and SNOT-20 scores were used as the outcome idicators, and the methodological quality of the literatures were evaluated strictly. The extracted data were analyzed by Revman 5.3 software.@*Results@#A total of 7 prospective before-after self-controlled studies were included, and the overall quality of which was relatively high. Meta-analysis showed that the Lund-Mackay scores at 6 months post-operation, the SNOT-20 scores at 6 months and more than 1 year post-operation were significant lower than baseline when balloon sinuplasty used in the surgery; the SNOT-20 scores at more than 1 year post-operation was lower than baseline when a standalone ballon sinuplasty was performed. All the results was statistically significant (P<0.05), and all the SMD were more than 0.8.@*Conclusions@#The postoperative effect of balloon sinuplasty on chronic rhinosinusitis is obvious, and the subjective symptoms in patients is relieved effectively.

A Case of Recurrent Sinus Headache Treated with Balloon Sinuplasty

Since its introduction in 2006, balloon sinuplasty has been a controversial procedure among rhinologists. It is considered to be a minimally invasive procedure for the treatment of chronic rhinosinusitis. However, some sinus surgeons prefer to use conventional sinus surgery. Nevertheless, the current evidence indicates that balloon sinuplasty results in the reduction of surgery duration, hospital stay, postoperative pain and the facilitation of early wound healing. Herein, we report the first case in Korea of the successful dilatation of the sinuses using balloon sinuplasty in a 39-year-old woman with recurrent headache episodes that were aggravated during airplane travel.

Balloon Sinuplasty / 대한이비인후과학회지

Balloon sinuplasty (BSP) is a newly developed catheter-based technique for dilating sinus ostia to improve sinus ventilation and drainage. BSP has been in clinical use since 2005, but there has been many debates and criticism between early movers and mainstream doctors. But, recently, many evidences strongly support its safety, efficacy, and growing popularity among patients and physicians. The objective of this clinical review is to present its theoretical background, technical considerations, and treatment outcomes. BSP will be an additional tool for treating sinusitis, either alone or with conventional sinus surgery technique.

Balloon Sinuplasty

The basic principles of surgery for chronic rhinosinusitis are ventilation of the sinus ostia and conservation of the sinonasal mucosa. Since its introduction in 2006, balloon sinuplasty has been considered controversial by rhinologists. Balloon sinuplasty is a minimally invasive procedure for the treatment of chronic rhinosinusitis. However, some criticism has originated from the familiarity and preference many sinus surgeons have for conventional sinus surgery. Independent of this controversy, the current evidence supports the feasibility, safety, and efficacy of balloon sinuplasty. Furthermore, there has been increased interest in this procedure among physicians as well as patients. The objective of this review is to present and discuss the surgical technique, treatment outcomes and controversy associated with balloon sinuplasty.

Surgical Management of Rhinosinusitis in Onco-Hematological Patients

OBJECTIVES: In onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients. METHODS: A retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction. RESULTS: Local anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group. CONCLUSION: Balloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure.

Sinusoplastía con balón en seno frontal: experiencia en 8 pacientes / Sinuplasty balloon in frontal sinus: experience in 8 patients

Introducción: La sinusoplastia con balón es una técnica cada vez más usada en patología sinusal, ya que previene el trauma, conserva la anatomía, evita la instrumentación del seno frontal, preserva la mucosa del receso frontal, con un alto grado de seguridad. Dentro de sus principales indicaciones se encuentra la patología de seno frontal, como es el caso de sinusitis aislada, osteítis focalizada, sinusitis posoperatoria y barotrauma. Las controversias se relacionan con sus indicaciones limitadas, costo actual elevado y la ausencia de remoción de tejido. Objetivo: Determinar la efectividad de la sinusoplastia con balón en patología del seno frontal. Material y método: Mediante estudio retrospectivo descriptivo se analizan 8 casos clínicos, antecedentes demográficos, indicación quirúrgica, técnica utilizada, seguimiento posoperatorio y complicaciones. Resultados: Ocho pacientes, con edad promedio de 51,4 años. En la mayoría de los pacientes se utilizó balón más técnica quirúrgica endoscópica clásica (7/8). En todos se evidenció permeabilidad del seno frontal posoperatoria y al año de seguimiento. Ningún paciente tuvo complicaciones. El seguimiento promedio fue de 22,2 meses. Conclusiones: La sinuplastía con balón es una técnica segura, siendo una herramienta más, disponible en cirugía nasosinusal. Es especialmente útil en dilatar el receso del seno frontal permitiendo su ventilación y drenaje. El conocimiento anatómico previo es esencial para su correcto uso.

Introduction: Sinuplasty with balloon is a technology increasingly used in sinus pathology, avoiding trauma, and preserving anatomy. It avoids the instrumentation of frontal sinus, and can be realized even in ambulatory form, with high degree of safety. Main indications are the pathologies of frontal sinus, such as isolated sinusitis, focused osteitis, postoperatory sinusitis or barotrauma, where it allows the conservation of the mucose of the frontal recess. Controversies relate to especific indications, cost and the absence of removal tissue. Aim: Asses the effectiveness of balloon sinuplasty in pathology of the frontal sinus. Material and method: Retrospective descriptive study analizing 8 clinical cases, demographic data, surgical indication, technology used, postoperatory follow-up and complications. Results: Eight patients, average age 51,4 years. In the majority of the patients was used balloon and endoscopic surgical (7/8). In all cases technique was demonstrated postoperatory permeability of the frontal sinus. No one patient report complications, with an average follow-up of 22,2 months. Conclusions: Balloon sinuplasty is a sure tool, and is a complementary instrument for nasosinusal surgery, being specially useful in dilatation and ventilation of the frontal recess. Anatomical previous knowledge is essential for its correct use.

Sinusoplastia por balão: revisão da literatura / Balloon sinuplasty: literature review

Introdução: A cirurgia nasossinusal apresentou um rápido desenvolvimento nas duas últimas décadas, porém, estenoses cicatriciais secundárias à manipulação cirúrgica ainda ocorrem, mesmo nas mãos de cirurgiões experientes e, principalmente, em regiões estreitas como o recesso do frontal. A sinusoplastia por balão utiliza o princípio da dilatação dos óstios sinusais por balões guiados por cateter. Objetivo: Apresentar e discutir a técnica cirúrgica, indicações, custos e resultados da sinusoplastia por balão, através de artigos publicados até agora sobre o assunto. Revisão da Literatura: A sinusoplastia por balão é uma alternativa no tratamento da rinossinusite crônica. Não é substituto da cirurgia funcional dos seios paranasais. O uso do balão combinado à abordagem cirúrgica endoscópica pode minimizar complicações cirúrgicas como as estenoses cicatriciais, principalmente em regiões como o recesso do frontal. Pacientes de UTI que tem um risco anestésico maior e que apresentam doença esfenoidal isolada também podem beneficiar-se com o uso do balão. A possibilidade de realizar-se a dilatação com anestesia local é outra vantagem. Com relação aos riscos, estes parecem ser baixos, apesar de existir a possibilidade de lesão de estruturas nobres como a órbita e a base do crânio. Comentários Finais: A sinusoplastia por balão parece ser uma tecnologia viável, segura e eficiente em pacientes selecionados. Apresenta-se como uma terapia auxiliar e complementar à cirurgia funcional. Possui maiores perspectivas no tratamento da doença relacionada ao recesso do frontal, pacientes febris de UTI com foco sinusal e pacientes com alto risco anestésico e de sangramento.

Introduction: The nasosinusal surgery showed a rapid development over the past two decades; but cicatricial stenoses secondary to surgical manipulation still occur, even in the hands of experienced surgeons and, especially, in narrow regions such as the frontal recess. The balloon sinuplasty uses the principle of dilatation of the sinus ostia by balloons guided by catheter. Objective: To present and discuss the surgical technique, indications, costs and results of the balloon sinuplasty, through articles published so far on the subject. Literature's Review: The balloon sinuplasty is an alternative in the treatment of chronic rhinosinusitis. It is not substitute for the functional paranasal sinuses surgery. The use of balloon combined with endoscopic surgical approach may minimize surgical complications such as cicatricial stenosis, especially in regions such as the frontal recess. ICU Patients with a higher anesthetic risk and presenting isolated sphenoid disease may also benefit from the use of the balloon. The possibility of carrying out the dilation with local anesthesia is another advantage. As for the risks, they appear to be low, although there is a possibility of lesion to noble structures as the orbit and skull base. Conclusions: The balloon sinuplasty appears to be a feasible, safe and effective procedure in selected patients. It presents itself as an ancillary therapy and complementary to FESS. It has greater prospects in the treatment of the disease related to the frontal recess, febrile patients in ICU with sinus focus and patients at high anesthetic and bleeding risk.