Marcey Walsh is training for a big hike. One year ago, she could barely get out of bed. Her sinuses really slowed her down, with constant infections.
"I would have one and it would come back three weeks later, and it would come back again," Walsh told Ivanhoe.
Instead of sinus surgery, Walsh's doctor used a device to perform what's called balloon sinuplasty.
Walsh commented, "I mean, having something put up your nose is not something you look forward to."
Doctors insert the device into the sinus opening and the balloon expands inside the nose. This restructures the tissue, opening up the passageways.
Scott Powell, M.D., Ear, Nose and Throat Specialist at Tampa Bay ENT said, "We're able to really change the dynamics, because we're not hurting the tissue. It's very minimally invasive and it really changes how we can address things."
Dr. Powell says the balloon clears the sinus pathways so the common cold won't turn into a severe infection that requires antibiotics.
"I have a life again. I remember a year where I just laid in bed feeling so little energy that I couldn't even get up," Walsh explained.
Now that her sinus problems have taken a hike, she's ready to get back on course.
Dr. Powell says the sinus path will stay open permanently after the balloon sinuplasty, as long as other inflammation issues are addressed. The procedure takes about 45 minutes and can be performed in the doctor's office.
Can a Balloon Cure a Sinus Infection? -- Research Summary
BACKGROUND: Sinusitis, or sinus infection, is a condition where the sinuses are inflamed. According to the CDC, over 28 million people have been diagnosed with sinusitis in the United States. The condition is very common and can be diagnosed as acute or chronic. Though both acute and chronic sinusitis have almost the same symptoms, acute sinusitis usually only lasts up to four weeks and is typically caused by a bacteria, while chronic sinusitis can last 12 weeks, or longer. Sinusitis can be caused by several conditions such as nasal polyps, allergies, face trauma and certain diseases like HIV or cystic fibrosis. Symptoms include reduced sense of smell and taste, mucous drainage from the nose and down the back of the throat, congestion, ear pain, cough, and sore throat. Though fever is associated with acute sinusitis, it is not a common symptom of chronic sinusitis. (Source: http://www.mayoclinic.org/diseases-conditions/Chronic-sinusitis/basics/symptoms/con-20022039, http://www.nlm.nih.gov/medlineplus/sinusitis.html, http://www.cdc.gov/nchs/fastats/sinuses.htm)
TREATMENTS: According to the American Academy of Allergy, Asthma and Immunology, up to 70 percent of acute sinusitis cases improve without any prescribed medications. Usually acute sinusitis is caused by a bacterial infection and can be helped by antibiotics, unlike chronic sinusitis. For chronic sinusitis, intranasal corticosteroid sprays, allergy shots or endoscopic sinus surgery may help in reducing the severity of the symptoms. When the lining of the sinuses is affected by viruses or bacteria, it can depress the immune system and cause inflammation, so the main goal of the treatments prescribed for sinusitis is to reduce the amount of inflammation in the nasal passages. (Source: http://www.emedicinehealth.com/script/main/mobileart-emh.asp?articlekey=58799&page=9, http://www.aaaai.org/conditions-and-treatments/allergies/sinusitis.aspx)
NEW TECHNOLOGY: A development in treating sinusitis is Balloon Sinuplasty (BSP), a safer and less invasive alternative to sinus surgery. The procedure does not use any cutting or removal of the bones or tissue in the nasal passages. Instead, a flexible balloon catheter is inserted into the sinus by an ear, nose and throat doctor and inflated to expand the sinus passage. Once the balloon is inflated, it allows the walls of the sinuses to open without damaging the delicate tissue. Currently over 380,000 sinusitis patients have been treated with the balloon sinuplasty surgery with improvement in quality of life and sinus symptoms. Because the surgery is less invasive, patients typically return to normal activity within two days. Scott Powell, M.D., Ear, Nose and Throat Specialist at Tampa Bay ENT, has performed this procedure on sinusitis patient, Marcey Walsh. Marcey suffered from several sinus infections but the balloon procedure has helped her regain control of her sinuses. Dr. Powell said the procedure can be done in the doctor's office and only takes about 45 minutes to complete. (Source: Scott Powell, MD, http://www.balloonsinuplasty.com/what-is-balloon-sinuplasty)
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Can a Balloon Cure a Sinus Infection? -- Doctor's In-depth Interview
Can you explain how sinuplasty works?
Dr. Powell: It's a process and a device that essentially goes in to the sinus opening and instead of cutting away tissue which is traditional sinus surgery the balloon device actually expands and becomes hard almost like a rock and restructures the underlying tissue. By doing that atraumatically, you don't alter tissue but the opening it creates is in fact permanent.
Is something like this going to be beneficial to a lot of people?
Dr. Powell: I think it's kind of changed the way we handle chronic sinus patients in that we can try to avoid waiting until the final destination of the operating room. The fact that we can do it in the office we can intervene a little earlier and change the disease course so instead of having repeated antibiotic courses after infections we can intervene, augment their sinuses and again change that destination.
What about the recovery time?
Dr. Powell: It's great because it's done in topical anesthetic so it's a topical medicine, avoiding needles, avoiding anesthesia and going to sleep. In that what we're able to do is people can drive in and drive home and in some cases go back to work the same day. They may just take some over the counter anti-inflammatories for discomfort.
Would this knock out their sinus infection, would this make a drastic difference?
Dr. Powell: Yes it's been shown with multiple studies to dramatically change how many infections they have. Now there are other reasons for infections which we have to address at the same setting but it definitely helps us change the amount of infections and how often and how severe they are.
What kind of patient would benefit from this?
Dr. Powell: Patients who have chronic infections six weeks or longer, lingering fatigue, pressure and drainage. As its evolved it's also included those chronic recurrent acute patients who have a few infections every year, three, four and five. They'll get better after antibiotics but they're only waiting for the next go around to get infected again. And by opening their sinus passages more widely that the common cold won't deteriorate into this severe infection.
How do you think this will change the lives of many patients who are dealing with this over and over?
Dr. Powell: We know that it affects quality of life and work and time off from work and with kids included it really affects the way people can behave and function. By intervening a little earlier we're able to change that pathway, reduce all the complications that we're seeing with antibiotics with the resistance and side effects and concerns. We're able to really change the dynamic because we're not hurting the tissue. It's very nearly invasive and it really changes how we can address things.
For somebody who is listening to this story and gets sinus infections three times a year, would they be a candidate?
Dr. Powell: It's hard to say because there's no clear cut number on that. It really is how it affects their quality of life. I have some patients who come in and it's just congestion they learn to live with it. They didn't realize there are alternatives to just living with it. So when I say three or four infections those are the ones that are down and out for weeks on end with multiple rounds of antibiotics. But in between those weeks they may have just a few days of feeling normal. Those are the ones we can intervene and we can decide whether or not they're a candidate at that time.
Once they get it done is that it? Do you have to come back in a couple of years?
Dr. Powell: It should be permanent. Studies have shown in fact that the tissue in and around the sinus does get restructured permanently; much like heart catheterizations do. But because of the bony structure we don't need to leave behind any stents or anything. It stays open as long as we address some other annoying inflammation.
What exactly do you do?
Dr. Powell: I have a device and essentially it's a little guidewire that we can snake into the sinus. On the tip of that is a light wire so that actually lights up their sinus to confirm yes, you're in the correct spot. It's a low complication risk if any. Then once you confirm that, there's a balloon that passes into the opening of the sinus. Now once that inflates it becomes very rigid and the surrounding structure gets kind of pushed out of the way. There's a paper thin tissue that permanently gets restructured and that's what makes it permanent. Then everything gets removed and they're feeling better almost instantly.
So the reason why people get sinus infections is because their passage ways are so narrow?
Dr. Powell: We're born with a certain size opening; some people have a smaller opening than others. With chronic inflammation, definitely with chronic infection scarring can occur and so you go from let's say a pencil eraser size down to a pencil tip size. You might image it doesn't take a whole lot of mucus or swelling before that's closed. And now the pressure builds, the fluid builds, and all of the symptoms build. By doing this procedure what we're able to do is re-dilate even beyond that pencil eraser size to a larger diameter that way there's a lot more room for air, for the common cold, swelling, and allergies before they really get symptomatic. We then can address those symptoms separately and they're much easier to deal with.
Can you tell from the get go if somebody has small passageways and they're just going to get sinus infections?
Dr. Powell: Essentially what we're able to do is tell by their history and in some cases we're actually able to see them in the office and we scope them and tell. But one of the final pieces we have is we do get a CAT scan of their sinuses and from there we can go over with the patient and say this is your problem. You can see the chronic stuff going on that we need to address. Those three things put together help us decide candidates.
Does it change the way they breathe or talk or their voice?
Dr. Powell: No voice changes but breathing for sure. They definitely feel more open and they can breathe better. I've had some patients tell me that it improves their snoring and their smell function and so forth. But there's no black and blue or external swelling or changes at all.
Some people say you don't want to mess with the sinuses, why do people say that?
Dr. Powell: Well there's that fear that once you touch them with traditional sinus surgery that it leads to more and more infections. Usually that's the case of not dealing with the primary reason of why they needed it. Whether it be allergy or just genetically they're predisposed. That's where we dive into the medical side post procedure to try to keep the good stuff good. By not violating the tissue it does reduce complication risk, it does reduce those issues in terms of healing because afterwards all they're really doing is salt water sprays to help finish off the healing, it's really nice.
How do you know if it's just allergies?
Dr. Powell: The symptoms are different. A lot of times what you can do is during the exam and history you can determine where allergies stop and sinus infections start. If you just deal with one or the other you're probably not going to be happy. This is a nice option because now we can say, listen we can treat your allergies whether that be with allergy shots etc., or medicine and they get you so far and then we can do a little bit more and get you back to normal. Versus before you were forced to do traditional surgery and more invasive procedures. So it kind of falls on the clinician to figure that out and separate the two out.
The traditional surgery would be reconfiguring the passageway?
Dr. Powell: It's that same opening I was referring to in terms of the pencil tip. You go in with sharp instruments and actually cut that tissue out so instead of making a small little doggie door you're actually taking the whole door down which works very well and has been shown to do so. But you deal with the crusting and the healing phase which is not very helpful or delightful for the patient if we can help it.
Is there any age group that would be better suited for this than another?
Dr. Powell: No, it's been shown for pediatrics and adults. The nice thing about the pediatric side is you can do things without violating tissue as their facial structures are growing so it helps augment that as well. It's one more tool in our tool belt for the pediatric population as well as all the way up to the geriatric population.
This is relatively new?
Dr. Powell: It's been in the conversation for quite a few years but in the office variety it's been probably three or four years now, maybe five. It just kind of took a little bit of practice because the patient is wide awake so it does take a little bit of personality to be able to handle talking to a patient while you're doing certain procedures. It's a comfort thing that just comes with experience.
Is it painful or just awkward?
Dr. Powell: People don't know what to expect and so what we try to do is try to walk them through exactly. People don't like surprises so as long as you tell them you're going to feel this, that and the other as it happens they're pretty good with it. There's some pressure obviously there's a balloon that's moving tissue but for the most part it's just a sensation that quickly goes away once that balloon deflates.
And how long does it take?
Dr. Powell: With numbing time about 45 minutes.