Feasibility of in-office endoscopic sinus surgery with balloon sinus dilation

• Published in: American journal of rhinology & allergy 2012-05, Vol.26 (3), p.243-248
• Main Authors: Albritton, 4th, Ford D, Casiano, Roy R, Sillers, Michael J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ambulatory Care - methods; Catheterization; Chronic Disease; Endoscopy - methods; Endoscopy - trends; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Paranasal Sinuses - diagnostic imaging; Paranasal Sinuses - surgery; Prospective Studies; Radiography; Rhinitis - physiopathology; Rhinitis - surgery; Sinusitis - physiopathology; Sinusitis - surgery; Treatment Outcome
• ISSN: 1945-8924; 1945-8932
• DOI: 10.2500/ajra.2012.26.3763

Balloon sinus dilation (BSD) tools are increasingly used in endoscopic sinus surgery (ESS) and post maximal may cause less tissue trauma/bleeding, potentially enabling office-based ESS. We evaluate the feasibility of ESS performed in-office using BSD instrumentation. All patients had a diagnosis with chronic rhinosinusitis. Because of symptom resolution failure postmaximal medical therapy (prolonged antibiotics, corticosteroids, and other adjuvant therapies), all patients were candidates for ESS. In-office ESS using BSD tools was performed on 37 subjects at nine sites. Procedure feasibility was assessed prospectively through technical success rate, procedure tolerability, quality of life, and radiographic outcomes. Subjects were followed at 1, 4, 24, and 52 weeks. In-office technical success by subject was 89% (33/37). There was one nonserious adverse event. In-office BSD was tolerable, with 93% (27/29) of patients reporting the procedure as tolerable or highly tolerable. Two in-office subjects (7%) indicated poor procedure tolerability. Intraprocedure pain was also well managed during in-office BSD, with 66% (24/36) of patients reporting no pain or pain of low intensity. While 33% (12/36) reported higher-scale pain, usually during balloon inflation, only 2 patients experienced intense pain. At 52 weeks, 95% of the subjects stated they would have procedure again. Sino-Nasal Outcome Test-20 scores revealed clinically and statistically significant treatment effects at all time points, comparable to previous balloon dilation studies conducted in an operating room setting. Lund-Mackay scores revealed a statistically significant reduction at 24 weeks. Office-based ESS with BSD is feasible with demonstration of high technical success rate, meaningful patient symptom improvement, and high patient satisfaction.