December 22, 2007
Relief From Sinus Pain: In Sinuplasty, Balloon Opens Blocked Cavities
Like an estimated 37 million other Americans, Glen Templeton has sought medical treatment for sinus infections. The 20-year-old Carroll High School graduate, who now attends Ball State University, began experiencing severe problems a couple of years ago due to allergies.
He took antibiotic after antibiotic in an attempt for relief.
"He'd finish one round, and then a couple weeks later, he'd have another infection," said his mother, Cheryl Templeton. In August, he developed an infection in the left frontal sinus cavity above his eye that would not clear up.
"Before the sinus infection I could bike 10 miles and not be hurting at all," he said. "Now I go 2 miles in the time I did 10. I knew something had to be done about it."
On Thursday, Templeton underwent a new type of sinus surgery that has been available in Fort Wayne for about a year. Sinuplasty, or balloon angioplasty of the sinus, parallels angioplasty of the heart, in which a balloon is used to open vessel walls.
In the nose, two frontal sinus cavities are among eight adjacent to or above the nose. Each has an opening into the nose that allows air to move in and out.
A continuous membrane lines the cavities. Mucus keeps the lining moist and is moved along the pathways via tiny hair-like cells called cilia. The sinuses do not drain by gravity, but by the action of the cilia.
A cold or allergies can irritate and inflame the lining, causing increased and thickened mucus. The inflammation can become severe enough to block the sinus, trapping mucus in the cavity and leading to infection. Sometimes air gets trapped, causing pain and pressure.
In an operating room at Lutheran Hospital, Dr. David Stein prepared a thin, flexible guide wire that he carefully snaked through Templeton's nasal passage, past several structures along the way and up into his left frontal sinus.
With the end of the catheter millimeters away from Templeton's brain, Stein could see on the monitor exactly where to stop. Then he slid a balloon catheter over the guide wire to the desired location. He slowly inflated the balloon, which pushed out the tissue and eggshell-like bones in the cavity to open the blocked passageway.
A smooth appearance on the sides of the balloon indicated he had inflated it to the level needed. In less than a minute, the balloon was deflated. Then Stein inserted an irrigation tool to wash out the pus and debris.
Templeton snoozed away under general anesthesia and was home less than two hours later. On Friday, he was back to helping shoppers find last-minute gifts at Macy's, where he has a seasonal job during his college break.
"I feel great," he said late Friday, noting he had almost no pain afterward and no swelling in his face.
"The procedure anatomically changes the sinus," said Stein, an otolaryngologist with Ear, Nose and Throat Associates in Fort Wayne.
Balloon Sinuplasty is not approved for use in all sinus cavities, and the technology, developed by Acclarent Inc., a California medical-device company, "does not fix allergies," Stein said. But for people like Templeton, it is a good alternative to traditional sinus surgery, which involves cutting away tissue and fracturing bone.
Although traditional surgery was discussed, Templeton said, "That didn't sound pleasant at all."
Sinuplasty involves less tissue damage and avoids scarring that can sometimes occur after traditional surgery and cause new blockages.
Recovery lasts several weeks, with swelling around the nose and eyes.
Stein said Templeton's re-opened sinus should remain that way indefinitely, although studies at this point are limited to about two years post-surgery. In severe cases with difficult blockages, doctors sometimes try Sinuplasty before resorting to traditional surgery.
Stein has done 10 Sinuplasty procedures so far and all were without complications, he said. A careful screening of patients, however, is crucial.
Technology is changing so rapidly that despite Sinuplasty's short history, the way it will be done will soon change. In the coming months, the large machine used to take the moving X-rays of the advancement of the guide wire and the balloon catheter will be replaced by a lighted guide wire that can be seen through the surface of the skin.