Published: Sept. 27, 2011
Updated: Sept. 28, 2011
Alicia Pierce used to feel the sinus pressure in her teeth. Each spring, her lifelong allergies flared up and her chronic sinus problems took a turn for the worse. The pain and pounding migrated south from her forehead and nose down to her mouth.
It was awful.
Every few years since 1992, Pierce went in for surgery to open up sinuses so prone to infection that twice she suffered from methicillin-resistant Staphylococcus aureus (MRSA), a bacterial infection highly resistant to antibiotics.
In all, she had five surgeries and countless courses of antibiotics. Often, recovery from surgery was just as unpleasant as a sinus infection -- blood drained down her throat, and she needed several days to get over the effects of the anesthesia.
Then, last March, with a raging sinus infection and her regular otolaryngologist out of town, Pierce met Donna Sharpe, MD, at Duke Otolaryngology of Durham. Sharpe cleaned out Pierce’s sinuses and discovered that her symptoms were off the charts.
Sharpe suggested balloon sinuplasty, an outpatient procedure performed under local anesthesia that could open up Pierce’s swollen sinuses without the side effects of previous surgeries.
It was a smash success.
“I feel great,” says Pierce, a 46-year-old mother. “I’ve had no problems. I would recommend it to anyone.”
In a specially outfitted procedure room at her office, Sharpe performed Pierce’s balloon sinuplasty on May 25, three weeks after performing the first such outpatient procedure in North Carolina.
For many patients, compared to traditional sinus surgery outpatient, balloon sinuplasty is gentle and easy as a breeze.
With the lights turned down low and relaxing music playing softly, the patient lies back in a reclining chair.
Sharpe inserts a flexible catheter into her patient’s nostril. Using a nearby video monitor along with a previous CT scan of the patient’s sinuses, Sharpe carefully guides the tiny catheter into an inflamed and mucus-filled sinus.
She follows that with a lighted guide wire that illuminates the hollow cavity. A spot on the patient’s head glows like a firefly, confirming that Sharpe has reached her target.
The physician inserts a small balloon, similar to those used for cardiac angioplasty, along the wire inside the catheter. Once the balloon is properly positioned, Sharpe inflates it, dilating the sinus opening.
As she removes the deflated balloon, the sinus drains. The patient feels a decrease in pain and pressure, and the procedure is over. In many cases, that’s it.
As needed, Sharpe will irrigate the sinus to flush out stubborn mucus or other material, but often, the relief is immediate. The patient is pain-free, breathing well, and ready for normal activity right away.
No incision, little or no bleeding, and a success rate exceeding 90 percent.
“It’s a pretty awesome technology,” Sharpe says.
Despite its success rate and examples like Pierce, outpatient balloon sinuplasty is not for all chronic sinusitis sufferers.
Patients must possess the anatomy to allow access via the catheter (blockages such as a deviated septum or sinus polyps are disqualifiers). They also need the temperament to tolerate surgical work inside their head under local anesthesia.
Sharpe performed balloon sinuplasty for three years in an operating room on patients under general anesthesia, which is still an option for people who are qualified for the procedure but too anxious to sit still for it.
During that time, she spoke often to colleagues about the possibility of doing the procedure on an outpatient basis. Then technology caught up: California physician and inventor Josh Makower, a sinusitis sufferer himself who created the technique, helped refine the equipment for use in an outpatient setting.
Sharpe says the technology is a revolution in patient care.
“It’s similar to the change in cardiology 25 years ago,” she says, “when many people no longer needed to have their chests opened up to unblock their arteries.”
Balloon sinuplasty also has become more accessible now that it’s less invasive. Approved by the Food and Drug Administration as well as the Centers for Medicare and Medicaid Services, the outpatient procedure costs about one-tenth as much as it does in an operating room.
Patients leave Sharpe’s office ready to return to their day, free of sinus pain for the first time in weeks or months.
Carter Thompson, who was the first person in the state to receive outpatient balloon sinuplasty (also in Sharpe’s office), experienced immediate relief much like Pierce did.
Thompson went home after her procedure, cleaned her house, and entertained guests that night.
“It’s surreal. I don’t know what to do with myself,” Thompson joked about her new life without sinusitis. She has found special pleasure in enjoying activities that were out of the question before, such as walking outside on a humid summer day.
“Dr. Sharpe has helped me tremendously.”