The lights are turned down low in the balloon sinuplasty room at Duke Otolaryngology of Durham. Relaxing music plays softly. A 63-year-old woman with a lifelong history of painful chronic sinusitis lies back in a reclining chair.
Donna Sharpe, MD, inserts a flexible catheter into her patient’s right nostril. Using the endoscopic image on a nearby video monitor, along with a previous CT scan of the patient’s sinuses, Sharpe carefully guides the tiny catheter into the inflamed and mucus-filled frontal sinus.
She follows that with a lighted guide wire that illuminates the hollow cavity. The patient’s forehead 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 in the blocked ostium, 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, no mechanical debriding of tissue or bone, little or no bleeding, and a patency rate exceeding 90 percent.
“It’s a pretty awesome technology,” Sharpe says.
Despite its success rate, 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), and need the temperament to tolerate surgical work inside their head under local anesthesia.
Sharpe was the first physician in North Carolina to perform balloon sinuplasty in an office setting. She performed it for three years in an operating room on patients under general anesthesia, which is still an option for patients who are otherwise qualified for the procedure, but are 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. Recently, technology caught up with the ambition of Sharpe and other like-minded otolaryngologists, allowing the technique to be comfortable and easily used in an office.
Balloon sinuplasty follows the trend of other surgeries that have become more accessible once they became less invasive. Approved by the Food and Drug Administration as well as the Centers for Medicare & Medicaid Services, the procedure costs about one-tenth as much as an office procedure as it does in an operating room.
And patients such as Sharpe’s lifelong sinusitis sufferer leave her office ready to return to their day -- sinus-pain free, says Sharpe. ”That patient went home and cleaned her house, and she entertained guests that night.”