.When Surgery to Treat Sinusitis is Needed.
When considering surgery for a child with chronic sinusitis …
When all else fails …
Last week I reviewed the first step in surgery to treat your child’s chronic sinusitis – adenoidectomy. We also talked about sinus centesis and new methods for identifying the bacteria that are causing the problem. Check out this link for Part 1 of “When Your Child Must Have Sinus Surgery“.
So, let’s assume that you have done EVERYTHING to eliminate your child’s chronic sinusitis. Let’s assume that you have followed my 5-Step Program to Eliminate Biofilm and Chronic Rhino-Sinusitis.
If all else fails and sinus surgery is absolutely indicated – perhaps your child has experienced one of the severe Complications of Sinusitis – the approach should always be minimally-invasive surgery: minimal surgery for maximal gain, especially for a child.
My own minimally-invasive preference for sinus surgery is “balloon sinuplasty” when possible, since there is minimal scarring, minimal post-operative crusting and bleeding, and excellent sinus openings are achieved. This is the method that I have been using for at least 5 years with great success.
This approach, balloon sinuplasty, has been found to have lasting results in adults. Dr. Ramadan recently reported that balloon sinuplasty is also safe and effective in children, corroborating my own experience (Ramadan, 2009). In fact, there is a huge number of medical studies now that report excellent long-term results for Balloon Sinuplasty – with somewhere over 3,000 patients now!
How Does Balloon Sinuplasty Work?
Most people have heard of cardiac balloon catheters – those are the balloons that are placed into the coronary arteries, and expanded to open the arteries, as an alternative to coronary artery bypass surgery.
For balloon sinuplasty, a similar balloon catheter is placed into the normal openings of the sinuses (called the sinus ostea), and expanded to stretch open the ostea. [Check here for the Anatomy of the Nose and Sinuses].
Balloon Sinuplasty: No cutting. No tearing or ripping the tissue. As a result, there is less bleeding, less potential for scarring, less post-op care required at home, and in clinic. Long-term follow up has shown excellent results.
The 4 steps to Balloon Sinuplasty:
Images courtesy of Frederick Kuhn, MD
All of these steps in children require a general anesthetic. For adults, some sinus surgeons are actually offering Balloon Sinuplasty in their clinics, without the need for general anesthetic.
Overall, my pediatric patients have achieved greater than 90% success with balloon sinuplasty! That is impressive, given that I will only perform sinus surgery for those children who fail every other possible medical and surgical treatment – including long-term nasal saline rinses, long-term antibiotics, and an adenoidectomy – before I will consider sinus surgery. That means that these children have chronic sinusitis that is particularly difficult to treat, by ANY means.
Watch the Balloon Sinuplasty Video / animation:
Transparency: I have no financial or other ties to the vendor of this surgical system (Acclarent Medical). I recommend those who are curious to check out their website.
If the care of your child does progress to the point of sinus surgery, keep in mind that exposure to tobacco smoke will significantly reduce the success rate of the surgery (Ramadan & Hinerman, 2002). Just one more reason to Quit Smoking (do it for your kids!), and to Eliminate Your Smoke Exposure – keep smokers away from you and your children!
Ann L. Griffen, Clifford J. Beall, Noah D. Firestone, Erin L. Gross, James M. DiFranco, Jori H. Hardman,Bastienne Vriesendorp, Russell A. Faust, Daniel A. Janies, Eugene J. Leys.CORE: A Phylogenetically-Curated 16S rDNA Database of the Core Oral Microbiome; PLoS ONE, 2011: http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0019051
Faust RA and Rimell FL: Chronic rhinosinusitis in children. Current Opinion in Otolaryngology, Head and Neck Surgery, vol. 4: 373-377, 1996.
Ramadan HH, Cost JL: Outcome of adenoidectomy versus adenoidectomy with maxillary sinus wash for chronic rhinosinusitis in children. Laryngoscope Vol. 118: 871-873; 2008.
Ramadan HH: Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children. Annals of Otology, Rhinology & Laryngology. Vol. 118(3): 161-165; 2009
Ramadan HH, Hinerman RA. Smoke exposure and outcome of endoscopic sinus surgery in children. Otolaryngology Head & Neck Surgery. Vol. 127(6): 546-548; 2002.
Acclarent Balloon Sinuplasty: https://www.acclarent.com/solutions/sinusitis-overview/balloon-sinuplasty-technology
Hi, I’m Russell Faust, author of this blog, and I appreciate your comments and questions. Keep ‘em coming. Please, “be excellent to one another.”
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