Thinking about surgery for chronic sinusitis? Here are five reasons endoscopic sinus surgery may be a better option than balloon sinuplasty.

Chronic sinusitis affects millions of people every year.  Some people with chronic sinus problems can’t get relief with medications, no matter what they try.  They may need to consider having sinus surgery to get some relief.  

Sinus surgery can help enlarge the sinus openings.  The goal is that the larger sinus openings will allow the sinuses to drain more easily.  The larger openings can also make it easier for medications to get into the sinuses.  All of this can then help the sinuses function better.

ENT doctors now perform two main types of procedures to treat chronic sinus problems. One is traditional endoscopic sinus surgery and the other is balloon sinuplasty.

Endoscopic sinus surgery is also called functional endoscopic sinus surgery (or FESS for short).  Surgeons have performed endoscopic sinus surgery over the course of 30+ years.  With endoscopic sinus surgery, the surgeon uses a little endoscope through the inside of the nostrils to look for the little openings into the sinuses.  The doctor then uses different surgical tools to enlarge the narrow sinus openings under direct visualization.

Balloon sinuplasty has been used for about 10 years.  With balloon sinuplasty, the doctor inserts a balloon into the nostrils.  They aim the balloon into the sinus opening.  They then inflate the balloon to try to stretch the sinus opening.  There has been a big increase in the number of patients having balloon sinuplasty over the last five years.

At our office, patients sometimes ask which type of procedure is better for them.  We typically find that traditional endoscopic sinus surgery is the better option for most of our patients.  Here are some reasons why:

Endoscopic sinus surgery is more precise and effective at opening the sinuses 

The goal of the sinus surgery is to enlarge the openings into your sinuses.  With endoscopic sinus surgery, small tools are used to enlarge the sinus openings.  The surgeon removes small amounts of material around the natural opening of the sinuses. The endoscope has a little camera so that the surgeon can see and enlarge that the opening.  The surgeon can also make the opening as large as they may need to for the type of sinus problem you are having.

Balloon sinuplasty stretches the sinus openings.  That can stretch the sinus opening, but stretching can only open the sinus so much.  The surgeon typically cannot see the location of the sinus opening as precisely with balloon sinuplasty.

For someone with very narrow sinus openings, the endoscopic sinus surgery will be able to enlarge the openings more effectively.

Endoscopic sinus surgery makes it easier to monitor your sinuses after surgery

Patients with chronic sinusitis issues can still have some sinus issues in the years after sinus surgery.  To diagnose and treat issues after sinus surgery, it is helpful for your doctor to look inside the sinuses.

A nasal endoscope is used to look inside the nose and sinuses of patients with chronic sinus problems.  After endoscopic sinus surgery, your doctor will typically be able to look directly into the sinus openings and see inside the sinuses.  They can do things like monitor the healing after surgery, monitor long term sinus inflammation, diagnose future sinus problems, and get samples of infected mucus from the inside of the sinuses.   If you have an infection, the doctor can take a sample for cultures.  This can then help treat future sinus infections more precisely. With the culture results, the doctor can select the correct antibiotic for the specific bacterial strains that may be causing a particular sinus infection.

After balloon sinuplasty, the opening into the sinus is typically not large enough to allow the doctor to look inside with a nasal endoscope.  Your doctor usually won’t be able to suction mucus or infected material from the inside of the sinus.  This can make it harder to monitor, diagnose, and treat sinus issues on a long term basis.

Endoscopic sinus surgery allows nasal sprays and nasal flushes to get inside the sinuses more effectively

Many patients with chronic sinus problems need to use some day-to-day treatments to keep the sinuses healthy after surgery.  Maintenance treatments can help keep the sinuses healthy.  

The larger sinus openings after endoscopic sinus surgery allow for nasal sprays and nasal irrigations to get inside the sinuses more effectively.  

The openings after balloon sinuplasty are smaller, making it more difficult for sprays and irrigations to enter the sinuses.

Endoscopic sinus surgery can be used to treat all of the sinuses

There are four sinuses on each side of the nose and face.  The names of the different sinuses are: the maxillary, ethmoid, sphenoid, and frontal sinuses.  With traditional endoscopic sinus surgery, a surgeon can enlarge the opening into each one of these sinuses.

With balloon sinuplasty, the doctor can stretch some, but not all, of the sinus openings. There is no balloon to treat problems with the ethmoid sinuses.  

The ethmoid sinuses have much smaller air pockets than the other sinuses.  They are often very prone to getting plugged, so they’re an important area for treatment if someone is having sinus surgery.

Endoscopic sinus surgery treats conditions like nasal polyps more effectively

Many patients with chronic sinus issues have nasal polyps.  Surgery for nasal polyps usually involves removing polyps and enlarging the openings into the sinuses.  

Endoscopic sinus surgery is very effective at removing polyps and at creating wide sinus openings.  Patients with nasal polyps usually have severe sinus inflammation.  Using maintenance medications to treat the inflammation is an important part of keeping the sinuses healthy.  The larger openings help medications get into the sinuses.  Nasal sprays or medicated nasal sinuses can enter the sinus areas after endoscopic sinus surgery.

Balloon sinuplasty may stretch the sinus openings, but a sinus balloon cannot remove nasal polyps.  The openings after balloon sinuplasty are typically smaller than with traditional endoscopic sinus surgery. The smaller sinus openings make it harder for medications to get into the sinuses after balloon sinuplasty.

We hope that answers some questions about the differences between endoscopic sinus surgery and balloon sinuplasty. It’s important to remember that different treatments are right for different situations.  If you are having chronic sinus issues, seeing a good sinus surgeon is a good starting point as you try to determine the best treatment options for your particular issues.

If you are interested in an appointment for evaluation of your sinus issues at our New Jersey or New York office, please contact us by phone or by requesting an appointment online.  

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