If you suffer from symptoms such as sinus headaches and nasal congestion year-round, sinus surgery proves a viable option. Those who suffer from seasonal allergies can simply treat the symptoms. As the season passes the symptoms fade away and they move on. Chronic allergy sufferers, however, continue to experience discomfort, even to the point where you are unable to function normally.
Chronic sinusitis can be a crippling condition and many of those who suffer from this allergy condition struggle their entire lives to find any type of sustainable relief.
In-office Balloon Sinuplasty Procedure is an advanced surgical procedure that removes the pain, discomfort, and hassle of the traditional operating room surgery and delivers life-changing results.
At Estrella ENT, our founding doctor, Jonathan Wiggenhorn, D.O., performs hundreds of in-office procedures every year and in this article, you will discover what you can expect when you make the decision to rid yourself of sinus problems using in-office sinus surgery. In addition, we address specific questions and concerns patients at Estrella ENT have expressed regarding the in-office option of surgery.
What Is Chronic Sinusitis and How Do You Know If You Have It?
Most adults are familiar with the saying, “My sinuses are acting up,” and in many cases, they may actually suffer from a sinus infection, or, sinusitis (pronounced [sahy-nuh-sahy-tis]). Sinusitis is when the cavities around the nasal passages become inflamed; it causes nasal congestion and sinus headaches. Nasal congestion is also caused by allergies, non-allergic rhinitis, weather pressure, changes in weather, and irritants breathed in through your nose. You can have nasal symptoms and not have sinusitis, but sinusitis typically also gives you nasal symptoms.
While seasonal ‘allergies’ tend to pass relatively quickly, a sinus infection (sinusitis) can linger and cause other symptoms and discomfort. Your sinus cavities have outflow tracts which allow fluids to pass through. When those outflow tracts close up, pressure builds up within the sinuses. Ever wonder why ‘allergies’ have pain associated with them? This blockage and mounting pressure is the reason why.
Nasal drainage is another noticeable symptom. There is normal clear drainage and then there is nasal drainage which is dark in color (greenish brown, brownish yellow, greenish yellow) and is thicker in its consistency. This darker, thicker drainage – often foul-smelling – can make its way down the back of your throat, preventing you from being able to see its color and hiding the evidence of whether or not you are actually experiencing sinusitis. If sinus symptoms linger, seeing an ENT becomes much more important, especially if you experience chronic nasal drainage. Chronic post nasal drainage can cause chronic throat pain and lead to other problems.
Another symptom of sinusitis is ear fullness. Adults and kids alike suffer from ear fullness. The Eustachian tube, which connects your middle ear space to the rear of the nose (near the soft palate), empties into the nasopharynx and serves as a pressure equalizing tube (it’s actually pretty cool how the body works in this way).
When we get the sensation that our ears are plugged, it means this tube is stopped up and negative pressure is now building up in the middle ear until that tube opens. When the tube does open, middle ear pressure is equalized with the atmosphere and the ‘plugged’ sensation goes away. Partial closure or complete closure of the Eustachian tube can be caused by any type of inflammatory process going on in the nose, including chronic sinusitis.
Physical and Mental Fatigue
Fatigue is another symptom of sinusitis. Why? Your body and immune system are working overtime, constantly fighting this infection. More sleep doesn’t remedy the situation because that isn’t the problem. The problem is that your body is using all its energy to help defeat illness. Along with physical fatigue, you can experience mental fatigue, or what many patients describe as foggy headedness. Difficulty concentrating, dizziness, general malaise, and an underlying ‘not-feeling-well’ sensation are all caused by this sinusitis-related fatigue.
Here are a list of symptoms we just covered above caused by sinusitis:
- Nasal congestion
- Sinus headaches
- Colored nasal drainage (greenish brown, brownish yellow, greenish yellow)
- Thick nasal drainage
- Foul-smelling post-nasal drainage
- Ear fullness
The difference between sinusitis and chronic sinusitis is that chronic doesn’t go away. There may be seasons when these symptoms may not be as dramatic, but that is only for a short time.
Those who experience chronic sinusitis, the persistent presence of the symptoms covered above, can find relief through balloon sinuplasty surgery.
Balloon Sinuplasty (BSP) is a safe and effective remedy and unlike more dramatic treatments, can be performed in-office, without the need or cost of hospital operating room surgeries. Dr. Wiggenhorn has performed this surgery hundreds of times both at the Estrella ENT office as well as at hospital surgery centers. This procedure provides chronic sinusitis sufferers with relief from uncomfortable sinus pain symptoms.
While you may be new to the concept of Balloon Sinuplasty, it is a tried and true method for treating chronic illness, approved by the United States Food and Drug Administration in 2005.
What is Balloon Sinuplasty?
When an Estrella ENT patient learns that they are a good candidate for this advanced sinus procedure, they want to know exactly what’s involved. From preparation, to what is actually done, all the way to recovery, and then finally long-term impact.
The main thing candidates should understand is what is actually being done through the advanced sinus procedure.
Balloon Sinuplasty is a type of endoscopic nasal surgery that uses small balloon catheters. It’s really quite something. This small catheter is inserted all the way into the sinuses and then inflates like a balloon to open up the sinuses allowing the build up in the large sinuses to drain, relieving pressure, and bringing relief. The balloon is no larger than a two centimeters.
Here is a link to a video presentation
In the past, many patients would opt for surgery that would remove bone and tissue so drainage could pass. With Balloon Sinuplasty, you now have a choice between non-destructive or destructive surgery, meaning no bones need to be broken or removed.
Besides the choice of a less invasive sinus procedure, patients have come to appreciate the flexibility in the choice of surgery locations. Dr. Wiggenhorn successfully performs BSP at his office every week and patients have been thrilled with their experience. The in-office procedure is done using IV sedation which leads right into the most commonly asked questions regarding in-office sinuplasty procedures: Will it hurt?
The consistent report from patients who have opted for the convenience of in-office sinuplasty procedure is that they have felt only slight pressure or numbness during the surgery, not discomfort and certainly not pain. In the past, general anesthetic administered in a hospital surgery room was required. Now, because of the comfort that is able to be achieved through the in-office procedure, patients are bypassing the inconvenience and cost of the hospital for the more efficient and cost-effective in-office route.
Once the IV sedation is administered, Dr. Wiggenhorn inserts the endoscope – a thin, flexible, plastic tube with a camera and light on the end – into the nasal passage. He guides it all the way to the cavity entrance and then slowly advances a small balloon catheter over the guiding endoscope wire. When the balloon catheter is correctly positioned, it will slowly be inflated and pressed against the sinus walls. After the balloon is fully inflated, Dr. Wiggenhorn flushes out the passageways and cavities with a saline rinse to further remove debri. Once complete, the balloon is removed and the sinuses continue to drain. There is no cutting of nasal bone or tissue with Balloon Sinuplasty Procedure.
Most patients are surprised that this procedure typically takes between 25 to 45 minutes, with the average procedure being 30 minutes. The brevity of the procedure combined with the in-office option has patients out and on their way in a couple of hours, in most cases.
Is the Balloon Sinuplasty Procedure Effective?
When other treatments and therapies fail to remedy a patient with medically diagnosed chronic sinusitis, Balloon Sinuplasty Procedure is a fantastic option to experience long-term, even lifelong relief from all the symptoms mentioned earlier in this article.
Along with the testimonials you’ll find from patients who have opted for BPP, you’ll find many studies that observed the impact of the treatment.
A 2016 study shared by the US National Library of Medicine and National Institutes of Health website reported that of 15 adults who received balloon sinuplasty, all reported improved symptoms such as open, clear nasal passages. The procedure helped preserve healthy nasal tissues, mucous membranes and structure.
A 2013 study shared by the same USNLM and NIH found that of 20 individuals who received balloon sinuplasty, all reported dramatically improved symptoms within one week of surgery. One Week! These participants were also symptom-free in the year following surgery.
Finally, a second 2013 study published on the USNLM and NIH website found that when performed in a doctor’s office under local anesthesia, people who had balloon sinuplasty reported an overall improved quality of life.
Treatment Prior to Balloon Sinuplasty Procedure
Balloon Sinuplasty Procedure is a wonderful solution to chronic sinusitis, however, it is not a ‘first-option’ treatment. A patient must first be diagnosed with chronic sinusitis in order to qualify for surgery. The majority of our BSP patients have come to Estrella ENT after treatments by primary care providers have been unsuccessful in relieving their symptoms.
Treatments that are typically prescribed prior to surgery include multiple rounds of antibiotics, nasal steroids and nasal irrigations. Dr. Wiggenhorn often performs allergy testing, allergy drops or allergy shots to try and bring allergy symptoms under control. Once a patient has gone through each option with no relief, it is at that point Dr. Wiggenhorn recommends this surgical option.
If you are coming to Estrella ENT prior to addressing sinus concerns with a primary care physician, Dr. Wiggenhorn starts with an exam as well as documenting your health history. If necessary, you would begin treatment such as an antibiotic or a nasal steroid. After this initial course of treatment, you would return for a follow-up visit.
In this scenario it is possible you would go through a couple rounds of antibiotics or be recommended for allergy testing (which is done in our office). If, following this course of treatment, the symptoms still linger you would proceed to qualifying for Balloon Sinuplasty Surgery.
Your Path: Balloon Sinuplasty Procedure
Dr. Wiggenhorn’s first step to qualify a patient for Balloon Sinuplasty Procedure is to take a CT scan. At Estrella ENT we have our own CT scan machine in-office in order to shave weeks off of waiting between meeting with Dr. Wiggenhorn and then being referred to a radiologist, receiving results and then reviewing results with Dr. Wiggenhorn. If the in-office CT scan confirms chronic sinusitis and the patient is an otherwise good candidate for the procedure, a procedure day can be scheduled during the same visit. In some cases, our schedule can accommodate same-week procedure appointments.
In addition to using the CT scan to diagnose your condition, similar imaging technology will be used as a guidance system during your procedure. Using this GPS-like system, Dr. Wiggenhorn can track the location of his instrument within millimeters using a live screen. Between the live screen and the multi-view CT scan, Dr. Wiggenhorn can confirm exactly where the endoscope is and work with precision.
While many will qualify for Balloon Sinuplasty, there are some patients who may not be a good candidate for the treatment. Patients who are at high risk of lung problems from being intubated, patients who have COPD, or those with chronic emphysema would have trouble being intubated and are unable to have the in-office BSP procedure done.
In addition, patients with facial trauma, any facial reconstruction, or your anatomy has been changed, the procedure may not be for you.
Though there are exceptions as listed above, we are happy to report that most people are able to have this life-changing procedure and Dr. Wiggenhorn is very straight forward when discussing with patients their eligibility and his recommendations.
Once your sinus procedure has been scheduled, there are a few things you need to do in order to prep for BSP. If you have any other medical concerns or problems, you will need clearance from the supervising doctor. If you are on blood thinners, you will need to be off of them for a minimum of seven days. You will not be able to drive yourself home following surgery so you will need to secure a ride from a friend or family member and have someone stay with you for 24 hours following the procedure.
On the day of your procedure, our office will go over all the post-procedure instructions with you thoroughly and answer any other additional questions in regards to your procedure, and after care. Dr. Wiggenhorn also goes over the procedure with you, giving you an opportunity to ask any questions or express any concerns.
Choosing Between In-Office Procedure or Hospital Surgery
You have the choice of in-office procedure as well as hospital operating room surgery. When you discussing the benefits of the procedure itself, Dr. Wiggenhorn will point to the added benefit of the in-office option.
Patients are concerned with the level of comfort they will experience in-office versus a hospital operating room. As an advocate for his patients, Dr. Wiggenhorn – in most cases – will recommend the in-office procedure. You will avoid the hospital altogether and your recovery will be much quicker. Our staff creates a very comfortable environment for your procedure and Dr. Wiggenhorn will administer topical medications so you won’t feel any pain during your procedure. An additional benefit for some patients is a lower out-of-pocket cost if the procedure is performed in a physician’s office.
What You Can Expect After a Balloon Sinuplasty
The post-procedure experience can vary from person to person, but the majority of patients report being a little groggy but alert and are able to answer questions and understand replies. You may experience tiredness, tenderness, headache, congestion, and bloody drainage following the procedure.
You and your family member will be given follow-up instructions and you will have a chance to ask any questions about them. Dr. Wiggenhorn may advise you not to blow your nose for a day or two after your procedure and you will be instructed to avoid strenuous activities for at least a week after. You also will be on traveling restrictions for at least two weeks. No flying or out of town trips.
A staff member from Estrella ENT will walk with you out to your car, a wheelchair won’t be needed. Within 10-15 minutes of the procedure, you will be on your way home. Most patients are very happy about how quickly the procedure was performed, and that it was so easy. And above all, that they’re not in any pain.
Following their procedure, it will be necessary for you to return to our office for a post-procedure debridement. There may be a build-up of blood or lingering debris such as packing which needs to be removed. Completing this debridement can be done in one to three office visits, depending on case by case scenario.
Once home, many of our patients find it helpful to sleep or rest with their head and neck in an elevated position to promote drainage. When resting, prompt some pillows behind your head to keep it in an inclined position. A recliner is also a good resting spot for the first few days after. Dr. Wiggenhorn, will write you prescriptions for medication(s) post-procedure to help manage any discomfort or pressure. Do NOT use any anti-inflammatories for at least one-week post procedure.
Patients can expect to return to normal activities quickly. In fact, most patients return to regular activities, including work, 48 hours after BSP. Wow!
Regarding Side Effects of Balloon Sinuplasty
As with any procedure, there can be side effects. Common side effects from balloon sinuplasty include:
- Nasal, cheek, or forehead tenderness & pressure
- Minor swelling in nasal cavities and passages
- Surrounding facial area congestion and infection (usually from lack of proper post-surgery cleansing of the sinuses)
- Sore Throat (rare, but sometimes happens)
While rare, there are additional side effects that patients need to be aware of. Sinuplasty has been reported to cause more severe symptoms, such as damage to the structures that separate the brain from the sinuses. While extremely rare and unreported by Dr. Wiggenhorn’s patients, sinuplasty has also been known to occasionally interfere with an individual’s sense of smell, and the appearance of their nose. Anytime a person is exposed to a form of anesthesia there is always a risk of adverse reactions. In-office surgery utilizes IV Sedation, avoiding general anesthesia.
Here are a few additional things patients have appreciated knowing before opting for balloon sinuplasty procedure.
- Balloon sinuplasty is considered very safe and effective when performed by a qualified doctor, for instance, our very own Dr. Jonathan Wiggenhorn, DO at Estrella ENT.
- BSP is associated with high rates of success and low risks of complications.
- Benefits of balloon sinuplasty over traditional endoscopic sinus surgeries include lower risk of bleeding, much faster recovery time, no damage or removal of sinus tissues, mucous membranes or sinus cartilage.
- Fewer post-op appointments are needed because there’s no need to inspect stitches or sutures.
- There is a reduced need for operative and post-op pain meds and general anesthesia, therefore lowering the risk of an adverse reaction to those medications.
- Reduced risk of postoperative infection, unintentional tissue or structure damage and scarring.
How Long It Takes To Feel Relief Post-Procedure
The real question is, how long will it take before experiencing relief from sinus symptoms? Depending on the patient and the extent of the sinus disease, some patients will feel relief within a day or two.
Some patients will take a little bit longer to recover, especially if more work was done beyond the BSP.
There are other things that can cause chronic sinusitis and nasal congestion and drainage, such as enlarged inferior turbinate hypertrophy. We all have turbinates in our nose that humidify and clean the air we breathe, as well as warm up the air we breathe; sometimes these can get quite large. Dr. Wiggenhorn can reduce them at the same time as the balloon dilation procedure.
Another condition that can be treated during the procedure is a deviated septum. Deviated septum is something that could cause nasal obstruction. This is also something that can be fixed at the same time. If you need those things corrected, you can have them all done at once. Dr. Wiggenhorn, is one of the first to pioneer an implementation of the in-office septoplasty. Throughout the state of Arizona you will find that most ENT physicians have not mastered this technique.
Balloon sinuplasty is highly successful – what success looks like from patient to patient can vary. Many patients have other underlying problems such as severe allergies which will need to be treated. In other words, the whole person needs to be treated, not just surgically, but also medically for any other ailments you may have that can trigger sinus infections.
Comments Regarding the Need for Future Surgeries after Balloon Sinuplasty
One question that Dr. Wiggenhorn is asked frequently is, “Am I ever going to have this procedure again?”
Most doctors don’t experience first-hand many of the conditions they treat, but Dr. Wiggenhorn is the exception. Having battled severe allergies and chronic sinusitis personally throughout his lifetime, and undergoing surgery for treatment, he is able to deliver knowledgeable and compassionate care to his patients..
When talking about the need for future surgeries, Dr. Wiggenhorn is almost glad he has had two surgeries, so he can say, “I don’t know. I’m going into your procedure with the belief it will be your last time, but every person is different and life is unexpected.” For the most part, if you have straightforward chronic sinusitis and no underlying allergies, it’s going to be the procedure, post-op care, and then you’re done. If you have nasal polyps, which can regrow, or horrible allergies, then you’ll have to come back. Other things can happen such as nasal polyps or scarring, making Dr. Wiggenhorn hesitant to ever say that you will never have another procedure/surgery. However, the likelihood is that you will never have this again.
What many patients appreciate about Dr. Wiggenhorn is that he has gone through the same process as his patients and can deliver care out of first-hand experience.
No surgery is 100% effective 100% of the time for 100% of patients. It’s been shown that the balloon dilation patency rate is over 90% effective for over three years. For balloon dilation, the one-year patency rate was 96.7%: one year after the sinus ostia were still unobstructed. That means “success” to Dr. Wiggenhorn and his patients.
Even with the exceptions and variables from patient to patient, BSP will have a long-term impact on your life. You are having this procedure so you will have healthy sinuses for the rest of your life. The severe nature of your chronic sinusitis will be gone and will stay gone. That doesn’t mean you will never have any episodic bouts of sinusitis, but if you do, they should not be as debilitating and last for a much shorter time. You will have less downtime, respond quicker to medications and antibiotics because your nose will be open and able to drain. The long-term goal is to not have any further sinus infections, but that, If you do get them, they should be less frequent and less severe.
Final Thoughts on Balloon Sinuplasty
Dr. Wiggenhorn believes that balloon sinuplasty is the wave of the future and that the in-office procedure is where sinus surgery is headed. Not many doctors have entertained BSP over other, more aged treatments. This breakthrough and medically approved procedure comes with decreased risk and no general anesthesia, less hospital time, and lower overall cost to individual patients and the healthcare system in general. It’s a reliable method that has been proven through many studies.
If you have been diagnosed with chronic sinusitis and are not responding well to medication, or if you have recurrent acute rhinosinusitis, you may be a candidate for Balloon Sinuplasty. It’s a proven, less invasive technology used by ear, nose and throat (ENT) doctors like Dr. Wiggenhorn to treat patients with chronic and recurrent acute sinusitis.