University Hospital uses advanced technology to treat chronic sinusitis

By Laura Latzko
news@columbiamissourian.com

Since fall 2007, University Hospital has been offering a less invasive procedure for patients with chronic sinusitis.

Using a balloon sinus device, doctors are treating patients with chronic sinus infections using a more minimal approach than traditional surgery. The device is a disposable catheter attached to a rod that is inserted into certain sinuses through the nasal cavity, where it then is inflated to expand and remodel the sinus opening.

Dr. David Chang, a surgeon in the Department of Otolaryngology at MU, said the new procedure is less invasive because it does not involve cutting through bone and tissue to get to the blocked sinuses.

“The goal of sinus surgery is to expand to drainage pathways in the sinuses,” Chang said. "Traditionally bone and tissue are removed to achieve this goal."

Chang and Dr. Al Barrier, also a surgeon in the Department of Otolaryngology at University Hospital, have used the device on 15 patients. Chang generally sees more than 100 patients a month with chronic sinusitis and said most can be treated with antibiotics and topical steroids. He said that traditional surgery is still the standard procedure for patients with chronic sinusitis.

The balloon sinus device costs about $1,200 per case, Chang said, but the additional cost may be offset by the reduction of operating time.

The technology was first introduced to the market in September 2005 through Acclarent, a medical device company out of Menlo Park, Calif.

Josh Makower, inventor of the balloon sinuplasty technology and a former chronic sinusitis sufferer, said the device makes it easier to access certain sinuses, especially those in the forehead above the eyes. It can also be used on maxillary and sphenoid sinuses in the cheek and below the skull. With traditional surgery, Chang said, accessing frontal sinuses can be more dangerous because of complicated anatomy and the close relationship of the frontal sinus to the brain.

“It is a more tricky area get to traditionally and takes more time,” Chang said of the frontal sinuses.

Makower said the balloon sinuplasty technology can be guided through passageways in sinuses without having to remove bone and tissue. Bleeding associated with traditional surgery for chronic sinusitis, before during and after the procedure, is lessened.

"Some people describe traditional sinus surgery as the hardest thing in their lives," Makower said.

Chronic sinusitis is an inflammation of the sinuses, which are located behind the eyes, forehead and cheeks. It can persist for 12 or more weeks. Common symptoms that occur are purulent nasal drainage, loss of smell, fatigue, pressure in the ears, nasal congestion, facial pain and pressure, and headaches. Chang said that it is a condition that affects around 37 million people in the United States.

For Makower, chronic sinusitis made him feel tired constantly and experience unrelenting pressure in his head for long periods, which gave him terrible headaches. He said that this especially affected his ability to fly because he would feel terrible pressure in his head and ears.

"Because the passageways to my sinuses were swollen and tight before my surgery, pressure could not equalize well during air travel and often the headaches were worse while descending," Makower said.

Makower said that after his surgery, he was able to fly on a plane and get back to work the next day. He said that one of the advantages of this surgery is that recovery time is less than with traditional methods. Chang said that with traditional surgery, recovery time is about a week. He said that it is usually a week before a patient is ready to resume his or her normal routine, and it takes several weeks for the inside of the nose to completely heal because of broken bone and tissue during surgery.

The new technique allows for faster patient recovery because it involves less disruption to surrounding tissues, Chang said.

While there are advantages to the new device, it may have drawbacks. Chang said some sinus experts wonder how long sinuses will remain open after the procedure. And the device may not work to remove polyps caused by chronic inflammation. But Makower said that even when traditional surgery is needed to remove polyps, his device can be used along with more commonly used methods and make it safer.

A study by Christopher Melroy, a surgeon in Savannah, Ga., found that the complication rate for the device was .0035 percent for the 28,500 people treated.

Chang said the device has caused no major complications or deaths in his experience and has provided an alternative, safer treatment for people with chronic sinusitis. “It can provide care to patients that don't want traditional surgery,” he said.