Read what another patient who had an in-office balloon sinus dilation had to say after her procedure. Below is a graph of her scores before and after the procedure from the Sino-Nasal Outcome Test, a validated questionnaire which rates the impact of chronic sinusitis on your life. Higher scores indicate the sinusitis is causing impairment on your quality of life. The impact of the procedure is shown by the improvements in this questionnaire.
The above scores are six months (and one brutal winter) after the in-office procedure despite having young children at home.
Stopping the obstruction behind the tongue continues to be an important part of treating sleep apnea surgically. Many techniques have been employed, from tissue excision or removal, suture slings to suspend the tongue from falling backwards during sleep as well as pending FDA approval techniques such as a nerve stimulator that will push the tongue out of the way at the appropriate time. However, most of these techniques require general anesthesia and some carry difficult postoperative recoveries.
The advent of radiofrequency (RF) energy has given way to a host of new surgical approaches for not only sleep apnea but many other specialties as well. It’s main advantage is in how this special energy is delivered, allowing much lower temperatures than traditional instrumentation which translates into more controlled release with less damage and pain for patients. This technique is often used for reducing the size of structures in the nose called turbinates. Turbinoplasty, or radiofrequency turbinate reduction, accomplishes shrinking of this tissue and improved nasal breathing with the technology. It can be performed in the operating room in conjunction with another procedure such as septoplasty or sinus surgery, but it can also be performed alone in the office under local anesthesia very successfully. I will sometimes offer this to patients who are seeking better nasal breathing, but it is unclear how much their deviated septum is contributing to this problem. By doing this first in the office, some may be spared having unnecessary septal surgery in the operating room.
Radiofrequency is also great for shrinking the base of tongue, which is often falling into the throat and causing an obstructive apnea for patients. It is accomplished with local anesthesia in the office with a special needle probe that delivers the advanced energy. While causing minimal pain, it does require multiple sessions to find significant clinical improvement. The risks, while rare, do include infection, abscess, bleeding and swelling, and should be taken seriously if there is any concern. If a patient is experiencing worsening pain after two to three days, they should immediately contact their doctor. I routinely use antibiotics and steroids post-procedure which reduce this risk dramatically. Patient experience mild discomfort after the procedure which reduces over a few days and is generally well tolerated.
This procedure is not for everyone, and like all sleep apnea procedures, results are never guaranteed. However, if you are interested in this procedure, a detailed evaluation of the head and neck by an Otolaryngologist specializing in Sleep Surgery will help determine your candidacy. Feel free to make an appointment if this minimally-invasive office procedure could be helpful for you.
In a previous post, I mentioned another minimally invasive sinus dilation tool. It has now been cleared for use by the FDA in the US. The Vent-OS takes balloon dilation to a gentle place. By allowing slow dilation over an hour, the company proclaims it is less painful and better tolerated by patients.
The question is really the utility of this device. Its current clearance is for the maxillary sinus and does not address any other sinuses at this time. I’m not sure how helpful this is in the clinical setting, whereby there are multiple sinuses that need to be addressed. Also, in my experience, I perform balloon sinus dilation in the office under purely local anesthesia. I, unlike some others in my field, have not felt the need to add anxiolytics and other drugs which may add risk to the procedure. Will this system be just a one trick pony with limited use or will it develop into other products which will allow the clinician to address other sinuses like the balloon tools currently available? Only time will tell.
Here is yet another less invasive sinus procedure that may further benefit chronic sinusitis suffers. From the website of SinuSys: “The Vent-Os System incorporates the Company’s proprietary osmotic technology, which utilizes the body’s natural fluids to expand the insert. After the ostia are opened, the insert is removed. The low-pressure, gradual expansion and simplicity of the device are designed to make it compatible for use in office-based procedures under local anesthesia.”
This is unlike the current balloon technology that I utilize in the office under local anesthesia which utilizes a high pressure rapid dilation. Currently, the pain profile from patient’s perspective is on average is ~3-4 out of 10 during the actual inflation. This technology might provide an even less painful option. FDA approval is pending. It will be interesting to see if this has clinical benefits to current balloon dilation technology.
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