Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction

Surgical management of rhinosinusitis for the allergist-immunologist

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease characterized by inflammation of the sinus, with or without nasal passage inflammation, occurring for more than 12 weeks at a time. CRS has historically been classified in 2 categories: CRS without nasal polyps or CRS with nasal polyps (25%-30% of cases). The mainstay of treatment for CRS with or without nasal polyps is medical management, and options may include a combination of saline irrigation, nasal steroids, allergy medications, antibiotics, oral steroids, and treatment with targeted monoclonal antibodies. Unfortunately, up to 60% of patents report symptoms refractory to maximal medical therapy. As such, a combined approach of surgery and medical therapy may be offered. Endoscopic sinus surgery for CRS is approached in a stepwise fashion, ranging from the simplest technique, such as polyp removal, to more expanded approaches that open the paranasal sinuses and allow gravity-dependent drainage. This review article provides a review and in-depth explanation of various surgical approaches for CRS, including the indications, techniques, and respective outcomes for each one.

Balloon Sinus Dilation Versus Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Systematic Review and Meta-Analysis

OBJECTIVE

To determine the efficacy of balloon sinus dilation (BSD) compared to functional endoscopic sinus surgery (FESS) or medical management for chronic rhinosinusitis (CRS).

METHODS

A qualified medical librarian conducted a literature search for relevant publications that evaluate efficacy of BSD. Studies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis.

RESULTS

From 315 abstracts reviewed, 18 studies were included in qualitative review, and 7 were included in meta-analysis. Quantitative analysis included 4 randomized clinical trials (RCTs) and 3 cohort studies comparing baseline and post-operative Sinonasal Outcome Test (SNOT)-20 scores in BSD and FESS. A meta-analysis restricted to the studies reporting SD for changes from baseline (2 RCTs, 1 cohort) showed the pooled difference in means to be 0.435, less than a clinically meaningful difference of 0.8. A separate sensitivity analysis of the studies including 4 additional studies with imputed values of SD for changes from baseline showed the pooled difference of means to be 0.237 assuming the highest level of correlation (Corr .8) between the pre- and post-intervention scores.

CONCLUSIONS

There is limited high-quality evidence that assesses the efficacy of BSD versus FESS in the management of CRS patients. To better inform CRS management, future studies should compare BSD with endoscopic sinus surgery, hybrid procedures, and/or medical management alone using validated objective and patient-reported outcome measures.

Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

OBJECTIVES

The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique.

METHODS

Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011.

RESULTS

Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation.

CONCLUSION

Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

The Utility of Preoperative Phone Calls for Endoscopic Sinus Surgery Procedures

OBJECTIVE

Perioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS).

METHODS

Patients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test.

RESULTS

Data from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p < 0.015) and satisfaction with their experience (call:8.8 ± 1.4 vs no-call:9.5 ± 1.1, p < 0.028). Patient age may contribute to lack of impact in the rhinology cohort, as compared to the otology group, but socioeconomic status does not seem to differentiate the two samples.

CONCLUSION

Though shown in other settings, a significant impact of educational phone calls prior to surgery was not observed in this sample. Patient education calls prior to endoscopic sinus surgery were not associated with changes in postoperative call volume to the clinic. Patient understanding and satisfaction may be related to other factors, such as patient selection or demographics. Future studies may target such patients prior to ESS.

Balloon sinuplasty: two-year follow up using Sino-Nasal Outcome Test-22 outcomes

BACKGROUND

Balloon sinuplasty is a relatively new surgical technology proposed as a less invasive way of treating chronic rhinosinusitis and frontal sinus disease. It is crucial to monitor safety and efficacy to allow informed clinical decisions and appropriate counselling of patients. There are few papers with long-term follow up.

METHOD

Patients were selected for surgery based on symptoms of frontal pain and pressure or headache, pre-operative Sino-Nasal Outcome Test-22 scores, and computed tomography findings. All were resistant to appropriate medical therapy. Balloon sinuplasty was performed followed by a Sino-Nasal Outcome Test-22 questionnaire at two months and then two years.

RESULTS

All patients underwent successful operations with no failure of technology or technique. There were no significant complications. The average Sino-Nasal Outcome Test-22 score reduced from 46 pre-operatively (standard error: +/- 5.7, n = 9) to 23 at 2 months (standard error: +/- 7.6, n = 7). At 2 years, the average Sino-Nasal Outcome Test score was 23 (standard error: +/- 4.3, n = 6). There was an even larger lasting benefit when pain or pressure symptoms were analysed in isolation.

CONCLUSION

This study adds to the evidence of technique safety and feasibility. The procedure resulted in a significant long-term improvement in symptoms.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

I.

EXECUTIVE SUMMARY

BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.

METHODS

ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.

RESULTS

ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.

CONCLUSION

This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.

Balloon sinuplasty in one-day surgery

Introduction

Balloon sinus dilation is becoming an increasingly common procedure, finding a niche as an invaluable tool in endoscopic sinus surgery.

Aim

To assess the effectiveness of balloon sinus dilation (BSD) in 1-day surgery in patients with chronic rhinosinusitis without polyps based on our own experience.

Material and methods

The study group consisted of 9 patients. The Lund-Mackay scale for computed tomography of the paranasal sinuses was assessed prior to surgery. Endoscopy was performed on the basis of the Lund-Kennedy scale and patients were asked to perform the SNOT-22 survey. Two patients underwent balloon sinuplasty under general and seven under local anaesthesia.

Results

Twelve maxillary and eight frontal sinuses were widened (four attempts were unsuccessful). The SNOT-22 survey was assessed the day after surgery (average of 8 points) and a month after surgery (average of 15.5 points).

Conclusions

BSD only allows widening of the ostia of the maxillary, frontal and sphenoid sinuses. BSD offers shorter post-surgical recovery, and a more rapid return to work because of its less invasive and less traumatic nature.

Telemedicine, Patient Satisfaction, and Chronic Rhinosinusitis Care in the Era of COVID-19

BACKGROUND

Telemedicine has become increasingly popular in the care of rhinologic patients during the COVID-19 pandemic. This change in practice patterns may place patients at risk of a perceived lower-quality exchange with their healthcare provider, which may in turn impact satisfaction.

OBJECTIVE

This study compares patient satisfaction scores between in-person clinic visits and telemedicine video visits in patients with chronic rhinosinusitis (CRS).

METHODS

Sixty-nine patients with CRS presenting to an academic rhinology clinic between March to April 2020 were retrospectively divided into video visits (VV) and clinic visits (CV) groups based on mandated state quarantine orders on March 19. Patient demographics, disease severity measures, and Patient Satisfaction Questionnaire-18 (PSQ-18) scores were collected and analyzed. Chi square test and Fisher's exact test were performed.

RESULTS

There were no significant differences in age (p = 0.81), gender (p = 0.55), CRS phenotype (p = 0.16), and disease severity measures (Sinonasal Outcomes Test-22 (SNOT-22) (p = 0.92); Lund-Mackay score (p = 0.96)) between the video and clinic visit groups. There were no significant differences in PSQ-18 total scores (VV PSQ-18 mean score = 78.1, CV PSQ-18 mean score = 78.4; p = 0.67) or the following subdomain scores between the two groups: general satisfaction (p = 0.73), technical quality (p = 0.62), interpersonal manner (p = 0.41), communication (p = 0.31), financial aspects (p = 0.89), time spent with doctor (p = 0.88), and accessibility and convenience (p = 0.47).

CONCLUSION

Patient satisfaction with telemedicine in the COVID-19 pandemic parallels that of traditional in-person visits. Video visits can serve as a viable alternative to clinic visits, while still maintaining high satisfaction.

3-year follow-up after balloon sinuplasty in children with chronic rhinosinusitis

OBJECTIVE

Balloon sinuplasty could restore nasal sinus drainage and airflow, limiting the damages and lowering the risks. This study aimed to assess the 3-year clinical efficacy, safety, and satisfactory degree of balloon sinuplasty through multiple aspects. Also the experience about treatment for postoperative adhesion was described.

MATERIALS AND METHODS

A study was performed in 30 children who had failed medical therapy, and received Balloon sinuplasty of selected sinuses. Data in 3-year follow-up including questionnaire, VAS, CT, and nasal endoscopy findings were collected. Also postoperative nose-related medications or auxiliary therapies, revision surgery, and incidence of complications were collected. The satisfactory degree of children and parents were assessed.

RESULTS

Compared to preoperative, the VAS scores, questionnaire (SN-5 or SNOT-22) scores and Lund-Mackay scores were significantly lower. In the 3-year follow-up, most of them did not require nose-related medications or auxiliary therapies, and were free of symptoms, or the symptoms did not affect their daily activities. None of the 30 children had complications of facial pain, teeth numbness, facial deformity, and dysosmia. However, nasal cavity adhesion still remained the most frequent. The satisfactory degree was relatively high.

CONCLUSION

The 3-year follow-up demonstrated that balloon sinuplasty had high clinical efficacy and safety, the satisfactory degree of children and parents remained relatively high. Improved the upper respiratory infection and increased the immunity, which were considered effective methods to reduce the risk of recurrence. Nasal spraying of steroids and nasal irrigation in three months after surgery cold help prevent the nasal cavity adhesion.

Exploring Balloon Sinuplasty Adverse Events With the Innovative OpenFDA Database

Background

Balloon sinuplasty (BSP) has become a common, minimally invasive treatment for chronic sinusitis. Like any surgical procedure, there are definite risks when using it as a stand-alone procedure or in conjunction with other revision procedures.

Objective

To explore the adverse events of BSP using the openFDA cloud with regard to malfunction and injury following surgery.

Methods

Between January 2015 and December 2018, the Food and Drug Administration’s (FDA) openFDA database was queried for adverse event use. Reports were further categorized by procedure location, injury type, device malfunction, procedure (stand-alone BSP vs hybrid), and source of complication (anatomical or surgeon related).

Results

Seventy-eight events were reported to the FDA in the study period. Majority of cases consisted of device malfunctions (64.1%), while patient injuries consisted of 43.5%. Frontal sinus procedures had the greatest presence of adverse events (47.4%) with the majority reporting significant cerebrospinal fluid (CSF) leaks ( P < .001) and device retention ( P = .021). Orbital complications ( P = .004) were found to be significantly associated with dilation of the maxillary sinus. Skull-based injuries were the only factor incident in which surgeon-reported anatomical complications were significant ( P = .018).

Conclusions

As balloon dilation procedure continues to rise in the United States, significant adverse events continue to occur. Frontal sinus BSP leads to the highest number of complications and a 4.75 reported CSF leaks yearly. Based on real data, surgeons performing the procedure should be acquainted with common BSP-related injuries so they can prepare for those circumstances and share informed consent with their patients.

[Balloon sinuplasty in children - Russian first experience]

AIM

To evaluate and compare the clinical outcome and impact of balloon sinuplasty and functional endoscopic sinus surgery (FESS) on the quality of life of pediatric patients and adolescents suffering from chronic rhinosinusitis (CRS).

MATERIAL AND METHODS

A retrospective study was performed of 47 children with failed medical therapy, who were scheduled for surgery. The first one pediatric balloon sinuplasty was performed by Ilya Zyabkin in Filatov Children's City Hospital on the 30-th of August 2012.They underwent treatment by balloon sinuplasty of selected sinuses in 553% (n=26) cases and hybrid FESS with BSP - in 44.7% (n=21). Data were collected, including perioperative CT Lund-Mackay score and SN-5 quality of life findings.

RESULTS

Compared with preoperative values, Lund-Mackay scores were significantly lower at 1 year (p<0.05) in 92,3% (n=12) patients after surgery. Moreover, balloon sinuplasty improved sinusrelated quality of life score in 93.3% (n=42) patients for up to 1 year after operation (p<0.05).

CONCLUSION

Balloon sinuplasty showed a clinical curative effect in the treatment of children and adolescents with refractory CRS, and was relatively safe by itself. BSP allows to postpone, if necessary, FESS or avoid circular mucosal trauma and infundibulotomy in hybrid FESS with balloon sinuplasty technique.

Analysis of Sinus Balloon Catheter Dilation Providers Based on Medicare Provider Utilization and Payment Data

BACKGROUND

The use of balloon catheter dilation (BCD) to treat chronic rhinosinusitis has increased dramatically since its conception, necessitating further characterization of BCD providers and trends in its usage. Medicare data on BCD providers have made it possible to study recent demographic patterns. There has also been an increase in mid-level providers' scope of otolaryngologic practice that is not well defined.

OBJECTIVE

To better understand BCD adoption by studying volume of BCD procedures as well as training, geography, and practice socioeconomic characteristics of BCD providers for Medicare beneficiaries.

METHODS

We reviewed Medicare Provider Utilization and Payment Data Public Use Files for 2014 and 2015 for providers with claims for BCD of the sinuses. We extracted provider zip code, state, gender, and number of services per BCD code. We obtained median household income by zip code and geographic region based on US Census Bureau data. Providers were classified using an Internet search to determine practice setting and type of specialty training/certification.

RESULTS

In 2014 and 2015, 428 providers performed 42 494 BCDs billed to Medicare beneficiaries. Among BCD providers, 5.1% were female, 98.1% had Doctor of Medicine/Doctor of Osteopathic Medicine credentials, and 1.9% had nurse practitioner/physician assistant credentials. Over the 2-year period, the median number of BCDs was 63 for physicians and 37 for mid-level providers. Fellowship-trained rhinologists performed a median of 38 BCDs over 2 years. The most common subspecialty certification/training was in facial plastics and reconstructive surgery. The majority of providers (63.8%) performed 1 to 99 BCDs over the 2 years. In the South, there were 21.9 BCD procedures performed per 100 000 people compared to 7.3 in the Northeast, 9.3 in the Midwest, and 8.5 in the West.

CONCLUSION

There is a large range in total BCD procedures performed by individual providers, and this varies by certain provider characteristics. Mid-level providers have emerged as a significant population performing BCD.

A 10-Year Follow-Up of a Randomized Prospective Study of 2 Treatments for Chronic Rhinosinusitis Without Nasal Polyps and Investigation of the Impact of Gastroeosophageal Reflux Disease in the Resistance to Treatment

OBJECTIVES

To compare the 2 long-term medical strategies in chronic rhinosinusitis without nasal polyps (CRSnNP) and to identify the role of gastroesophageal reflux disease (GERD) and Helicobacter pylori as factors of treatment failure.

MATERIAL AND METHODS

Fifty-seven patients with CRSnNP were randomized into 2 therapeutic groups. The first group was treated with 4 weeks of amoxicillin/clavulanate and a short course of oral steroids. The second group received 8 weeks of clarithromycin. Sinonasal Outcome Test-20 (SNOT-20) and Lund and Mackay scores were assessed at baseline and after treatment, and GERD Health-Related Quality of Life (GERD-HRQL) questionnaire was evaluated in all patients. Patients with a GERD-HRQL score >8 received esogastroscopy and H pylori detection. Patients were followed during a 10-year period for clinical course and GERD evolution. The 10-year evolution of patients was described in terms of recurrence, medical, and surgical treatments.

RESULTS

Thirty-seven patients completed the study; SNOT-20 and Lund and Mackay scores similarly improved in both groups. Amoxicillin/clavulanate group had significantly more adverse reactions than the clarithromycin group (P = .03). After the therapeutic course, 35% (amoxicillin/clavulanate) and 41% (clarithromycin) of patients needed functional endoscopic sinus surgery (FESS). During the long-term follow-up, 54% (amoxicillin/clavulanate) and 40% (clarithromycin) of patients had late CRSnNP recurrence; FESS was performed in less than 15% of cases of recurrence. Gastroesophageal reflux disease complaint's severity was associated with late recurrence of CRSnNP.

CONCLUSION

Amoxicillin/clavulanate and clarithromycin would be competitive treatments for CRSnNP. Gastroesophageal reflux disease seems to be a negative factor for treatment response and recurrence.

Adverse Events Associated with Balloon Sinuplasty: A MAUDE Database Analysis

Objective

Balloon sinuplasty utilization has increased significantly since its introduction over a decade ago. However, the most common associated complications are still unknown. The objective of this study was to analyze adverse events related to balloon sinuplasty.

Study Design

Retrospective cross-sectional analysis.

Setting

Food and Drug Administration’s MAUDE database (Manufacturer and User Facility Device Experience; 2008-2018).

Subjects and Methods

The MAUDE database was searched for all reports on adverse events involving balloon sinuplasty devices from the 3 leading manufacturers: Acclarent, Entellus, and Medtronic. Reported events were reviewed and categorized.

Results

During the study period, there were 211 adverse events from 208 reports divided into the following categories: patient related (n = 102, 48.3%), device related (n = 101, 47.9%), and packaging related (n = 8, 3.8%). Four periprocedural deaths were reported but were not clearly associated with technical complications. The most common device-related complications were guide catheter malfunction (39.6%), balloon malfunction (38.6%), and imprecise navigation (17.8%). The most common patient-related complications were cerebrospinal fluid leak (36.3%), eye swelling (29.4%), and epistaxis (11.8%). A lateral canthotomy was performed in 30.0% of eye-swelling complications. Sixty percent of eye complications occurred during balloon dilation of the maxillary sinus. The years 2014 (n = 48) and 2012 (n = 32) had the highest number of adverse events reported as compared with all other years.

Conclusion

The most common adverse events associated with balloon sinuplasty include balloon malfunction, guide catheter malfunction, cerebrospinal fluid leak, and significant eye swelling. Health care providers should discuss these possible complications when consenting patients for balloon sinuplasty.

Preoperative Management of Chronic Rhinosinusitis Prior to Office Balloon Sinus Dilation: A 2011-2014 MarketScan® Analysis

Background

In-office balloon sinus dilation (BSD) has recently gained popularity as a surgical treatment option for chronic rhinosinusitis (CRS). However, utilization, indications, and practice patterns surrounding in-office BSD remain unclear.

Objective

The purpose of this study was to use a large national administrative database to assess preoperative management of CRS prior to in-office BSD.

Methods

Patients undergoing standalone in-office BSD from 2011 to 2014 were identified on MarketScan and compared to a control group undergoing functional endoscopic sinus surgery (FESS). Visits to the otolaryngologist, number of computed tomography (CT) scans, number of antibiotic and steroid prescriptions, and duration of time from first visit to procedure were compared.

Results

When compared to the FESS group, the in-office BSD group overall had fewer office visits (2.0 vs 2.2), CT scans (1.0 vs 1.1), prescriptions for antibiotics (2.0 vs 2.2), prescriptions for systemic steroids (1.5 vs 1.8), and topical steroids (1.4 vs 1.5) in the preoperative period. They also had a shorter mean duration of time between first visit and CT scan (17.5 vs 21.4 days) as well as between first visit and procedure (55.0 vs 67.8 days). All of these findings were statistically significant.

Conclusion

In-office BSD for CRS was overall associated with less intense management in the preoperative period when compared to FESS. Such differences may reflect ongoing shifts in practice patterns and need to be further investigated.

Visualized ethmoid roof cerebrospinal fluid leak during frontal balloon sinuplasty

Balloon sinus dilation (BSD) is generally accepted as a safe alternative to traditional sinus surgery. It is a unique technique designed to potentially minimize complications associated with traditional functional endoscopic sinus surgery (FESS). We present a case in which a 65-year-old man experienced a cerebrospinal fluid (CSF) leak in the ethmoid roof that was visualized instantly after balloon dilation in a revision sinus surgery. In this case report, we discuss the causes of CSF leaks and explain in detail the immediate endoscopic repair with a collagen matrix. Also, literature is reviewed on the safety of BSD versus traditional FESS. Postoperatively, the patient has been without CSF leak and remains symptom free. CSF leak is a rare but major complication during both FESS and BSD. As BSD use increases, its complication profile will become clearer when used alone, in conjunction with FESS, and/or during revision surgery. Although BSD is considered a benign procedure, one should be cautious when using it in revision sinus surgery.

Balloon Catheter Dilation of the Sinuses: A 2011-2014 MarketScan Analysis

OBJECTIVE

This study uses a large national claims-based database to analyze recent practice patterns related to balloon catheter dilation (BCD) of the sinuses.

STUDY DESIGN

Retrospective study.

SETTING

Academic.

SUBJECTS AND METHODS

Patients with chronic rhinosinusitis (CRS) undergoing BCD and functional endoscopic sinus surgery (FESS) from 2011 to 2014 were identified in Truven Health MarketScan Databases with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology, Fourth Edition. Prevalence of CRS and frequency of sinus procedures were trended over the study period. Information related to site of service, demographics, and comorbidities was analyzed.

RESULTS

Although the prevalence of CRS and sinus procedures remained stable over the study period, there was a consistent increase in the annual number of BCD procedures performed in the office. Among BCD procedures, multisinus dilation had the largest increase. A higher proportion of patients undergoing BCD were women, aged ≥65 years, and from the South. There was a higher prevalence of headache disorder and allergic rhinitis in the BCD group, as compared with the FESS and hybrid groups.

CONCLUSION

BCD, especially in the office, has risen in popularity since the introduction of Current Procedural Terminology codes in 2011. This study reveals significant differences in demographics and comorbidities between patients undergoing BCD and those undergoing FESS. Such disparities may highlight the need for better-defined indications for use of this technology.

Factors Associated with Revision Surgery after Balloon Sinuplasty

Objective

Although balloon sinuplasty (BSP) is increasing in popularity, little is known about which patients are the ideal candidates. The objective of this study is to investigate factors that may be associated with BSP failure.

Study Design

Retrospective review.

Setting

Academic center.

Subjects and Methods

This is a 6-year (July 2011-June 2017) retrospective review of patients who underwent BSP or revision endoscopic sinus surgery (rESS) after BSP within a single tertiary health system. Demographics, clinical findings, and radiographic findings were investigated for association with rESS via univariate analyses and a multivariable backward elimination selection procedure.

Results

A total of 154 patients were identified (median age, 53 years): 146 patients underwent BSP at a single health system, with 16 (11%) undergoing rESS; 8 patients underwent BSP at an outside institution and underwent rESS with the senior author. Mean ± SD follow-up was 12.8 ± 16.6 months. Univariate analyses revealed that prior endoscopic sinus surgery, polyps, allergic rhinitis, and gram-negative infection were significantly associated with rESS. As for radiographic findings, a higher Lund-Mackay score, neo-osteogenesis, moderate or complete opacification, and hyperdensities were associated with rESS. The final model after multivariable selection showed that higher radiographic scores (odds ratio, 1.08; 95% CI, 1.01-1.17) and neo-osteogenesis (odds ratio, 5.25; 95% CI, 1.68-16.42) were associated with higher odds for rESS.

Conclusions

This study identifies several clinical and radiographic factors that may be associated with the need for rESS after BSP. Surgeons can take these factors into consideration when deciding whether a patient should forego BSP and undergo conventional FESS.

Clinical curative effect and safety of balloon sinuplasty in children with chronic rhinosinusitis

OBJECTIVE

Balloon Sinuplasty for the management of paranasal sinus inflammatory diseases was introduced in otolaryngology in 2005. Over the past decade, evidence strongly supports its safety and efficacy for the treatment of chronic rhinosinusitis (CRS) in adults. Because it requires no bone or tissue removal, this procedure could be suitable in children. We present our initial experience of its use for the treatment of CRS in children.

MATERIALS AND METHODS

A prospective study was performed of 30 children with failed medical therapy, who were scheduled for surgery. They underwent treatment by balloon sinuplasty of selected sinuses. Data were collected, including age, VAS score, CT score, and nasal endoscopy findings.

RESULTS

The procedure was successful in 61/65 sinuses (93.84%). Balloon sinuplasty improved sinus-related quality of life scores as well as computed tomography (CT) and endoscopic findings for up to 1 year after operation (p < 0.05).

CONCLUSION

In this initial study, balloon sinuplasty showed a clinical curative effect in the treatment of children with refractory CRS, and was relatively safe. Structural abnormalities in sinus ostia and hypoplastic sinuses may not be amenable to balloon catheter sinuplasty.

A six-month analysis of frontal sinus drainage pathway in patients with frontal sinusitis after balloon sinuplasty

BACKGROUND

The balloon catheter has been used for a decade to dilate paranasal sinus outflow tracts. The question is: how wide and how durable is the dilation of drainage pathways in patients in long-term observations after this procedure?

OBJECTIVE

The objective of our study was to observe the changes occurring in the frontal sinus drainage pathway (FSDP) in patients with frontal sinusitis at least 6 months after surgery using balloon catheters in an isolated procedure.

MATERIALS AND METHODS

We analyzed and measured the FSDP width on computed tomography (CT) of 23 images before and after the use of balloon catheters. We also assessed mucosal changes using Zinreich's scale, and symptom improvements with the Sino-Nasal Outcome Test (SNOT-20).

RESULTS

A statistically significant difference in the width of the FSDP was found before and after sinuplasty in the study group (p ≤ .0016). On average, the FSDP increased by 24.1%. Clinically meaningful and statistically significant (p ≤ .0002) symptom improvement as indicated by the mean SNOT-20 score was observed. Mucosal changes were also statistically significant (p ≤ .0018) after surgery.

CONCLUSION

The findings at least 6 months after follow-up indicated that the use of balloon catheters in an isolated procedure allowed durable modeling of FSDP and was associated with radiological and clinical improvements.

Industry relationships are associated with performing a greater number of sinus balloon dilation procedures

BACKGROUND

Industry outreach promotes awareness of novel technologies. However, concerns have been raised that such relationships may also unduly impact medical decision-making. Our objective in this study was to evaluate industry relationships among practitioners who frequently employ balloon dilation (BD), characterizing whether there is any association between financial relationships and BD utilization.

METHODS

Provider utilization data (FY-2014) was accessed for individuals billing BD procedures to Medicare, the largest healthcare payor in the United States. The names of individuals included in these data sets were cross-referenced with the Centers for Medicare and Medicaid Services Open Payment site to determine the extent of industry relationships during this same year. Individuals included in this analysis were organized by those with "significant" ($1,000 to $10,000) and "major" (> $10,000) industry relationships. Practice setting, training, and experience were also evaluated.

RESULTS

Of the 302 otolaryngologists who billed enough BDs for inclusion in this data set, 99.3% were in private practice, 89.7% were board-certified, 8.3% had facial plastic and reconstructive fellowship training, and 1.3% had rhinology fellowship training. There was a significant increase in BDs performed with increasing BD company financial contributions (analysis of variance, p = 0.0003). Individuals without "significant" relationships with BD companies billed fewer BDs than those with at least "significant" (>$1,000) relationships (57.0 ± 4.3 vs 87.7 ± 10.0, p = 0.001).

CONCLUSION

There is an association between receiving money from industry and the frequency with which otolaryngologists employ BD. Although our analysis demonstrates an association, these results in no way imply causation. Further analysis exploring the reasons for this association may be necessary.