Balloon catheter technology in sinus surgery.

Abstract

The application of balloon catheter technology to sinus surgery has been an important recent development in the surgical treatment of chronic rhinosinusitis. The literature assessing the efficacy of balloon dilation treatment has thus far been limited to level 4/grade C evidence (case series without controls). In the absence of a randomized, controlled clinical trial comparing balloon dilation to existing surgical techniques, we look to larger clinical series as the best available evidence. Within this issue of the American Journal of Rhinology, in “Functional endoscopic dilatation of the sinuses: Patient satisfaction, postoperative pain, and cost,” Friedman et al. assessed clinical outcomes in a group of 35 patients undergoing balloon dilation compared to a group of 35 patients undergoing traditional functional endoscopic sinus surgery (FESS). As acknowledged by the authors, the comparison cohort was neither randomized nor a matched control group. Patients self-selected their treatment modality, which may have introduced bias in the self-reported symptom and satisfaction scores. In addition, 77% of traditional FESS patients underwent ethmoidectomy, whereas 0% of balloon dilation patients underwent ethmoidectomy (“hybrid” procedures were excluded). The heterogeneity of the treatment groups raises the question of whether valid comparisons of clinical outcome or cost can be made between the two groups. Furthermore, as acknowledged by the authors, the follow-up period was short at three months. Friedman et al. demonstrate that balloon dilation techniques can be applied safely and effectively in selected patients with chronic rhinosinusitis with respect to short-term outcomes. However, valid comparisons to traditional FESS for comparable disease severity remain elusive and will hopefully be addressed by future studies.