Originally created 06/02/06

Relieving pressure



The first time it happened to Brian Cheshire, the pressure was intense and focused on the right side of his face.

"I thought my eyeball was about to pop out of my head," said Mr. Cheshire, 31, who works as a golf pro on a cruise ship. "I didn't know what was going on."

The pain from his clogged sinus was later relieved by surgery, but about a year ago the pain returned - the sinus opening probably was clogged by scar tissue from the first procedure.

This time, ear, nose and throat surgeon Alan Whitehouse had a new option. Called balloon sinuplasty, it uses balloon-catheter technology similar to what is used to open clogged vessels around the heart.

"A lot of the legwork for the procedure has been done and the problems have been solved in cardiology and other vascular applications of balloon technology," Dr. Whitehouse said. "It's been applied all over the human body. This is just the next new place where it seemed appropriate."

In an operating room at Doctors Hospital, Dr. Whitehouse carefully threaded a catheter into Mr. Cheshire's right nostril and, watching his progress on the fluoroscope screen, manipulated the wire into Mr. Cheshire's clogged right frontal sinus. He then worked a balloon over the wire to the opening of the sinus and inflated the balloon to widen the opening, before flushing and draining the sinus.

A procedure that might take an hour and a half if done the traditional way, is over in 17 minutes. In addition to being quicker, because there was no cutting, there should be a much easier recovery, Dr. Whitehouse said.

"For the right patient, it's a better procedure because there's less trauma to the patient to accomplish the goal," he said. "And the less things we traumatize in our effort to open these sinuses, the less pain the patient has, the less bleeding they have, the less time off work."

After having the traditional procedure about 12 years ago, Mr. Cheshire said, his sinus was packed with gauze for several days and he looked as though he had been beaten up.

"My nose was all swollen up, it was bad," he said. "My eyes were black."

After the most recent procedure, his recovery was over the next day and all he had was a sore throat.

"It's great," Mr. Cheshire said. "I don't know what the long-term effects are going to be, but right now I feel great."

That lack of long-term follow-up is a concern with the procedure itself. Acclarent, of Menlo Park, Calif., can provide a 10-patient clinical study, and another is under way.

Dr. Stil Kountakis, of the Georgia Sinus Center at the Medical College of Georgia, has been trained by the company, and he has the equipment, but he is still cautious about performing the procedure.

"We also need to be careful to make sure that this device is used appropriately on patients that really do need to have surgery," he said. "The advantage is, it's a minimally invasive procedure. It doesn't cause trauma. The disadvantage is that it's not for everybody. You have to choose the patients carefully."

Those who have a fairly straightforward obstruction of the sinus, sometimes from previous surgeries, are the better candidates for the procedure, Dr. Whitehouse said. Those who have fungal disease or polyps would not be, he said.

The catheter does have an advantage for some areas, Dr. Kountakis said. The frontal sinus, for instance, can be difficult to reach, and instruments inserted for the first time can cause scarring and trauma there, he said.

"So, it is recommended that the first time you operate on the frontal sinus, you be as conservative as possible," Dr. Kountakis said. "This procedure is conservative because you did not really remove any bones or create severe scarring."

Though the procedure is approved by the Food and Drug Administration, acceptance is still not widespread and the technology is still being adapted, Dr. Whitehouse said.

"There's quite a bit of forward progress to be made," he said. "It's really a technology that is basically in its infancy. We're all very excited about it."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

By the numbers

About 30 million people suffered from chronic sinusitis in 2003, according to the Summary Health Statistics for U.S. Adults from the Centers for Disease Control and Prevention. It resulted in 14.9 million office visits and 1.6 million outpatient clinic visits to hospitals, the CDC said.