„Small Bone Bridges are Blasted“ -- MEDICA - World Forum for Medicine

„Small Bone Bridges are Blasted“

Photo: Nose sniffing a plant

Balloon catheters don't destroy the
mucosa but they are not proper for
all patients; © cameraobscura/

Professor Jochen Werner is director of the Ear, Nose and Throat Clinic at the University Hospital Gießen and Marburg and uses a new gentle treatment which should cure chronic paranasal sinusitis. MEDICA.de asked him about the balloon sinuplasty and what the limits of this new method are.

MEDICA.de: Mister Werner, what is the difference between a balloon sinuplasty when compared to conventional surgery?

Jochen Werner: We want to widen the channels of the paranasal sinuses without destroying the mucosa. When the mucosa is harmed this could give rise to other complications such as adhesions which is one of the dangers with conventional surgery. The aim of the balloon sinuplasty is to also improve the ventilation of the sinuses - but in a gentle way.

MEDICA.de: And how does this work?

Werner: The ENT doctor sticks a balloon catheter into the frontal sinus, for example. The balloon is filled with a contrast agent and is led to the narrowed area and subsequently being pumped up there. The process is observed with x-rays and the medic can see everything on a monitor. That way, small bone bridges are blasted but the mucosa does not get injured. The balloon sinuplasty widens the channels to let secretion drain off. Normally scars do not result from this and if it did than less than after classic surgery.

MEDICA.de: Who can benefit from the method?

Werner: Patients with a chronic paranasal sinusitis. If they are not treated serious consequences can occur. In the case that adenoids are present the sense of smell can get lost completely. Other patients with breathing problems who think that a widening of their sinuses would be the solution of their problems are not suited because patients with breathing problems usually have enlarged nasal conchas and that means the person has to undergo a conventional surgery. Also in the case of a deflected nasal septum a conventional surgery is necessary. The balloon sinuplasty is only applicable for certain patients with paranasal sinus problems.

MEDICA.de: What advantages has a patient from the balloon sinuplasty?

Werner: Advantages are clearly that the mucosa is prevented from damage and that the wound bleeds less. Furthermore, the after treatment is less complex compared to that after a conventional surgery. The balloon sinuplasty is carried out ambulant in parts. The patient can go home often the very same day and has only little pain. However, the conventional surgery is not to be replaced because there are constant progressions in that field and also complications are fewer nowadays.

MEDICA.de: But certainly there are also disadvantages.

Werner: For the reason that the method is still very new so far we know only few disadvantages. The x-rays taken surely are a negative aspect. It is already worked on a new technology though with which x-rays would be unnecessary in the future. A further disadvantage is the costs. Even though one treatment is enough, it costs around 2000 Euro in material. The statutory health insurance does not cover these expenses.

MEDICA.de: Is it possible to prove that the balloon sinuplasty is effective?

Werner: Since 2006, this technique is applied in the USA. According to studies, many patients have been treated successfully with it. However, these studies have to be seen with some reservation because they only monitor short periods of time, with a maximum of two years. There are no long-term studies available yet. Since January of this year, I myself have treated about 15 patients with the balloon catheter but the procedure is still very new in Germany and only few clinics and practices work with it.

MEDICA.de: When is a doctor allowed to use this technique?

Werner: He has to be an experienced ENT surgeon. The handling of balloon catheters can be learned in a training seminar of one day. But often many problems accumulate and the doctors have not only to treat the chronic paranasal sinusitis but also have to rectify the nasal septum or carry out other surgery on paranasal sinus in addition. And this is only possible with the scalpel and requires the experience of the doctor.

MEDICA.de: What about the balloon sinuplasty has still to be improved?

Werner: We have to wait for the results of long-term studies. Only then this question can be answered reliably. I think that the new procedure in combination with the conventional surgery will become established in future.

The interview was conducted by Simone Heimann