The role of minimally invasive sinus procedures

Rhinologists and otolaryngologists recently are at a crossroads about new treatments for chronic sinus infections. This biggest game changer is the Acclarent Ballon Sinuplasty technology that allows for a tiny catheter to thread an inflatable balloon across narrow sinus openings and stretch it (think heart catheters & angioplasty). This technology has been available in the operating room since about 2005. The big twist is that in 2011 the procedure became available as an office-based technology to ENT docs, opening the door to surgical sinus procedures that don’t require general anesthesia.

So far the big criticisms of the technology center around its long term effectiveness. Ease of use and lucrative reimbursements for surgeons make the the procedure also at risk for abuse and over-utilization. It may wind up that a procedure with the opportunity to lower treatment costs overall actually winds up costing the system more, as more patients are willing to have the procedure done – even in the case of otherwise minimal symptoms that would not have been treated with surgery before (this is arguably better for patients’ wellbeing however).

To be fair there is a growing library of data on effectiveness of the procedure, even out to 5-7 years. Also to be fair, there is not really great evidence that our prior surgical techniques were all that fantastic anyway.

Tools that are currently costly, although less controversial, include steroid eluting implant devices. While an old-fashioned concept, treatment with steroid hormones to reduce inflammation is not very specific therapy, but is effective. IntersectENT‘s Propel device is a novel steroid-releasing temporary implant placed in the sinuses during surgery. They have shown improved healing and reduced problems after surgery with their first product. They no doubt will be looking to apply their success in the immediate post-operative timeframe to chronic treatment, likely looking for a place in office-based technologies. Currently this is not available in the office.

In summary, as a patient you may now be offered a minimally invasive treatment option. As a physician, you now have treatment options that do not involve general anesthesia or a long recovery period. Probably for the next 10 years we will see an explosion of minimally invasive treatment options out of the device industry. It will probably take another 10 years to assess which technologies really work and change the disease landscape.

The art of medicine still remains that we must apply the right technologies to the right patients.