John De Carpentier
Consultant ENT Surgeon and Rhinologist
Consultant Rhinologist and Facial Plastic Reconstructive Surgeon, and Associate Professor of Rhinology at UCL
Consultant Rhinologist, and Endoscopic Skull Base Surgeon
Increased use of minimally-invasive balloon procedure could offer a fast and effective alternative to conventional sinus surgery, potentially saving the NHS millions of pounds.
People suffering for years with persistent sinus problems could have symptom relief with a quick recovery, if only a proven balloon technology was more widely adopted within the NHS.1
New technology, which is approved by the National Institute for Health and Care Excellence (NICE) and available on the NHS, can get people with chronic sinusitis back at work within hours of treatment. According to NICE, the tech could also save the NHS millions of pounds compared to conventional treatment requiring a full surgical team, general anaesthetic and a hospital stay.
Sinusitis is a common problem, particularly during hay fever season, affecting around one in ten people with painful inflammation of the air-filled pockets around the nose. For some people, symptoms can persist for years despite trying over-the-counter decongestants or nasal steroids and/or antibiotics from the GP.
The new treatment option is called a balloon sinuplasty, which involves inserting and then inflating a small balloon into the sinus cavity to physically expand the space, restoring drainage. Treatment takes around 20-30 minutes under local anaesthetic and people can generally be back at work the next day.1
As Dr Raj Bhalla says: “Using local anaesthetic means you’re potentially freeing up theatre infrastructure; freeing up the anaesthetist who would have been working with you in theatre, freeing up the theatre team, so they can be doing something else that helps the NHS to reduce waiting times.”
Balloon sinuplasty benefits can last a lifetime
Since development of the technology in 2004, hundreds of thousands of patients worldwide have benefited from this procedure’s success rate, which is clinically proven in excess of 80%.1
According to Mr John De Carpentier, a consultant ENT surgeon in Preston, Lancashire, the best outcomes are seen in patients who receive the balloon treatment within 12 months of diagnosis. “Unfortunately, there are delays in the system,” he says.
Peter Andrews, also an ENT consultant and a head and neck surgeon at the Royal National Throat, Nose and Ear Hospital, says around one in three patients will wait up to five years before they are referred. He says: “We need to see patients earlier, but it’s such a subjective area: unlike high blood pressure or high blood sugar levels, sinus congestion cannot be measured. There is nothing available in primary care to point patients and their GPs to a definitive diagnosis.”
Recognising the benefits and cost savings of offering patients minimally-invasive, out-patient procedures, the NHS is supportive of balloon sinuplasty: Medicines watchdog NICE approved the technology in 2016.
But more needs to be done to improve take-up of the procedure, says Andrews. He suggests that GP services could include ‘nose clinics’, where specialist practitioners give specific input on diagnosis, symptom management and treatment. Consultants also need to get into the habit of using this technique as their first line intervention in suitable patients, he says. “It will be a slow change, but one that will be facilitated by new-generation devices launched in the past three to four years, which are much more effective and easier to use.
Consultants just need to be convinced that the results will be good, and for me, the results already are.
1Chandra RK, Kern RC, Cutler JL, Welch KC, Russell PT. REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies. Laryngoscope. 2016 Jan;126(1):44-50.