In Office Procedures

What is Balloon Sinus Dilation?

Balloon sinus dilation is a procedure commonly performed in our office for the treatment of chronic and recurrent acute sinusitis. It involves placing small balloons into the affected sinus opening, dilating the balloon, and removing it. The result is permanent remodeling and widening of your sinus openings.

‍Why should I choose ENT Associates of Nassau County for my sinus procedure?

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Our number one focus is your care. We work tirelessly to stay up-to-date and invested in the most cutting-edge techniques and technologies. Our surgeons have been trained at some of the most prestigious institutions in the country and nearly solely focus on sinus and nasal surgery. Additionally, we have extensive experience in office-based sinus and nasal procedures. Many centers perform balloon sinus dilation, but at ENT Associates of Nassau County, we also perform hybrid procedures as well and comprehensive sinus surgery in the office. If you would like to avoid the operating room and general anesthesia, you’ve come to the right place. If you prefer to go to the operating room, we can do that too!

Am I a candidate for Balloon Sinus Dilation?

We will have to do a thorough review of your history and CT scan. If you haven't had a CT scan, we can easily get one ordered for you. Typically, patients who have failed medical management and have chronic or recurrent acute sinusitis are candidates for this procedure.

Recurrent Acute Sinusitis - 3-4 or more sinus infections/year lasting at least 7-10 days with asymptomatic periods in between.

Chronic sinusitis - 12+ weeks of sinus symptoms. These may include: facial pain, facial pressure, nasal congestion, nasal drainage, altered smell, upper tooth pain, headaches, fatigue. 

Are the Surgeons at ENT Associates of Nassau County experienced in Balloon Sinus Dilation?

We perform some of the highest volumes of balloon sinus dilation in the Region and have extensive experience and training in all forms of sinus and nasal surgery, from comprehensive traditional functional endoscopic sinus surgery in the operating room, to minimally invasive balloon sinus dilation. 

I am scheduled for Balloon Sinus Dilation, What should I expect?

The day of your procedure, you will take the prescribed medication at home to help with minor anxiety that some patients experience. Since the medication can make you feel a bit drowsy, you will need to have someone drive you to and from your procedure.

Once you are in the office, you will be greeted by one of our well trained medical assistants and will be escorted into the procedure room. In a relaxed environment, with dim lights and spa music, your surgeon will gently numb your nose and sinuses with a combination of gel and cotton pledgets. Once the nasal cavity is completely numb, there will be an additional numbing injection which most patients will not feel at all. The entire process to numb the nose takes approximately 10 minutes.

Once the nose is numb, the balloons will be placed into the sinus openings and dilated. Since the small sinus openings are made up of thin bone, you will hear some cracking and feel some pressure. On a pain scale from 1-10, with 10 being severe pain and 1 being zero pain, most patients rate their discomfort at a level 2. 

Does Balloon Sinus Dilation work?

When balloon sinus dilation is indicated, it works. There are many variables that will determine whether we will recommend office balloon sinus dilation vs an office hybrid balloon/FESS procedure vs a FESS in the office or operating room. In the right patients, BSD alone results in long-term relief and improvement in 94% of the time. We are very experienced in identifying the patients who may NOT respond to a balloon and are sure to offer those patients a hybrid or FESS procedure, often also easily done in the office.

The REMODEL study, published in 2013, demonstrated Balloon Sinus Dilation is as effective as conventional sinus surgery at improving chronic sinusitis symptoms long term, but with less downtime, less postoperative pain and a faster return to normal activities.

What is the recovery like for Balloon Sinus Dilation?

Typically patients will have mild discharge from their nose for the few days following the procedure. Since there is no cutting, bleeding is not really expected. Most patients can return to their normal activities the following day. We will often place absorbable packing into the nose to aid the healing process. The packing will dissolve with saline sprays, but we will help the process along by suctioning remnant packing from the nose when you see us back in the office.

Do I need to come back for doctor visits after the balloon procedure?

We have all of our balloon patients return for three post-procedure visits, typically spaced out weekly, for the three weeks following the procedure. These visits are essential and quick. The purpose of the visit is to ensure the sinus openings remain clean and to remove any scar tissue that may have formed after the procedure. Failure to do this may result in suboptimal outcomes. 

What is the REMODEL Study?

The REMODEL was the first prospective, multicenter, randomized controlled trial comparing traditional Functional Endoscopic Sinus Surgery (FESS) to Balloon Sinus Dilation (BSD) for the treatment of chronic or recurrent sinusitis. It demonstrated that Balloon Sinus Dilation is as effective as conventional sinus surgery at improving chronic sinusitis symptoms long term, but with less downtime, less postoperative pain and a faster return to normal activities.

In 2015, an update to the original REMODEL study was published based on a larger patient population and followed outcomes out to 2 years. 

Results:

Both BSD and FESS delivered comparable significant symptomatic improvement at each time point.

BSD resulted in significantly faster recovery, less post-operative pain, and fewer debridements compared to traditional sinus surgery (FESS). 

Balloon Sinus Dilation META-ANALYSIS 

Meta-analysis studies combine the date from several similar studies. This paper compared data from 6 BSD studies totaling 358 patients with 6 month to 24 month follow-up

Results

• 97.5% success rate of BSD
• Significant, long lasting clinical improvement in symptoms
• 1.4 day average recovery time
• Patients reported improved productivity
• Outcomes consistent across Chronic Rhinosinusitis (CRS) and Recurrent Acute Rhinosinusitis (RARS).
  

Why are these studies important?

They confirmed that BSD is a safe and effective alternative to traditional sinus surgery, allowing us to care for you in our office with little downtime.

What are Nasal Polyps?

Nasal polyps are caused by excessive inflammation in your nose. They can be caused by chronic sinusitis, severe allergy, underlying nasal masses and other medical conditions. In a vast majority of patients, they are caused by chronic rhinosinusitis.

Are Nasal Polyps Dangerous?

The short answer is, no. Nasal polyps are due to inflammation. However, if they get large enough, they can block the nasal passage causing difficulty with breathing. Similarly, polyps can block the small sinus openings, preventing them from draining. When this occurs, fluid becomes stagnant in the sinus and germs can rapidly develop, further exacerbating the inflammatory process in a vicious cycle. 

How are Polyps Treated?

At ENT Associates of Nassau County, we never use a “one-size fits all” approach. Each situation is unique. Treatment will depend on the severity of your symptoms and the extent of your polyps. Some of our patients require no treatment - especially if they don't have any symptoms. Others may require only nasal sprays. Others, with more severe cases, may require an office procedure to remove the polyps and open the sinus cavities. 

Can polyps grow back?

Yes. Sometimes. That’s why it is important to have a doctor who specializes in the treatment of nasal polyps. Some patients will be more prone to regrowth than others. Patients who have underlying chronic sinusitis are at increased risk for regrowth. For select patients, there are new technologies and treatments we frequently employ to reduce the likelihood of regrowth. We will determine if you are a candidate for any of these treatments. See the videos below for more information.

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To learn more about Dupixent please click here.

The Clarifix procedure is a simple procedure performed in our office; It’s pain free, and only takes a few minutes. It is FDA approved for allergic rhinitis, vasomotor rhinitis, and nasal obstruction. After gently numbing the nose, the clarifix device is used to freeze the nerve that’s responsible for your symptoms! This causes the nerve to degenerate and provides long-lasting relief for a vast majority of our patients.

CLICK HERE to see how Clarifix works.

What is a turbinate reduction?

A turbinate reduction is a procedure commonly performed at ENT Associates of Nassau County to permanently reduce the size of the turbinates and get you breathing much better! Most commonly, this is done quickly and pain free in our office. If we are performing it in conjunction with a complex sinus surgery, or complex septoplasty, it may be performed in the operating room. The area is gently numbed, a small incision is made on the front part of the turbinate, and a tiny rotating machine called a microdebrider is used to remove excess mucosa and/or bone. The procedure takes less than 10 minutes and is pain free. Since there are no external cuts, your nose will look the same!

What should I expect after a turbinate reduction?

Anytime we make an incision, there is a risk of bleeding. This risk is extremely low and we don't expect you to have significant bleeding or discomfort in the days following the procedure. Nasal congestion in the days following the procedure is common and expected. As your turbinates heal, they swell. Thankfully, the swelling is temporary and once healing is complete, your turbinates will be significantly smaller and your breathing will be significantly improved!

How is a deviated septum treated?

At the ENT Associates of Nassau County, we determine what specific treatment each patient requires based on their symptoms and our physical exam. Some patients have a deviated septum and breath well! Those patients require no treatment! For patients who are suffering from nasal obstruction, we may first offer nasal sprays to reduce swelling around the septum. If the deviation is significant or sprays don’t help, a septoplasty may be required. 

What is a septoplasty?

Septoplasty is the name of the procedure we frequently perform at our office to straighten a crooked septum. Depending on the severity of the deviation, it will be either performed in the office under local anesthesia or in the operating room. A small incision is made inside the nose, and the lining over the crooked parts of the septum is lifted. The crooked septal elements are then removed and the lining is laid back into place. 

What can I expect if I’m getting a septoplasty?

Since the incisions are made inside the nose, and the nasal bones are not broken, there will be NO external scars or bruising. The only person who will know you had a septoplasty is YOU! Sometimes, if the deviation is severe and a lot of lining has to be lifted, we will place stents in the nose to allow for better healing and decreased swelling. Stents will typically be removed 5 days later, in our office. In order to optimize your breathing, we will typically perform an inferior turbinate reduction in conjunction to the septoplasty (see the turbinate reduction tab under “in-office procedures” for more information). Most patients do not have significant pain, are fully recovered, and are breathing better than ever within a week of the procedure. We may prescribe prescription pain medicine for select patients but most do well with over-the-counter medications like motrin and tylenol.

I am scheduled for an Ear Lobe repair, what should I expect?

Ear lobe repair is a procedure commonly performed by our surgeons in the office. We will start by cleaning the ear with an antibacterial solution. Then, the lobe will be numbed with a small injection. Patients will not have any pain and the procedure typically takes 30-45 minutes. You can go right home after the procedure. All we ask is that you keep the lobe dry and clean until you see us again in the office.  Often, nonabsorbable sutures will be placed which will have to be removed in the office the following week.