ME & MY OPERATION: The balloon guided by ‘satnav’ that could relieve blocked sinuses

THE PATIENT

Around ten years ago I suddenly started suffering with what seemed to be chronic hay fever — though I’d never had any problems with my sinuses before.

I was congested, my eyes were always incredibly sore with tears streaming down my face, and I found it increasingly hard to work or go out in the evening. Although the symptoms got worse in summer on my drive to and from work past large rapeseed fields, as time went on they became year-round.

I went to see my GP several times, who suggested antihistamines, which I was already taking. While they did help, even the non-drowsy type made me feel tired and I knew I wasn’t really dealing with the root cause. Then last year my symptoms started to worsen.

I felt like I couldn’t breathe through my nose and I was getting pain in my ears, neck and back. I tried steroids and salt water nasal sprays, but nothing helped. 

Finally, in October 2017, I used my private medical insurance through my work to see ear, nose and throat consultant David Lowe. He said my problem was almost certainly due to a build-up of fluid in my sinuses and polyps — small growths inside the nose.

He told me about a procedure he’s now doing, in which a balloon attached to a wire is inserted up your nostril and inflated to open and clear the passageways. 

This would be instead of the conventional surgery, where parts of the sinus passages are cut away to widen it. Normally this takes several weeks to heal, and around two months to fully recover, whereas recovery from the balloon procedure would be much quicker.

He explained he was also using a system a bit like a satnav to guide the balloon in place, which meant it was more accurate. A month later, I had the operation, under general anaesthetic. When I woke up, I felt as if my nose had been punched — but regular painkillers helped.

Mr Lowe told me the procedure had gone well, but during the operation he had observed some polyps blocking my right nostril, which he’d removed.

I stayed in overnight for my own convenience as the operation had been at the end of the day, then went home to rest for a week. Every day I rinsed my sinuses with salty water to clear out all the gunk as they healed.

I started to feel the benefit after two weeks — my right nostril was clear for the first time in years and my other symptoms had gone. I couldn’t quite believe it. Through habit on some days I took antihistamines, but soon realised I didn’t need to.

I had a follow-up in December and Mr Lowe was happy with my progress. Since then I’ve had one bout of sore eyes, which could be just down to tiredness, but apart from that I’m completely symptom-free.

I’m sleeping better and I’ve got bags more energy. I just wish I’d had this done sooner.

THE SURGEON

David Lowe is a consultant ear, nose and throat (ENT) surgeon at South Tees NHS Foundation Trust and Nuffield Tees Hospital.

The sinuses are bony compartments in the face that form a crucial part of your airways — you have them in your cheek, behind your forehead and between the eyes at the very back of the nose.

Most people have experienced sinusitis after a cold, where the sinuses and their drainage channels inflame and block up. However, for some it becomes a chronic problem, with ongoing cold or hay-fever-like symptoms, as well as facial pressure, pain and loss of sense of smell. It can be debilitating, easily affecting sleep, quality of life and ability to work.

Don’t delay: There is good evidence that delaying surgery can mean patients need more invasive, expensive and possibly riskier treatment later on

As part of the inflammation, jelly-like swellings called polyps may also arise in the lining of the nasal passage and further block the nose and sinuses. More than ten per cent of the population are said to suffer with chronic sinusitis. Initially, sinus problems should be treated with salt water sprays and nasal douching, to wash away excess mucus or irritants and reduce inflammation.

Steroid sprays or drops to reduce swelling and antibiotics to combat infection may also be offered. Surgery to effectively trim the nasal lining is usually reserved for those where these options haven’t helped.

However, in the NHS, GPs now seem reluctant to refer patients for specialist sinus treatments. But there is good evidence that delaying surgery can mean patients need more invasive, expensive and possibly riskier treatment later on.

Traditional sinus surgery works by physically cutting away tissue blocking the sinuses with access through the nostrils. In recent years, balloon technology has been used to push back the lining blocking the sinuses from the inside — as there is no cutting, this means a faster recovery and fewer risks.

And a further technological development we are now using is an image guidance system, which works a bit like a satnav, allowing surgeons to position the balloon more precisely.

This navigation technique has been used widely in brain surgery for many years, but is only recently being incorporated into ENT procedures. Previously, a surgeon would confirm the balloon’s position by shining a light to see where blockages and sinus narrowings are. But for blockages deep in the centre of the head, using the traditional light technique to navigate can be challenging.

The new satnav system allows us to be much more precise. At every step of the procedure I know to a fraction of a millimetre where the problem area and my instruments are, thanks to real-time electromagnetic 3D images displayed on a screen by the operating table.

Without this, the surgeon relies traditionally on judgment alone, operating millimetres away from the brain, eyes and optic nerves. While serious complications such as bleeding and damage to the surrounding tissue are rare, even with conventional sinus procedures, this technology has further reduced such risks.

First, the patient has a CT scan to confirm the problem is sinus disease and the areas affected. That scan is then uploaded onto the image guidance system. An electromagnetic transmitter linked to the system is then directed at the patient’s head so it can monitor where the instruments are.

Before we insert the balloon, we remove any polyps using a device called a debrider, like a vacuum cleaner with rotating blades. Then a metal wand is inserted into each sinus that is found to be blocked. A balloon is inflated and the pressure of it clears and expands the sinus. This takes a matter of seconds. We then use saline to flush out each sinus.

The procedure can be done in less than half an hour using local anaesthetic, but to minimise the patient’s movements and maximise the precision of the imaging system, a general anaesthetic is preferable.

This combination of balloon technology to open the sinus pathways and image guidance systems is recommended by NICE and has been available privately and on the NHS for several years, but is only now becoming more widespread.

Ideally this will become standard procedure in coming years and be available in all ENT departments.

The procedure costs around £4,000 privately and to the NHS.