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News — CHICAGO, IL—The American Academy of Otolaryngology—Head and Neck Surgery Foundation Board of Directors (AAO-HNSF) has approved a clinical consensus statement on balloon dilation of the sinuses to ensure patient safety and proper utilization. 

The consensus statement was presented Wednesday during the AAO-HNSF 2017 Annual Meeting & OTO Experience and will be submitted to the journal, Otolaryngology–Head & Neck Surgery.

“Our new clinical consensus statement addresses one of the most pressing issues we face today.  It is a game-changing statement,” said Executive Vice President and CEO James C. Denneny III, MD.

An expert panel of otolaryngologists, representing AAO-HNSF and relevant subspecialty societies, reached consensus on 13 clinical statements in three categories: patient criteria, perioperative considerations, and outcomes. 

Patient Criteria

• Balloon dilation is not appropriate for patients who are without both sinonasal symptoms and positive findings on CT
• Balloon dilation is not appropriate for the management of headache in patients who do not otherwise meet the criteria for chronic sinusitis or recurrent acute sinusitis
• Balloon dilation is not appropriate for the management of sleep apnea in patients who do not otherwise meet the criteria for chronic sinusitis or recurrent acute sinusitis
• CT scanning of the sinuses is a requirement before balloon dilation can be performed
• Balloon dilation is not appropriate for patients with sinonasal symptoms and a CT that does not show evidence of sinonasal disease
• Balloon dilation can be appropriate as an adjunct procedure to FESS in patients with chronic sinusitis without nasal polyps
• There can be a role for balloon dilation in patients with persistent sinus disease who have had previous sinus surgery
• There is a role for balloon sinus dilation in managing patients with recurrent acute sinusitis as defined in the AAO-HNSF guideline based on symptoms and the CT evidence of ostial occlusion and mucosal thickening

Perioperative Considerations

• Surgeons who consider reusing devices intended for dilation of the sinuses should understand the regulations set forth by the FDA for reprocessing such devices and ensure that they are followed
• Balloon dilation can be performed under any setting as long as proper precautions are taken and appropriate monitoring is performed
• Balloon dilation can be performed under local anesthesia with or without sedation

Outcomes

• Balloon dilation can improve short term quality of life outcomes in patients with limited CRS without polyposis
• Balloon dilation can be effective in frontal sinusitis

The statement applies to adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom sinus ostial dilation (SOD) is being recommended. 

The panel defined SOD as the endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery.

A consensus statement reflects the opinions developed by an organized group of experts.  This consensus statement was developed based on an a priori protocol outlined in the AAO-HNSF development manual. Two modified Delphi surveys were used to distill expert opinion into clinical statements that met a standardized definition of consensus. 

The panel included Jay F. Piccirillo, MD, chair; Spencer C. Payne, MD, assistant chair; Richard M. Rosenfeld, MD, MPH; Fuad M. Baroody, MD; Pete S. Batra, MD; John M. DelGaudio, MD; David R. Edelstein, MD; Andrew P. Lane, MD; Amber U. Luong, MD, PhD; R. Peter Manes, MD; Edward D. McCoul, MD, MPH; Michael P. Platt, MD; Douglas D. Reh, MD; and Maureen D. Corrigan.

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About the AAO-HNS/F

The American Academy of Otolaryngology—Head and Neck Surgery, one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning. The organization's vision: "Empowering otolaryngologist-head and neck surgeons to deliver the best patient care."