Balloon sinuplasty of the frontal sinus

What is balloon sinuplasty?

Balloon sinuplasty treats frontal sinusitis (infection or inflammation of the sinuses behind the forehead) when medication has not controlled symptoms. Under a short general anaesthetic, I pass a small telescope through your nostril and guide a thin, flexible balloon into the narrow channel that drains the frontal sinus.

Inflating the balloon for a few seconds widens the channel, and the sinus can then drain and ventilate normally. The balloon is removed at the end; nothing is left in your nose.

Unlike conventional sinus surgery (FESS), no bone or lining is removed. This preserves the normal anatomy, causes less bleeding, and most people recover within days rather than weeks. If I find more extensive disease during the operation, some tissue may still need to be removed, and occasionally the operation is combined with or converted to conventional sinus surgery. I will discuss this with you beforehand.

The procedure code is E1360 (endoscopic balloon dilation of the frontal sinus). Check with your insurer that the operation is covered.

Alternatives

Continued medical treatment (nasal steroid sprays, saline rinses, and antibiotics for infections) is always an option, and the decision to operate can be revisited later. Conventional endoscopic sinus surgery (FESS) is better suited to extensive polyps or disease beyond the frontal sinus.

Asking for your consent

I involve you in all the decisions about your care. By law I must ask for your consent and will ask you to sign a consent form on the day. I will explain all the risks, benefits, and alternatives beforehand. If you are unsure about anything, please ask me again before signing.

Preparing for the operation

You will have a pre-assessment appointment with the hospital to confirm you are safe to have the operation, usually by phone. Follow the fasting instructions the hospital gives you.

Arrange an escort, a responsible adult, to take you home and stay with you overnight
Arrange transport home, by car or taxi
Bring all the medication you currently take
Tell the hospital if you have a cold, flu, or tonsillitis in the two weeks before admission, as your operation may need to be postponed
If you smoke, stop as early as you can. Smoking adversely affects healing and increases the risk of infection

What happens on the day

A short general anaesthetic. The operation is done as a day case and takes about 30 to 60 minutes.
A small telescope goes in through the nostril. There are no cuts or bruises on your face.
A fine guidewire with a light at its tip finds the frontal sinus channel. The light glows through the skin of your forehead, confirming it is in exactly the right place.
The balloon slides over the wire into the channel and is inflated for a few seconds, gently widening it.
The balloon is deflated and removed, and the sinus is washed out.
You go home the same day, usually three to four hours after returning from theatre.

Recovery at a glance

Recovery after balloon sinuplasty is much quicker than after conventional sinus surgery. Most people are back to normal within a few days.

First 24 hours. Rest at home with your escort. Mild stuffiness and a little blood-stained discharge are normal.
Days 1 to 3. The nose feels blocked, like a mild cold. Start saline rinses on day 1. Most people return to desk work within 2 to 3 days.
First week. Avoid strenuous exercise, heavy lifting, and straining for a week.
Two weeks. No flying for two weeks. Any discharge and crusting settle.
Follow-up. I review you in clinic to check the sinus is draining well.

Aftercare

Saline rinses from day 1. These keep the newly widened channel clean while it heals. See the saline nasal rinses guide for the method.
Use any nasal steroid spray or drops as prescribed. Rinse first, wait five minutes, then use them.
Do not blow your nose for the first 48 hours. After that, blow gently.
If you need to sneeze, do so with your mouth open.
Take painkillers regularly as prescribed. Paracetamol is usually enough. Do not take aspirin-based painkillers (for example Anadin) as they can make you bleed.
If you have heavy bleeding, pinch the soft lower part of your nose for 10 minutes while sitting upright with your head tilted forward.

Risks

The large majority of balloon sinuplasty cases are straightforward, and serious complications are rarer than with conventional sinus surgery. The risks to know about are:

Bleeding. A small amount of bleeding is normal. A severe nosebleed is uncommon
Infection. A small number of patients develop a sinus infection after the procedure and may need antibiotics
Failure to relieve symptoms, or re-narrowing. The channel can narrow again over time. A further procedure, sometimes conventional sinus surgery (FESS), may be needed
Eye complications. The frontal sinus is close to the eye socket (orbit). Significant eye complications are very rare, around 1 in 1,000 or less
CSF leak. The sinus is close to the thin bone at the base of the brain. Very rarely this can be damaged, leading to a leak of cerebrospinal fluid (CSF). This is very rare, around 1 in 1,000 or less, and is usually repaired during the same operation
Anaesthetic risks. The anaesthetist will discuss these with you on the day

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This page is general information and not a substitute for individual medical advice. The right treatment depends on your assessment.