Cingi Cemal, Bayar Muluk Nuray, Lee Jivianne T
Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir.
Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey.
Curr Opin Otolaryngol Head Neck Surg. 2019 Feb;27(1):7-13. doi: 10.1097/MOO.0000000000000506.
The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area.
The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms.
Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia.
本综述旨在评估球囊鼻窦成形术的当前适应证和禁忌证，并回顾该领域进行的临床试验。
球囊鼻窦扩张术的适应证与内镜鼻窦手术的适应证有些相似。已发现球囊鼻窦口扩张术（BSD）在治疗复发性急性鼻窦炎（RARS）和药物治疗无效的无鼻息肉慢性鼻-鼻窦炎（CRSsNP）方面最为有效。多项随机临床试验已证明BSD在改善CRSsNP程度较轻患者的生活质量方面的疗效，无论是在门诊还是手术室环境中。然而，由于BSD仅扩张阻塞的鼻窦口而不切除组织，它通常仅限于治疗涉及额窦、蝶窦和上颌窦的疾病。筛窦有严重病变的个体可能需要在内镜鼻窦手术的辅助下进行BSD。BSD不适用于全鼻窦息肉病、广泛的真菌性鼻窦炎、晚期结缔组织疾病或潜在恶性肿瘤的主要治疗方式。最近一份专家临床共识声明还得出结论，BSD不适用于不符合CRS或RARS诊断标准的头痛患者，或计算机断层扫描上没有鼻窦疾病阳性发现且没有鼻窦症状的患者。
球囊鼻窦成形术是治疗经适当药物治疗失败的鼻窦炎的一种选择。对于CRSsNP累及额窦、蝶窦和上颌窦的局限性疾病，证据最为充分。由于BSD可以在门诊进行，对于无法耐受全身麻醉的合并症患者，它可以是一种可行的治疗选择。
