Chronic rhinosinusitis is one of the most common ailments in the world, affecting all age groups and causing significant suffering. First-line management of this condition is medical, usually comprising a nasally applied steroid, supplemented with a combination of antihistamines, antibiotics and/or oral steroids. Surgical intervention usually becomes necessary if there is failure of a prolonged course of medical treatment. In adults, functional endoscopic sinus surgery (FESS) has become established as the main surgical strategy in these circumstances. Recently a new technology, balloon dilation of sinus ostia (sinus opening), has been introduced. This is designed to open up the drainage pathways of the sinuses by the inflation of a high-pressure balloon in the sinus opening. We sought evidence in the literature evaluating the effectiveness of balloon dilation of sinus ostia compared to conventional surgical methods in the surgical management of patients of all ages suffering with chronic rhinosinusitis.
One unpublished trial met our inclusion criteria. This randomised 34 patients with chronic frontal sinusitis into two groups: in one group balloon dilation was used to open up the drainage pathways of the frontal sinuses; in the other group conventional endoscopic sinus surgery was used to do the same. For both groups all other sinuses were treated using conventional functional endoscopic sinus surgery. Balloon dilation did not show an improvement in the resolution of frontal sinusitis as demonstrated by imaging studies, however the technique was associated with an increased likelihood that someone observing a frontal sinus opening would find this open. However, it is not clear whether this was a statistically significant result. The study report appeared to be biased in the way it reported its outcome measures. At present, therefore, we cannot recommend the use of balloon dilation of sinus ostia over conventional surgical treatment modalities in this setting.