office-based procedure, according to Mani Zadeh, MD, FACS, a Los
Angeles-based ENT surgeon. Dr. Zadeh estimates that at least half of
the balloon sinuplasties performed nationally now take place in doc-
tors' offices. "It's a procedure for which general anesthesia is not
required," says Dr. Zadeh. "We can use local or topical anesthetics that
greatly minimize any discomfort."
The procedure treats sinusitis by widening the sinus drainage cav-
ity to six millimeters. A deflated or compressed balloon is inserted
into the narrow portion of the patient's sinus. When inflated, it
essentially squeezes and crushes the soft tissue and creates
microfractures in the nearby bone to widen the cavity.
Performing the procedure in the office has multiple benefits for
patients. First, they don't have to undergo general anesthesia. Because
of that, the recovery is quick. They're awake for the entirely of the
operation — the worst post-op symptom is often the feeling of having
a stuffy nose — so they can drive themselves home. Patients also
avoid the time-consuming admissions process at a hospital or surgery
center, and they can skip the pre-op blood test that's part of the evalu-
ation to determine if they're a safe candidate for general anesthesia.
The local anesthetics used for balloon sinuplasties have improved
in the last two years, after the operation had begun to move to pro-
cedure room, which makes it even more suitable for the office set-
ting. Dr. Zadeh says he used to use common topical sprays or local
injectable anesthetics. Now, he partners with compounding pharma-
cies to increase the concentration of tetracaine, which is commonly
used at a lower strength in eye procedures, to 6% in the local anes-
thetic he uses, making it effective in sinus surgeries. Further, the
higher-dose tetracaine used to come in a liquid that tended to drip to
the back of the throat. Now it's delivered in a paste form that makes
its coverage more precise and effective. "These two simple improve-
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