Balloon procedure may open up clogged sinuses

MEDICAL MATTERS

May 12, 2006|By JUDY FOREMAN

Is there a less-invasive way than conventional surgery to open up clogged sinuses?

Yes. There's a new procedure called sinuplasty in which a balloon is threaded into the sinuses and inflated to push apart the thin bones that form the sinus cavity, making the opening bigger so mucus can drain better. In traditional endoscopic surgery, doctors thread metal instruments into the sinuses to actually cut away some sinus bone.

So far, data on the new technique are awaiting publication, so it's impossible to gauge how safe and effective the procedure is.

Dr. Peter J. Catalano, chairman of otolaryngology at the Lahey Clinic in Burlington, Vt., has performed sinuplasty on about 60 patients.

Doctors had worried, he said, that when the balloon was inflated, it would fracture the thin sinus bones in such a way that they would migrate to the eye or the brain.

So far, in studies in cadavers and 125 patients who have had the procedure, there appear to have been no complications. In 95 percent of patients the sinuses appear to stay open for at least six months, he said.

Dr. Andrew Lane, director of the division of rhinology at Johns Hopkins Medical Institutions, said, sinuplasty "is a good idea for selected patients. The trick will be figuring out who needs sinuplasty and who needs traditional endoscopic surgery."

But Dr. Ralph Metson, a sinus surgeon at the Massachusetts Eye and Ear Infirmary, is more cautious. "It's a very intriguing idea," he said. But he added that chronic sinusitis victims have obstruction in the ethmoid sinuses (along the nose by the corners of the eyes), which would not be helped by sinuplasty.

The other sinuses -- the frontal ones above the eyebrows and the maxillary ones in the cheeks -- drain through the ethmoid sinuses. So the only patients suitable for sinuplasty, he said, would be those who only had problems in the frontal or maxillary sinuses, a small percentage.

Does using a computer for hours in a darkened room hurt teenagers' eyes?

Probably not, though there's no hard proof.

"In theory, we do think that the more you use your eye muscles and the visual processes in the brain, the more likely you are to develop nearsightedness, especially at a young age," said Dr. Sandra Cremers, an ophthalmologist at the Massachusetts Eye and Ear Infirmary. And there are animal studies suggesting this effect does occur.

"But when we do randomized controlled studies in people, we don't find it an issue," Cremers said, adding that there's controversy over the issue.

"I don't see any clinical evidence in the last 10 or 20 years that young people who spend more hours at the computer require glasses more often than anybody else," said Dr. Elliott Myrowitz, an optometrist and assistant professor of ophthalmology at the Wilmer Eye Institute at Johns Hopkins School of Medicine.

Like older people, teenagers who spend long hours at the computer report more eye fatigue, Myrowitz said, as well as more muscle strain in the eyebrow area.

But teens who stare at computer screens for long periods "are not ruining their eyes," he said.

As for staring at a bright computer in a dark room? Not to worry.

"Young people have very good contrast sensitivity," Myrowitz said, unlike their elders, who do have more trouble focusing when they shift rapidly from light to dark environments.

And there's more good news. "There's no proof that watching TV up close in a dark room is bad, either," Cremers said. As a matter of common sense, though, she advises teens and adults to "have as good light as possible."

Send your questions to foreman@baltsun.com.

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