Ear-Nose and Throat Doctor (ENT) Questions Sinusitis

I had a balloon sinuplasty and symptoms are coming back. Do I need it again?

4 years ago I had a balloon sinuplasty procedure done by my ENT. But now I am getting symptoms of sinusitis again, not as bad as before. Why is this happening, is it normal? Will I need this procedure a second time?

14 Answers

Hi, yes, this can happen. If it persists, sometimes the best option is to surgically increase the size of the sinus opening.That would take only a few minutes...
Dr. Brousseau
If you had indications for first procedure, most likely your sinus disease is chronic. Bone can regenerate and mucosa can become thickened again. Any maintenance with nasal steroids sprays/saline irrigations, etc? See your ENT.
You’d probably need a sinus CT and/or an endoscopic sinus exam to determine this.
It all depends on your symptoms. If it's a headache problem realize that migraine plays a huge role in sinus pain or pressure or headache. If it's congestion then allergies may need to be addressed. If it's recurrent infections that may require something else.
Sinusitis is a very complex disease and can be caused by a variety of
factors. The inflammation in sinusitis can be caused by a combination of
allergic inflammation, environmental factors, and your genetics as well as
viruses, bacteria, and fungus. The anatomy of the sinuses can certainly
play a role in increasing inflammation. Balloon sinuplasty works to help
improve the anatomy by increasing the size of the sinus opening. It does
not treat any of the other causes of inflammation. I would recommend
another evaluation of your sinuses so you can try to determine the cause(s)
of your inflammation to find the best course of treatment.
That depends on a lot of factors. Balloon sinuplasty is a good procedure and can help people significantly, but it also reimburses well, so there are a lot of physicians out there that are performing the procedure on patients that really do not need the procedure. Specifically patients who have what is called atypical facial pain. Patients with atypical facial pain have facial pain and pressure that patients often think are sinus infections. But their CT scan, when they are symptomatic are completely normal. If you balloon these patients, for unknown reasons, their facial pain improves temporarily, but it does come back (usually sooner than 4 years though). So you could be having a relapse of symptoms because you have atypical facial pain which is like a migraine but located over the face. If this is the case you need to see a neurologist. One other option (and more likely given that your symptoms were better for 4 years) is that you are having sinus infections in one of the sinuses that was not ballooned. You can't balloon the ethmoid sinuses, and your surgeon may have only ballooned the affected sinuses. For instance say he ballooned both your frontal sinuses, but on the scan your maxillary sinuses looked normal, so he didn't balloon your maxillary sinuses. Now you could develop maxillary sinusitus. Another option is that your ballooned sinuses have scarred down. This is not very common and probably not the cause, but you can't tell without a CT scan. Another option is that you have nasal polyps that were removed during the first case. IF you had nasal polyps removed, they typically grow back. How quickly they recur depends on a lot of factors. But a polyp can block a sinus that was successfully ballooned in the past and has not scarred down, and this blockage will cause a sinus infection. Pretty much the only way to tell what is going on is to see your ENT physician, undergo a nasal endoscopy in clinic and perhaps a CT scan.
Balloon sinuplasty does not address all of the sinuses. Ethmoid sinuses are not treated with balloon sinuplasty. In addition, you may have other contributing factors for the recurrence.
What symptoms? What medications have you tried or are using? What were your main reasons for (symptoms) for the first surgery? Did you have allergy testing? How many sinuses were dilated the first time? On one side or both? What did your first CT scan show? Have you had another scan? Are you blowing fowl material from your nose, or is it running at all. Was/is your main symptom facial pain/headaches? If so, absent other major signs and symptoms of sinusitis, balloon sinuplasty is not likely to be effective.
Hi - The balloon sinuplasty will typically "squish" some linings aside to create a wider opening, if those linings were swollen or partially polyp-ridden, and can push some weak bone aside in some cases. However, the linings can become swollen again, and start causing obstruction and recurrence of your symptoms. Depending on the underlying issues, even people who get formal sinus surgery can end up with recurrence. The key is to continue with your medical management:

- nasal saline rinses
- nasal steroids if prescribed
- smoke avoidance (both tobacco and marijuana)
- antihistamines as suggested depending on allergies).

If that fails, then yes, you might need a repeat procedure, or if it has progressed, you might need formal surgery.

I hope that helps. Good luck!
Balloon sinuplasty is not always a permanent solution. It is not rare to need further sinus procedures.
The sinus opening could narrow again or you might have problems not addressed by simple sinuplasty.
It may require a redo.
We have to examine and get the CT scan of sinuses done to see the condition of your sinuses.
Balloon sinuplasty is effective, but problems may return. You may have some swelling or scarring which has formed. Yes, you may need it repeated or even traditional sinus surgery. See an ENT, preferably one who is
Board Certified.