In severe sinusitis that has failed medical management, then surgical treatment is of choice.

Nowadays, Endoscopic sinus surgery is used and the older open technique (opening the maxillary sinuses from under the upper lips) is not used anymore as it is more traumatic to the patient.

The endoscopic minimalist technique is Balloon Sinuplasty. The Alfred Hospital have been using this technique in Australia since 2006 (it was first started in the USA with FDA approval in 2005), but it is only introduced to Hong Kong in 2012. It uses a guide wire to enter the blocked sinus cavity and a narrow balloon is then inflated to reopen the sinus passageway to allow drainage with minimal structural damage. This is particular useful for patients who has frontal sinusitis. It is akin to the angioplasty that is in widespread use today for blocked coronary arteries. The down side of Balloon Sinuplasty technique is it cannot deal with nasal polyps or ethmoid sinsusitis properly.

If there is a lot of nasal polyps and severe sinusitis, then the traditional Functional Endoscopic Sinus Surgery (FESS) is probably more appropriate.

Commonly now I use a hybrid technique with Balloon Sinuplasty for the frontal sinuses and traditional FESS for the other sinuses as this tend to give the best result with less recurrence of sinusitis and less chance of further sinus surgery.

Guide wire with illumination safely identifies the frontal sinus before inflation of balloon.

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