title: First clinic experience: patient selection and outcomes for ostial dilation for chronic rhinosinusitis.
abstract: BACKGROUND
  To report outcomes for subjects undergoing balloon dilation in either the operating room (OR) or the clinic and define criteria to identify suitable candidates for local anesthesia procedures.
  
  
  METHODS
  Subjects with medically refractory chronic rhinosinusitis (CRS) underwent de novo surgery via transantral balloon dilation of the maxillary sinus ostium and ethmoid infundibulum. Concomitant nasal or endoscopic sinus surgeries were contraindicated. Technical success, surgical parameters, and long-term outcomes were evaluated through 12-month follow-up.
  
  
  RESULTS
  Seventy-one subjects underwent balloon dilation and 94% completed follow-up through 12 months. A total of 132 maxillary ostia were targeted for treatment and 129 were successfully dilated (98%). Almost one-half (33) of the procedures were performed in the OR under local anesthesia with intravenous sedation. Average balloon procedure times for unilateral and bilateral treatment were 28.3 ± 21.1 and 40.2 ± 17.7 minutes, respectively. Thirty-three ostial dilations in 19 subjects were attempted in the clinic. Each ostium was successfully accessed and ballooned under local anesthesia. Patient tolerance was very good with an average self-reported pain level of 2.7 (2 = hurts a little bit) out of 10. Each subject was discharged within 2 hours of the procedure and there was no postoperative bleeding. Symptomatic improvement of the clinic subgroup at 3, 6, and 12 months postprocedure was statistically significant (p ≤ 0.0012) and clinically meaningful and similar in magnitude to improvement seen across all subjects regardless of site of service.
  
  
  CONCLUSIONS
  Transantral balloon dilation can be performed safely in the clinic and operative settings with symptom improvement sustained through 1 year.
authors.affiliation: Colorado Sinus Institute, Denver, CO 80210, USA. jeffrey.cutler@hotmail.com
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cutler
authors.forename: Theodore
authors.initials: T
authors.lastname: Truitt
authors.forename: James
authors.initials: J
authors.lastname: Atkins
authors.forename: Bradford
authors.initials: B
authors.lastname: Winegar
authors.forename: Brent
authors.initials: B
authors.lastname: Lanier
authors.forename: B Todd
authors.initials: BT
authors.lastname: Schaeffer
authors.forename: Joseph
authors.initials: J
authors.lastname: Raviv
authors.forename: Diana
authors.initials: D
authors.lastname: Henderson
authors.forename: James
authors.initials: J
authors.lastname: Duncavage
authors.forename: James
authors.initials: J
authors.lastname: Stankiewicz
authors.forename: Thomas
authors.initials: T
authors.lastname: Tami
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D002404:Catheterization / Q000379:methods*; D002908:Chronic Disease; D005005:Ethmoid Sinus; D005260:Female; D006801:Humans; D008297:Male; D008443:Maxillary Sinus; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D016896:Treatment Outcome