1. What are the treatment options for chronic sinusitis? The treatment of chronic sinusitis can be chosen from medication. However, medication cannot address the anatomical abnormalities, the medication itself has side effects and about 30% of patients are not sensitive to medication. Therefore, another option for treatment is surgery. The purpose of surgical treatment is to correct anatomical abnormalities, remove irreversible lesions, improve the ventilation and drainage of the sinuses in order to restore the ventilation and drainage of the sinuses, and facilitate the normal functioning of the mucous membrane clearance of the sinuses and nasal cavity. 2.What is the principle of functional sinus surgery under nasal endoscopy at present? What are the disadvantages and shortcomings? Functional endoscopic nasal surgery is currently promoted in clinical practice. The principle of this surgery is to remove the bone and inflammatory mucosa of the middle nasal tract, sieve sinus, maxillary sinus, frontal sinus and pterygoid sinus opening through surgical methods to open the sinus openings to open the drainage of each sinus and achieve the purpose of treating sinusitis. However, because the surgery is to remove tissue, scarring and adhesions are inevitable after the surgery, which will to some extent destroy the normal anatomical structure and damage the ciliary system of the mucosa. The scar tissue can form a “threshold” at the sinus opening again and affect the drainage of the sinuses. In addition, although endoscopic surgery is already minimally invasive, it is after all a surgical excision, and the surgeon has to remove varying amounts of nasal sinus tissue depending on the condition. In order to prevent postoperative bleeding, a tight nasal cavity filling is required, therefore, functional nasal endoscopic surgery is still somewhat invasive and relatively more painful for patients. 3. How did the sinus balloon dilation technique come about? In 2004, engineers in Silicon Valley were inspired by the principle of interventional catheters for the treatment of coronary stenosis, and introduced the concept of sinus balloon dilation based on an understanding of the pathogenesis of sinusitis. 4.What is the concept and principle of balloon catheter dilation? The pathogenesis of sinusitis is the narrowing or closing of sinus openings due to certain pathogenic factors, resulting in the inability to properly ventilate and drain the sinuses, which in turn causes the retention of nasal mucus in the corresponding sinuses and the development of sinusitis. The key to treatment is to reopen the blocked sinus orifice, clean the sinus, drain the retained pus, and then try to keep the sinus orifice open to cure sinusitis without recurrence. As shown in Figure 1, the mucous membrane at the frontal sinus opening is swollen, resulting in pus accumulation in the frontal sinus. The concept and principle of balloon catheter dilatation is that after accurate diagnosis of the disease, the doctor places the unfilled balloon at the sinus opening to be opened after anesthesia based on the information provided by endoscopy and CT and other imaging. Pressure is then applied to inflate the balloon, which causes microfractures in the inelastic thin bony structures at the sinus opening, thus opening the blocked sinus opening. The pus then flows out. Can you explain the concept of sinus balloon dilation surgery in depth? The current sinus balloon dilation surgery can be roughly compared to the following: it is like opening the closed door of the sinus opening, i.e. the thin layer of bone at the sinus opening is fractured slightly, while the original endoscopic surgery mechanism can be compared to the surgery to remove the door of the sinus opening, and in many cases, the wall of the doorway is also demolished; therefore, it is more traumatic. 6. Why is sinus balloon dilatation less invasive? After the balloon dilates the sinus opening, the mucous membrane adjacent to the sinus opening opens up with the open bone fragments, and the sinus opening is opened, while the continuity of the mucous membrane is not destroyed; whereas endoscopic resection surgery causes the destruction of the mucous membrane, the continuity of the mucous membrane is destroyed, the local bone is exposed, and scars are easily formed, thus causing more trauma, more bleeding, and longer healing time, which may lead to adhesions. 7.What are the basic components of the sinus balloon dilation instrument? The balloon catheter device includes 0, 70, 110 degree sinus guide tube; guide tube handle; sinus guide wire and sinus balloon catheter. During operation, the sinus balloon is carefully inserted into the guiding catheter, and then the guidewire is pushed into the guidewire port of the sinus balloon catheter. Depending on the condition of the sinus, the guidewire is inserted into the sinus and the target sinus is confirmed by luminescence. The balloon is placed into the sinus opening. After the position is confirmed, pressure is applied and maintained for tens of seconds, which can be repeated several times, depending on the condition. 8. What is the efficacy and safety of sinus balloon dilation? Recent international literature indicates that balloon sinus dilation is feasible and safe. It is less invasive, less bleeding, and has no serious complications compared to endoscopic surgery. A prospective, non-randomized study of 115 patients with CRS found that 96.9% of sinus openings were successfully dilated intraoperatively; the 6-month opening rate was 80.5% and an indeterminate 17.9%. All postoperative quality of life assessments (SNOT-20) were consistently improved beyond baseline. Only 3 patients required reoperation. In the last 2 years, a large number of international case reports comparing the efficacy of the balloon technique with conventional endoscopic sinus surgery have concluded that the long-term outcomes of both treatments are similar, but that the balloon technique is less invasive and the patients have a higher quality of life. At international conferences, it has been suggested that in children with sinusitis requiring surgical treatment, the use of balloon sinus orifice dilation can, in cases where the indication is appropriate, provide the same results as surgical resection with less trauma and without compromising the development of the child’s nasal sinuses at all. Our experience has shown that balloon catheter sinus dilation is as effective as conventional nasal endoscopic surgery, while the patient’s postoperative pain is greatly reduced, bleeding is greatly reduced, and the patient’s postoperative hospital stay is greatly shortened. 9.What are the indications and contraindications for sinus balloon dilation? The indications for sinus balloon dilation are: patients with chronic sinusitis who are not treated with antimicrobial, local hormone and anti-allergic drugs and need nasal endoscopic surgery; patients who are in the exacerbation period after standard treatment, but have abnormal sinus CT performance, and those who have more than 3 acute attacks of sinusitis per year. Contraindications: extensive nasal polyps; history of multiple nasal surgeries, extensive osteophytes, nasal tumors, loss of cilia function, cystic fibrosis, definite anatomical abnormalities, and acute active phase of inflammation. 10.What is the current procedure for sinus balloon dilation? At present, after the diagnosis and treatment of chronic sinusitis is clear, the doctor determines whether balloon dilation is appropriate. Balloon dilation is usually performed under general anesthesia; a patient in good general condition, of appropriate age and without systemic disease, has a hospital stay of 3-5 days. In summary: sinus balloon dilation has good results for some CRS, and the procedure is extremely minimally invasive. Basically, no tissue is removed, the trauma is smaller than the minimally invasive endoscopic surgery, and the postoperative recovery is fast. Nearly 11 years of experience with tens of thousands of cases abroad shows that this technique is safe, effective and minimally invasive. This technology is already a direction of treatment of chronic sinusitis with compound drug anti-inflammatory treatment.