Balloon Dilation of Sinus Ostia in the Department of Defense: Diagnoses, Actual Indications, and Outcomes

Introduction In the past decade, increasing evidence bas supported the use of balloon catheter dilation BCD of sinus ostia in the treatment of chronic and recurrent acute rhinosinusitis. However, this technology is often advertised and utilized for off-label indications, which lack evidence-based support. Therefore, we sought to evaluate actual indications for BCD in a profit-blind healthcare system - the Department of Defense DoD. Methods A retrospective review was performed on 319 consecutive patients who underwent BCD in the DoD from January 1, 2011 - December 31, 2013. All charts were reviewed for ICD-9 diagnoses, presence of chronic rhinosinusitis CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps EPOS, pre-op Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, post-operative outcomes, and complications. Results Of the 319 patients identified, 217 had sufficient documentation to be included. A CRS ICD-9 code was applied in 182217 83.9 and recurrent acute rhinosinusitis in 12217 5.6. Only 50.5 of CRS patient charts met criteria using EPOS guidelines. In contrast, 39.6 met the ICD-9 criteria for atypical facial pain. Patients with Lund-Mackay scores 4 were reviewed for number of sinuses dilated. Eighty-eight of 123 patients 71.5 had sinuses dilated that were free from opacificationmucosal edema on pre-operative imaging. Conclusion Balloon dilation of sinus ostia has an expanding role in treating sinus disease. In the studied population, BCD is often utilized for off-label indications for which there is currently no evidence. Future studies are needed to evaluate the efficacy of this technology in treating these alternate indications.