As a fellowship-trained rhinologist, Dr. Jeevan Ramakrishnan specializes in the medical and surgical treatment of patients with disorders of the nose and sinuses. After completing his Otolaryngology residency at the University of Arkansas, he completed additional fellowship training in the subspecialty of rhinology at the University of Pittsburgh, where he received specialized training in nasal and sinus surgery. He is pleased to bring his expertise to Raleigh and writes today about minimally invasive options for sinus surgery in the office.

At Capitol ENT, we constantly strive to provide comprehensive services for our patients with sinonasal disorders, and are now pleased to offer several new procedures that can be performed in the office under local anesthesia. These include balloon sinuplasty for chronic sinusitis, turbinate reduction for nasal congestion, and nasal polypectomy.

Performing these procedures in the office provides many benefits including minimally invasive techniques, reduced bleeding, very quick recovery time, preservation of future treatment options, eliminating the need for general anesthesia, and reducing the financial burden for eligible patients.

Sinusitis is one of the most common chronic healthcare problems in the U.S., afflicting about 37 million Americans annually. Sinusitis significantly impacts patients physically, functionally, and emotionally and takes a toll on quality of life.

Treatment for chronic sinusitis consists initially of medical therapy, including antibiotics, steroids, nasal saline, and treatment of comorbidities such as allergies. However, for over 20% of patients, medical therapy does not provide adequate symptom relief, and endoscopic sinus surgery is often the next step in the treatment algorithm. Typically, this type of surgery is performed in the operating room under general anesthesia, but now, patients have the option of a minimally invasive treatment in the office.

Balloon sinuplasty is a minimally invasive procedure used to treat chronic and recurrent acute sinusitis. This FDA-approved technology has been available for use in the operating room since 2005, and we are proud to be the first ENT practice inRaleigh to offer and perform this treatment in the office.

Similar to a dental procedure, candidates for balloon sinuplasty are anesthetized with topical and local anesthetics. The sinus ostia are then visualized with an endoscope and camera while a lighted guide-wire is positioned atraumatically into the sinus to be dilated. A small balloon catheter is then threaded over the wire, inflated for 5 to 10 seconds, and the sinus dilation is complete. The next sinus is then treated in the same fashion. If necessary, the sinus can simultaneously be irrigated with saline. Almost all patients tolerate this procedure very well, especially when properly selected. There is no removal of tissue, so bleeding is minimal. The procedure is very safe with very low risk for complication. Return to normal daily activities is almost immediate. Patients return for a follow-up visit so the dilated sinus openings can be visualized and post -operative cleanings or debridements are generally unnecessary.

This procedure has undergone rigorous clinical validation, which has shown


90% sinus ostial patency rate at 1 year

No serious adverse events at 2 years

Symptom improvement for 85% of patients at 2 years post-operatively

In addition to balloon sinuplasty, we are also offering turbinate reduction in the office for patients with nasal congestion due to turbinate hypertrophy. Again, the patient is anesthetized with a topical and local anesthetic, and the turbinates are coblated by delivering radiofrequency energy to the tissue, effectively shrinking the turbinates and opening the nasal airway. Finally, for patients with recurrent nasal polyps causing nasal obstruction, we are offering nasal polypectomy in the office under local anesthesia.

If you are suffering from chronic or recurrent acute sinusitis and have not found adequate relief from medical therapy, you may be a candidate for balloon sinuplasty. For those who are not, we offer comprehensive medical and surgical treatments for sinusitis that will be individually tailored to fit your needs. Please visit for more information about our sinonasal services and call 919-787-1374 for an appointment. Don’t forget to follow us on Facebook and Twitter!

Article posted by Jeevan Ramakrishnan, MD