Balloon sinuplasty, by a specialist rhinologist.

Prices vary by unit, by which rhinologist does the case, by whether the setting is a clinic under LA or a day-case theatre under GA, and by how many sinuses are dilated. NHS availability under NICE IPG635 supports use in selected cases if you want to explore that pathway first.

1. 01 Before

   You send us your history and any CT report

   A short confidential form. Symptoms, INCS and saline trial, antibiotic course, any oral steroid or dupilumab, and a Lund-Mackay score if you have one.

2. 02 Before

   We come back with a recommendation

   Within one working day: whether balloon sinuplasty fits, whether FESS is safer, or whether medical therapy needs longer. Indicative price, honest either way.

3. 03 Before

   We arrange the consultation and CT

   Nasal endoscopy in clinic, CT sinuses with Lund-Mackay scoring, allergy workup and AERD screen if suspected, dental review if odontogenic maxillary sinusitis is likely.

4. 04 On the day

   Arrival at the unit

   Consent with the rhinologist and anaesthetist. Local anaesthetic and sedation in a clinic setting, or a light general anaesthetic in a hospital day-case theatre.

5. 05 On the day

   The balloon sinuplasty itself

   Around 30 to 60 minutes. Endoscopic access via the nostril, guide wire into the target ostium confirmed by fluoroscopy or transillumination, balloon inflated for 10 seconds and repeated.

6. 06 On the day

   Home the same day

   A short recovery, saline irrigation instructions and written aftercare. Home within a few hours. You will need someone to collect you after sedation or a general anaesthetic.

7. 07 After

   Follow-up and ongoing medical therapy

   Back to desk work in 1 to 3 days, gentle activity at 1 week, contact sport at 2 weeks. Ongoing INCS and saline as chronic rhinosinusitis remains a long-term condition.

• Chronic rhinosinusitis without polyps

  Persistent facial pressure, nasal obstruction, discharge and hyposmia beyond 12 weeks despite 6 to 12 weeks of maximal medical therapy.

• Recurrent acute rhinosinusitis

  Four or more discrete acute episodes each year, with clear intervals in between, and a CT that confirms ostial narrowing on the affected side.

• Barotrauma in pilots and divers

  Painful frontal or maxillary blocks on descent that keep grounding you or aborting dives, with imaging that shows a stenotic ostium.

• Selected paediatric sinusitis

  Older children with recurrent maxillary disease where adenoidectomy alone has not worked and a tissue-sparing dilation buys time.

• After failed medical therapy

  INCS plus saline irrigation, a targeted antibiotic if bacterial, a short oral steroid course, and dupilumab if polyps, all documented and still symptomatic.

• Not for extensive polyps or mucocele

  Bulky nasal polyps, mucocele, fungal ball, suspected inverted papilloma or tumour need FESS with tissue removal, not a balloon.

• Unilateral disease needs a biopsy first

  Unilateral polyp or opacification is inverted papilloma or malignancy until proven otherwise. Biopsy before any dilation.

• Red flag: orbital or intracranial signs

  Vision change, painful eye movement, periorbital swelling, severe headache or confusion needs A&E, not a private booking.

• Local anaesthetic with sedation, or a light GA

  Single-sinus balloon dilation is comfortable under LA and sedation in a clinic. Multi-sinus, revision or combined cases are safer under a short GA.

• Realistic outcomes at 2 years

  The BREATHE and CLEAR trials show 75 to 85 per cent substantial symptom improvement at two years. Not curative. Chronic disease still needs INCS and saline.

• Mild epistaxis is common

  A little bleeding for 24 to 48 hours is expected. Persistent or heavy bleeding after 48 hours needs a call to the unit, not a wait-and-see.

• Orbital injury is rare with careful technique

  The lamina papyracea sits millimetres from the ethmoids. Fluoroscopy or transillumination confirms the wire is in the ostium, not the orbit.

• CSF leak from the frontal recess is rare

  A recognised risk of any frontal sinus work. If it happens it is repaired at the time. You would be counselled specifically before frontal dilation.

• Persistent sinusitis after dilation

  If the ostium was inadequately dilated, or the disease is more mucosal than ostial, symptoms can return. A conversion to formal FESS may be needed.

• Saline irrigation post-op

  Large-volume saline irrigation from day one keeps the newly dilated ostia clear of clot and crust. It is the single most important aftercare step.

• Ongoing intranasal corticosteroids

  INCS continues after balloon sinuplasty. Chronic rhinosinusitis is a long-term inflammatory condition, and dilation alone does not switch it off.

• When to call

  Severe headache, vision change, painful eye movement, periorbital swelling, clear watery discharge from one nostril, or heavy bleeding beyond 48 hours.