Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Current indications for balloon sinuplasty Cemal Cingi a , Nuray Bayar Muluk b , and Jivianne T. Lee c Purpose of review The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. Recent findings The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Summary Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia. Keywords balloon dilation technology, balloon sinuplasty, contraindications, indications, sinus ostial dilation INTRODUCTION Balloon sinus ostial dilation (BSD) was introduced in 2005 as a less invasive alternative to endoscopic sinus surgery in the treatment of recurrent acute (RARS) and chronic rhinosinusitis (CRS). The technique involves placement of a balloon catheter under trans- illumination or navigation into the sinus ostium, with inflation resulting in dilation of the sinus open- ing and subsequent relief of obstruction. Since its development, extensive research has been conducted regarding its safety and efficacy. The purpose of this article is to review the current indications and contra- indications for BSD as well as the pertinent evidence on its safety and efficacy. BALLOON SINUPLASTY Acclarent (based at Menlo Park, California, USA) was the first to obtain US FDA approval to introduce the balloon sinuplasty system as a catheter-dependent device for enlarging the paranasal ostia in 2005. The new device was similar to other apparatus in medical use for relieving obstruction in other organ systems while being minimally invasive. It is currently most appropriate to describe the equipment as a device, tool or instrument in the surgical toolkit rather than as a different, innovative way per se of performing surgical procedures [1–5]. a Eskisehir Osmangazi University, Medical Faculty, Department of Otorhi- nolaryngology, Eskisehir, b Kirikkale University, Medical Faculty, Depart- ment of Otorhinolaryngology, Kirikkale, Turkey and c Rhinology & Endoscopic Skull Base Surgery, UCLA Department of Head & Neck Surgery, Los Angeles, California, USA Correspondence to Cemal Cingi, MD, Professor, Department of Otolar- yngology, Head and Neck Surgery, University of Eskisehir Osmangazi, 26020 Eskisehir, Turkey. Tel: +90 532 2676616; e-mail: ccingi@gmail.com Curr Opin Otolaryngol Head Neck Surg 2019, 27:7–13 DOI:10.1097/MOO.0000000000000506 1068-9508 Copyright ß 2018 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com REVIEW