Balloon sinus dilation in the office: guidance, consensus and outcomes

Published 12 October 2026 · IN OFFICE Course editorial team

Balloon sinus dilation, often called balloon sinuplasty, widens the natural drainage pathways of the paranasal sinuses with a catheter-mounted balloon instead of removing tissue. It can be performed in the operating room or, in selected patients, in the office under local anaesthesia. This is a summary of what guidance bodies and clinical studies report.

What guidance and consensus say

NICE interventional procedures guidance IPG273 (2008) states that the evidence on short-term efficacy is adequate and raises no major safety concerns, provided standard arrangements are in place for clinical governance, consent and audit. IPG273 describes the procedure under general anaesthesia.
NICE medical technologies guidance MTG30 (2016) on the XprESS multi-sinus dilation system states that, in uncomplicated chronic sinusitis without severe polyposis, it works as well as FESS, is associated with faster recovery and can more often be done under local anaesthesia. NICE considers the economic advantage uncertain.
The AAO-HNSF Clinical Consensus Statement on balloon dilation of the sinuses (Piccirillo et al., 2018) reached consensus on 13 statements. They include that CT of the sinuses is required before balloon dilation, that it is not indicated in patients without sinonasal symptoms and positive CT findings, and that it can be performed under local anaesthesia with or without sedation.

Outcomes in the office

Gould et al. (2014) treated 81 patients in the office under local anaesthesia only. Technical success was 307 of 313 dilations (98.1%), mean procedural pain was 2.8 out of 10, there were no serious device or procedure related adverse events, and 1.3% needed revision surgery at one year.
In the ORIOS 2 study (Sikand et al., 2015), 122 patients treated in the office were followed for a mean of 1.4 years. The clinically meaningful SNOT-20 improvement was maintained and 7.4% had revision surgery.

Balloon dilation compared with FESS

A 2023 systematic review and meta-analysis (Sinha et al.) included 18 studies, 7 of them in the meta-analysis. The pooled difference between balloon dilation and FESS was 0.435, below the clinically meaningful difference of 0.8, and the authors stress that high-quality evidence comparing the two remains limited. An earlier Cochrane review (Ahmed et al., 2011) found only one unpublished trial and no convincing evidence in favour of balloon dilation; it predates most of the current data and is useful mainly as historical context.

Practical points for the office

The consensus statement makes CT mandatory and reserves the procedure for patients with symptoms and imaging findings. Experts consulted by NICE advise starting under general anaesthesia in the operating room before moving to day case and office settings. Topical and local anaesthesia technique, patient selection and the ability to convert or stop are part of the learning curve.

How the IN OFFICE 2026 course covers this topic

The International IN OFFICE Breathing Disorders Surgery Course runs from 10 to 12 December 2026 at Hospital Dr. Nélio Mendonça in Funchal, Madeira, with lectures, live surgery and supervised hands-on training in groups of 4. The programme lists the sessions on this topic with the course day and the speaker.

Programme sessions on this topic · Registration and fees

Sources

Written for healthcare professionals. This summary does not replace the original publications or clinical judgement.