As a trainee surgeon, I was once told: “You’re not the first walk on water!” And there I was, my elation at having completed a great (I thought) operation that I’d never done before, completely deflated. But as you get on in years, you realize that in medicine, advances are seldom made by individuals: the fact is, most of what is better nowadays is simply due to technological advancements. I came across something like this a while back.

Whilst at a conference I met some nice folk from a company called  Acclarent. They showed me their device: Balloon Sinuplasty. The concept is simple: in the same way as a blocked coronary artery can be unblocked by passing a balloon catheter and stretching it open, (coronary angioplasty), so can a blocked sinus be unblocked - very atraumatically.  I was a bit sceptical, but I’ve used this technique on many patients now, and I have to say, in the right patient, it is fantastic.

Who then is “the right patient”? Well, those who have a blocked and painful frontal sinus are ideal. This is a dangerous area it operate in. In fact, many ENT surgeon will not carry out frontal sinus surgery, for fear of complications, like Cerebrospinal fluid leakage (the fluid that surrounds your brain). The balloon sinuplasty technique opens the area up much more safely and atraumatically than traditional methods. I used it on just such a lady a while ago. She was wide awake when I went to go and see her shortly afterwards. She had undergone two previous sinus surgeries in the past, and knew exactly what to expect. When I saw her, she told me that her constant, chronic forehead pain was completely gone, but she felt almost as if she had not actually had her operation, because there was no pain, bleeding, blockage, (all the post-op things she was expecting). I explained to her that I had inserted the Balloon Sinuplasty catheter and drained out a lot of yellow pus. She went back to work the next day and was delighted. She has never had any further trouble. I asked if she’d like to write a short testimonial for my website, but bless her, she declined because she was too shy!

I felt that same elation I’d had as a junior surgeon-in-training, but this time the little voice warning me that I wasn’t magic was not my Professor’s, but my own. It really is the technology that makes the difference.

Sometimes medicine is enthralling, but at others it leaves one with a feeling of trepidation. I was teaching my new trainee today in my clinic in the NHS. He had never done any ENT before and was impressing me with pertinent questions about the patients we were seeing together in a very busy clinic. I had just made the point that there are no short-cuts in medicine when an otherwise well, non-smoking young lady in her 30’s came in with an “ear infection”. Or that’s what her GP referred her as. Turns out she had a nasty cold whilst on holiday and her ear became blocked and full. On return, she received some antibiotics, but five weeks later, it was still blocked. Her hearing test suggested some fluid behind the eardrum, but it really didn’t looked inflamed at all. I asked my trainee to feel her neck carefully for any glands and he asked if you normally get glands in the neck from an ear infection. Meanwhile, I took a fibreoptic endoscope and passed this gently through her nostril to take a look at the postnasal space, where the eustachian tube opens. There, I found a pink, fleshy mass covering over the opening of the tube.

We are making urgent arrangements to biopsy this under general anaesthetic. Problem is, this may well turn out to be a malignant tumour. when it finally dawned on my trainee that this was no simple ear infection his face suddenly dropped. Then he understood what I meant by “no shortcuts”. I think it may have ruined his day.