The PIVA Office Balloon Sinuplasty Procedure


37 million Americans and about 10-20% of the World’s population suffers from sinus problems also known as chronic sinusitis.

Are you one of them?



Do you suffer from one or more of the following?

  • Repeated or persistent sinus infections

  • Sinus pressure or frequent headaches

  • Facial pressure or pain

  • Stuffy nose

  • Reduced or foul smell

  • Nasal discharge or thick postnasal drip

  • Feeling tired all the time from sinus issues

  • Sleep problems from sinus issues

Then CALL US FOR A CONSULTATION TO SEE IF Dr. Khetarpal’s PIVA Office Balloon Sinuplasty Procedure MIGHT BE RIGHT FOR YOU.


Is balloon sinuplasty indicated for all nose and sinus problems or all headaches?

No. Balloon Sinuplasty is indicated for chronic rhinosinusitis and headaches or nasal/sinus congestion as it relates to chronic sinusitis.

Why is Balloon Sinuplasty garnering so much attention?

Simply because it is a very elegant way of opening the sinuses right in the office instead of performing surgery in the operating room under general anesthesia. Also because there is minimal bleeding, less scarring and minimal down time after balloon sinuplasty. Furthermore, chronic rhinosinusitis is a very common condition and almost 37 million or so Americans suffer from chronic rhinosinusitis. Chronic rhinosinusitis affects quality of life.

My doctor told me I had polyps in the nose. Can balloon sinuplasty be used for that?

YES Balloon Sinuplasty can be used to open the sinuses which contain polyps but generally additional use of shavers or other instruments in the office is necessary to remove the polyps, especially in the ethmoid sinuses.

How does balloon sinuplasty work?

Just like balloon angioplasty opens up the clots in the heart blood vessels, balloon catheters when used in the sinuses, open the small sinus openings called ostia. By opening the ostia and making them larger without pulling or cutting tissue, they reduce the risk of scarring and minimize bleeding. Once the sinuses are open, they generally drain better and therefore infections, if and when they do occur, clear more readily. It is also hoped that balloon sinuplasty will restore the mucus lining back to normal.

Which sinuses can balloon sinuplasty be useful in?

Typically balloon sinuplasty is used for the frontal (forehead) and maxillary (cheek) sinuses and also the sphenoid sinuses (sinuses in the back).

How is Dr. Khetarpal’s Exclusive PIVA Office Balloon Sinuplasty Procedure performed?

In our office, balloon sinuplasty is performed either under local anesthesia with or without sedation or with IV anesthesia. Dr Khetarpal is now using a procedure called PIVA Balloon Sinuplasty or painless IV anesthesia balloon sinuplasty for maximum comfort during this in office procedure. After laying the patient down on a office chair, local anesthesia is injected in the nose to numb the mucus lining. IV anesthesia or sedation may be given prior to that and a laryngeal mask airway placed. Once this is accomplished, the procedure is begun. The catheters are passed into the sinuses and the balloons expanded to open them. The time for surgery depends on the number of sinuses that need to be opened. In some patients, I will use a shaver to remove bone and unhealthy mucosa or polyps from the ethmoid sinus. When a shaver is used in conjunction with a balloon procedure the procedure is called a hybrid procedure. Correction of a deviated nasal septum may also be performed at the same time if necessary.

How long does the procedure usually take?

This depends on the number of sinuses that need to be expanded by balloon sinuplasty and if ethmoid sinuses also need surgery. Generally the procedure can be completed in less than an hour or so even with the most extensive disease. For milder disease, the procedure generally takes less than 30 minutes.

What is Dr Khetarpal’s experience with balloon sinuplasty?

Dr. Khetarpal has been performing balloon sinuplasty in Mcallen since the middle part of the last decade soon after it was first released for use. He was among the initial group of surgeons to be trained in its usage. However, he did not bring the technology into the office until he was confident that it was ready for prime time and to be able to access and open the sinuses reliably. Today he is at the forefront in the movement for performing endoscopic sinus surgery with balloon sinuplasty in the office. At this time very few physicians in the country are doing this with image guidance. Over the years, Dr Khetarpal has performed some very complex sinus surgeries of the sinuses and skull base.

What is Dr Khetarpal doing that is more cutting edge in balloon sinuplasty

Dr. Khetarpal has obtained a Western Institutional Review Board Review approval to assess the outcomes of balloon sinuplasty in patients with chronic sinusitis with and without polyps, as well as in those with sinus headaches. He is in a very select group of physicians to do so. In addition to this, he is exploring different medications for their use in patients with polyps after expanding the sinuses with a balloon procedure. He is also at the forefront of using image guidance in the office along with balloon sinuplasty.


Sinusitis is a common condition that affects over 37 million Americans, causing pain, pressure and congestion in the forehead, nose, cheek and eye area. Over 17 percent of women and 10 percent of men in the US are affected by sinus problems. These problems can be temporary and develop as the result of a cold, or may be long lasting and exist for months to years with no relief from the troubling symptoms.

The sinuses are the hollow air spaces behind the bones of the upper face, which can become blocked and inflamed to cause a buildup of mucus or pus. This buildup can cause pain, pressure and fullness along with:

   • Difficulty breathing through the nose
   • Yellow or green mucus discharge
   • Teeth pain
   • Loss of sense of smell or taste
   • Headache or head feeling full
   • Fatigue
   • Sore throat

Sinus problems often affect patients’ quality of life and interfere with regular activities. If you are suffering from persistent sinus problems, it is important to meet with us or your primary doctor and discuss your treatment options.

Sinusitis may be treated with antibiotics, oral steroids and/or nasal steroid sprays, decongestants and saline nasal sprays. While many people can feel relief with the help of these medications, others may continue to experience their symptoms and have trouble enjoying regular activities.

For those that do not respond to medication for sinusitis symptoms, treatment includes endoscopic sinus surgery or balloon sinuplasty. Endoscopic Sinus Surgery is a traditional treatment option that clears blocked sinuses by placing an endoscopic instrument in the nose to examine the area and remove bone and tissue to enlarge the sinus openings. This procedure requires general anesthesia in the hospital or a surgery center, and bleeding/scarring may accompany this.

Balloon sinuplasty is an FDA-approved advanced treatment option to relieve the symptoms of chronic sinusitis. This minimally invasive procedure uses a thin, flexible balloon catheter that is placed in the nose and gradually inflated to relieve blockages in the nasal passage by gently restructuring the bones in the nose. It restores normal sinus function while maintaining the lining of the sinus and keeps post-operative pain and bleeding at a minimum. Balloon sinuplasty procedure offers patients many benefits as an alternative to conventional sinus surgery. Some of these benefits include:

   • Minimally invasive – The soft, flexible tube gently opens sinus openings and reduces damage to surrounding tissue

       or bones compared to standard endoscopic sinus surgery.
   • Safe – Balloon sinuplasty is regarded as a safe and effective procedure. Complications are quite infrequent.
   • Faster recovery times – Many patients return to their regular activities within 24-48  hours
   • Reduced bleeding – By not removing tissue or bone during this procedure, bleeding and other surgical side

       effects are often reduced

Balloon Sinuplasty can be performed in the office under local anesthesia with or without IV sedation or IV anesthesia depending on severity of disease. After balloon sinuplasty as a stand alone procedure, most patients can return to work and other normal activities within 24-48 hours.

Most patients enjoy significant relief from their sinus symptoms after undergoing balloon sinuplasty. We have found that even in the most severe disease, patients find significant relief after balloon sinuplasty or standard endoscopic sinus surgery.

While balloon sinuplasty is an effective treatment for relieving many sinus problems, it is important to note that not everyone can benefit from this procedure. Balloon sinuplasty does not treat ethmoid sinusitis or nasal polyps, and cannot be used on patients with extensive scarring within their sinus openings.

In Office Balloon sinuplasty is FDA-approved for the treatment of sinus conditions and has been safely performed on thousands of patients across the world.