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Invited Commentary
January 23, 2020

The Ever-Expanding Balloon—Is Profit Shaping Practice?

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Sciences University, Portland
JAMA Otolaryngol Head Neck Surg. 2020;146(3):269. doi:10.1001/jamaoto.2019.4481

In the study by Kasle and colleagues1 in this issue of JAMA Otolaryngology–Head and Neck Surgery, the authors report that use of balloon catheter dilation of the sinuses is increasing rapidly, along with concomitant Medicare payments. The increase in payments in the study is stunning, even though it is only reflective of the Medicare population. Interestingly, this increase is driven by a relatively small proportion of otolaryngologist–head and neck surgeons. Estimates from industry colleagues suggest that more than 5500 otolaryngologist–head and neck surgeons perform sinus surgical procedures. In 2016, 382 surgeons (<7% of sinus surgeons) performed more than 60% of balloon procedures. Meanwhile, many clinicians have attended national presentations and panels where experts discuss appropriate use of the balloon technology, and in every panel I can recall over the past decade and a half, the take-home message has been the same: the balloon procedure is useful in a relatively small population of patients who are carefully selected. This has certainly been consistent with my practice experience. One is left to wonder: “Why is there such substantial growth of balloon catheter dilation of the sinuses, especially in a very small group of proceduralists who are doing these procedures at high volumes?”

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