Devices, systems and methods for treating disorders of the ear, nose and throat
Sinusitis, mucocysts, tumors, infections, hearing disorders, choanal atresia, fractures and other disorders of the paranasal sinuses, Eustachian tubes, Lachrymal ducts and other ear, nose, throat and mouth structures are diagnosed and/or treated using minimally invasive approaches and, in many cases, flexible catheters as opposed to instruments having rigid shafts. Various diagnostic procedures and devices are used to perform imaging studies, mucus flow studies, air/gas flow studies, anatomic dimension studies and endoscopic studies. Access and occluding devices may be used to facilitate insertion of working devices such asendoscopes, wires, probes, needles, catheters, balloon catheters, dilation catheters, dilators, balloons, tissue cutting or remodeling devices, suction or irrigation devices, imaging devices, sizing devices, biopsy devices, image-guided devices containing sensors or transmitters, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting or delivering devices and implants, etc.
1. A method for enlarging a natural paranasal sinus ostium that has not previously been surgically altered, the method comprising the steps of:
inserting and advancing an elongate guide having a preset shape, a distal end and a lumen to a position within or near the natural paranasal sinus ostium;
advancing a dilator through the lumen of the elongate guide and positioning the dilator and guide such that the dilator is located beyond the distal end of the guide and within the natural paranasal sinus ostium; and
using the dilator to dilate the natural paranasal sinus ostium causing breakage of bone that underlies the mucosa of the natural paranasal sinus ostium.
2. A method according to claim 1 wherein the guide has a curve and wherein the advancing step comprises advancing the dilator through the lumen of the guide and around the curve.
3. A method according to claim 2 wherein at least a portion of the guide is malleable and wherein the method further comprises the step of:
shaping a malleable portion of the guide.
4. A method according to claim 1 wherein the dilator comprises a balloon catheter, and wherein the advancing step comprises advancing the balloon catheter through the lumen of the guide and positioning the dilator and guide such that a balloon of the balloon catheter is positioned within the natural paranasal sinus ostium.
5. A method according to claim 4 wherein at least a portion of the guide is malleable and wherein the method further comprises shaping a malleable portion of the guide.
6. A method according to claim 5 wherein the guide comprises a flexible guide catheter and a malleable outer tube through which the dilator extends.
7. A method according to claim 1 wherein the inserting step comprises:
inserting the elongate guide to a first position; and
advancing a guidewire through the lumen of the elongate guide such that the guidewire extends into or through the natural paranasal sinus ostium;
and wherein the advancing step further comprises:
advancing the dilator over the guidewire to a position where the dilator is positioned within the natural paranasal sinus ostium.
8. A method according to claim 7 further comprising the steps of:
removing the dilator; and
advancing a tubular sheath over the guidewire.
9. A method according to claim 8 further comprising the step of:
removing the guidewire leaving the tubular sheath in place.
10. A method according to claim 9 further comprising the step of infusing or aspirating matter through the tubular sheath.
11. A method according to claim 9 further comprising the step of inserting a different guidewire through the tubular sheath.
12. A method according to claim 8 wherein the tubular sheath having a lumen and a curved portion is inserted through the lumen of the elongate guide to a position where the curved portion of the tubular sheath extends out of the distal end of the elongate guide; and
the guidewire is advanced through the lumen of the curved tubular sheath such that the guidewire extends into or through the natural paranasal sinus ostium.
13. A method according to claim 1 wherein the dilator comprises a balloon that is positionable in the natural paranasal sinus ostium and expandable therein to dilate the natural paranasal sinus ostium.
14. A method according to claim 1 wherein a distal end of the dilator is bent or angled.
15. A method according to claim 1 further comprising using an endoscope for visualization.
16. A method according to claim 1 further comprising advancing the dilator through a lumen of a stabilizing member.
17. A method according to claim 1 wherein the natural paranasal sinus ostium is a maxillary sinus ostium.
18. A method according to claim 1 wherein the natural paranasal sinus ostium is a frontal sinus ostium.
19. A method according to claim 1 further comprising treating an ethmoid sinus.
20. A method according to claim 1 wherein the dilator has at least one distance marking or marker band.