MKT00858 Rev. D10/7/2014 Pre Question 1 Adequate medical therapy for chronic sinusitis consists of: 1 A.Extended day (20-30 days) course of appropriate antibiotic B.Nasal steroid spray C.Nasal decongestant D.At least two of the above. 10

MKT00858 Rev. D10/7/2014 Pre Question 2 For the appropriate patient with chronic sinusitis, unresponsive to adequate medical therapy, office balloon sinuplasy offers all the following except: 2 A.Local anesthesia only B.No need to fast for 8 hours C.Off work for 5-7 days D.Back to normal activities in about 24 hours. 10

MKT00858 Rev. D10/7/20143 Sinusitis in the Office Gordon Katz, DO Devore, Katz, Michaelson ENT

MKT00858 Rev. D10/7/20144 Sinusitis in the Office ( Your Office and My Office ) Gordon Katz, DO Devore, Katz, Michaelson ENT

"Top Ten" Reasons to Join The Dayton District Academy of Osteopathic Medicine 1.First two year’s dues are reduced! 2.Web site including member directory. 3."Capsule Comments" newsletter with information you need to know. 4.Local issues/concerns taken to state affiliation Ohio Osteopathic Association and if successful, the American Osteopathic Association. We were instrumental in submitting and passage that went before the Ohio legislative body and the American Osteopathic Association for potential nationwide legislative changes. 5.Political Action Committee "D.O.PAC" supports candidates and/or issues that in turn affect your practice. 6.Our social events are FUN! 7.Physician referral service. 8.Dedicated support staff. 9.Medical lecture dinners and other CME programs. 10.Members only pocket size roster book – "coming soon." If you currently reside in Butler, Champaign, Clark, Clinton, Darke, Greene, Logan, Miami, Montgomery, Preble, Shelby or Warren counties then consider joining your local Academy. As a professional organization it is important to stand together as a group. Please take a few minutes during this event and fill out an application. 5

MKT00858 Rev. D 37 million sinusitis sufferers in the U.S. 1 $8 billion in direct cost 2,3 7 million sinusitis patients visit a doctor each year 3,4 Chronic sinusitis is debilitating 5 Sinusitis Facts

MKT03060 Rev. B Inflammation of the sinus lining caused by: Bacterial, viral and/or microbial infections Non-infectious etiology- allergic and non-allergic congestion Structural issues Narrow sinus openings and/or ostial blockage Sinus symptoms may include: Sinus pressure and congestion Sinus Headache Facial pain Tenderness and swelling around the eyes, cheeks, nose and forehead Difficulty breathing through the nose Loss of the sense of smell or taste Yellow or green mucus from the nose Teeth pain Fatigue Sore throat from nasal discharge Bad breath Inflammation of the sinus lining caused by: Bacterial, viral and/or microbial infections Non-infectious etiology- allergic and non-allergic congestion Structural issues Narrow sinus openings and/or ostial blockage Sinus symptoms may include: Sinus pressure and congestion Sinus Headache Facial pain Tenderness and swelling around the eyes, cheeks, nose and forehead Difficulty breathing through the nose Loss of the sense of smell or taste Yellow or green mucus from the nose Teeth pain Fatigue Sore throat from nasal discharge Bad breath 10/7/20147 Sinusitis Overview

MKT00858 Rev. D The sinuses are hollow spaces in the skull which serve to lighten the skull and give resonance to the voice. Each sinus has an opening that allows mucus to drain – this drainage is essential to keeping your sinuses working well and you healthy. Anything that obstructs that flow may cause a buildup of mucus and lead to a sinus infection. What are the sinuses?

MKT00858 Rev. D Sinusitis (also called rhinosinusitis) is an inflammation of the sinus lining that prevents normal mucus drainage through the nose. Sinusitis is often preceded by a cold or allergy attack. Colds and allergies can lead to inflamed sinuses, causing the sinus openings to become blocked. What is sinusitis? Normal SinusBlocked Sinus

MKT00858 Rev. D If your symptoms resolve with medication, but you experience 4 or more sinus infections in a year, you could have recurrent acute sinusitis. If your symptoms do not resolve with medication, or if you experience symptoms for longer than 12 weeks you could have chronic sinusitis. Recurrent Acute vs. Chronic Sinusitis

MKT00858 Rev. D Sinusitis Care Continuum Medication Nasal Steroids Antibiotics Decongestants Oral Steroids Mucus-thinning Drugs FESS Functional Endoscopic Sinus Surgery Balloon Sinuplasty

MKT00858 Rev. D Healthcare professionals often find it difficult to treat chronic sinusitis sufferers with medication. At least 20% of chronic sinusitis patients are not successfully treated with medical therapy 6. If multiple uses of antibiotics, medications or other sinusitis treatments have failed to relieve your symptoms, your ENT doctor may recommend sinus surgery. Medication Options

MKT00858 Rev. D Functional Endoscopic Sinus Surgery (FESS) Previously, the only surgical option for clearing blocked sinuses was FESS. FESS with traditional tools requires removal of bone and tissue from the nose to enlarge the sinus opening. This removal of bone and tissue can require uncomfortable nasal packing after surgery and lead to post-surgery pain and scarring. FESS with traditional tools

MKT03060 Rev. B Evolution of sinus surgery – From open (Caldwell-Luc) to less invasive surgery (FESS) – Introduction of endoscopic tools – Discovery that blocked sinus ostia may be the primary culprit Goals of Functional Endoscopic Sinus Surgery (FESS) – Clear blocked sinuses – Restore normal sinus drainage and function – Preserve normal anatomy and mucosal tissue Inherent Limitations – Removal of bone and tissue may lead to post-op pain, scarring and bleeding – Difficult or atypical anatomy – Nasal packing may be used to control bleeding – Delay in return to work or lifestyle 10/7/ Traditional Treatment Options Surgical Techniques

MKT03060 Rev. B Rigid Instrumentation – Excellent for when the surgical goal is to remove bone and tissue – Limited for when the surgical goal is to restore function with maximum bone and tissue preservation 10/7/ Instrumentation is the Key

MKT03060 Rev. B Flexible Instrumentation – Excellent for when the surgical goal is to restore sinus drainage and function with maximum bone and tissue preservation 10/7/ Instrumentation is the Key

MKT00858 Rev. D  Balloon Sinuplasty is an innovative procedure used by ENT doctors to treat patients with recurrent acute or chronic sinusitis. Balloon Sinuplasty relieves the pain and pressure associated with sinusitis.  Balloon Sinuplasty uses a soft, flexible guidewire to access the inflamed sinuses. A small balloon catheter is advanced over the flexible guidewire, gradually inflated to restructure the previously blocked nasal passage, and then removed.  Balloon Sinuplasty preserves the normal anatomy of the sinuses and mucosal tissue, and unlike traditional sinus surgery, Balloon Sinuplasty requires no cutting and no removal of bone and tissue. What is Balloon Sinuplasty?

MKT00858 Rev. D How does Balloon Sinuplasty work?

MKT03060 Rev. B10/7/ Endoscopic View – Balloon Sinuplasty 1. Place flexible guidewire into sinus and advance balloon catheter over wire 2. Inflate balloon 3. Deflate balloon 4. Remove the entire system

MKT00858 Rev. D Safe & Less Invasive With Balloon Sinuplasty, there is no cutting of nasal bone or tissue. More than 400,000 patients suffering from sinusitis have been treated by physicians using Balloon Sinuplasty technology. 7 Proven Effective Most chronic sinusitis patients report clinically meaningful improvement in sinus symptoms and quality of life through 2 years following procedure. 8 More than 1 million sinuses have been dilated using Balloon Sinuplasty technology. 7 Fast Recovery While recovery time varies with each patient, recovery is typically fast. In a study of in-office balloon dilation, patients returned to work and normal activity as soon as 24 hours. 10 Available in the Office Balloon Sinuplasty is now performed by some doctors in their office under local anesthesia. More than 40,000 patients suffering from sinusitis have had Balloon Sinuplasty In-Office. 7 10/7/ Why Choose Balloon Sinuplasty?

MKT00858 Rev. D In-Office Procedure No fasting period Local anesthesia Wear own clothes Potential out of pocket savings 9 Patients return to normal activity as soon as 24 hours 10 The Balloon Sinuplasty In-Office Patient Experience Hospital Surgery Fasting prior to surgery General anesthesia Hospital gown Intubation and IV May be conducted in conjunction with other procedures requiring general anesthesia

MKT00858 Rev. D Local Anesthesia Balloon Sinuplasty In-Office is an option for patients who decline or are ineligible for general anesthesia. Fast Recovery While recovery time varies with each patient, patients who have Balloon Sinuplasty In-Office procedure may return to work and normal activities as soon as 24 hours. 10 Comfortable Surroundings Experience the procedure in the comfort of your physician’s office rather than a hospital operating room. High Patient Satisfaction 9 The majority of patients who had Balloon Sinuplasty In-Office would recommend the procedure to family and friends. 10 Potential for Significant Cost Savings Some eligible patients may have lower out-of-pocket costs if the procedure is performed in a lower cost of care setting, such as a physician’s office. 10/7/ Benefits of Balloon Sinuplasty In-Office

MKT00858 Rev. D Balloon Sinuplasty may be right for you if: 1. You experience two or more of the following symptoms:  Facial pain  Facial pressure  Recurrent sinus infections  Sinus headaches  Sinus congestion 2. A doctor has prescribed sinus medication for you to address your condition. 3. You have had more than 4 sinus infections in the past 12 months, or if you have taken sinus medication for your condition for more than 12 consecutive weeks. Is Balloon Sinuplasty Right for You?

MKT00858 Rev. D For more information on Balloon Sinuplasty go to Facebook.com/RealSinusRelief Twitter.com/RealSinusRelief Youtube.com/RealSinusRelief Learn More

Post Question 1 Adequate medical therapy for chronic sinusitis consists of: A.Extended day (20-30 days) course of appropriate antibiotic B.Nasal steroid spray C.Nasal decongestant D.At least two of the above. 10

Post Question 2 For the appropriate patient with chronic sinusitis, unresponsive to adequate medical therapy, office balloon sinuplasy offers all the following except: A.Local anesthesia only B.No need to fast for 8 hours C.Off work for 5-7 days D.Back to normal activities in about 24 hours. 10

MKT00858 Rev. D Ray et al. Healthcare expenditures for sinusitis in 1996: Contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol 1999;103: Inflation adjusted using CPI 2010 dollars. 3.Benninger et al. Adult chronic rhino sinusitis: Definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003;129S:S1-S M visits/2.5 Avg visits per patient = 7M patient visits. Avg patient visits derived from figure 3 and averaged with Bhattacharyya et al statistic 3 4.Bhattacharyya N. Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis. Laryngoscope 2006;116(Suppl 110): Soler et al. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope 121: , Lal et al. Efficacy of targeted medical therapy in chronic rhinosinusitis, and predictors of failure. Am J Rhinol Allergy, 2009;23(4): Data on file at Acclarent, #10. 8.Weiss RL, Church CA, et al. Long-term outcome analysis of balloon catheter sinusotomy: two-year follow up. Otolaryngol Head Neck Surg 2008;139:S38-S46. 9.Some eligible patients may have lower out-of-pocket costs if the procedure is performed in a lower cost of care setting, such as a physician’s office. 10.Karanfilov B, Silvers S, Pasha R, Sikand A, Shikani A, Sillers M; for the ORIOS2 study investigators. Office- based balloon sinus dilation: a prospective, multicenter study of 203 patients. Int Forum Allergy Rhinol. 2013;3(5): Sources