What Are the Risks of Balloon Sinus Dilation?

Every patient who comes in for balloon sinus dilation deserves a complete, honest conversation about risk before the procedure. Not a watered-down reassurance. Not a consent form handed over without explanation. A real conversation.

Here is exactly what I tell my patients.

The Complete Risk List

The risks of balloon sinus dilation fall into two categories — those that are common and manageable, and those that are rare but worth knowing about.

In the common and expected category: post-procedure nasal congestion, throat discomfort, and some bleeding. These are the three I see most often in my practice and all are temporary. Nasal congestion after the procedure is the nose’s normal healing response. Throat discomfort comes from the topical anesthesia and instrumentation. Minor bleeding can occur, particularly when patients push their activity level too soon after the procedure — more on that in a moment.

Other recognized risks include scar formation inside the nasal passages, temporary double vision, cough, numbness of the throat or palate, temporary voice changes, difficulty swallowing, and in some cases the need for further surgery if the procedure does not achieve adequate long-term patency. Altered sense of smell has been reported. Recurrence of sinusitis remains possible — balloon dilation opens the drainage pathway but does not eliminate the upstream drivers of chronic sinus disease if those have not been addressed.

In the rare category: injury to the eye, injury to the brain or skull base, and subcutaneous air collection — what physicians call subcutaneous emphysema. The most serious rare complications reported in the literature include cerebrospinal fluid leak, orbital injury, and significant epistaxis. These are real risks that deserve mention, even though in experienced hands they are exceedingly uncommon.

When we perform a Eustachian tube balloon dilation or a Neuromark procedure in the same visit, there are additional considerations specific to the topical anesthetic gel used in the posterior nasal cavity. That gel can migrate into the back of the throat where it mixes with saliva and temporarily numbs whatever it touches. The result is a temporary difficulty coordinating a swallow, a temporary cough, or a brief change in voice quality. These effects are expected, they are explained to every patient beforehand, and they resolve within minutes to a few hours.

Because of this temporary throat numbness, I give every combination procedure patient two specific instructions: avoid anything hot to drink or eat until sensation fully returns — we do not want the throat’s temperature protection down when something hot goes in — and avoid large gulps of liquid while the swallowing reflex is temporarily altered. Small sips only until everything is back to normal.

The Bike Ride

I always tell patients to give me 72 hours of taking it easy. No activities that raise the heart rate significantly. No activities that make the face hot and sweaty. The reason is straightforward — increased heart rate means increased blood pressure and blood flow to the surgical site, and that is the mechanism for post-procedural bleeding.

One of my patients felt so well the day after his procedure that he told his wife he was going for a bike ride. She reminded him the doctor said to take it easy. He said he understood — he was not going for his usual 30-mile road ride, just an easy 5 to 10 miles. She asked if he was sure. He said he’d be fine.

About a mile and a half in, he looked down and there was blood all over his shirt and legs. He pulled off the road, turned away from traffic — he said he was worried someone would think he had been shot — and called his wife. She came to get him, but not before she called him a dumb ass. He called our after-hours line, followed the instructions, and the bleeding stopped easily. At his follow-up he was healing well with no lasting effects.

The story is funny in retrospect. The point is not. When I say take it easy for 72 hours, I mean it specifically. Light walking. No exertion. No heavy lifting. No yard work. Listen to your body — and if your body says it feels better than expected, that is not permission to push it.

The Camping Trip

The second story involves a patient who did everything right initially — and then made one decision that caused a serious complication.

He recovered well from his procedure and within 48 hours decided to take his family camping. It was fall. Pollen counts were high. He had known allergies and planned to manage them with his usual medications. What he did not account for was 24 hours a day of pollen exposure at exactly the moment his nasal passages were in early healing — swollen, reactive, and not yet stable.

His nose blocked completely. He had been doing his saline rinses as instructed, but the allergic response overwhelmed the treatment. When the blockage became complete, he began blowing his nose — aggressively and repeatedly. Shortly after, one side of his face swelled significantly and his eye closed completely. His wife called our after-hours line and was instructed to go to the nearest emergency room.

Imaging confirmed subcutaneous emphysema — air that had been forced through the thin bony walls of the sinus into the surrounding soft tissue during aggressive nose blowing. The facial bruising and swelling persisted for approximately 10 days before fully resolving. There was no permanent damage.

This is why the post-procedure instructions include a specific prohibition on aggressive nose blowing for the first several days. The walls of the sinuses are temporarily more vulnerable immediately after dilation. Forceful pressure — from blowing, from straining, from sneezing with the mouth closed — can force air through those walls. If you need to clear your nose, gentle dabbing only. No forceful blowing.

How These Risks Compare

A large retrospective cohort study comparing outcomes across 16,040 patients found an overall complication rate of 5.26% for balloon sinuplasty versus 7.35% for conventional FESS, with a revision rate of 7.89% for balloon sinuplasty compared to 16.85% for FESS. That comparison matters when a patient is weighing their options.

Repeated courses of antibiotics carry their own risks — antimicrobial resistance, microbiome disruption, and the progressive failure to resolve what is driving the disease in the first place. Doing nothing carries the risk of continued chronic inflammation, progressive mucosal damage, and the downstream effects of unresolved airway disease on sleep, cognition, and quality of life.

No procedure is without risk. The question is always whether the risk of the procedure is justified by the benefit — and for appropriately selected patients with chronic sinus disease that has not responded to medical management, it consistently is.

Want to Understand More?

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them series on the Airway & Sinus Wellness Review.

→ Does Balloon Sinuplasty Actually Work?

→ Is Balloon Sinuplasty Painful?

→ Is the Combination Procedure Too Much at Once?

Airway & Sinus Wellness Review — Full Publication

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them section of the Airway & Sinus Wellness Review.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience treating sinus and airway disease. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in office-based nasal and sinus procedures under local anesthesia. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying posterior nasal mucosal inflammation driven by pepsin and laryngopharyngeal reflux as an etiological precursor to chronic rhinosinusitis. His hypothesis manuscript is currently under peer review, with a preprint available at Preprints.org (DOI: https://doi.org/10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. If you experience significant bleeding, facial swelling, eye swelling, vision changes, or severe pain following balloon sinus dilation, seek immediate medical evaluation or go to your nearest emergency room.