Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat

• US 8,142,422 B2
• Filed: 03/04/2008
• Issued: 03/27/2012
• Est. Priority Date: 04/21/2004
• Status: Active Grant

• Current Assignee: Acclarent Incorporated (Johnson & Johnson)
• Original Assignee: Acclarent Incorporated (Johnson & Johnson)
• Inventors: Makower, Joshua, Chang, John Y.
• Primary Examiner(s): Sirmons, Kevin C
• Assistant Examiner(s): Hall, Deanna K
• Application Number:
  US12/042,221
• Publication Number:
  US 20080154250A1
• Time in Patent Office: 1,484 Days
• Field of Search: 604/528, 600/101, 600/114, 600/178, 606/2, 606/3
• US Class Current: 606/2
• CPC Class Codes: A61B 1/233 for the nose, i.e. nasoscopes , e.g. testing of patency of Eustachian tubes
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 10/0233 Pointed or sharp biopsy instruments
• CPC Class Codes: A61B 10/06 Biopsy forceps , e.g. with cup-shaped jaws
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1688 for the sinus or nose
• CPC Class Codes: A61B 17/24 for use in the oral cavity, larynx, bronchial passages or nose for medical inspection of cavities or tubes in the body A61B1/00; Tongue scrapers
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3201 Scissors for biopsy A61B10/02
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/22061 : for spreading elements apart
• CPC Class Codes: A61B 2017/320052 : Guides for cutting instruments by marking A61B2090/395
• CPC Class Codes: A61B 2017/320064 : with tissue or sample retaining means
• CPC Class Codes: A61B 2018/00327 : Ear, nose or throat
• CPC Class Codes: A61B 2018/00595 : Cauterization
• CPC Class Codes: A61B 2018/0212 : using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/1405 : Electrodes having a specific shape
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• CPC Class Codes: A61F 11/20 : Ear surgery
• CPC Class Codes: A61F 13/2005 : specially adapted for the nose cavity
• CPC Class Codes: A61F 2/18 : Internal ear or nose parts, e.g. ear-drums implants for middle ear ventilation or drainage A61F11/202
• CPC Class Codes: A61F 2/186 : Nose parts
• CPC Class Codes: A61F 2/82 : Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents stent-grafts for tubular structures of the body other than blood vessels A61F2/04; stent-grafts for blood vessels A61F2/07; instruments specially adapted for placement or removal of stents or stent-grafts A61F2/95; for closing wounds, or holding wounds closed A61B17/04 - A61B17/115; dilators A61M29/00
• CPC Class Codes: A61F 2250/0039 : differing in diameter
• CPC Class Codes: A61M 16/0434 : Cuffs
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104
• CPC Class Codes: A61M 31/00 : Devices for introducing or retaining media, e.g. remedies, in cavities of the body A61M25/00 takes precedence ; introducing or retaining ophthalmic products into the ocular cavities A61F9/0008
• CPC Class Codes: A61M 31/005 : for contrast media
• CPC Class Codes: A61N 1/0541 : Cochlear electrodes

Abstract

Sinusitis, enlarged nasal turbinates, tumors, infections, hearing disorders, allergic conditions, facial fractures and other disorders of the ear, nose and throat 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, endoscopic studies and transillumination studies. Access and occluder devices may be used to establish fluid tight seals in the anterior or posterior nasal cavities/nasopharynx and to facilitate insertion of working devices (e.g., scopes, guidewires, catheters, tissue cutting or remodeling devices, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc.

Claims

1. A method for emitting light from an instrument, the method comprising:

advancing an illuminating portion of a light emitting instrument from exterior of a patient'"'"'s anatomy into a paranasal sinus of a patient;

emitting light from the illuminating portion of the instrument into the paranasal sinus; and

directly observing the emitted light through tissue from exterior of the patient'"'"'s anatomy.

2. A method as in claim 1, wherein advancing the illuminating portion comprises passing the instrument through a nostril of the patient'"'"'s nose and through a paranasal sinus ostium into the paranasal sinus.

3. A method as in claim 2, wherein passing the instrument through the ostium comprises passing it through a natural ostium.

4. A method as in claim 2, wherein passing the instrument through the ostium comprises passing it through a surgically modified ostium.

5. A method as in claim 2, wherein advancing the illuminating portion comprises passing a flexible illuminating instrument through a guide catheter.

6. A method as in claim 5, wherein passing the flexible illuminating instrument comprises passing a flexible illuminating wire through the guide catheter.

7. A method as in claim 2, wherein advancing the illuminating portion comprises passing an illuminating catheter into the nostril and through the ostium.

8. A method as in claim 7, wherein the catheter is passed over a guidewire extending into the nostril and through the ostium.

9. A method as in claim 8, further comprising, before passing the light emitting catheter:

inserting a guide catheter into the nostril to position a distal end of the guide catheter at or near the ostium; and

advancing the guidewire through the guide catheter, into the paranasal sinus,

wherein the light emitting catheter is advanced through the guide catheter over the guidewire.

10. A method as in claim 1, wherein emitting light from the illuminating portion comprises emitting light from a distal end of the light emitting instrument.

11. A method as in claim 1, wherein observing the emitted light comprises observing light transmitted through tissue of the patient.

12. A method as in claim 1, wherein observing the emitted light comprises observing light with an endoscope positioned in a nostril or nasal cavity of the patient.

13. A method as in claim 11, wherein observing the emitted light comprises observing light with a flexible endoscope having a distal end positioned in the paranasal sinus.

14. A method as in claim 1, wherein observing the emitted light further comprises observing an anatomical structure.

15. A method as in claim 1, wherein observing the emitted light further comprises detecting an aberrant opening or leak through which the light passes.

16. A method for emitting light from an instrument, the method comprising:

advancing a flexible illuminating catheter from an exterior of a patient'"'"'s anatomy through a nostril of a patient and through a paranasal sinus opening to position an illuminating portion of the catheter in a paranasal sinus of the patient;

emitting light from the illuminating portion of the catheter; and

directly observing the emitted light through tissue from exterior of the patient'"'"'s anatomy.

17. A method as in claim 16, further comprising, before advancing the catheter, advancing a guidewire through the nostril and the paranasal sinus opening to position a distal end of the guidewire in the paranasal sinus of the patient, wherein the illuminating catheter is advanced over the guidewire.

18. A method as in claim 17, further comprising, before advancing the guidewire, inserting a guide catheter into the nostril to position a distal end of the guide catheter at or near the paranasal sinus opening, wherein the guidewire is advanced through the guide catheter and the illuminating catheter is advanced through the guide catheter over the guidewire.

19. A method as in claim 16, wherein observing the emitted light comprises observing light transmitted through tissue of the patient.

20. A method for emitting light from an instrument, the method comprising:

advancing an illuminating portion of a light emitting instrument from exterior of a patient'"'"'s anatomy into a cavity in a patient'"'"'s head, the cavity selected from the group consisting of a nasopharynx, a Eustachian tube, an inner ear and a middle ear;

emitting light from the illuminating portion of the instrument; and

directly observing the emitted light from exterior of the patient'"'"'s anatomy.

21. A method as in claim 20, wherein the illuminating portion of the instrument is passed into the Eustachian tube, and wherein observing the light comprises observing light through the patient'"'"'s ear.

22. A method as in claim 20, wherein the illuminating portion of the instrument is passed into the nasopharynx, and wherein observing the light comprises observing light through at least one of the patient'"'"'s ear, the patient'"'"'s mouth and the patient'"'"'s jaw.