K Number
K043527
Device Name
RELIEVA SINUS BALLOON DILATION CATHETER
Date Cleared
2005-04-05

(105 days)

Product Code
Regulation Number
874.4420
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Relieva Sinus Balloon Dilation Catheter is intended to provide a means to dilate ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.
Device Description
The Relieva Sinus Balloon Dilation Catheter will be provided in the following balloon sizes: - 3 mm Sinus Balloon Catheter . - 5 mm Sinus Balloon Catheter . - 7 mm Sinus Balloon Catheter . The family of Relieva Sinus Balloon Dilation Catheters allows for the enlargement of sinus ostia and paranasal spaces with a minimally invasive method. The Relieva Sinus Balloon Dilation Catheters are placed in the narrow opening over a guidewire. Once positioned the balloons are inflated with a high pressure inflation device that provides feedback as to the internal pressure of the balloon. After a few seconds at the desired balloon inflation pressure, the balloon can be deflated and removed or repositioned.
More Information

Not Found

No
The device description and performance studies focus on mechanical properties and function, with no mention of AI/ML terms or capabilities.

Yes
The "Intended Use" explicitly states that the device is for "therapeutic procedures," and the "Device Description" explains how it functions to enlarge sinus ostia and paranasal spaces, which is a therapeutic action.

No

Explanation: The device description states its purpose is to "dilate ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures." While it can be used during diagnostic procedures, the device itself is for dilation, which is a therapeutic manipulation, not a diagnostic one. It does not perform any diagnostic function such as imaging, analysis, or measurement to identify a condition.

No

The device description clearly details a physical catheter with balloons of various sizes, intended for mechanical dilation. The performance studies also focus on physical properties and performance of the hardware components. There is no mention of software as the primary or sole component.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states that the device is for "dilating ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures." This describes a physical intervention on the body, not a test performed on a sample taken from the body.
  • Device Description: The description details a physical catheter with an inflatable balloon used to mechanically enlarge passages. This is a surgical or procedural device, not a diagnostic test.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting biomarkers, or providing information about a patient's health status based on laboratory testing.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device is used to physically modify structures within the body.

N/A

Intended Use / Indications for Use

The Relieva Sinus Balloon Dilation Catheter is intended to provide a means to dilate ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.

Product codes

LRC

Device Description

The Relieva Sinus Balloon Dilation Catheter will be provided in the following balloon sizes:

  • 3 mm Sinus Balloon Catheter .
  • 5 mm Sinus Balloon Catheter .
  • 7 mm Sinus Balloon Catheter .

The family of Relieva Sinus Balloon Dilation Catheters allows for the enlargement of sinus ostia and paranasal spaces with a minimally invasive method. The Relieva Sinus Balloon Dilation Catheters are placed in the narrow opening over a guidewire. Once positioned the balloons are inflated with a high pressure inflation device that provides feedback as to the internal pressure of the balloon. After a few seconds at the desired balloon inflation pressure, the balloon can be deflated and removed or repositioned.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

paranasal sinus cavities

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Products were tested to ensure conformance to product specification. Testing included:

  • Visual Inspection .
  • Dimensional Analysis .
  • Surface Finish .
  • . Catheter Hub Leak
  • Shaft to Hub Separation .
  • Balloon Inflation Cycle Fatigue .
  • Balloon Burst Pressure .

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

Pre-Amendments, K935233

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 874.4420 Ear, nose, and throat manual surgical instrument.

(a)
Identification. An ear, nose, and throat manual surgical instrument is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator; tracheal bistour (a long, narrow surgical knife); tracheal dilator; tracheal hook; laryngeal injection set; laryngeal knife; laryngeal saw; laryngeal trocar; laryngectomy tube; adenoid curette; adenotome; metal tongue depressor; mouth gag; oral screw; salpingeal curette; tonsillectome; tonsil guillotine; tonsil screw; tonsil snare; tonsil suction tube; tonsil suturing hook; antom reforator; ethmoid curette; frontal sinus-rasp; nasal curette; nasal rasp; nasal rongeur; nasal saw; nasal scissors; nasal snare; sinus irrigator; sinus trephine; ear curette; ear excavator; ear rasp; ear scissor, ear snare; ear spoon; ear suction tube; malleous ripper; mastoid gauge; microsurgical ear chisel; myringotomy tube inserter; ossici holding clamp; sacculotomy tack inserter; vein press; wire ear loop; microrule; mirror; mobilizer; ear, nose, and throat punch; ear, nose and throat knife; and ear, nose, and throat trocar.(b)
Classification Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 874.9.

0

Kou35a7

2005 APR 5

510(k) Summary

General Information
Classification:Class I
Classification Name:Ear, Nose & Throat Manual Surgical Instrument
Regulation Code:21 CFR 874.4420
Product Code:LRC
Trade Name:Relieva Sinus Balloon Dilation Catheter
Submitter:ExploraMed NC1, Inc.
2570 West El Camino Real, Suite 310
Mountain View, CA 94040
Telephone: (650) 472-0300
Contact:William M. Facteau
President & CEO
Date Revised:05 April 2005

Intended Use

The Relieva Sinus Balloon Dilation Catheter is intended to provide a means to dilate ostia and spaces within the paranasal sinus cavities for diagnostic and therapeutic procedures.

Device Description

The Relieva Sinus Balloon Dilation Catheter will be provided in the following balloon sizes:

  • 3 mm Sinus Balloon Catheter .
  • 5 mm Sinus Balloon Catheter .
  • 7 mm Sinus Balloon Catheter .

The family of Relieva Sinus Balloon Dilation Catheters allows for the enlargement of sinus ostia and paranasal spaces with a minimally invasive method. The Relieva Sinus Balloon Dilation Catheters are placed in the narrow opening over a guidewire. Once positioned the balloons are inflated with a high pressure inflation device that provides feedback as to the internal pressure of the balloon. After a few seconds at the desired balloon inflation pressure, the balloon can be deflated and removed or repositioned.

1

Materials

All materials used in the manufacture of the Relieva Sinus Balloon Catheter are suitable for their intended use and have been used in numerous previously cleared products.

Testing

Products were tested to ensure conformance to product specification. Testing included:

  • Visual Inspection .
  • Dimensional Analysis .
  • Surface Finish .
  • . Catheter Hub Leak
  • Shaft to Hub Separation .
  • Balloon Inflation Cycle Fatigue .
  • Balloon Burst Pressure .

Summary of Substantial Equivalence

The Relieva Sinus Balloon Catheter is substantially equivalent to marketed predicate devices with respect to intended use and technological characteristics.

Comparison Chart of Relieva Sinus Balloon Catheter and Predicate Devices

| | Relieva Sinus
Balloon | Circular Cutting
Punch | Antrum Curette | Lacricath |
|--------------------------|--------------------------|---------------------------------|---------------------------------|--------------------|
| Manufacturer | ExploraMed NC1 | Karl Storz
Endoscopy America | Karl Storz
Endoscopy America | Atrion |
| 510(k) Number | K043527 | Pre-Amendments | Pre-Amendments | K935233 |
| CFR Section | 874.4420 | 874.4420 | 874.4420 | 886.4350 |
| Device
Classification | I | I | I | I |
| Product Code | LRC | LRC | LRC | HNW |
| Intended Use | Dilation of tissue | Dilation of tissue | Dilation of tissue | Dilation of tissue |
| Working Diameter | 3mm, 5mm, 7mm | 4.5mm | 5mm | 3mm, 5mm |
| Working Length | 30cm | 18cm | 19cm | 20cm |

2

Image /page/2/Picture/2 description: The image is a black and white seal for the Department of Health & Human Services - USA. The seal is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the top half of the circle. In the center of the seal is a stylized image of a bird or abstract shape, composed of three curved lines that resemble wings or feathers.

APR 5 2005 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

ExploraMed II, Inc. c/o William M. Facteau President & CEO 2570 W. El Camino Real Suite 310 Mountain View, CA 94040

Re: K043527

Trade/Device Name: Relieva Sinus Balloon Catheter Regulation Number: 21 CFR 874.4420 Regulation Name: ENT manual surgical instrument Regulatory Class: Class I Product Code: LRC Dated: March 24, 2005 Received: March 25, 2005

Dear Mr. Facteau:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 827-8910. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

David M. Whipple

David M. Whipple Acting Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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INDICATIONS FOR USE

510(k) Number (if known):This application
Device Name:Relieva Sinus Balloon Dilation Catheter
Indications for Use:The Relieva Sinus Balloon Dilation Catheter is
intended to provide a means to dilate the sinus
ostia and spaces within the paranasal sinus
cavities for diagnostic and therapeutic
procedures.

PLEASE DO NOT WRITE BELOW THIS LINE -(CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use Per 21 CFR 801.109) OR

Over-The-Counter Use . (Optional Format 1-2-96)

Kuna A. Baker
(Division Sign-Off)

Division of Ochthalmic Ear, ExploraMed NC1, Inc. Confidential Information Nose and Throat Devises

510(k) Number.

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012

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