Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis

Objectives: The aim of the study was to evaluate the long‐term efficacy of microdebrider‐assisted inferior turbinoplasty with lateralization (MAITL) compared to submucosal resection for hypertrophic inferior turbinates. Study Design: Surgical outcomes were evaluated with respect to visual analogue scale, anterior rhinomanometry, and saccharin test results. Methods: From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR group, each comprised of 80 patients. Ten patients who did not display any nasal discomfort served as normal controls. For the submucosal resection group, patients underwent submucosal resection of the inferior turbinate, whereas patients in the MAITL group underwent microdebrider‐assisted inferior turbinoplasty with lateralization. Assessments (visual analogue scale, anterior rhinomanometry, and saccharin test) were conducted prior to the surgery and 1, 2, and 3 years after completion of surgery. Results: Compared to preoperative values, subjective complaints including nasal obstruction, sneezing, rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in both groups (P < .05 for all). Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years postoperatively in both groups (P < .05 for all). Saccharin transit time was significantly decreased (P < .05 for all) compared to preoperative values 1, 2, and 3 years after surgery in both groups. Conclusion: Microdebrider‐assisted inferior turbinoplasty with lateralization appears to be as effective as submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have had substantial nasal obstruction.     

Endoscopic microdebrider-assisted inferior turbinoplasty with and without posterior nasal neurectomy

Objective

Endoscopic microdebrider-assisted inferior turbinoplasty (EMAIT) has been recognized as an efficient surgical technique in the management of hypertrophied inferior turbinate. In an attempt to further increase surgical successful outcomes, posterior nasal neurectomy (PNN) was developed. The aim of this retrospective case–control study was to assess the position of PNN in the surgery of hypertrophied turbinate.

Methods

Seventy patients were assigned to the two treatment groups: Group A (EMAIT) and Group B (EMAIT and PNN). Subjective outcomes were represented by symptom score and quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire – RQLQ). Objective outcomes were nasal resistance, saccharin transit time and acoustic rhinometry parameters.

Results

The survey demonstrated that symptoms and objective parameters improved postoperatively in both groups, with no statistical significant differences in objective and subjective outcomes between the surgical groups.

Conclusion

The addition of PNN appears to offer no additional benefit in the subjective and objective outcome related with surgery of hypertrophied inferior turbinate. However, longer follow-up studies and larger number of patients are required in order to validate our results.     

Patients with positive allergen test have less favorable outcome after endoscopic microdebrider-assisted inferior turbinoplasty

BACKGROUND: Endoscopic microdebrider-assisted inferior turbinoplasty is a newly developed surgical technique to treat patients with nasal obstruction. Although the procedure has been reported to be safe and effective, we tested the hypothesis that the prognosis might deteriorate with time in allergic rhinitis patients as identified by a positive allergen test in patients who have a persistent regional inflammation of the nose. We assessed the degree of nasal obstruction in a prospective cohort to investigate whether positive allergen test predicts outcome. METHODS: In 70 consecutive patients, the symptom of nasal obstruction was evaluated subjectively by a visual analog scale (VAS) and objectively by acoustic rhinometry using cross-sectional area of the second notch (CSA-2) and nasal cavity volume before operation, and 3 months, 12 months after operation, respectively. Then, patients were classified and compared according to the multiple-antigen simultaneous test (MAST). RESULTS: Both MAST(+) and MAST(-) groups showed statistically significant improvement in VAS score, CSA-2, and nasal cavity volume at 12 months after operation (p < 0.01). Of note, MAST(+) patients showed less favorable results than MAST(-) patients at 12 months after operation (p < 0.05). CONCLUSION: Microdebrider-assisted inferior turbinoplasty provides effective relief for patients with nasal obstruction. However, such turbinate surgery may be successful only for a short period of time in patients with allergic rhinitis. Our finding suggests that, in selecting appropriate candidates, surgeons should consider criteria other than symptomatology, especially in patients with allergic rhinitis who may have manifestations other than at the level of the inferior turbinate contributing to nasal blockage.     

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES: The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates. MATERIALS AND METHODS: One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery. RESULTS: In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group. CONCLUSION: MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.     

粉尘螨点刺试验与粉尘螨鼻黏膜激发实验相关性分析

目的评价目前粉尘螨过敏的常年性变应性鼻炎（AR）患者皮肤点刺试验（skin prick test,SPT）和鼻黏膜激发实验（nasal provocation test,NPT）的相关性。方法选择90例临床症状及体征符合常年性AR的患者行SPT及NPT。结果粉尘螨SPT及NPT灵敏度分别为84.6%和100%,其SPT及NPT的特异度分别为94.1%和98.0%。阳性级别在（＋＋）、（＋＋＋）和（＋＋＋＋）的SPT阳性患者,NPT阳性率分别为24.2%、30.3%和45.5%。结论 SPT为诊断AR的必要先行检查手段,NPT对于可疑变应原的确诊、鼻黏膜的非特异性高反应性的诊断及特异性免疫治疗（specific immunotherapy,SIT）具有较高价值。SPT级别强度越高,NPT阳性率越高,但SPT级别强度与NPT液浓度之间无明显相关性。     

The alteration of nasal resistance before and after local exposure to heated aerosol in perennial allergic rhinitis.

To determine the patho-physiological effects of heated vapour to the normal or allergic nasal mucosa, we measured the nasal resistance before and after a 10 min. exposure of hyperthermal (43.0 degrees C) aerosol to the nasal mucosa in normal subjects and perennial allergic rhinitis patients. In the allergic patients the mean nasal resistances after hyperthermal stimulation were significantly higher than those resistances without stimulation, both in expiration or inspiration. No significant differences of nasal resistances in normal individuals during the whole schedule with and without heated aerosol stimulation were found on expiration or inspiration. The local heated aerosol exposure increases the nasal resistance in nasal allergic patients while in normal subjects no changes were found, and the reaction may have arisen from a non-specific hypersensitivity of the susceptible allergic nasal mucosa.     

季节性和常年性中重度持续性变应性鼻炎患者生活质量对比研究

目的　探讨季节性和常年性中重度持续性变应性鼻炎患者间的生活质量是否存在差异。方法　将是否受季节影响的中重度持续性变应性鼻炎患者分为常年组和季节组,对比两组患者的生活质量评分以及变应原的种类和数量,分析所有患者致敏变应原数量与生活质量评分之间的相关性,并将两组致敏变应原的数量进行对比。结果  季节组的生活质量评分要高于常年组,并有统计学意义,患者的生活质量评分与其致敏变应原的种类数量显著相关,数量越多,生活质量越差。季节组多种变应原致敏的患者所占的比例更大。结论　季节性和常年性中重度持续性变应性鼻炎患者的生活质量存在差异,这可能与致敏变应原的种类、数量以及患者的耐受性有关。     

Acoustic rhinometry in nasal provocation test in perennial allergic rhinitis

Acoustic rhinometry is one method to evaluate nasal geometry by an acoustic reflection technique. The aim of this study was to investigate the changes in acoustic rhinometry after nasal provocation in patients with exclusively perennial allergic rhinitis. In 19 patients, acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal provocation test. There was a statistically significant nasal flow reduction measured by active anterior rhinomanometry after nasal provocation (p < 0.05) and a median symptom score of four points, both indicating a positive response to nasal provocation. On the other hand, there was no statistically significant change in the values of acoustic rhinometry after nasal provocation (p > 0.05). In patients with exclusively perennial allergic rhinitis, acoustic rhinometry does not seem to significantly change after nasal provocation. In contrast, active anterior rhinomanometry values decreased significantly after nasal provocation. The presented results indicate that acoustic rhinometry does not seem to be a diagnostic method superior to active anterior rhinomanometry in this context.     

常年性变应性鼻炎患者鼻粘膜中粘蛋白MUC5AC的表达

目的 :探讨粘蛋白 MUC5 AC在常年性变应性鼻炎发病中的意义。方法 :采用 PAS染色和免疫组化 SABC法检测了 2 3例常年性变应性鼻炎患者鼻粘膜中粘蛋白 MUC5 AC的表达。结果 :2 3例变应性鼻炎鼻粘膜组织中 PAS染色均为阳性 ,粘蛋白 MU C5 AC染色阳性率为 85 .2 % ,主要表达在粘膜下腺体上皮的杯状细胞中。结论 :粘蛋白 MUC5 AC在常年性变应性鼻炎的过度分泌过程中具有重要的意义     

Investigation of the nasal mucosa in perennial allergic rhinitis with SEM and TEM

The ultrastructure of 20 PAR nasal mucosa specimens was investigated with both transmission and scanning electron microscopes. The cilia were found to be defective or desquamated in advanced cases. Cilia in PAR may be divided into three types: normal, adherent and exfoliative types. It had been found that changes in cilia morphology and its function varied with the duration of the disease. The nasal mucosa showed inflammatory cell infiltration and increase in number of glands. Plasma cells full of secretory granules were found both in the epithelial layer and lamina propria. Capillaries, arterioles and venules showed various degrees of pathological changes. The cholinergic nerve endings had increased in number at the expense of the adrenergic nerve endings.     

Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters

Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is associated with decreased quality of life and difficult to treat as perceived by the patients. The purpose of this study is to evaluate the mid-term objective and subjective outcomes of management of nasal congestion using intranasal steroid (INS) therapy or radiofrequency turbinoplasty (RFT) in patients with persistent AR who have mucosal hypertrophy of the inferior turbinate. Fifty-five adult patients with AR, who claimed nasal congestion refractory to oral antihistamine (desloratadine) therapy, were randomized to INS (mometasone furoate) or temperature-controlled RFT treatment groups. Outcomes were determined by active anterior rhinomanometry, visual analog scale (VAS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) at least 12 months after treatment. The median total nasal resistance decreased from 0.49 ± 0.17 to 0.39 ± 0.12 Pa/cm³/s (p = 0.42), and from 0.51 ± 0.18 to 0.29 ± 0.07 Pa/cm³/s (p = 0.003) with INS and RFT, respectively. RFT provided a better reduction in the perception of congestion in VAS scores. RQLQ scores improved significantly in both groups 1 year after treatment (mean follow-up 14.2 months) (p < 0.05). No adverse reactions were encountered in either group. Nasal congestion refractory to antihistamine appears to be improved by INS at some point, while reduced significantly by RFT in objective and subjective parameters. Both options are also effective in increasing the quality of life in patients with AR. RFT might be a safe and effective treatment of option in AR compared with INS.     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.     

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Introduction

Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure.

变应原特异性免疫治疗对螨过敏的难治性变应性鼻炎症状和生活质量的影响

目的 评估变应原特异性免疫治疗(specific immunotherapy,SIT)对常规方法症状控制不满意的难治性变应性鼻炎(AR)患者症状和生活质量的影响.方法 选取螨过敏的常年性AR患者47例,经过常规避开螨、药物治疗效果不佳后进行变应原SIT,使用鼻部症状总评分(total nasal symptoms sc...     

变应性鼻炎患者生活质量研究

目的 采用对照研究的方法,探讨变应性鼻炎(allergic rhinitis,AR)对患者生活质量的影响.方法 以普适性量表--医学结局研究简表36项健康调查(medical outcome study short-form 36-items health survey,简称SF-36)为工具,通过前瞻性对照设计,对101例尘螨过敏的AR患者、97例慢性咽炎(chronic pharyngitis,CP)患者及121例健康体检者进行生活质量的调查,分析AR患者生活质量.以疾病专用昔表--鼻结膜炎生存质量调查问卷(rhinoconjunctivitis quality of life questionnaire,RQLQ)为工具,分析AR患者生活质量最受影响的方面.同时采用Pearson相关分析,对SF-36与RQLQ两量表的相关性进行分析.结果 SF-36调查显示,AR患者在躯体疼痛、总体健康和社会功能3个维度的得分((x)±s,下同;分别为:78.02±18.37,56.13±17.49,78.81±16.47)较健康体检者的相应得分(84.00±18.36,74.69±14.13,83.78±14.31)低(P值均<0.05),但生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能和精神健康7个维度得分(分别为:91.78±11.78,79.16±30.23,78.02±18.37,56.13±17.49,78.81±16.47,67.66 4-39.57,68.78±13.65)与CP患者的相应得分(94.12±6.88,80.67±32.38,73.57±17.96,59.73±16.58,80.41±17.01,63.58±39.99,66.43±13.71)相近(P值均>0.05).RQLQ调查显示,AR患者在鼻部症状和实际问题2个维度得分(分别为:2.70±1.29,2.53±1.37)最高.SF-36与RQLQ相父性分析提示,两量表仅呈弱负相关(r=-0.199～-0.526,P<0.05).结论 AR患者生活质量较健康体检者差,与CP患者相近.鼻部症状和实际问题是AR患者生活质量最受影响的方面.SF-36和RQLQ均适用于评价AR患者生活质量.SF-36与RQLQ评价AR患者生活质量的不同方面,两量表联合应用可以更全面、准确地评价AR患者的牛活质量.     

变应性鼻炎伴哮喘患者经微波治疗后的肺功能及呼吸阻力改变

目的 探讨变应性鼻炎伴哮喘患者经微波治疗后,肺通气功能及呼吸阻力受到的影响和变化。 方法 选取变应性鼻炎伴哮喘患者43例,分别在治疗前后对所有患者进行肺功能检测。微波治疗,功率选择30 W,启动时间4 s,针对下鼻甲黏膜下、中鼻甲前段以及鼻丘进行微波多点凝固。 结果 总有效率100%,显效30例(69.8%)、有效13例(30.2%)。未发生不良反应或并发症。一秒用力呼气量(FEV1)、一秒呼气/用力肺活量(FEV1%)、用力呼气量75%流速(FEF75)的改善差异有统计学意义(P<0.05),用力呼气量25%流速(FEF25)、用力呼气量50%流速(FEF50)的改善差异无统计学意义(P>0.05)。 结论 微波治疗变应性鼻炎伴哮喘患者,肺通气功能有效改善,呼吸阻力降低。