Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is a common cause of nasal airway obstruction. In cases unresponsive to conservative treatment, various surgical techniques are commonly performed, but the issue of the optimal surgical procedure is still controversial. The objective of the present study was to evaluate the effectiveness and safety of ultrasound treatment of the hypertrophied inferior turbinates, which is a technique recently applied in rhinologic surgery. We aimed, also, to compare this method with the radiofrequency cold coblation turbinate reduction and the traditional submucosal monopolar inferior turbinate cauterization. We studied prospectively 60 patients with chronic hypertrophic rhinitis of nonallergic etiology, who underwent different surgical methods of turbinate reduction, divided into two groups: (1) in 30 patients, inferior turbinate volume reduction using ultrasound procedure on the left side and monopolar diathermy on the right was performed; (2) in 30 patients, radiofrequency coblation technique on the left side and ultrasound turbinate reduction on the right side was undertaken. Subjective evaluation of nasal obstruction and pain was performed using visual analog scales and objective evaluation of the surgical outcome was obtained using active anterior rhinomanometry and acoustic rhinometry. Examinations were performed preoperatively, and 1, 3 and 6 months after surgery. Both subjective and objective evaluation showed significant postoperative improvement in all cases. The best results were obtained with the ultrasound procedure, and second with the radiofrequency technique. The least improvement was observed in the electrocautery group, although its results did not differ significantly from the radiofrequency group. It may be, thus, concluded that ultrasound turbinate reduction is an effective and safe procedure for the management of chronic hypertrophic rhinitis, in patients failing to respond to medical treatment. Using this method, better results were obtained in decreasing subjective symptoms and nasal obstruction, in comparison with radiofrequency and electrocautery.     

How we do it: Radiofrequency‐turbinectomy for nasal obstruction symptoms

? Radiofrequency energy has been reported to be effective to reduce nasal obstruction because of inferior turbinate hypertrophy. ? A total of 158 patients who had undergone such surgery are reported. ? Three to 30 months postoperatively 85% of the patients reported a marked decrease in nasal obstruction. This was irrespective of a short‐term or a long‐term follow‐up, and was applicable to patients that had septal deviations in addition. ? Radiofrequency‐turbinectomy is a simple and effective method for treatment of nasal obstruction as a result of hypertrophy of the inferior turbinates, even if combined with a moderate septal deviation.     

A safe, alternative technique for inferior turbinate reduction

OBJECTIVE: Submucous resection of the inferior turbinates is a conventional technique for reducing their size to achieve patent nasal airways in situations where an enlarged turbinate contributes to airway obstruction. Many techniques and complications have been described in the past. We describe a new inferior turbinate reduction technique performed with powered instrumentation and assess its success and complication rates. STUDY DESIGN: A prospective study of 120 consecutive patients who underwent submucous resection of the inferior turbinates with a microdebrider. METHODS: Patient questionnaires were used for subjective assessment of symptoms before and after the procedure. We graded each patient's inferior turbinates for size from I to III before and 6 weeks after surgery for objective analysis. RESULTS: The common complications of standard submucous resection of inferior turbinates include excessive resection, postoperative bleeding, and crusting. The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue that is removed on a submucosal plane. The complications encountered with this technique are limited to postoperative bleeding that occurred in 1.6% of patients. There was no crusting or excessive removal of tissue. CONCLUSION: The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.     

Long-term results after argon plasma coagulation (APC) inferior turbinates reduction

Interior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Authors analyzed long-term results of argon plasma coagulation (APC) for inferior turbinates reduction in patients with chronic nasal obstruction. Rhinomanometric parameters, clearance of saccharine test results and cytological examination were statistically analyzed in 70 patients after 3 month and in 47 after 12 month after surgery. Five patients received a second operation. Only patients with first degree in T/S (turbinate/septum) nasal septum deviation were enrolled in both groups. Every patients were treated ineffectively with nasal drops. All patients received topical anesthesia. The procedure of APC were easy to perform end we did not experience postoperative bleeding. Rhinomanometric measurement demonstrated a significant nasal flow at 3 and 12 month after APC. Before 3 and 12 month after surgery the values for resistance shoved significant difference. There were no changes in saccharine transit - time during the follow-up period. At 3 postoperative month, the nasal stuffiness had improved 62 (88%) patients. At 12 month after surgery, the nasal stuffines had improved 34 (73%) patients. APC was shown to effectively reduce the symptom of nasal obstruction without any complications. Argon Plasma Coagulation should be an alternative method in treating the patients with hyperplastic inferior turbinate.     

Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty

OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblation that uses the radiofrequency and microdebrider is being increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblation- and microdebrider-assisted partial turbinoplasty. METHODS: We selected 60 patients for this prospective study who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblation (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6, and 12 months after the procedure. A cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip, and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups at 3, 6, and 12 months after the procedure. However, when compared between two groups, symptom improvement was statistically significant in group 2 at 12 months after surgery. Acoustic rhinometry performed at 12 months demonstrated a significant increase of cross-sectional area of second notch and volume of nasal cavity in group 2 in comparison with group 1. There were no significant differences in degree of postnasal drip, operation time, or duration of crust formation between the two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction in mucosal volume of anterior head of inferior turbinate.     

Trends in turbinate surgery literature: a 35‐year review

A MEDLINE search was used to identify articles involving all forms of turbinate surgery over a 35‐year period. Five hundred and sixty‐one papers were identified. Of these, 283 specifically detailed turbinate surgery. These demonstrated a marked increase in the number of papers detailing endoscopic and laser turbinate surgery in the last 5 years. No randomised controlled studies were identified describing inferior turbinate surgery for nasal obstruction or middle turbinate surgery for any cause. The evidence supporting the efficacy of these procedures remains debatable. Research in this field appears to be driven by technological advancement rather than by establishment of patient benefit. Properly conducted randomised controlled trials are required to establish whether there is a long‐term patient benefit from these commonly performed operations.     

鼻内镜下鼻甲成形术疗效分析

目的分析鼻内镜不同下鼻甲成形术的疗效。方法将138例患者随机分为两组,所有患者均同时接受双侧下鼻甲的同一术式处理。A组72例,行双侧下鼻甲骨黏骨膜下骨质部分切除术;B组66例,行双侧下鼻甲骨折外移术。比较两组患者术后1、6及12个月的恢复以及疗效情况。结果两组患者术后12个月疗效具有统计学意义(P<0.01);两组鼻阻塞视觉模拟评分术后6、12个月比较,差异具有统计学意义（P<0.05）,鼻阻力检测术后12个月比较差异具有统计学意义（P<0.05）。A组远期疗效优于B组。结论两种术式都保留了下鼻甲的黏膜以及舒缩功能的血窦组织,在进行有效减容的同时,保留下鼻甲正常的功能, 但从远期效果来看,下鼻甲前端黏骨膜下入路骨部分切除术的疗效明显好于下鼻甲骨折外移术,对于下鼻甲黏膜下组织增生或（和）下鼻甲骨质增生所引起的鼻阻塞均有良好的效果,值得适当放宽手术适应证。     

Carbon dioxide laser vaporization of the inferior turbinate for allergic rhinitis: short-term results

Carbon dioxide laser vaporization of the turbinate has recently become accepted as a common treatment for allergic rhinitis. Usually, only a single procedure is applied to minimize trauma. However, repeated procedures on separate days are often required to achieve an adequate effect. Therefore, we attempted a new method of vaporization and evaluated the outcome, and also tried to determine which patients have good indications for laser treatment. To widely and deeply vaporize the inferior turbinate, we repeated the procedure 3 times in 1 session after removing the carbon coating from the previous vaporization under nasal endoscopic observation. After the procedure, most patients experienced complete nasal obstruction for 2 or 3 days, but there was no intraoperative or postoperative bleeding or severe pain. All patients obtained improvement of their chief complaints and were satisfied 2 months after the operation. In particular, 60% of the patients were completely relieved of refractory nasal obstruction. Most patients were more satisfied with the effects than are those treated by the usual methods. Completely successful cases (improvement in all symptoms and complete satisfaction obtained) were selected and were compared with other cases. Favorable prognostic factors are more severe complaints, longer symptomatic periods, stronger allergic reactions, and worse nasal resistance and its greater improvement with administration of decongestant nasal drops. This method may be especially accepted by patients with severe complaints, in particular nasal obstruction, who do not experience enough relief with conservative therapies or have enough time to make frequent visits to an outpatient clinic over a period of several weeks.     

Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy.

OBJECTIVE/HYPOTHESIS: We hypothesized that the success rate of radiofrequency energy (RFe) tissue ablation of the inferior turbinate for nasal obstruction achieved by previous investigators would be improved by using a longer needle electrode and creating two lesions per turbinate. METHODS: Ten patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. A 40-mm needle delivered RFe to two sites in each inferior turbinate. Patients used a visual analog scale (VAS) to grade nasal obstruction preoperatively and at 1 week and 8 weeks after surgery. Preoperative and postoperative digital images of the nasal cavity were graded for obstruction (0% to 100%) in a blinded manner. RESULTS: All patients (100%) were subjectively improved at 8 weeks. Mean obstruction (VAS) improved from 50%+/-21% to 16%+/-15% (right side) and from 53%+/-29% to 13%+/-13% (left side). Mean improvements were 68% (right side) (P = .004) and 75% (left side) (P = .001). Mean obstruction graded during blinded review of nasal cavity images improved from 73.5%+/-8% to 51%+/-8% (right side) and from 76%+/-6% to 64%+/-7% (left side). Of nine patients using medications for nasal obstruction before treatment, eight (89%) noted no further need for medications at 8 weeks. CONCLUSION: The use of RFe for submucosal tissue ablation in the hypertrophied inferior turbinate is an effective modality for reducing symptoms of nasal obstruction. Improved results may occur by using a longer needle and creating two lesions per turbinate. Of patients in this study, 100% reported improvement of nasal obstruction.     

Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function

ObjectiveThe impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.Study designRetrospective case series.SettingTertiary Australian Hospitals.Subjects and methodsA retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0–4) was determined by the number of inferior or middle turbinate subtotal resections.Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.)Results294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93–3.38], OR = 0.60[0.33–1.12], B = 0.56[−1.58–2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04–4.13], P = 0.04, OR = 3.97[1.08–14.49], P = 0.04, respectively).ConclusionIn patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.     

改良中鼻甲部分切除术在功能性鼻内镜手术中的应用

目的探讨改良中鼻甲部分切除术在功能性鼻内镜手术中的应用及其对慢性鼻窦炎症状改善和疗效的影响。方法选择中鼻甲垂直部长度≥25mm的慢性鼻窦炎患者60例,随机分为试验组和对照组,各30例。两组患者术前各项观察指标（鼻塞、流涕、头痛、嗅觉VAS评分,鼻内镜检查Lund Kennedy评分、CT Lund Mackey评分）差异无统计学意义（P>0.05）。试验组实施经鼻内镜鼻窦、鼻息肉手术并清除中鼻甲本身病变（泡甲、肥厚、息肉样变等）后,根据CT测量结果,以保留中鼻甲垂直部长度约21mm为参考值,切除多余的中鼻甲垂直部游离缘（即切除长度＝CT测量长度-21 mm）;对照组完成鼻窦、鼻息肉手术,按传统理念处理中鼻甲病变和变异,需要时切除中鼻甲前下部1/2~2/3。术后随访10~12个月,观察主观症状（鼻塞、流涕、头面痛及嗅觉障碍）、内镜检查Lund Kennedy评分、病情控制及疗效。结果两组术后各种症状VAS评分和内镜Lund Kennedy评分均明显优于术前（P均<0.05）;术后试验组的各项观察指标及总疗效均优于对照组,两组鼻塞及头痛的改善、鼻内镜Lund Kennedy评分及疗效差异具有统计学意义（P均<0.05）;而流涕、嗅觉改善方面,两组差异无统计学意义（P>0.05）;鼻窦炎伴鼻息肉、鼻窦炎伴中鼻甲病变者,试验组的疗效优于对照组（P<0.05）。结论“改良部分切除”主要针对过长的中鼻甲垂直部,必须是在处理中鼻甲病变（泡甲、肥厚、息肉样变等）、保证中鼻道一定宽度后才予切除,有助于术后鼻部症状的改善和减少术腔粘连,提高鼻内镜手术疗效。     

KTP laser inferior turbinoplasty: an alternative procedure to treat the nasal obstruction

OBJECTIVE: Nasal obstruction resulting from inferior turbinate hypertrophy (ITH) was treated with KTP laser inferior turbinoplasty (KIT). The effectiveness of the procedure was assessed. METHODS: A prospective clinical trial was carried out in King Chulalongkorn Memorial Hospital from October 1, 1998 to September 30, 2000. Forty-eight patients with chronic nasal obstruction underwent KIT. Nasal obstruction was pre- and postoperatively assessed, based on 4-point scale, by the patient and investigator. The scores were compared by paired t-test. The correlation of assessment by the patient and investigator was also demonstrated by weighted kappa test. Pre- and postoperative rhinomanometric evaluations were performed in 29 patients and were compared with paired t-test. RESULTS: Significant reduction of nasal obstruction was obtained from assessment by the patient (P<0.000) and by the investigator (P<0.000). The symptoms of sneezing, itching and rhinorrhea were significantly reduced postoperatively (P<0.000). The cure and improvement rate of nasal obstruction were at 70.8 and 100% (assessed by the patient) and at 77.1 and 100% (assessed by the investigator) respectively, and they showed a moderate correlation (Kw=0.65). Rhinomanometrically, the total airway resistance decreased but of not statistic significance (P=0.219), however, the inspired nasal airflow at 150 Pa and the volume of nasal cavities were significantly increased (P<0.00 and P<0.001, respectively). CONCLUSION: KIP was shown to effectively reduce the symptom and sign of nasal obstruction as well as other nasal symptoms without any significant complications. It should be an alternative method in treating the patients with nasal obstruction resulting from hyperplastic inferior turbinate.     

Assessment of symptom improvement following nasal septoplasty with or without turbinectomy

Most studies show that objective measures to quantify and determine surgical success in the treatment of nasal obstruction do not correlate with subjective improvement as reported by patients.AimTo evaluate the subjective improvement of nasal symptoms in patients undergoing septoplasty with or without turbinectomy.Materials and methodsA prospective study. We evaluated 72 septoplasty patients with or without partial inferior turbinectomy; the patients answered a questionnaire preoperatively and on the 60th day after surgery.ResultsSeptoplasty was done associated with bilateral partial inferior turbinectomy in 83.3% of patients; it was unilateral in 9.7%; there was no need for turbinate reduction in 6.9%. An improvement of all symptoms was observed after surgery. Nasal obstruction had improved in 68 patients (94.4%) by the 60th postoperative day. The average nasal obstruction score in patients with and without allergic symptoms was similar before surgery and on the 60th postoperative day. Older patients had milder preoperative allergic symptoms.ConclusionsNasal symptoms in patients undergoing septoplasty, with or without turbinectomy, improved. Patients with and without allergic symptoms showed a similar improvement of nasal obstruction on the 60th postoperative day.     

Laser treatment of rhinitis—1 year follow-up

Laser cautery of the inferior turbinates for the treatment of rhinitis has been shown to be as effective as sub-mucosal diathermy in the short-term and to produce less morbidity. However, the long-term effects are unknown. A cohort of patients who were treated by either of these methods were reviewed 1 year after treatment. Subjective and objective measurements of airway obstruction were performed using a linear analogue scale and a nasal peak inspiratory flowmeter. The results obtained were compared with those recorded pre-operatively, 3 days post-operatively and 6 days post-operatively. In contrast to the results of sub-mucous diathermy of the inferior turbinates for the treatment of rhinitis, the reduction in subjective nasal airway obstruction obtained by laser cautery to the inferior turbinates is maintained 1 year after surgery. Neither method of turbinate reduction was associated with a sustained objective improvement in nasal airway patency as measured by peak nasal inspiratory flow rate determinations.     

鼻内镜下108例鼻腔扩容术疗效分析

目的 探讨鼻内镜下鼻腔扩容术的疗效.方法 选择108例鼻中隔偏曲和慢性肥厚性鼻炎患者,根据具体病情分别行个性化手术,如鼻中隔偏曲行鼻内镜下鼻中隔成形术或三线减张鼻中隔矫正术;慢性肥厚性鼻炎行鼻内镜下下鼻甲外移术酌情联合下鼻甲等离子消融术或下鼻甲黏膜下切除术及下鼻甲部分切除术等.结果 术后随访3～12个月,有效率为97.2%,患者无头痛,鼻干等并发症发生.结论 鼻内镜下鼻腔扩容术处理鼻中隔偏曲和慢性鼻炎疗效确实.

Abstract：

Objective To investigate the efficacy of endoscopic nasal cavity enlarging surgery for the alleviation of nasal obstruction.Methods One hundred and eight patients with deviation of the nasal septum ( DNS) and chronic hypertrophic rhinitis ( CHR) were included in this study.Individualized operations were performed.DNS patients were treated by three line tension relaxing correction or nasal septum plasty.CHR patients were treated by inferior turbinate outfracture in combination with plasma radiofrequency ablation for reducing the volume of nasal soft tissue,sub-mucoperiosteal partial resection of the inferior turbinate or partial inferior turbinectomy.Results All patients were followed for 3-12 months after surgry with an effective improvement in 97.2%.Symptoms of headache or complications of rhinitis sicca were not found.Conclusions Being careful to keep the physiological function of nasal mucosa,the integrity of the nasal septum,appropriate expansion of the nasal cavity volume,and restore ventilation with bilateral symmetry of the nasal cavity,satisfactory relief of nasal obstruction can be achieved.     

鼻声反射在OSAS患者鼻功能评估中的应用

目的：探讨修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎的手术效果及应用价值。方法35例难治性鼻-鼻窦炎经CT检查、鼻内窥镜检查、局部用药等规范术前准备,行改良鼻丘径路额窦开放为主修正手术加中鼻甲全部或部分切除,术后凭鼻内镜保健手册进行定期复查,规范随访。26例合并鼻中隔偏曲者其中16例行内镜下传统矫正切除,10例行局限性矫正切除;15例合并变应性鼻炎者对下鼻甲前端、中鼻甲对应鼻中隔等部位黏膜电凝。结果35例患者门诊内镜随诊3-6月以上,治愈11例（31.4%）,黏膜完全上皮化;好转18例（51.4%）,黏膜可以上皮化,但变应性鼻炎发作时,术腔黏膜水肿,经局部处理及药物治疗后可恢复上皮化;无效6例（17.2%）。总有效率82.8%,6例无效均为合并变应性鼻炎及哮喘患者。结论修正性鼻内镜手术联合中鼻甲切除术综合治疗难治性鼻-鼻窦炎,疗效较为确切,值得临床推广。     

A randomised clinical trial of turbinectomy for compensatory turbinate hypertrophy in patients with anterior septal deviations

Turbinectomy is performed at the time of nasal septal surgery by many otolaryngologists. One reason given for this procedure is the presence of a hypertrophied contralateral inferior turbinate. A randomised trial was undertaken to evaluate the relief of nasal obstruction following contralateral turbinectomy with septal surgery. Patients presenting with nasal obstruction who had a unilateral septal deviation and contralateral inferior turbinate enlargement were prospectively randomized to contralateral turbinectomy or no turbinate surgery at the time of septal surgery. Questionnaires and active anterior rhinomanometry were used for evaluation. Twenty-six patients (mean age 31 years) demonstrated a reduction in subjective and objective measures of nasal obstruction (P < 0.05) 8 weeks after operation. There was no intergroup difference, the median total decongested nasal resistance postoperatively in the non-turbinectomized patients was 0.17 kPal-1 s and 0.21 kPal-1 s in the turbinectomized patients. Contralateral inferior turbinectomy does not add to the relief of nasal obstruction beyond that attained by septal surgery in these patients.     

Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement

Nasal obstruction is one of the most common chronic presenting symptoms encountered by otolaryngologists. In most patients, the cause of nasal obstruction is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestions, or allergy desensitization; however, surgery is required in some cases. Surgical treatment is controversial, and many surgical methods of treatment have been proposed. We have recently evaluated the results of our experience with submucosal diathermy (SMD) on 51 patients suffering from chronic nasal obstruction. We have found that diathermy demonstrated good results in 78% of the cases at 2 weeks postoperatively and in 76% of the cases 2 months following the procedure. Patients who had no complaints and had good nasal airflow were not followed-up after 2 months. In the present study, we have carried out a long-term follow-up of another group of patients who had undergone SMD diathermy because of hypertrophy of the inferior turbinates. Patients were examined at 2 months postoperatively and after 1 year, with both subjective and objective assessments of nasal breathing. Two months postoperatively 64 of 91 patients (70.3%) experienced subjective improvement in nasal breathing, where as 73 patients (80.2%) had good nasal breathing as indicated with the Gertner-Podoshin plate. During the follow-up year, secondary operations were deemed necessary for 16 patients because of unsatisfactory results of the original procedure. Of these secondary procedures 4 were revision SMD, 9 patients underwent a septoplasty, in 2 patients functional endoscopic sinus surgery was conducted, and 1 patient had a submucosal turbinectomy. This group of patients was excluded from the 1 year follow-up evaluation. At the 1-year follow-up visit, 65 patients (of the 75) were symptom-free with respect to nasal breathing (86.7%), and 67 patients (89.3%) had good nasal breathing as examined with the Gertner-Podoshin plate. No means were apparent for predicting preoperatively which patients would benefit most from submucosal diathermy. Submucosal diathermy is carried out under local anesthesia and can be implemented as an office procedure. It does not require expensive instrumentation and is a safe, effective procedure for improving nasal breathing in patients with chronic obstructive inferior turbinates, both on a short-term and long-term basis.     

Radiofrequency is a safe and effective treatment of turbinate hypertrophy

OBJECTIVE: To evaluate the safety and efficacy of radiofrequency for reduction of inferior turbinate volume. STUDY DESIGN: Prospective before-and-after trial. METHODS: Fourteen patients complaining of chronic nasal obstruction and failing to respond to medical treatment were prospectively enrolled. All patients presented with inferior turbinate hypertrophy and no septal deformity. Radiofrequency inferior turbinate tissue reduction with three punctures in each turbinate (mean energy/puncture: 342 +/- 36 J, mean duration: 69 +/- 17 s, plateau tissue temperature: 75 +/- 6.4 degrees C). Patients were evaluated before and on days 3, 7, and 60 after intervention. RESULTS: No postoperative pain or complications were reported. Evaluation of nasal obstruction, quantified by visual analogue scale, showed a significant decrease of day time and nighttime obstruction after surgery. Acoustic rhinometry measurements showed that turbinate hypertrophy was significantly reduced in the sitting and supine positions on day 60 after surgery. Saccharin transit times decreased significantly on day 60 compared with preoperative measurements. Ciliary beat frequency, measured in vitro in nasal epithelial cells sampled from the inferior turbinate by brushing, was not significantly different before surgery and on day 60 after surgery. In the same samples, ciliated cells were the most abundant epithelial cell type before and after surgery, although in five cases, moderate numbers of squamous cells were detected on either day 7 or day 60 after surgery. CONCLUSION: Radiofrequency is a safe surgical procedure capable of reducing turbinate volume without altering the nasal mucosa, and causing minimal discomfort for the patient.     

等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术

目的比较等离子下鼻甲部分消融术与吸切钻下鼻甲部分切除术对慢性肥厚性鼻炎患者术中、术后的影响。方法等离子组患者25例,对照组14例。等离子组用低温等离子射频消融系统连接45号刀头,行下鼻甲前、后部中隔侧的4～6通道消融。对照组用吸切钻自前向后切割下鼻甲肥厚黏膜,术后需填塞止血2日。术后患者对疼痛和鼻堵程度采用VAS评分。术前、术后1个月、3个月、6个月均由医师对每侧下鼻甲进行评分,由患者评估鼻堵程度和频度。结果等离子组术中出血较对照组明显减少,术后疼痛和鼻堵程度较轻。术后1个月等离子组和对照组的鼻堵程度、鼻堵频度和下鼻甲体积较术前均有明显改善,二者改善的程度无明显差别。术后3个月两种术式均疗效稳定且等离子组鼻堵频度进一步改善。术后6个月两种术式疗效依然稳定。结论等离子下鼻甲部分消融术创伤小,术中、术后出血少,痛苦小;术后1个月患者主观症状与客观体征均有明显改善;术后3个月患者主观症状进一步改善;术后6个月内疗效均稳定且与吸切钻下鼻甲部分切除术疗效相当。