A comparison of laser cautery and sub-mucosal diathermy for rhinitis

A randomized prospective trial was conducted to compare the efficacy of laser cautery against sub-mucosal diathermy to the inferior turbinates in 29 patients with rhinitis. Laser diathermy was performed using an arthroscopic fitment to a CO₂ laser. Subjective and objective measurement of airway obstruction were performed, using a linear analogue scale and a nasal peak inspiratory flow meter, before operation and at 3 days and 6 weeks afterwards. In both groups there was a similar and significant improvement in subjective scores at 6 weeks (SMD from 3.6 to 1.8, P < 0.01; laser from 3.9 to 2.1, P < 0.001), but only the laser group was significantly better at Day 3 (SMD from 3.6 to 3.5, n.s.; laser from 3.9 to 3.0, P < 0.05). In addition, there was significantly more general subjective morbidity at Day 3 in the SMD group (P < 0.01). The objective scores improved equally in both groups but were not significant. We conclude that laser cautery of the inferior turbinate is a superior alternative to SMD for the treatment of rhinitis.     

Ho:YAG laser treatment of hyperplastic inferior nasal turbinates.

OBJECTIVES: Although preliminary studies about the successful use of the Ho:YAG laser in nasal turbinate surgery have been reported, no clinical study has been performed on this procedure. The aim of this prospective clinical study was to assess the long-term effect of Ho:YAG laser in the treatment of hyperplastic inferior nasal turbinates. METHODS: Eighty-five patients with nasal obstruction who did not respond to conservative medical treatment were treated with a pulsed Ho:YAG laser (wavelength of =2080 nm). Fifty-two of these patients were included in this clinical study and were followed for 1 year. RESULTS: Within the first 2 weeks, nasal obstruction was correlated to the extent of nasal crusting. Six months after laser treatment, the mucociliary function test showed no variation compared with the preoperative measurements. One year after laser treatment 77% of the patients demonstrated improved nasal airflow on rhinomanometry and questionnaire. CONCLUSIONS: Ho:YAG-laser treatment of hyperplastic turbinates can be performed as outpatient surgery under local anesthesia and offers controllable ablation of soft tissue in a short operation time with satisfactory results and excellent patient acceptance.     

Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months' follow-up

OBJECTIVES/HYPOTHESIS: The present report is a pilot clinical study about a new bipolar ablation technique for the treatment of turbinate hypertrophy, which offers an alternative to conventional methods. STUDY DESIGN: Prospective, clinical. METHODS: From August 1999 to March 2000, a new bipolar radiofrequency system with acoustic feedback control was submucosally applied for the treatment of 38 patients with nasal airway obstruction of vasomotor (n = 31) or allergic (n = 7) genesis. The therapy was made ambulatory with surface anesthesia. Data were collected by questionnaire and rhinomanometry preoperatively and 2 and 20 months postoperatively. RESULTS: Nearly all patients reported an improvement of their nasal breathing, with 68% of them reporting a full and 29% a partial recovery. No significant differences were reported with regard to the response of the allergic versus the vasomotor rhinitis. On average, a definite benefit was observed after 2 weeks. Side effects, such as bleeding, synechia, or atrophic changes of the mucosa, which would have to be treated, were not observed. CONCLUSION: The new bipolar radiofrequency thermotherapy presents an efficient option for the treatment of turbinate hypertrophy, which meets the requirements for an outpatient treatment.     

Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment

OBJECTIVE: To assess the efficacy and morbidity of bipolar radiofrequency thermal ablation of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. STUDY DESIGN: Prospective, nonrandomized study and outpatient treatment. METHODS: Twenty patients (age range, 23-77 y; median age, 52 y) enrolled in the study. There was one dropout. All the patients had nasal blockage despite medical treatment. Bipolar radiofrequency thermal ablation was delivered to inferior turbinates at 100 kHz with a voltage root mean square value of 168 to 182. The preoperative and postoperative nasal functions were investigated by immediate and long-term visual analogue scale (VAS) scores of symptom parameters, olfactory thresholds, saccharine transit time, rhinomanometry, and acoustic rhinometry. The follow-up was conducted at 1 week and 3, 6, and 12 months. RESULTS: The VAS scores of subjective complaints (nasal discharge, itching, sneezing, crusting) decreased, and the VAS scores of evaluation of the effectiveness (frequency of nasal obstruction, degree of nasal obstruction, and patient satisfaction) increased statistically significantly in the 12-month follow-up without relapses. There were no adverse effects on nasal epithelial clearance time and olfactory functions. In rhinomanometry the changes in total nasal resistance and response to the vasoconstrictor agent were not statistically significant. In acoustic rhinometry the change in the sum of both nasal cavity volumes from nostril to 5 cm was statistically significant 6 and 12 months after the treatments. The difference between the preoperative and postoperative vasoconstrictive effect was not statistically significant. CONCLUSION: The bipolar radiofrequency thermal ablation of inferior turbinates is a promising alternative, which should be considered when planning inferior turbinate interventions.     

The surgical management of drooling—a 15 year follow-up

Drooling is rarely seen in the normal child after the age of 6 months, but an estimated 10% of children with neurological impairment suffer significant interference with everyday living due to excessive drooling. Submandibular duct relocation is a procedure that involves the dissection and re-routing of the submandibular ducts to the posterior tonsillar pillar. This procedure has been carried out on 53 patients over the past 15 years at the Childrens Hospital, Dublin. All patients have been followed up with a detailed questionnaire to determine symptomatic improvement, parent satisfaction and complications. Parental satisfaction regarding this procedure is high, with 94% of parents stating that their child had benefited from the operation and over half the parents reported complete cessation of all drooling within 3 months of the operation. The major complication of post-operative pneumonia presumed secondary to salivary aspiration occurred in three children. These patients all made a full recovery. Early minor complications occurred in two children, involving post-operative submandibular gland swelling, and the late complication of a ranula was seen in four patients. We believe this is a safe and highly successful procedure that can significantly improve the quality of life of these children.     

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.     

选择性筛前神经切断和下鼻甲挤压术治疗常年性变应性鼻炎

目的：探讨选择性筛前神经切断和下鼻甲挤压术治疗常年性变应性鼻炎的临床疗效。方法：选择70例符合常年性变应性鼻炎诊断的患者,行选择性筛前神经切断和下鼻甲挤压术。统计其术前和术后症状和体征评分,观察其疗效。结果：所有患者经1年随访,总有效率90．0％。结论：选择性筛前神经切断和下鼻甲挤压术治疗常年性变应性鼻炎疗效确切,手术操作简便,且无明显并发症,值得临床推广。     

Mucormycosis in an immunocompetent patient: follow-up of 1 year after treatment

Mucormycosis is a rare acute fatal fungal infection. It is typically observed in diabetic or immunocompromised patients but not in systemically healthy individuals. Here, we describe an unusual mucormycosis case in an immunocompetent patient who had clinical signs of a maxillary sinusitis and associated osteomyelitis at the first examination. He was treated by surgery and removal of the necrotic bone and amphotericin B medication. At 1-year follow-up he shows complete recovery.     

Laser myringotomy in otitis media with effusion: long-term follow-up

Otitis media with effusion is a leading cause of conductive hearing loss in children. Myringotomy and insertion of tympanostomy tubes is the accepted form of treatment. Recently, several studies utilizing laser myringotomy have been published, but few of them present late results. The objective of this study was to compare late results of the treatment with laser and classical myringotomy. A clinical effectiveness trial was conducted in three groups of children: (1) 37 children treated with laser myringotomy (ML), (2) 29 children treated with laser myringotomy and the insertion of tympanostomy tubes (ML+V) and (3) 43 children treated with classical myringotomy and the insertion of tympanostomy tubes (MC+V). All types of surgery were performed under general anesthesia because adenoidectomy and/or tonsillectomy was done at the same time. The results of treatment were assessed on the basis of the otoscopic examination (recurrences of effusion, condition of the tympanic membrane, and audiological examination (pure-tone audiometry, tympanometry and DPOAE). The minimum follow-up period was 1 year. The recurrence rate was lowest in the ML+V (11%) group, and highest in the ML group (36%). The difference between ML+V and MC+V was not significant. Permanent changes in the tympanic membrane were observed in 8% of the ears after ML, 19% after ML+V and 31% after MC+V. The difference was significant between the ML and MC+V groups. PTA was significantly higher in the MC+V group than in the control group of otologically healthy children. Mean amplitudes of DPOAE, measured in treated children with normal tympanometry results, were significantly lower than in the control group, but within the normal range. The use of CO₂ laser during myringotomy has no negative effect on the function of the cochlea. Healing of the tympanic membrane after laser myringotomy was uneventful with a low percentage of permanent sequelae.     

下鼻甲粘膜下凝固术对鼻气道阻力的影响

目的 :观察下鼻甲粘膜下凝固术对鼻气道阻力的影响。方法 :应用主动性前鼻测压法 ,测定 17例慢性鼻炎患者 ,行下鼻甲粘膜下凝固术前后鼻气道阻力和主观鼻开放感觉评分情况。结果 :鼻炎组 17例患者术前鼻气道阻力是 (0 .6 6 7± 0 .2 1) k Pa· s/ L;术后 3个月 (0 .30 2± 0 .17) k Pa· s/ L,10个月 (0 .397± 0 .2 5 ) k Pa· s/ L,统计学显示术后两者和术前的差异有极其显著性意义 (P <0 .0 1)。术前主观鼻开放感觉评分是 7.5± 1.5 ,术后 3个月 2± 2 .0 ,10个月 3± 2 .5 ,两者和术前相比差异亦有极显著性意义 (P <0 .0 1)。结论 :下鼻甲粘膜下凝固术可显著性地降低患者的鼻气道阻力 ,同时可明显的改善患者的主观鼻开放感觉。     

低温等离子射频消融和Nd:YAG激光治疗慢性肥厚性鼻炎的疗效比较

目的观察等离子射频和激光治疗慢性肥厚性鼻炎的疗效及术后并发症。方法分析66例慢性肥厚性鼻炎患者接受等离子射频和激光治疗,其中30例行等离子射频治疗,36例行激光治疗。术后随访6个月,分别于术前及术后6个月应用VAS评分评价鼻塞的主观感觉,并观察术后鼻腔干燥、出血、粘连等并发症。结果等离子组患者术前鼻塞VAS评分为8.43±0.77,激光组为8.38±0.84;术后6个月等离子组为3.60±0.67,激光组为3.31±0.79。等离子组和激光组术前与术后比较均有统计学意义(P<0.01),两组间疗效比较差异无统计学意义(P>0.05)。等离子组并发鼻腔干燥2例,激光组12例,两组间并发症比较有统计学意义(P<0.01)。结论低温等离子射频消融和激光是治疗慢性肥厚性鼻炎的有效方法,均具有安全可靠、微创、无切口、操作简便、术后出血少等优点。但激光治疗术后所致黏膜损伤更重,易并发鼻腔干燥。     

Laser surgery of T<Subscript>1a</Subscript> glottic carcinomas; significance of resection margins

Since 1995 patients with T_1a glottic carcinomas have been treated with laser surgery at the Department of Otorhinolaryngology, Rikshospitalet in Oslo. During this period we have in many cases noticed an inconsistency between the clinical outcome and the histopathological report describing that the resection margins were not free. We wanted to investigate this discrepancy, and the charts with the histopathological reports of 171 patients treated between 1995 and 2005 have been reviewed. Seventeen patients (10%) experienced a recurrence of the initial disease and were treated by repeated laser surgery, radiotherapy, or radiotherapy and laryngectomy. Two patients (1%) had died from the disease. In 36% of the cases (62 patients) the histopathological report indicated “not free” or “probably not free” resection margins. The discrepancy between the histopathological reports and the clinical outcome reflects the pathologist’s difficulty in orienting and determining resection margins in laser-resected specimens. Because of the low number of recurrences or metastases, the verdict of a violated resection margin should probably not be crucial for further treatment. The surgeon’s peroperative judgement may be trusted, however, with very close follow-up in order to detect early recurrences.     

Small cavity mastoidectomy—5 year review

It has been recognized that the traditional method of open mastoid surgery often produces a larger mastoid cavity than necessary. Small cavity mastoidectomy is advocated to reduce the size of the mastoid cavity by exteriorizing the cholesteatoma from the epitympanum backwards. When this operation is performed in a sclerotic mastoid bone, the resulting cavity is very small. The 5 year review of 39 ears with small cavity mastoidectomy is presented. Not only were the mastoid cavities small, they remained stable and trouble-free. It also enabled the patients to enjoy swimming and minimizing wax accumulation within the cavities. The hearing results after 5 years were comparable to that of the closed technique. Formation of cholesterol granuloma behind the concho-meatal flap was an uncommon complication.     

Transforming Growth Factor-α and Rhinitis

Objectives: Transforming growth factor-α (TGF-α) has been implicated in diverse physiologic and pathophysiologic functions including immunological, inflammatory, and neoplastic processes. TGF-α has been localized in the hyperproliferative, inflammatory environment of chronic otitis media, cholesteatoma, and asthmatic airways. TGF-β1, which must be present with TGF-α to transform fibroblasts, has been found in rhinitic mucosa and in asthma in prior studies. The authors sought to identify whether TGF-α also played a role in the inflammatory cascade and fibrosis of rhinitis. Study Design: A nonrandomized, prospective study was carried out in which samples of inferior turbinate and nasal polyps from rhinitic and nonrhinitic patients were subjected to immunohistochemistry and Western blotting to determine the presence of TGF-α. Methods: Twenty-seven subjects undergoing surgery for rhinitis, obstructive sleep apnea, nasal fracture, and rhinoplasty were recruited for this study, the latter three groups acting as controls. Immunohistochemical and Western blotting techniques were employed to identify the presence of TGF-α in inferior-turbinate and nasal-polyp samples of rhinitic subjects. Results: Immunohistochemistry demonstrated the selective staining of TGF-α in the basement membrane and extracellular matrix, including lymphatic, vascular, and glandular structures, in most turbinate samples and the absence of staining in corresponding controls. Further, TGF-α was isolated to a discrete 30-kD band in both inferior turbinate and polyp tissues by Western blotting without staining in the corresponding controls. Conclusions: These results suggest that TGF-α may play a role in the inflammatory derangement of rhinitis.     

激光悬雍垂腭咽部手术治疗阻塞性睡眠呼吸暂停综合征

应用激光悬雍垂腭咽部手术治疗阻塞性睡眠呼吸暂停综合征71例，临床症状改善达97．2％，术后多导睡眠监测有效率达90％。本手术要点是；准确选择手术适应证，根据患者的解剖特点，激光手术类型随之改变；手术主要以形成瘢痕、拉紧提高软腭来扩大咽腔，从而有效地提高手术成功率，减少了术后并发症的发生。     

A blinded in vitro comparison of five sets of bipolar diathermy forceps

The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.     

Long-term follow-up of children after submucosal diathermy to the inferior turbinate for rhinitis

Background

There is currently poor evidence base to support turbinate surgery in children. Submucosal diathermy (SMD) is a day case procedure offered to children who have refractory rhinitis. There is currently no well-defined population who will benefit from this procedure. The Glasgow Children's Benefit Inventory (GCBI) is a validated questionnaire that can be used to assess benefit following an intervention.

Methods

In September 2009, questionnaires were sent by post to the parents of 70 children who underwent SMD between 2003 and 2006. If no response was received, an attempt to contact the parents by telephone was made. These questionnaires were then analysed to ascertain benefit scores.

Results

Returned questionnaires were received for 47 children (68%). 70% (33) felt that this had been a worthwhile procedure. Residual nasal symptoms were recorded, of which rhinorrhea was the most frequent (30, 64%), followed by nasal blockage (28, 60%). Of these children, 23 had a positive radio-allergosorbent test (RAST) and 21 were negative. Overall the median GCBI for children receiving SMD was 19.5. This was elevated in the RAST positive group (median score 27) and lower for the RAST negative group (median score 14).

Conclusion

This study highlights some benefit to inferior turbinate study in children by using the GCBI. Improved benefit was not demonstrated significantly in older or younger children or in RAST positive or negative children. Further studies, by means of a randomised controlled trial are required to provide a better level of evidence for this procedure.     

低温等离子消融术与下鼻甲成形术治疗慢性鼻炎的对比研究

目的 通过研究低温等离子消融术与下鼻甲成形术术后患者鼻塞改善情况和对鼻腔黏膜纤毛功能的影响,探讨治疗慢性鼻炎更有效的方法。方法 选取慢性鼻炎患者40例,随机分为两组,分别行等离子消融术(A组)与下鼻甲成形术(B组)。术前,术后1周、1个月、3个月分别用VAS评分评价患者鼻腔症状。糖精试验评价术前及术后3个月患者鼻腔黏膜纤毛传送功能。结果 等离子组术中出血、手术时间较下鼻甲成形组明显减少,且术后并发症较少;术后3个月两组患者鼻塞均有明显改善;两种手术方式对鼻腔黏膜纤毛功能无影响。结论 对单纯黏膜肥厚的慢性鼻炎,等离子消融疗效显著;对鼻甲骨质肥厚或形态异常的慢性鼻炎,下鼻甲成形术效果好。     

电话随访对粉尘螨滴剂舌下脱敏治疗变应性鼻炎依从性的评价

目的:评价电话随访对粉尘螨滴剂舌下脱敏治疗变应性鼻炎依从性的作用,并对患者脱落的原因进行分析.方法:将132例4～16岁变应性鼻炎患者随机分为2组,53例为对照组,79例为电话随访组,进行为期6个月的观察.结果:在舌下脱敏治疗6个月内,对照组53例,坚持治疗28例,脱落25例,依从率52.8%;随访A组27例,坚持治疗17例,脱落10例,依从率63.0%;随访B组28例,坚持治疗21例,脱落7例,依从率75.0%;随访C组24例,坚持治疗22例,脱落2例,依从率91.7%(P＜0.05),从第4个月开始差异显著(P＜0.01).疗程长难以坚持和用药后认为病情控制或已治愈是影响患者治疗依从性的主要因素.结论:及时电话随访对患者进行教育和指导能显著提高舌下脱敏患者的依从性.