Trimming of the inferior turbinates: a prospective long-term study

The aim of this study was to determine whether the initial benefits of radical trimming and anterior trimming of the inferior turbinates on nasal airflow persisted in the long term. Radical trimming significantly reduced nasal resistance at 2 months following operation (n = 12) (P less than 0.005). There was no significant change in nasal resistance over the next 20 months. Symptom scores for nasal obstruction also showed a significant reduction (n = 16) (P less than 0.005), at 2 months, and did not change significantly over the next 20 months. Radical trimming of the inferior turbinates is a highly effective operation in patients with hypertrophy of the inferior turbinates with few initial complications. However, further analysis of the data revealed that up to 20% of patients lose the initial subjective benefit of relief of nasal obstruction within 2 years of follow-up. Late onset crusting occurs in some patients though this is not directly attributable to an increase in nasal airflow. This study also concludes that anterior trimming of the inferior turbinates cannot be recommended as a form of treatment.     

The nasal valve: a physiological and clinical study

Fifteen subjects underwent nasal pressure gradient studies to determine the resistance profile of the nose. Seventy-nine per cent of nasal resistance to airflow occurred in the segment 0 cm.-2.8 cm. from the posterior margin of the anterior nares. The greater part of this resistance (43 per cent) occurred in the segment 1.5 cm.-2.8 cm. within the nose, and this area approximated to the site of the pyriform aperture. Eighteen patients underwent a trial of radical trimming of the inferior turbinates (12 patients) versus anterior trimming of the inferior turbinates (6 patients). Both operations produced a similar fall in nasal resistance to airflow, confirming that the region of the pyriform aperture was the site of maximum nasal resistance. Whereas the radical operation significantly reduced the sensation of nasal obstruction, the anterior operation did not. The results of the study are discussed with reference to previous work on the subject.     

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。     

The effect of inferior turbinate outfracture on nasal resistance to airflow in vasomotor rhinitis assessed by rhinomanometry

Twenty-eight patients with nasal obstruction due to vasomotor rhinitis were assessed using anterior rhinomanometry before and six weeks after the operation of out-fracture and amputation of the posterior ends of the inferior turbinates. It was found that the operation did not significantly improve the nasal airway. Though just over half the patients had an objective improvement in nasal airflow, only half of this group reported a subjective improvement in their symptoms.     

A comparison of the effects of two commonly used vasoconstrictors on nasal mucosal blood flow and nasal airflow.

This study compared two commonly used vasoconstrictors, cocaine and xylometazoline. Non-invasive techniques of measurement were utilised, with active anterior rhinomanometry indirectly assessing changes in nasal mucosal blood volume, and laser Doppler flowmetry assessing changes in nasal mucosal blood flow. Twelve healthy volunteers received 0.1 ml of the topical vasoconstrictor at the anterior end of both inferior turbinates. Following the application of xylometazoline, a significant rise in nasal airflow (p less than 0.005), and a significant fall in blood flux occurred in the probe nostril (p less than 0.05). Following the application of cocaine, no significant change in nasal airflow occurred (p less than 0.05), but a significant fall in blood flux occurred in the probe nostril (p less than 0.02). A comparison of the paired data for the same subject demonstrated no significant difference in the change in blood flux produced by xylometazoline and cocaine, but a significant difference in the change in airflow produced by the two vasoconstrictors (p less than 0.005).     

等离子射频消融术在鼻腔手术中的联合应用

目的:探讨在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎的疗效。方法:91例伴下鼻甲肥大及变应性鼻炎的鼻中隔偏曲或鼻息肉患者,行鼻中隔成形术或鼻内镜下鼻息肉摘除加筛窦开放术后,其中62例行等离子射频消融术(消融组),29例未行等离子射频消融术(对照组)。术前及术后3个月应用视觉模拟评分表(VAS)评价鼻塞的主观感觉。根据1997年海口会议疗效评定标准判断变应性鼻炎的疗效。结果:消融组术前鼻塞VAS评分左、右侧分别为(89.5±8.7)%和(90.3±10.5)%,术后3个月分别为(26.2±8.7)%和(32.1±10.3)%,左、右侧分别与术前比较,差异有统计学意义(均P<0.01);32例变应性鼻炎患者,显效31例(96.9%),有效1例(3.1%)。对照组术前鼻塞VAS评分左、右侧分别为(90.5±8.0)%和(89.9±11.5)%,术后3个月分别为(39.2±8.9)和(48.1±8.1)%,左、右侧分别与术前比较,差异均有统计学意义(均P<0.01);16例变应性鼻炎患者,显效4例(25.0%),有效10例(62.5%),无效2例(12.5%)。两组术后VAS评分差异有统计学意义(P<0.01)。结论:在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎安全、有效。     

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance

The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance was assessed in 15 subjects. A single blind parallel group trial was undertaken in 30 subjects, with lignocaine as the active drug, and normal saline as the placebo. Fifteen subjects were included in each group. Both agents were infiltrated bilaterally into the floor of the nasal vestibule on each side via the sublabial route. Local anaesthesia of the nasal vestibule by infiltrating lignocaine produced a sensation of nasal obstruction in 9 out of 15 subjects (P less than 0.02). The infiltration of normal saline had no such effect. The difference between the effect of the 2 agents on nasal airflow sensation was significant (P less than 0.05). Neither injection had any significant effect on nasal resistance to airflow as assessed by active anterior rhinomanometry.     

Tenascin在鼻息肉组织中的表达及其临床意义

目的：探讨Tenascin(TN)在鼻息肉组织中的表达和分布特征及其在鼻息肉发生中的可能作用。方法：采用免疫组化链霉菌抗生物素蛋白—过氧化物酶(SP)法检测24例鼻息肉标本(鼻息肉组)和15例慢性肥厚性鼻炎下鼻甲标本(下鼻甲组)中TN的表达，并以5例健康者(对照组)下鼻甲黏膜作对照。结果：鼻息肉组和下鼻甲组黏膜上皮细胞及腺上皮细胞均表达TN；鼻息肉组TN的黏膜上皮阳性细胞表达的吸光度值显著高于下鼻甲组(P＜0．01)；鼻息肉组TN的腺上皮阳性细胞表达的吸光度值显著高于下鼻甲组(P＜0．01)；对照组下鼻甲组织中黏膜上皮及腺体几乎检测不到TN的表达；鼻息肉组腺体TN阳性率明显高于下鼻甲组(P＜0．05)。结论：TN在鼻息肉组织中的高表达与鼻息肉的发生、发展相关；TN在鼻腔内的表达细胞是黏膜上皮细胞和浆液性腺上皮细胞。     

MUC5AC在人类鼻息肉及下鼻甲黏膜上皮的表达

目的 :探讨MUC5AC与鼻息肉及慢性肥厚性鼻炎黏液过量分泌的关系。方法 :免疫组织化学ABC法检测 2 7例鼻息肉、19例慢性肥厚性鼻炎下鼻甲及 9例正常下鼻甲黏膜上皮MUC5AC的表达。结果 :鼻息肉黏膜上皮及慢性肥厚性鼻炎下鼻甲黏膜上皮MUC5AC阳性细胞表达率明显高于正常下鼻甲黏膜上皮 (P <0 .0 5 ) ,且MUC5AC阳性表达细胞主要为杯状细胞。结论 :MUC5AC在鼻息肉及慢性肥厚性鼻炎下鼻甲黏膜上皮呈高表达 ,且阳性细胞为杯状细胞 ,表明MUC5AC确实对鼻息肉及慢性肥厚性鼻炎的黏液过量分泌起了一定作用。     

Changes in nasal resistance and quality of life after endoscopic microdebrider-assisted inferior turbinoplasty in patients with perennial allergic rhinitis

OBJECTIVE: To assess objective and subjective outcomes in patients with perennial allergic rhinitis who had undergone endoscopic microdebrider-assisted inferior turbinoplasty. DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Fifty patients with perennial allergic rhinitis who had substantial mucosal hypertrophy of the inferior turbinates and who underwent endoscopic microdebrider-assisted inferior turbinoplasty with follow-up 1 year after surgery. INTERVENTION: A newly designed microdebrider blade incorporated with an elevator was used to perform this procedure in the clinical setting with the patient under local anesthesia and with 30 degrees endoscopic guidance. MAIN OUTCOME MEASURES: Both objective outcome evaluated by total nasal resistance at anterior rhinomanometry and subjective outcome assessed with the Rhinoconjunctivitis Quality of Life Questionnaire were analyzed before and 1 year after surgery. RESULTS: The median total nasal resistance in 50 patients decreased from 0.45 Pa/cm(3) per second preoperatively to 0.28 Pa/cm(3) per second 1 year postoperatively, a statistically significant difference (P<.001). Compared with preoperative scores, the postoperative scores of these patients significantly improved in both 7 separate domain scores and overall Rhinoconjunctivitis Quality of Life Questionnaire scores (P<.005). CONCLUSION: Our results suggest that endoscopic microdebrider-assisted inferior turbinoplasty is effective for decreasing nasal resistance and improving quality of life in patients with perennial allergic rhinitis who have substantial nasal congestion.     

Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid

PURPOSE: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance. MATERIALS AND METHODS: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases. RESULTS: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups. CONCLUSIONS: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function.     

血管通透性因子在鼻息肉中的表达及意义

目的探讨血管通透性因子（ｖａｓｃｕｌａｒｐｅｒｍｅａｂｉｌｉｔｙｆａｃｔｏｒ，ＶＰＦ）在鼻息肉组织中的表达及意义。方法将９例鼻息肉标本及８例下鼻甲粘膜标本行ＶＰＦ及其受体ｆｌｋ１的免疫组化染色，光镜观查。结果ＶＰＦ在鼻息肉组织的血管内皮细胞和腺体细胞的表达明显高于下鼻甲组织（Ｐ＜０．０１，Ｐ＜０．０５），ｆｌｋ１在血管内皮细胞的表达明显高于下鼻甲组织（Ｐ＜０．０１）。结论ＶＰＦ对鼻息肉发生过程中组织极度水肿的产生可能有非常重要的作用。     

Radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates: a new method in the treatment of chronic nasal obstruction

Twenty-two Caucasians (16 male and 6 female) with chronic bilateral nasal obstruction due to hypertrophic inferior turbinates were followed up over a three-month period. They were assessed by clinical examination, as active anterior rhinometry, and acoustic rhinometry before and after topical decongestion, preoperatively and three months after surgery. All patients were treated by application of radiofrequency-volumetric-tissue reduction (RFVTR, or somnoplasty) to both inferior turbinates. Initial postoperative edematous response disappeared during the first week after RFVTR. Three months postoperatively 20 of 22 patients (91%) reported subjective improvement of nasal patency. The average cross-sectional area for both sides of the nasal cavity (measured at the head of the inferior turbinate (C-Notch) before decongestion) increased in 15 of 22 patients (68.2%). This means a significant improvement from 1.24 to 1.49 cm2 for both sides of the nasal cavity (p = 0.0054). We conclude that RFVTR can safely reduce turbinate volume in a precise manner in patients with nasal obstruction due to hypertrophic inferior turbinates.     

Anterior turbinectomy. A new surgical approach to turbinate hypertrophy: a review of 220 cases

Surgical correction of mechanical nasal airway obstruction is commonly treated by septoplasty. The nasal airflow, however, is often inadequate postoperatively. The inferior turbinates are responsible for nasal obstruction more often than is realized. Recent studies have confirmed that the main site of respiratory resistance is located at the level of the anterior ends of the inferior turbinates. A new turbinectomy approach in which the anterior end of the inferior turbinate is resected with a specially modified forceps is described. A large series of patients, along with their follow-up data, are described. The advantages of the anterior turbinectomy are discussed.     

血管通透性因子在鼻息肉中的表达及意义

目的 探讨血管通透性因子（ｖａｓｃｕｌａｒ ｐｅｒｍｅａｂｉｌｉｔｙ ｆａｃｔｏｒ，ＶＰＦ）在鼻息肉组织中的表达及意义。方法 将９例鼻息肉标本及８例下鼻甲粘膜标本行ＶＰＦ及其受体ｆｌｋ－１的免疫组化染色，光镜观查。结果 ＶＰＦ在鼻息肉组织的血管内皮细胞和腺体细胞的表达明显高于下鼻甲组织（Ｐ〈０．０１，Ｐ〈０．０５），ｆｌｋ－１在血管内皮细胞的表达明显高于下鼻甲组织（Ｐ〈０．０１）。结论 ＶＰＦ对鼻     

Long-term results of trimming of the inferior turbinates

The long-term benefit of trimming of the inferior turbinates for nasal obstruction is unclear and our aim was to assess this. Fourteen patients who had had pre-operative nasal symptom scores and anterior rhinomanometry prior to inferior turbinate resection were reassessed at least 7 years post-operatively. Both nasal symptom scores for obstruction and nasal resistance had increased significantly in the intervening time period. Nasal crusting and hypertrophy of the cut inferior turbinate are considered to be responsible for this. Patients should be warned some degree of nasal obstruction may recur post-operatively.     

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.     

Primary nasal tuberculosis: a case report

We report a case of a 36 year old woman who presented a chronic rhinitis and a hypertrophy of the inferior turbinates. Primary nasal tuberculosis was discovered by chance after the inferior turbinectomy. Primary nasal tuberculosis is very rare and is more frequent in women. Symptomatology is often unilateral with nasal obstruction, anterior rhinorrhea or epistaxis. The clinical examination may discover ulceration or a polyp located generally in the nasal septum or the inferior turbinate. Diagnosis relies on the anatomopathologic and bacteriological examinations. The treatment is mainly medical based on antituberculosis drugs. In the light of this case report, a review of the literature was made.     

鼻部气道的气流感觉

为了观察正常人鼻部气流感觉与鼻通气度的关系，采用视觉类比标度法和前鼻测压法进行研究，发现鼻部对气流的主观感觉民实际鼻通气度即鼻气道阻力之间无明显相关性；并证实感觉鼻通气度的部位主要在鼻前庭。传统中药治疗鼻阻塞的挥发类药物只能改善鼻通气的感觉，并不能改善鼻气道阻力。提示鼻部对气注的主观感觉不能完全反映实际的鼻通气程度，临床上诊断和治疗以鼻阻塞症状为主诉的患者时，应将患者鼻部对气流的主观感觉和测定鼻气     

鼻部气道的气流感觉

为了观察正常人鼻部气流感觉与鼻通气度的关系，采用视觉类比标度法和前鼻测压法进行研究，发现鼻部对气流的主观感觉与实际鼻通气度即鼻气道阻力之间无明显相关性；并证实感觉鼻通气度的部位主要在鼻前庭。传统中药治疗鼻阻塞的挥发类药物（樟脑和薄荷）只能改善鼻通气的感觉，并不能改善鼻气道阻力。提示鼻部对气流的主观感觉不能完全反映实际的鼻通气程度。临床上诊断和治疗以鼻阻塞症状为主诉的患者时，应将患者鼻部对气流的主观感觉和测定鼻气道阻力结合起来，以对实际的鼻通气度和治疗效果作出客观评价。