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At least 307 records · Page 17Linked to original sources
PubMed2002

Density of middle turbinate subepithelial mucous glands in patients with chronic rhinosinusitis.

OBJECTIVE: Histologic changes have not been systematically assessed in chronic rhinosinusitis. Quantitative histochemical studies evaluated the extent of sinus disease and gland density in the middle turbinates. STUDY DESIGN AND SETTING: Sinus computed tomography scans of 34 patients with chronic rhinosinusitis were retrospectively graded 0 to IV according to the May classification. Middle turbinates from patients with chronic rhinosinusitis (n = 46) and normal patients (n = 7) were harvested during endoscopic sinus surgery. The areas of Alcian blue-stained glands were assessed in paraffin sections using a computer-assisted microscopy video system. RESULTS: Alcian blue-stained glands occupied 7.94% of normal mucosa. The staining in all grade III rhinosinusitis subjects was increased to 12.94% (P < 0.01). In contrast, grade IV pansinusitis was associated with nasal polyposis (6 of 6) with decreased gland area (3.04%, P < 0.01). When polyp patients were excluded from grade III rhinosinusitis, the Alcian blue-staining area was 17.68% (P < 0.01). CONCLUSIONS: Distinct polypoid and glandular histopathologic patterns are present in chronic rhinosinusitis.

Alcian Blue↗
PubMed2006

Lobular capillary haemangioma of the middle turbinate.

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.

Diagnosis, Differential↗
PubMed1999

Effect of submucosal diathermy to the inferior turbinates on unilateral and total nasal airflow in patients with rhinitis.

The efficacy of the controversial treatment of submucosal diathermy to the inferior turbinates (SMDIT) was evaluated objectively. Twenty-seven patients with chronic rhinitis were investigated by hourly posterior rhinomanometry to assess changes in total and minimum (Fmin) and maximum (Fmax) unilateral nasal airflow over 5 h, before and 2-3 months after standardized SMDIT treatment. Nasal airflow was recorded at a sample pressure of 75 Pa and the results are reported as medians with interquartile range. Whilst SMDIT caused a significant 51% increase (p < 0.0001) in total nasal airflow from 246 cm3/s (131) to 371 cm3/s (133) the changes in unilateral airflow provided further evidence which strongly supported the benefits of this operation. Unilateral Fmin significantly increased by 136% (p < 0.0001) from 69 cm3/s (82) to 163 cm3/s (74) and Fmax significantly increased by 23% (p < 0.0001) from 171 cm3/s (74) to 211 cm3/s (59). The effect of surgery was to "splint" to the turbinate in a state of relative vasoconstriction. Our findings therefore provide functional evidence of submucosal fibrosis following SMDIT. The greater percentage change in unilateral Fmin suggests that this parameter is a more sensitive index of the effect of nasal surgery than total nasal airflow measurements. The importance of considering the nose as two separate airways in the evaluation of nasal treatments is emphasized.

Adolescent↗
PubMed1992

A pilot study of the holmium YAG laser in nasal turbinate and tonsil surgery.

A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation.

Adolescent↗
PubMed1999

Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode.

OBJECTIVE: The objective of this clinical trial was to assess the safety and efficacy of radiofrequency (RF) tissue ablation of the inferior turbinates in the treatment of nasal obstruction using an RF energy delivery system with a thermocouple feedback electrode. METHODS: A prospective, nonrandomized study of 11 patients (mean age, 47+/-12 y) with chronic nasal obstruction was conducted. Using patient-based visual analogue scales (VAS), symptom parameters were assessed. These included degree of nasal obstruction, frequency of nasal obstruction, and pain. Physician assessment of nasal obstruction was also collected by the principal investigator. Follow-up was conducted at 24 hours, 1 week, 4 weeks, 8 weeks, and 1 year. ANOVA was carried out to determine statistically significant differences in the data. Data were fit to a regression model, and confidence intervals were determined from a 95% confidence level. RESULTS: In patient-assessed degree of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.001, P<.0001, and P<.0008, respectively). There was no difference between 8 weeks and 1 year (P<.15). The data appeared to follow an exponential decay to a constant value. The pretreatment baseline average degree of obstruction was 7.5+/-0.5 on a scale of 0 to 10. The degree of obstruction after 8 weeks was 2.7+/-0.6. The time constant for this change was 21 days to reach 90% of the final value. At 1 year, degree of obstruction was 3.3+/-0.7. For frequency of nasal obstruction, statistical significance was seen among baseline and 4 weeks, 8 weeks, and 1 year (P<.0001, P<.0001, and P<.0001, respectively). There was no difference between 8 weeks and 1 year (P<.15). The pretreatment baseline average frequency of obstruction was 7.8+/-0.5. The remaining frequency of obstruction after 8 weeks was 2.9+/-0.6. The time constant was 18 days. At 1 year, frequency of obstruction was 3.3+/-0.6. Physician assessment of nasal obstruction revealed statistical significance among baseline and 4 weeks, and baseline and 8 weeks (P<.0055 and P<.0056, respectively). There was no difference between 4 weeks and 8 weeks (P<.24). The average initial obstruction was 83%+/-4%. The remaining obstruction after 8 weeks was 58% +/-5%. The time constant was 14 days. Mild pain was reported by 55% of patients during the procedure; the remaining 45% reported no pain. Only one patient required pain medication consisting of acetaminophen after the procedure. There were no significant complications. CONCLUSIONS: Degree and frequency of nasal obstruction, as reported by patients, decreased following RF tissue ablation of the inferior turbinates. This improvement in symptoms was still evident after 1 year (P<.001). Physician assessment of obstruction also correlated with patient reports for the initial 8-week study period. The procedure was safe and well tolerated. Thermocouples within the active electrode provided additional feedback to the operating surgeon allowing the use of relatively lower tissue temperatures, power, and energy as compared with traditional techniques. These results support the need for continued research to evaluate this modality as a treatment for chronic nasal obstruction.

Adult↗
PubMed2001

Endoscopic inferior turbinate reduction: an outcomes analysis.

OBJECTIVES/HYPOTHESIS: In a previous publication, we introduced an endoscopic technique for the treatment of nasal obstruction caused by inferior turbinate hypertrophy. The technique, a modification of the procedure popularized by Mabry, involves resecting the inferior and lateral aspects of the inferior turbinate with a microdebrider under endoscopic guidance. Our preliminary postoperative results were favorable. All 20 patients experienced improvement by postoperative day 5 and the incidence of complications over the first 6 months after surgery was low. The objective of this study is to perform a long-term outcomes analysis of patients undergoing the procedure. STUDY DESIGN: Follow-up survey questionnaire and analysis. METHODS: We sent questionnaires to 60 patients, ranging from 6 to 40 months after surgery, inquiring about continued use of nasal medications, need for further surgery, presence of adverse effects, and improvement in symptoms. Nasal airway obstruction was assessed on a subjective scoring scale from 1 (no obstruction) to 6 (complete obstruction). RESULTS: Of the 28 (47%) patients who returned questionnaires, the severity of daytime nasal obstruction was rated as 2.3 and nighttime nasal obstruction as 2.7. The use of nasal steroids and oral decongestants was 25% and 21%, respectively. Adverse effects were minimal and all but one patient (96%) experienced improvement in their nasal airway. CONCLUSION: These results confirm the long-term effectiveness of this procedure for the relief of nasal obstruction.

Endoscopy↗
PubMed2003

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.

Adolescent↗
PubMed1988

Surgical reduction of hypertrophied inferior turbinates: a comparison of electrofulguration and partial resection.

Two adjunctive or primary surgical procedures, partial resection and electrofulguration, are popular today for reducing offending inferior turbinates. Both are relatively successful. However, there seems to be a growing consensus that judicious partial resection of the inferior turbinates is associated with a higher long-term success rate (86 versus 69 percent) as well as a lower postoperative morbidity rate. This paper outlines the specific symptom complex that brought 200 patients to corrective intranasal surgery. These are as follows: nasal obstruction (99 percent), sinus pressure headaches (61 percent), dry, raw pharynx (61 percent), abnormal migration of the nasal mucous blanket or "postnasal drip" (35 percent), and recurrent bacterial rhinosinusitis (57 percent). Based on this symptom complex, this paper attempts to give the expected long-term results when a single operator performed 100 consecutive operations using each technique.

Adult↗
PubMed2003

Secure endoscopic sinus surgery with partial middle turbinate modification: a 16-year long-term outcome report and literature review.

The efficacy of functional endoscopic sinus surgery for the treatment of chronic sinusitis is well established. Two contrasting European techniques were introduced to North America in the 1980s: that espoused by Wigand, which included endoscopic isthmus modification of all sinus ostia and cavities with modification of the middle turbinates, and that developed by Messerklinger, who practiced only minimal opening of the narrow osteomeatal tract at the anterior ethmoid sinus to achieve physiologic reversal of sinus disease. These techniques were additionally modified recently by the introduction of power resection techniques by Setliff and Christmas and stereotactic computer navigation by Anon and Fried. In 1986, after exposure to both original techniques, I developed a middle-ground approach that lies between the extremes of the two European schools. The benefits of this middle-ground multimodal secure technique include a high success rate, maximal safety, and the ability to be performed as an adjunct to any other indicated functional nasal surgery. Since its inception, a key feature of this technique has included partial modification of the bulky inferior portion of the middle turbinates. This has contributed markedly to successful long-term outcome and safety rates.

Endoscopy↗
PubMed1988

The inferior turbinate flap for closure of septal perforations.

In 31 patients a symptomatic septal perforation was repaired using an inferior-turbinate flap originally described by Masing. In approximately 50% of the cases the perforation was closed for two-thirds or more. Postoperative scarring causing nasal obstruction or alar asymmetry occurred in 21% of the cases. Some specific symptoms such as epistaxis, whistling and frontal headache appeared to improve even after partial closure. However, the overall degree of satisfaction of the patients and the degree of closure of the perforation were related. Based on the results of this series the inferior-turbinate flap did not prove satisfactory for the closure of septal perforations.

Adult↗
PubMed1988

A comparison of anterior and radical trimming of the inferior nasal turbinates and the effects on nasal resistance to airflow.

A study of 18 patients with chronic rhinitis who underwent anterior or radical trimming of the inferior turbinates is presented. Radical trimming produced a significant decrease in both total nasal resistance to airflow and subjective nasal obstruction (P less than 0.005). Anterior trimming produced a significant decrease in total nasal resistance to airflow (P less than 0.05), but had no significant effect on subjective nasal obstruction. These results suggest that the main site of nasal resistance in patients with chronic rhinitis is the same as in the normal nose. On the basis of this study, adoption of anterior trimming in place of radical trimming of the inferior turbinates cannot be recommended.

Adolescent↗
PubMed1996

Contact laser turbinate surgery for the treatment of idiopathic rhinitis.

To evaluate the value of contact laser turbinate surgery using a diode laser in the treatment of idiopathic rhinitis. 53 patients were examined before and after surgery. Six months following surgery, nasal obstruction was significantly improved and a significant decrease in nasal airway resistance was noted on active rhinomanometric measurements (P < 0.05). There were no significant post-operative changes in olfactory acuity using the butanol threshold test and in mucociliary transport using the saccharin transit time. The results of this study suggest that contact laser turbinate surgery may be a valuable alternative form of surgical treatments for patients with idiopathic rhinitis.

Adult↗
PubMed1987

Turbinate surgery: how effective is it? A long-term assessment.

The results of turbinate reduction surgery carried out on 307 patients are reviewed. This is a retrospective study over 16 years. The results of submucosal diathermy with and without outfracture, partial inferior turbinectomy and linear cautery were all equally disappointing in the long term. At 1 month postoperatively the overall success rate, as defined by patient satisfaction, was 82%, but this declined steadily with time to 60% at 3 months, 54% at 1 year and 41% at 1-16 years. There was no significant difference found in the success rates between methods of turbinate reduction used. These findings are compared with more optimistic reports in the literature and their relevance to current surgical practice is discussed.

Adolescent↗
PubMedDate not supplied

Intracellular Ca2+ mobilization in cultured human mucosal microvascular endothelial cells from the nasal inferior turbinate.

Human mucosal microvascular endothelial cells (HMMECs) were isolated and cultured from the mucosa of nasal inferior turbinates. These cells were identified by human factor-VIII antigen and UEA-I. We also investigated alterations in intracellular calcium concentration [Ca2+]i, in HMMECs using the Ca(2+)-sensitive dye fura-2. Depolarization by high K+ (150 mM) induced no changes in [Ca2+]i in HMMECs, thereby indicating the lack of voltage-dependent Ca2+ channels in these cells. Extracellular ATP increased [Ca2+]i in HMMECs both in the presence and absence of extracellular Ca2+. These results suggest that ATP may induce a release of Ca2+ from intracellular stores in HMMECs. Adenosine induced no changes in [Ca2+]i in HMMECs. It is thus likely that HMMECs obtained from the nasal inferior turbinate may carry P2-purinoceptors but not P1-purinoceptors.

Calcium↗
PubMed2002

Immunohistochemical localization of subtypes of muscarinic receptors in human inferior turbinate mucosa.

The regulation of glandular secretions and vasomotor tone in human nasal mucosa implicates muscarinic receptors. There are 5 recognized classes (m1 through m5) of muscarinic receptor subtypes, and the aim of our study was to localize muscarinic receptor subtypes (m1 through m5) in human inferior turbinate mucosa by an immunohistochemical method. We found m1 and m2 receptors distributed on glands, arteries, veins, and epithelia; m4 receptors were found around arteries; and m5 receptors were identified on glands and arteries. We found m3 receptors to be the most extensively distributed on glands, arteries, and veins of all of the muscarinic receptor subtypes. The m3 receptor is probably important in the physiology of the human inferior turbinate. This study may help identify the best target for more selective muscarinic drugs and guide the treatment of allergic and nonallergic rhinitis.

Adult↗
PubMed2003

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.

Adolescent↗
PubMed2004

Bioactive glass and turbinate flaps in the repair of nasal septal perforations.

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft and the use of turbinate flaps in 23 patients with septal perforations. Another 16 patients were treated with mucoperiosteal flaps only. The perforations were successfully closed in 38 of the 39 patients. One patient had a near-total septal perforation due to hypophysial surgery; it could not be closed. No extrusions of the BAG and no BAG-associated infections were seen; the average follow-up period was 28 months. BAG S53P4 seems to be a good interpositional graft in the repair of medium and large nasal septal perforations, and turbinate flaps are also reliable.

Adult↗
PubMed1997

Comparison of carbon dioxide and neodymium: yttrium-aluminum-garnet lasers in surgery of the inferior turbinate.

At the Department of Otorhinolaryngology-Head and Neck Surgery of the University of Kiel, 533 patients with hyperplastic inferior turbinates were treated between 1987 and 1994 with various carbon dioxide (CO2) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser techniques. We report on the therapeutic results of both types of laser turbinectomy and compare their long-term results with those of submucosal diathermy. Among the different techniques, we preferred the following approaches. The CO2 laser technique involved the application of a few laser spots (laser energy density 6,100 J/cm2 per lesion) to the head of the turbinate under the operating microscope. In the Nd:YAG laser procedure, diffuse, low-power irradiation (laser energy density < 53 kJ/cm2) of the entire concha was performed under endoscopic control. The CO2 laser procedure involved little bleeding and hardly any pain. It produced a positive effect after only a few days and required no follow-up treatment. The success of Nd:YAG laser treatment, by contrast, only became evident after weeks or months, due to the slow scarring process. Compared to submucosal diathermy, both laser methods produced better long-term results. Two years postoperatively, the overall success rate, as defined by patient satisfaction, was 79.6% for the CO2 laser, 68.3% for the Nd:YAG laser, and 36% for submucosal diathermy.

Adult↗