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PubMed1982

Effect of turbine dental drill noise on dentists' hearing.

The effect of high-speed dental turbines on dentists' hearing was investigated. The two types of dental turbines used most commonly in the Tel Aviv area and their average time of daily use were established by means of questionnaires. The noise pressure level of these turbines at a distance of 30.0 cm was measured. Twenty subjects were exposed to the turbine noise for a period equal to the average time of the drill's daily use. The noise pressure levels of the turbines were found to be nonhazardous by the accepted damage-risk criteria. The temporary threshold shifts of the subjects exposed were nil or insignificant. It was concluded that the risk of damage to the dentist's hearing due to dental turbine noise in the normal course of a working day is slight.

Auditory Fatigue↗
PubMedDate not supplied

Nasal reconstruction using the inferior turbinate mucosal flap.

Reconstruction of nasal defects can be a difficult task if large amounts of nasal mucosa are missing. We have found the inferior turbinate mucosal flap to be a reliable and effective flap in a series of 16 patients undergoing nasal reconstruction or repair of septal perforations. Most of these patients had insufficient mucosa to use traditional flaps harvested from the nasal floor or the lateral nasal wall. Eight patients underwent reconstruction of septal perforations, 9 patients underwent nasal reconstruction of large nasal defects after tumor extirpation, and 1 patient underwent closure of a palatal fistula. Six of the septal perforations were closed completely and 3 were reduced in size by 50%. All 11 turbinate flaps used for nasal reconstruction (2 patients had bilateral flaps) survived. Two flaps underwent mild superficial epidermolysis without flap necrosis or exposure of overlying cartilage grafts. The turbinate flap is based anteriorly and provides large amounts of well-vascularized mucosa. The turbinate is rotated anteriorly and bivalved and the conchal bone is removed to increase the dimensions of the flap. The flap is sometimes staged to allow transfer of mucosa to distant sites, such as the septum, the nasal ala, and the nasal wall. An anatomical dissection of 10 turbinate flaps on 5 fresh cadaver specimens demonstrated an average flap size of 4.97 cm2. The average length of the flap was 2.83 cm, which is sufficient length to reach the nasal dorsum. A description of the surgical technique and the vascular supply of this flap will be discussed.

Cadaver↗
PubMed2003

Expression patterns of galectin-1 and galectin-3 in nasal polyps and middle and inferior turbinates in relation to growth regulation and immunosuppression.

BACKGROUND: The term nasal polyposis describes benign growth processes in the nasal and sinus mucosa, which are mainly located in the middle meatus and never in the inferior meatus. As a step to define the biochemical determinants relevant for growth regulation, we focused on endogenous lectins known for anti-apoptotic (galectin-3) and immunomodulatory (galectin-1) activities. DESIGN: Using computer-assisted microscopy, we performed an immunohistochemical investigation defining the quantitative parameters of expression of galectin-1 and galectin-3 in 10 nasal polyps, 10 middle turbinates, and 10 inferior turbinates, all of which were obtained from surgical resection. RESULTS: Our data show that galectin-3 expression is markedly (P<.001) higher in nasal polyps than in turbinates. No relation to the allergic status was discovered. Galectin-1 expression is higher in nasal polyps than in middle turbinates (P<.001) in nonallergic patients compared with allergic ones (in glandular epithelium, P =.009; in connective tissue, P =.006). The lowest galectin-1 expression was observed in the middle turbinate. CONCLUSIONS: These data are in line with a positive influence of galectin-3 on growth and an immunoregulatory role of galectin-1, mimicking an increased expression dependent on glucocorticoid.

Adjuvants, Immunologic↗
PubMed2004

Time course in the relief of nasal blockage after septal and turbinate surgery: a prospective study.

OBJECTIVE: To evaluate prospectively the time course of the change in efficacy of septal and turbinate surgery in relieving nasal obstruction. DESIGN: Interventional study, before-after trial. SETTING: Referral center, institutional practice, hospitalized care. PATIENTS: Thirty-four consecutive patients undergoing septal and turbinate surgery were recruited. Seven patients were unwilling to complete the follow-up after surgery. No patient withdrawal was because of adverse effects. Twenty-five normal subjects with no nasal obstruction were included as control subjects. INTERVENTION: Functional nasal septal and turbinate surgery was performed to relieve nasal obstruction. MAIN OUTCOME MEASURE: Patient assessment of severity of nasal blockage on a 0-mm (no blockage) to 100-mm (maximum blockage) visual analog scale before surgery and at fixed intervals after surgery. RESULTS: The mean nasal blockage scores significantly decreased from the preoperative values at all intervals of follow-up. For the whole group, the nasal blockage score was on average 52% of the preoperative value at the last follow-up. The probability of having at least a 50% reduction in blockage decreased from 73%, to 60%, to 41%, and then to 27% at 3 months, 6 months, 1 year, and 2(1/2) years, respectively. CONCLUSIONS: Improvement in nasal blockage was found in patients after functional septal and turbinate surgery. However, the probability of substantial relief gradually decreased with time. Patients should be followed up after septal and turbinate surgery for possible recurring symptoms.

Adult↗
PubMed2005

Aerodynamic effects of inferior turbinate reduction: computational fluid dynamics simulation.

OBJECTIVE: To investigate the aerodynamic consequences of conservative unilateral inferior turbinate reduction using computational fluid dynamics methods to accomplish detailed nasal airflow simulations. DESIGN: A high-resolution, finite-element mesh of the nasal airway was constructed from magnetic resonance imaging data of a healthy man. Steady-state, inspiratory airflow simulations were conducted at 15 L/min using the techniques of computational fluid dynamics. INTERVENTION: Circumferential removal of 2 mm of soft tissue bulk along the length of the left inferior turbinate was modeled. MAIN OUTCOME MEASURES: Nasal airflow distribution and pressure profiles were computed before and after simulated left inferior turbinate reduction. RESULTS: Simulated inferior turbinate reduction resulted in a broad reduction of pressure along the nasal airway, including the regions distant from the inferior turbinate vicinity. In contrast, relative airflow changes were regional: airflow was minimally affected in the valve region, increased in the lower portion of the middle and posterior nose, and decreased dorsally. CONCLUSION: Use of computational fluid dynamics methods should help elucidate the aerodynamic significance of specific surgical interventions and refine surgical approaches to the nasal airway.

Computer Simulation↗
PubMed1996

Ultrastructural study of turkey rhinotracheitis virus infection in turbinates of experimentally infected chickens.

Ultrastructural changes associated with turkey rhinotracheitis virus infection were studied in turbinates of chickens experimentally infected with the isolate CVL 14/86/1. Chickens were sacrificed at 3, 5 and 7 days after inoculation and samples of the middle turbinate were taken, fixed, dehydrated and embedded in an hydrophilic resin. An immunofluorescence technique on semithin sections was carried out and viral antigen was observed in the cytoplasm and associated to cilia of the turbinate epithelial cells, on days 3 and 5 after inoculation. Ultrastructurally, gold stained intracytoplasmic nucleocapsid aggregates of turkey rhinotracheitis virus were observed in ciliated and non-ciliated epithelial cells, as well as budding virus particles, at days 3 and 5 postinoculation. Different ultrastructural abnormalities, including cytoplasmic blebs, clumping and loss of cilia were observed in the apical cell membrane of many infected cells, associated with the presence of intracytoplasmic inclusions. On day 5 after inoculation, substitution of ciliated and non-ciliated epithelial cells was noted and many desquamated epithelial cells were observed within the lumina. Regenerative changes in the ciliated epithelium were observed by day 7 postinoculation. These results indicate that turkey rhinotracheitis virus is able to replicate in ciliated and non-ciliated epithelial cells causing severe alterations to the cell surface and ciliary apparatus of the turbinate epithelium. Viral-induced damage to the turbinate epithelium could enhance the susceptibility of epithelial cells to secondary bacterial infection.

Animals↗
PubMed2003

Clinical effectiveness of coblation inferior turbinate reduction.

OBJECTIVE: We sought to determine the safety and clinical effectiveness of coblation (short for "cold ablation") inferior turbinate reduction for turbinate hypertrophy. METHODS: A consecutive series of adult patients with inferior turbinate hypertrophy were treated with the coblation technique in the office setting. Subjective symptoms were assessed prior to treatment and at the 3- and 6-month intervals after treatment with the Rhinosinusitis Symptom Inventory (RSI) and a short nasal symptom questionnaire. RESULTS: Twenty-four of 26 treated patients completed the protocol. At the 3-month follow-up, statistically significant decreases in the nasal and overall symptom domains of the RSI were noted (changes of -10.5 and -8.7, with P = 0.018 and P = 0.015, respectively). These improvements were also significant at the 6-month follow-up (-20.1 and -15.8 with, P < 0.001 and P < 0.001, respectively). At the 3-month interval, nasal obstruction and amount of time with nasal obstruction were significantly decreased (P = 0.006 and P = 0.011, respectively). These decreases remained statistically significant and slightly larger in magnitude at 6 months (P = 0.001 and P = 0.006, respectively). Postoperative epistaxis occurred in 2 of 24 (8.3%) of patients. CONCLUSION: Coblation inferior turbinate reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit persists at 6 months after the procedure.

Adolescent↗
PubMed1995

Frequency of radiopaque turbinate bones on lateral cephalometric radiographs.

The lateral cephalometric radiograph of an orthodontic patient demonstrated a large round radiopaque mass resembling an osteoma in the posterior maxillary sinus. Determination that this mass was simply a prominent inferior turbinate bone prompted this study to determine the frequency of visible turbinates on cephalometric radiographs. After calibration, one observer evaluated 479 pretreatment lateral cephalometric radiographs from an orthodontic/orthognathic surgery patient pool for radiopaque inferior turbinates. Ten percent of the films were reevaluated to assess intraexaminer reliability. The sample had a mean age of 23 years, range of 5 to 69 years, with a male/female ratio of 1:15. Visible inferior turbinates were observed on 76.8% of the radiographs. The frequency of visible turbinates was independent of gender, age, and film density. Clinicians should be aware of the frequency of this anatomic finding, so that patients are not subjected to unnecessary diagnostic tests.

Adolescent↗
PubMed2001

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.

Endoscopy↗
PubMedDate not supplied

Nasal respiratory turbinate function in birds.

Nasal respiratory turbinates are complex, epithelially lined structures in nearly all birds and mammals that act as intermittent countercurrent heat exchangers during routine lung ventilation. This study examined avian respiratory turbinate function in five large bird species (115-1,900 g) inhabiting mesic temperate climates. Evaporative water loss and oxygen consumption rates of birds breathing normally (nasopharyngeal breathing) and with nasal turbinates experimentally bypassed (oropharyngeal breathing) were measured. Water and heat loss rates were calculated from lung tidal volumes and nasal and oropharyngeal exhaled air temperatures (T(ex)). Resulting data indicate that respiratory turbinates are equally adaptive across a range of avian orders, regardless of environment, by conserving significant fractions of the daily water and heat budget. Nasal T(ex) of birds was compared to that of lizards, which lack respiratory turbinates. The comparatively high nasal T(ex) of the lizards in similar ambient conditions suggests that their relatively low metabolic rates and correspondingly reduced lung ventilation rates may have constrained selection on similar respiratory adaptations.

Adaptation, Physiological↗
PubMed2001

Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate.

OBJECTIVES: Temperature-controlled and temperature-monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment ofRFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Twenty-four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Sixteen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency. RESULTS: At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.

Acoustics↗
PubMed2002

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.

Adult↗
PubMed2003

The normal inferior turbinate: histomorphometric analysis and clinical implications.

OBJECTIVE: To study the histological and morphometric features of the normal inferior turbinate. STUDY DESIGN: A prospective, nonrandomized study. METHODS: Sixteen specimens were removed at autopsy and during septoplasty operations, stained with H&E, and investigated microscopically. The soft tissue and bony elements were measured. Morphometric analysis included measurements of the relative proportions of the soft tissue constituents. RESULTS: The medial mucosal layer is thicker than the bone and the lateral mucosa; the difference between the mucosal layers is statistically significant. The inferior turbinate is almost exclusively covered with a pseudostratified ciliated columnar epithelium that houses more goblet cells on its lateral side. It has a well-defined basement membrane zone that is significantly thicker on the medial side. The main bulk of the inferior turbinate is the lamina propria that is built of loose connective tissue and superficially harbors an inflammatory cell infiltrate. The area fraction of glands in the lateral mucosa significantly exceeds that of the medial and inferior mucosal layers, whereas that of venous sinusoids varies significantly, with the greatest difference inferiorly. Decreased proportion of glands and an increase in venous sinusoids are associated with advanced age. The cancellous central bony layer is made of interwoven trabeculae and houses the major arterial supply of the turbinate. After the major arteries exit the bone, they lie in the deepest portions of the medial and lateral mucosal layers but are missing from the inferior layer. CONCLUSION: In-depth histomorphometric analysis can assist in developing new function-preserving approaches to turbinate surgery.

Adult↗
PubMed2004

Evaluation of the inferior turbinate in patients with deviated nasal septum by using computed tomography.

OBJECTIVES/HYPOTHESIS: The objective was to measure the dimensions, composition, and possible structural and radiological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum. STUDY DESIGN: A prospective, nonrandomized clinical trial at a university medical center. METHODS: Twenty-three patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity were examined by computed tomography. RESULTS: The dimensions of the compensatory hypertrophic inferior turbinate in patients with septal deviation were compared with normal control subjects. The difference in width of the medial and lateral mucosa and the conchal bone between the two groups was statistically significant (P <.05). CONCLUSION: The present study uncovers the dimensions and composition of the inferior turbinate with compensatory hypertrophy in patients with nasal septum deviation. The findings support the decision to excise the inferior turbinate bone at the time of septoplasty, because of the significant bony and mucosal expansion.

Adult↗
PubMed2004

Surgical treatment of the inferior turbinate: new techniques.

PURPOSE OF REVIEW: Nasal obstruction causing airway resistance is often a result of structural abnormalities. Frequently, turbinate reduction procedures have been used after failure of medical management to address enlarged inferior turbinates, which potentially cause functional narrowing at the nasal valve. Controversy still exists as to the best or most appropriate method for surgical reduction of the inferior turbinate. The multitude of approaches available to the rhinologist is a testament to the lack of a single established method. RECENT FINDINGS: This paper highlights recently published literature regarding current popular and cutting-edge techniques. There is a trend toward less invasive techniques that can potentially be performed in the clinic setting, rather than in the operating room. In addition, surgical turbinate intervention demonstrates benefit in controlling symptoms of allergic rhinitis other than nasal obstruction. SUMMARY: Surgical reduction of the inferior turbinate can be performed using a variety of techniques. When analyzing different methods, emphasis on efficacy, function preservation, and avoidance of complications is paramount.

Humans↗
PubMedDate not supplied

Argon plasma surgery for treatment of inferior turbinate hypertrophy: a long-term follow-up in 157 patients.

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophic inferior turbinates. In cases of nonresponse to conservative medical management, the surgical reduction of the inferior turbinates is often required. Surgical techniques for the reduction of hyperplastic nasal turbinates include monopolar or bipolar coagulation, partial or total reduction of the turbinates with a conchotome or scissors and laser surgery with Nd:YAG, CO(2) or KTP. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngology which is based on high-frequency electrocoagulation with an argon gas source. The fast and short surgery times, the absence of hemorrhagic complications and, in rhinosurgery, the complete abstention from any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgery Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t test was used for statistical data. After 24 months, 87% (p < 0.001) of the patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. The indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery are reviewed and discussed.

Adult↗
PubMed2006

First findings concerning airflow in noses with septal deviation and compensatory turbinate hypertrophy--a model study.

BACKGROUND: The nasal septal deviation is a common cause of nasal obstruction. On the other hand, many septal deviations are asymptomatic. It seems a physiological adaptation occurs on both sides. Septal deviation leads to internal nasal asymmetry, which in turn causes compensatory change in turbinate morphology (e.g. turbinate hypertrophy respectively hypotrophy). This mechanism is investigated with the help of fluid dynamic experiments and functional rhinologic diagnostics. METHODS: Functional models of the nose (modified Mink's boxes) were used and assessment was made by acoustic rhinometry and rhinoresistometry, followed by flow dynamic investigations. Septal deviations of varying position, together with turbinates of differing grades of hypertrophy, were simulated and assessed. RESULTS AND CONCLUSIONS: We observed in models of septal deviation an increase in flow resistance on the ipsilateral side as a result of friction of flow particles in the narrowing. Furthermore, on the opposite side of the deviation, the enlargement of the stream channel did not generally lead to a reduction in flow resistance, but rather to a 'dead space', where only a slow-circling eddy was observed. This eddy causes an increase in turbulence. In vivo turbinate hypertrophy occurs to fill this dead space, thereby reducing turbulent flow without a significant increase in resistance. In cases of moderate septal deviation, compensatory mechanisms of the turbinates can lead to a normalization of nasal airflow and surgical therapy would not be indicated. Deviations in the anterior part of the septum seem to be more symptomatic, because the mechanism is missing and due to the physiological narrowing of the nasal isthmus. To differ between physiologic and pathologic deviation, functional diagnostics are needed.

Computer Simulation↗
PubMed2000

Argon plasma coagulation for inferior turbinate reduction.

Surgical reduction of the inferior turbinate remains a widely used therapy for nasal obstruction caused by hyperplastic turbinates. Current methods are costly and time-consuming, require nasal packing, and cause extended postoperative swelling. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngological surgery that is based on high-frequency electrical current. The current is transmitted through ionized argon gas (plasma) contact-free to the tissue surface and creates a coagulation and devitalization zone with limited penetration. Forty-five patients with nasal obstruction were treated under local anesthesia for reduction of the inferior turbinates with APC. Seventy-six percent of the patients reported an improvement of postoperative swelling within the first week. After 3 months, 86% reported having better nasal airflow than they had before the operation. Macroscopically, after 4 weeks the turbinate was covered by normal mucosa in 51% of the patients. Crust formation was minimal, and no bleeding occurred. Turbinate reduction with APC is an alternative technique with many advantages, and the results are comparable to those of standard techniques. Ninety-five percent of the patients were satisfied with the operation.

Argon↗