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PubMed2006

Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement.

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

Diathermy↗

PubMed1997

Middle turbinate headache syndrome.

The middle turbinate and nasal septum are innervated by the anterior ethmoidal nerve, a branch of the ophthalmic division of the trigeminal nerve. As reported in the classical work of Wolff (1948), stimulation of these regions causes pain in the medial canthus of the supraorbital region. Periorbital pain due to middle turbinate compression against the septum or the lateral wall of the nose may be due to congestion of the nasal mucosa or to pneumatization of the middle turbinate (concha bullosa). The diagnosis is made by exclusion and requires a high index of suspicion, anterior rhinoscopy, computerized tomography (CT), and confirmation by the lidocaine test. We present five cases of middle turbinate headache syndrome, all with concha bullosa. Four were treated surgically by partial middle turbinectomy and septoplasty more than 1 year ago, with excellent results. One patient refused surgical treatment which was suggested after failure of medical treatment with antihistamines, decongestants, and a topical corticosteroid, and continues to be symptomatic. Despite the small number of cases studied, the authors concluded that the procedure used was effective for the resolution of headache.

Adult↗

PubMedDate not supplied

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.

Adolescent↗

PubMed1996

[Nd:YAG laser light-induced reduction of the nasal turbinates].

BACKGROUND: Different types of laser have been used for reduction of hyperplastic inferior turbinates in the recent years with good results. Reports about the long-term benefit of the laser treatment are rare. PATIENTS AND METHODS: At the Dept. of Otorhinolaryngology, Head and Neck Surgery, University of Kiel between 1987 and 1994, 89 patients with hyperplastic inferior turbinates were treated using the Nd:YAG laser. With the Nd:YAG laser, low-dose irradiation (laser power density: 1770-3540 W/cm2, non-contact-technique) of the entire turbinate is performed under endoscopic control. RESULTS: Twenty-seven patients (67.5%) who were treated by laser surgery were without complaints 6 months postoperatively. After one and two years, this applied to 29 (72.5%) and 26 (65%) patients, respectively. The success of treatment was seen after several months. The procedure involves little or no bleeding. The mucocillary clearance of the epiturbinate is not disturbed by Nd:YAG laser treatment. CONCLUSIONS: The Nd:YAG laser is suitable for the treatment of hyperplastic inferior turbinates. The disadvantages of the Nd:YAG laser therapy are that the success of treatment becomes evident only after weeks or months due to the scarring process which takes very long, and time consuming wound care is necessary.

Adult↗

PubMed2006

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis.

CONCLUSION: Fluticasone propionate (FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. OBJECTIVE: To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. MATERIAL AND METHODS: Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray (200 microg/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. RESULTS: Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period (p < 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p < 0.05).

Administration, Intranasal↗

PubMed1989

Covalent binding of [14C]-2,6-dimethylaniline to DNA of rat liver and ethmoid turbinate.

The xylidide 2,6-dimethylaniline (2,6-DMA) has produced carcinomas and papillary adenomas in the nasal cavity of rats at high dietary doses (3000 ppm) in a 2-yr bioassay. The objective of the present study was to measure the covalent binding of 2,6-DMA to DNA of rat ethmoid turbinate tissues and, for comparison, to DNA of rat liver. The potent hepatocarcinogen 2-acetylaminofluorene (AAF) was studied as a positive control for adduct formation and covalent binding index (CBI) calculation. Both 2,6-DMA and AAF were administered as 14C-(ring)-labeled agents to naive rats and to rats pretreated for 9 d with unlabeled 2,6-DMA or AAF. The CBI value for 2,6-DMA adduct formation with ethmoid turbinate DNA was below the assay's sensitivity limit in nonpretreated rats, but increased to 41.9 in rats pretreated with unlabeled 2,6-DMA. It also increased from 0.6 in nonpretreated to 7.9 in liver of pretreated rats. The opposite pattern, however, was observed for AAF. In nonpretreated rats considerable adduct formation was observed in liver (CBI = 271.5) and modest values (CBI = 39.3) were calculated for ethmoid turbinate tissues. Pretreatment with unlabeled AAF caused a significant decrease in CBI values, to 18.3 for liver and less than 0.5 for ethmoid turbinate. The results suggest that there may be value in conducting DNA covalent binding assays in both naive animals and animals pretreated with the test article.

Aniline Compounds↗

PubMed2004

Endoscopic potassium-titanyl-phosphate laser treatment for the reduction of hypertrophic inferior nasal turbinate.

OBJECTIVE: This study investigated the efficacy of using the KTP/532 laser in endoscopic inferior turbinate reduction surgery. BACKGROUND DATA: Potasium-titanyl-phosphate (KTP/532) laser is a useful tool in endoscopic intranasal operations, due to its outstanding capabilities in hemostasis, tissue penetration, and the maneuverability of its flexible transmission optic fiber. MATERIALS AND METHODS: A total of 124 patients (male/female 73:51, mean age 38.7 +/- 12.3 years) with chronic hypertrophic rhinitis who received endoscopic KTP/532 laser inferior turbinate reduction surgery (7 Watts, continuous mode, 0.6-1-mm spots) were available for follow-up (mean follow-up period, 25.1 +/- 7.3 months). Medical records were retrospectively reviewed, and patients were interviewed with a questionnaire. RESULTS: The KTP/532 laser was excellent in relieving nose obstruction caused by inferior turbinate hypertrophy; 87% of patients reported improvement. The outcomes were less promising in reducing post-nasal drip; 12.9% reported only some improvement. Under intranasal endoscopy, the risk of postoperative bleeding and complication was low. CONCLUSION: The findings proved that, with the use of an endoscope, the KTP/532 laser appears to be an excellent alternative for treating hypertrophic inferior turbinate.

Adult↗

PubMed1979

Treatment of obstructing inferior turbinates with intranasal corticosteroids.

The most common cause of nasal obstruction is chronic enlargement of the inferior turbinate bones. The variety of medical and surgical treatments available for this condition bears testimony to their frequent ineffectiveness and the frustration of the physician or surgeon caring for these patients. Removal or destruction of the inferior turbinates has received strong criticism from rhinologists, although at present there is renewed interest in turbinectomy combined with rhinoplasty. A technique employing intranasal injections of long-acting corticosteroids has been used successfully for over twenty years in treating obstructing inferior turbinates secondary to allergic and vasomotor rhinitis. The indications, technique, and complications of this method are reviewed; the technique is presented as an alternative to destruction or resection of the inferior turbinates.

Adrenal Cortex Hormones↗

PubMed1996

Histopathology and CT analysis of partially resected middle turbinates.

Thirty-eight partial middle turbinate resections from 20 patients undergoing endoscopic sinus surgery were evaluated by histopathology of mucosa and bone and by computed tomography (CT) appearance prior to resection. Histopathologic analysis revealed not only mucosal inflammation but also chronic osteitis of the bone in all patients with sinus disease. The preoperative CT was accurate in predicting turbinate osteitis when the scans displayed advanced grades III and IV disease. These findings suggest that in advanced disease, conservative partial middle turbinate resections may be necessary to remove chronically infected bone from the osteomeatal complex. Because it is unsafe to remove all of the middle turbinate, consideration should also be given to long-term antibiotic therapy to treat the osteitis found in advanced disease.

Chronic Disease↗

PubMed1996

Endoscopic sinus surgery with partial middle turbinate resection: effects on olfaction.

Few studies have investigated the effects of endoscopic sinus surgery (ESS) on olfaction. In particular, the effect of surgical manipulation of the middle turbinate on olfaction has not been established. Using the University of Pennsylvania Smell Identification Test (UPSIT) and patient questionnaires, the authors performed a prospective study of olfaction in 64 patients undergoing ESS. Thirty-eight patients (59%) underwent partial middle turbinate resection; in the remaining 26 patients (41%), the middle turbinate was preserved. All patients were reevaluated approximately 8 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. Patients who underwent no resection had a median decrease in UPSIT score of 1.4, and those who underwent resection had a median decrease of 0.5; this difference was not statistically significant. Further, no correlation was found between changes in UPSIT score and follow-up time, sex of the patient, or the patient's subjective assessment of postoperative olfaction. It is concluded that middle turbinate resection has no effect on olfaction.

Adolescent↗

PubMed2001

Radiofrequency treatment of turbinate hypertrophy in subjects using continuous positive airway pressure: a randomized, double-blind, placebo-controlled clinical pilot trial.

OBJECTIVES: To estimate the treatment effect of temperature-controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep-disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate. STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical pilot trial. METHODS: Twenty-two CPAP-treated patients with SDB with turbinate hypertrophy were randomly assigned to either TCRF turbinate treatment (mean energy 415 +/- 37 J/turbinate; n = 17) or placebo control (n = 5). Changes in nasal obstruction were evaluated between pretreatment and 4 weeks post-treatment. The primary outcome assessed changes in the blinded examiners' findings of nasal obstruction on a visual analogue scale (VAS). Secondary outcomes included blinded patients' and unblinded examiner assessments of nasal obstruction (VAS), nightly CPAP use, adherence, and tolerance, along with sleepiness and general health status scales. The treatment group findings were subtracted from the changes in the placebo group to yield treatment effect. RESULTS: The primary outcome treatment effect by VAS was -0.9 cm (95% confidence interval [CI], -2.4, 0.7), and beyond the placebo effect of -1.5 cm (95% CI: -3.4, 0.3). The secondary treatment effect of the unblinded examiner was -3.0 cm (95% CI, -4.9, -1.1). A beneficial treatment effect was also seen on every secondary outcome except general health status, but only self-reported CPAP adherence (P = .03) was statistically significant. CONCLUSIONS: TCRF turbinate treatment appears to benefit nasal obstruction and CPAP treatment for SDB. Placebo control and double blinding are critical for establishing the true treatment effect. A future definitive trial is feasible to establish statistical significance of these findings.

Adult↗

PubMed2002

Middle turbinate lateralization: a simple treatment for rhinologic headache.

OBJECTIVE: To introduce a minimally invasive method to eliminate the symptoms of contact-point rhinologic cephalgia. STUDY DESIGN: A prospective study of 55 patients with chronic nasal or glabellar pain and endoscopically proven nasal origin. METHODS: All 55 patients in whom endoscopic examination demonstrated a contact point between the middle turbinate and the nasal septum were treated by fracturing the middle turbinate lateralward using a small metal tongue depressor under 10% lidocaine HCL topical anesthesia. RESULTS: Of the treated cohort, 48 (87%) of the patients had complete clinical symptom resolution after one treatment and all had resolution after two treatments. Recurrence occurred in 1 patient. There were no short-term or long-term adverse sequelae. The results persisted at a mean follow-up time of 50 months (range, 6-84 mo). CONCLUSION: Middle turbinate lateralization is safe and effective in eliminating the symptoms of rhinologic cephalgia induced by contact point between the middle turbinate and nasal septum.

Adult↗

PubMed2004

Impact of resection of the turbinates and the lateral nasal wall on particle deposition.

OBJECTIVES/HYPOTHESIS: The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry. STUDY DESIGN: Retrospective study. METHODS: Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed. RESULTS: Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found. CONCLUSION: Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.

Adult↗

PubMed1999

Controversies in the management of inferior turbinate hypertrophy: a comprehensive review.

Nasal obstruction must frequently be addressed during functional rhinoplasty. Even after a properly performed septorhinoplasty correcting septal deflection and/or nasal valve collapse, nasal obstruction may persist due to turbinate hypertrophy. Turbinates have many important functions, including warming and humidification of inspired air, and numerous factors can contribute to pathologic enlargement. Management of inferior turbinate hypertrophy has been actively debated for more than a century. The primary goal of therapy is to maximize the nasal airway for as extended a period as possible while minimizing complications of therapy, such as nasal drying and hemorrhage. This review describes the various medical and surgical therapeutic modalities widely used today, with emphasis placed on surgical management of the inferior turbinates. Advantages, disadvantages, complications, and controversies of each form of treatment are reviewed and discussed. A staged protocol of increasingly invasive interventions is proposed.

Humans↗

PubMed2006

Long-term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care?

OBJECTIVE: The objective of this study was to report the long-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) and to compare this with other accepted surgical treatments of inferior turbinate hypertrophy. STUDY DESIGN AND SETTING: Prospective, 2-year follow-up of 19 patients originally enrolled in a prospective, randomized, single blinded, placebo controlled trial for treatment of inferior turbinate hypertrophy with RFVTR. Patients evaluated their severity of obstruction, frequency of obstruction, and overall ability to breathe by way of a 10 cm visual analogue scale. RESULTS: RFVTR for inferior turbinate hypertrophy showed continued benefit at 2 years posttreatment, with no indication of increasing symptomatology. The benefit demonstrated in frequency of obstruction, severity of obstruction, and overall ability to breathe (P < .05) was maintained at 2 years. No complications occurred. Review of the literature shows lower short- and long-term complications for RFVTR compared with other surgical methods CONCLUSION: RFVTR is effective in treating inferior turbinate hypertrophy with sustained benefit at 2 years follow-up while resulting in fewer complications than other surgical methods. SIGNIFICANCE: RFVTR is a relatively new procedure, and therefore there are few long-term evaluations of its effectiveness; this is the first prospective study to document successful outcomes at 2 years follow-up.

Catheter Ablation↗

PubMed2006

Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates.

OBJECTIVES/HYPOTHESIS: To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates. STUDY DESIGN: Prospective, randomized, comparative surgical trial. METHODS: Nineteen patients with medication-resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively. RESULTS: Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow-up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy. CONCLUSION: Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long-term results when compared with submucosal cauterization.

Adolescent↗

PubMedDate not supplied

Pneumatization of the inferior turbinates: incidence and radiologic appearance.

OBJECTIVE: The objective of this work was to determine the incidence and radiologic appearance of pneumatized inferior turbinates (PITs). METHODS: Pneumatized inferior turbinates were investigated among 2500 consecutive cases with coronal paranasal sinus computed tomography (CT) scans that were performed for different reasons between 2000 and 2004. RESULTS: Ten new PIT cases diagnosed with CT were identified. Pneumatization was diagnosed in 2 patients aged 7 and 14 years. Therefore, this is the first time that PIT has been described in the pediatric age group. Complete or incomplete pneumatizations were unilateral in 7 cases and bilateral in 3 cases. In bilateral PIT cases, pneumatizations were asymmetric. In 2 cases, only bulbous parts of the inferior turbinates (ITs) were involved. Inferior turbinate expansion related to pneumatization was not observed in any case. In cases with maxillary sinus communication, axial CT sections revealed a defect on the medial wall of the maxillary sinus. CONCLUSIONS: The incidence of PIT was found to be 1 in 250 cases. It is suggested that most PIT cases may be a result of articulation defects between the maxillary process of the palatine bone and the maxillary bone. In such a situation, the maxillary process of the palatine bone and the nasal process of the maxillary bone, which form the medial wall of the maxillary sinus at the IT level, can attach to the IT separately.

Adolescent↗

PubMed1990

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.

Adolescent↗