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PubMed1995

Measurement of nasal mucociliary transport rates on the isolated human inferior turbinate.

The mucociliary transport rate was measured using sequential images of graphite particles moving on 17 isolated human inferior turbinates. These had been removed from 13 patients who had normal saccharin clearance tests on the day of surgery. The initial mean mucociliary transport rate was found to be 4.1 mm/min rising to 5.0 mm/min 2 h after harvesting. After 4 h it fell to 3.7 mm/min. Where the rate was measured at two different sites on the same turbinate (n = 4), there was a close correlation over 6 h (r = 0.95, P < 0.001). When the turbinates were exposed to an aqueous solution of adrenaline (1:10,000) or a 2.5% cocaine solution, the rate increased or decreased respectively by 100% and 58% but returned to within 10% of the initial level within 2 h. We believe that the isolated inferior turbinate can be considered a useful model for the study of mucociliary clearance and agents that may influence it.

Cocaine↗
PubMed1992

Vaccine efficacy for reducing turbinate atrophy and improving growth rate in piggeries with endemic atrophic rhinitis.

Two vaccines, based on formalin-killed whole cells of toxigenic Pasteurella multocida type D and Bordetella bronchiseptica combined with a partially toxoided cell extract of P multocida, were prepared with Freund's incomplete adjuvant (vaccine 1) or by alum precipitation (vaccine 2). Each was tested for safety and efficacy in reducing the severity of nasal turbinate atrophy and improving the growth rate of pigs in three Western Australian commercial piggeries with endemic atrophic rhinitis. In safety experiments with vaccine 1, no adverse clinical effects were observed in vaccinated sows or their progeny. Piglets receiving vaccine 2 showed no injection site abnormalities, pyrexia or turbinate atrophy. In field trials, vaccine 1 significantly reduced the prevalence of moderate to severe nasal turbinate atrophy (Done score 3 to 5) when used in two piggeries (A and B). Progeny from vaccinated sows in piggery B also grew significantly faster than controls. When vaccine 2 was used in piggery A at a later date and in another piggery (C), growth rate was not improved in either piggery and the prevalence of moderate to severe turbinate atrophy was reduced only in piggery C.

Adjuvants, Immunologic↗
PubMed2000

Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection.

The aim of endonasal sinus surgery is to ameliorate sinonasal symptoms and to achieve a functional nose. Although the importance of opening the ostiomeatal complex is accepted, the role of middle turbinate surgery remains controversial. Although some surgeons emphasize the importance of maintaining the middle turbinate as a physiological humidifier and anatomic landmark, others resect it without adverse sequelae. To date, there have only been limited reviews published to support either approach. This paper examines 1,106 matched patients who underwent similar functional endonasal sinus surgery with (509 patients) or without (597 patients) middle turbinate surgery. We demonstrate a paucity of complications and the potential outcome benefits of judicious partial middle turbinate resection in some patients with more severe rhinosinusitis.

Adolescent↗
PubMedDate not supplied

Surgery of the inferior nasal turbinates.

The inferior turbinates are responsible for nasal obstruction more often than commonly thought. When there is no other obvious cause or nasal obstruction, and when allergic disorder or other medical condition is not responsible, attention should be given to treatment of the inferior turbinates in many instances of nasal obstruction. Such treatment is usually surgical and may consist of submucous resection of the turbinate bone or excision of redundant hyperplastic turbinate tissue, or a combination of the two. Other treatments consist of electrocautery or cryotherapy. Injection of corticosteroids have produced blindness through embolism and, in general, this treatment is discouraged. The paper discusses in some detail which patients are best suited for submucous resection and which for excision of soft tissue. Techniques, which are simple, are also described.

Airway Obstruction↗
PubMed1991

The potassium--titanyl phosphate laser for treatment of turbinate dysfunction.

Patients with nasal turbinate dysfunction most often are seen by the physician with such symptoms as watery nasal secretions, nasal obstruction, congestion, facial pressure, or pain. There will often have been multiple attempts to manage the problem medically and symptomatically with antihistamines, decongestants, antibiotics, nasal cromolyn, and topical or systemic steroid therapy. Some patients will have undergone numerous attempts at surgical therapy, most often with cryosurgery or cauterization. The cause of the symptoms of turbinate dysfunction for most of these patients is either vasomotor rhinitis, allergic rhinitis, or polypoid hypertrophic turbinates. A visible-wavelength laser with a wavelength of 532 nm, the potassium-titanyl phosphate laser has been used with nasal endoscopes to perform laser photocoagulation of the nasal turbinates. A description of the technique and early results have been previously reported. This article reports good long-term results with the technique.

Endoscopy↗
PubMed1985

The pathogenesis of persistent turbinate atrophy induced by toxigenic Pasteurella multocida in pigs.

Six one-week-old piglets were pretreated with a 1% acetic acid solution for two days in one or both nostrils. Three piglets were not treated with acetic acid. Three days after treatment all nine piglets were inoculated in both nostrils with a toxigenic type D strain of Pasteurella multocida. Three piglets were killed seven days after inoculation; one died spontaneously 13 days after inoculation and the remaining pigs were killed at approximately 90 kg body weight, i.e., five to six months of age. All acetic acid-treated animals developed severe atrophy of the turbinates in the treated nostrils. Untreated nostrils were normal. The present results showed that toxigenic P. multocida can induce turbinate atrophy that persisted until 90 kg body weight when the lesions were similar to spontaneous atrophic rhinitis in pigs. The turbinate atrophy was not accompanied by inflammatory reaction, atrophy of other bone structures, or lesions in other organs. The experiment showed furthermore that toxigenic P. multocida may be present in the tonsils of control animals without causing turbinate atrophy. A pathogenesis for atrophic rhinitis in pigs is proposed.

Acetates↗
PubMedDate not supplied

Inferior turbinate fracture and congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children. METHODS: In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention. RESULTS: In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4). CONCLUSIONS: Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.

Case-Control Studies↗
PubMed2007

Pneumatized superior turbinate as a cause of headache.

BACKGROUND: A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis. CASE PRESENTATION: We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained. CONCLUSION: Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.

Adult↗
PubMed2005

Inferior turbinate arterial supply: histologic analysis and clinical implications.

OBJECTIVE: To study the arterial architecture of the normal inferior turbinate. DESIGN: A prospective, nonrandomized, histologic study. MAIN OUTCOME MEASURES: Fourteen samples were removed at autopsy and during septoplasty operations, processed in the usual manner, stained with hematoxylin-eosin, and investigated microscopically. The analysis included data on the number, location within or outside the bone, the mean area, wall thickness, and distance the arteries traverse from the point of entrance into the bone to the point of exit into the soft tissue. RESULTS: One to three arteries enter the inferior turbinate posteriorly. In 7 of 14 inferior turbinates (50%), the arteries lie within the bone and in 2 (14%) within the soft tissue, and in 5 (36%), a mixed pattern was observed. The arteries run along a mean of 1.2 +/- 0.49 cm before piercing the bone into the soft tissue and split off to one to six branches. The mean area and the mean wall thickness of the arteries at the entrance into the bone posteriorly were significantly greater than that of the arteries emerging from the bone and entering the soft tissue anteriorly (0.099 +/- 0.056 mm2 vs 0.051 +/- 0.022 mm2 [p < .01] and 0.116 +/- 0.042 mm vs 0.083 +/- 0.031 mm [p < .05], respectively). The inferior mucosal layer lacks major arteries. CONCLUSION: Given the data presented here, the excision of the inferior mucosal layer and the anterior portion of the inferior turbinate bone distal to the point of arterial exit constitute a relatively low risk for postoperative arterial bleeding.

Adult↗
PubMedDate not supplied

Subjective comparison of Nd:YAG, diode, and CO2 lasers for endoscopically guided inferior turbinate reduction surgery.

Lasers using different wavelengths and delivery systems have been used to reduce the inferior turbinate mass when hypertrophic inferior turbinates obstruct the nasal airway. Different laser systems produce different laser-tissue interactions. This study presents a comparison between three laser systems: CO2, Nd:YAG, and Diode lasers for inferior turbinate reduction surgery, all performed under endoscopic control. A total of 46 patients were randomized into three treatment groups and followed for more than 1 year. Subjective and objective data were collected. Subjective impressions of improved nasal airway was achieved in 41% (Diode), 47% (Nd:YAG) and 57% (CO2) and was not statistically significant. There was more postoperative bleeding in the CO2 laser group, with 3 patients requiring tamponade. The CO2 laser procedure also took longer to perform. These results failed to show a significant difference between the different lasers for inferior turbinate reduction. Overall, the results were not impressive.

Adult↗
PubMedDate not supplied

Parameters for argon laser surgery of the lower human turbinates. In vitro experiments.

On 8 human lower turbinates in vitro, experiments were performed using an argon laser with a power of 1-10 W, a beam diameter of 0.2 and 2 mm. For clinical laser surgery of the turbinates 1-2 W is sufficient. Drilling, incision, coagulation and vaporizing experiments, were done on the tissue of the lower turbinates. The results of this laser surgery are discussed and compared with present-day surgical methods such as conchotomy, cutting of the posterior ends by slinging, and electrocautery of the lower turbinates.

Aged↗
PubMed2000

Conventional versus endoscopic inferior turbinate reduction: technique and results.

Different modalities of turbinate reduction procedures are available for treatment of vasomotor rhinitis not responding to appropriate medical therapy. Amongst these, conventional inferior turbinectomy (non-endoscopic) is the most widely performed procedure. With the advent of nasal endoscopes, inferior turbinoplasty has been gaining popularity worldwide. The purpose of this study was to compare the post-operative complaints and hospital stay of conventional versus endoscopic inferior turbinate reduction techniques performed non-randomly on 15 and 21 patients of vasomotor rhinitis respectively from January 1998 to December 1999 at Hospital Universiti Kebangsaan Malaysia (HUKM). A total of 36 patients (22 males and 14 females) with a mean age of 30.6 years underwent turbinate reduction procedures during this period with a post-operative follow up ranging from 3 months to 6.7 months (mean 3.8 months). There was a significant difference between the conventional and the endoscopic technique with regards to nasal discomfort (p = 0.05) and dry throat (p = 0.02) which was less severe when performed endoscopically. The average hospital stay in hours by the endoscopic technique was almost half compared to the conventional technique. Due to the improved visualisation and minimal post-operative complaints and reduced hospital stay, the technique of endoscopic inferior turbinoplasty is currently the procedure of choice at our center. In septoplasty when endoscopic instrument is not needed, the standard turbinate reduction procedure is still performed. The availability of pre and post-operative acoustic rhinomanometric evaluation will be helpful as an objective measurement of nasal symptoms in the near future.

Adolescent↗
PubMedDate not supplied

An immunohistological study of the localization characteristics of thymus and activation-regulated chemokine in the allergic inferior turbinate mucosa with reference to the effectiveness of trichloroacetic acid treatment.

To investigate the background of the effectiveness of trichloroacetic acid (TCA) treatment, we examined the localization of thymus and activation-regulated chemokine (TARC) on allergic inferior turbinate mucosa using immunohistological methods. After obtaining informed consent, only one side of the inferior turbinate was treated with 80% (wt/vol) TCA solution under topical anesthesia using 4% lidocaine with epinephrine in 19 cases of allergic rhinitis. Among those, 17 cases did not show clinical improvement and underwent nasal septal reconstruction surgery and turbinectomy. Bilateral inferior turbinate specimens were obtained. The untreated turbinate specimens showed positive TARC findings. The positive findings were confirmed in the outer side of cytoplasm in the stratified ciliated columnar epithelium but not in the goblet cell. In the lamina propria, the glandular tissue and afew of the infiltrated lymphocytes just beneath the epithelium up to the depth of 120 microm were found TARC-positive (TARC+). The average number of positive cells in one microscopic visual field using 100x magnification was 3.97 +/- 4.04. On the other hand, the epithelium of the TCA-treated side showed positive findings only in two cases. The TCA-treated side also showed a relative decrease in infiltrated cells. Even in areas where there still were infiltrated cells, they were confirmed to be TARC-negative (TARC-) after TCA treatment. It is considered that the regenerated epithelium after TCA treatment originates from the glandular epithelium with negative TARC expression existing in the area deeper than a 120-microm level and that this immunohistological change would lead to the effectiveness of TCA treatment.

Adult↗
PubMed2003

Cauterization of inferior nasal turbinate for idiopathic headache.

OBJECTIVE: Idiopathic headache is a stressful complaint, whose treatment is not well established. Our study is an attempt to examine the relationship between idiopathic headache and inferior turbinate cauterization as a surgical treatment, and to explain the central physiological effect of cauterization. METHODS: Thirty-four patients, 15 females and 19 males complaining of idiopathic headache were treated by inferior turbinate cauterization. Cauterization of the inferior-medial aspect of the turbinate was carried out once under local anesthesia for few seconds. This study was performed between November 1993 and December 1996, a joint project of the Zarka Government Hospital, Zarka and Faculty of Medicine, University of Jordan, Amman, Jordan. RESULTS: More than 82% of the patients showed significant improvement in the sense of decreased headache. CONCLUSION: Cautery of the nasal turbinate could be a novel method for treatment of idiopathic headache.

Adult↗
PubMed2003

[Radiofrequency ablation for treatment of nasal obstruction secondary to inferior turbinate hypertrophy].

OBJECTIVE: To assess the efficacy of bipolar radiofrequency ablation on inferior turbinate in patients with nasal obstruction caused by inferior turbinate hypertrophy. METHOD: Eighteen patients enrolled in the study and bipolar radiofrequency ablation was delivered to inferior turbinate. The preoperative and postoperative nasal obstruction were investigated by visual analogue scale (VAS). RESULT: All patients were improved in 3 months. Mean obstruction(VAS) improved from 70.5% +/- 10.5% to 53.3% +/- 11.6% (right side), and from 67.7% +/- 9.4% to 45.0% +/- 9.2% (left side). CONCLUSION: The use of radiofrequency for submucosal tissue ablation in the hypertrophied inferior turbinate is an effective modality for reducing symptoms of nasal obstruction.

Adult↗
PubMed2003

High frequency surgery in the treatment of turbinate hypertrophy: 11 years' experience.

For over a century, surgical management of lower turbinate hypertrophy has given rise to much discussion. Aim of the present investigation was to establish, by means of the analysis of a large patient population, the efficacy and reproducibility of high frequency surgery in the treatment of this condition. A total of 1689 non-allergic patients with nasal obstruction, presenting hypertrophy of the lower turbinates, were submitted, under local anaesthesia, to turbinates decongestion using a high frequency instrumental unit with a bipolar terminal electrode. Efficacy of the procedure was evaluated on the basis of objective examination, results of questionnaires, active anterior rhinomanometry and mucociliar transport time. Results revealed a reduction of hypertrophy, an improvement in symptoms, a reduction in nasal resistances and an improvement of mucociliar transport time. The large patient population, low post-operative complication rate and the good patient compliance, due also to the fact that no haemostatic procedure is necessary, would suggest that this method is particularly valid, effective and safe for the treatment of hypertrophy of the lower turbinates.

Adolescent↗
PubMed2004

[To repair perforation of nasal septum with free mucosa of inferior turbinate].

OBJECTIVE: To study a new treatment to repair perforation of nasal septum with free mucosa of inferior turbinate between two sides of mucosa of nasal septum. METHOD: The mucosa around perforation of nasal septum was separated by means of submucous correction of nasal septum, and some mucosa of inferior turbinate was cut down, then the mucosa bag of nasal septum and the free mucosa of inferior turbinate were sutured and the perforation could be covered completely. RESULT: The perforations of nasal septums in 21 patients were closed satisfactorily. Perforation of nasal septum did not recur and the follow-up time ranged from 3 months to half a year. CONCLUSION: The free mucosa of inferior turbinate is easy to be got and survive. What's more, it can be used to repair a big perforation of nasal septum. Our method is easy to be performed and the free mucosa can be fixed tightly.

Adolescent↗
PubMedDate not supplied

Clinical outcomes of septoplasty and inferior turbinate reduction in the geriatric veterans' population.

BACKGROUND: Patients older than 65 years constitute an increasingly large percentage of the patient population that presents to an adult otolaryngology practice due to the increase in life expectancy. The objective of this study is to assess the clinical outcomes of septoplasty with or without inferior turbinate reduction in patients who are 65 years or older. METHODS: This is a prospective nonrandomized longitudinal study of 40 patients aged 65 years or more and who underwent septoplasty with or without inferior turbinate reduction. Patients received Nasal Health Survey (NHS) and General Health Status Short Form (SF-12) questionnaires before and 6 months after surgery. Statistical analysis was performed using the paired t-test. RESULTS: The preoperative NHS score was 52.3, while the postoperative score was 76.6 (p < 0.001). The reported benefit reflected improvement in symptoms (p < 0.001) and reduction in medication usage (p < 0.001). In addition, the SF-12 score improved after the surgery but the difference did not reach statistical significance (p = 0.055). CONCLUSION AND SIGNIFICANCE: Septoplasty and inferior turbinate reduction is beneficial in the veterans' population for patients 65 years or older who present with nasal obstruction and are noted on physical examination to have septal deviation and inferior turbinate hypertrophy.

Aged↗