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Maniaci A, Cocuzza S, Riela PM, Lechien JR, Calvo-Henriquez C, Saibene AM, Michel J, Radulesco T, Fakhry N, La Mantia I. The submucosal approach influences long-term outcomes of refractory obstructive rhinitis: A prospective study and a STROBE analysis. Am J Otolaryngol 2023; 44:103808. [PMID: 36905914 DOI: 10.1016/j.amjoto.2023.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/29/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The surgical approach to refractory hypertrophy of the inferior turbinates is the main therapeutic choice in the management of its symptoms. Although submucosal approaches have demonstrated efficacy, long-term results are debated in the literature and show variable stability. Therefore, we compared the long-term outcomes of three submucosal turbinoplasty methods with regard to the efficacy and stability managing the respiratory disorders. DESIGN Multicenter prospective controlled study. A computer-generated table was used to allocate participants to the treatment. SETTING Two teaching and university medical centers. METHODS We used the EQUATOR network for guidelines describing design, conduct, and reporting of studies and searched the references of these guidelines to identify further relevant publications reporting adequate study protocols. Patients with persistent bilateral nasal obstruction due to lower turbinate hypertrophy were prospectively recruited from our ENT units. Participants were randomly assigned to each treatment and then underwent symptom assessment by visual analog scales, endoscopic assessment at baseline and 12, 24 and 36 months after treatment. RESULTS Of the 189 patients with bilateral persistent nasal obstruction initially assessed, 105 met the study requirements; 35 were located in the MAT group, 35 in the CAT group and 35 in the RAT group. Nasal discomfort was significantly reduced after 12 months with all the methods. The MAT group presented better outcomes for all VAS scores at the 1-year follow-up, greater stability at the 3-year follow-up for VAS results (p < 0.001 in all cases) and lower disease recurrence (5/35; 14.28 %). At the 3-year follow-up intergroup analysis, a statistically significant difference was confirmed except for RAA scores (H = 2.88; p = 0.236). Rhinorrhea (r = -0.400; p < 0.001) was demonstrated as a predictive factor of 3-year recurrence, while sneezing (r = -0.25; p = 0.011), and operative time needed (r = -0.23; p = 0.016) did not reach statistical significance. CONCLUSIONS Long-term symptomatic stability varies depending on the turbinoplasty method used. MAT demonstrated greater efficacy in controlling nasal symptoms, presenting better stability in reducing turbinate size and nasal symptoms. In contrast, radiofrequency techniques presented a higher rate of disease recurrence both symptomatically and endoscopically.
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Affiliation(s)
- Antonino Maniaci
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy.
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
| | - Paolo Marco Riela
- Department of Mathematics and Informatics, University of Catania, 95123 Catania, Italy
| | - Jerome R Lechien
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Department of Otolaryngology-Head Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Christian Calvo-Henriquez
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Department of Otorhinolaryngology-Head and Neck Surgery, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), Santiago de Compostela, Galicia, Spain
| | - Alberto Maria Saibene
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Justin Michel
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Conception, APHM, 147 Boulevard Baille, 13005 Marseille, France; Aix Marseille Univ, Marseille, France
| | - Thomas Radulesco
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Conception, APHM, 147 Boulevard Baille, 13005 Marseille, France; Aix Marseille Univ, Marseille, France
| | - Nicolas Fakhry
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, 75001 Paris, France; Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Conception, APHM, 147 Boulevard Baille, 13005 Marseille, France; Aix Marseille Univ, Marseille, France
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy
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Sleurs K, Postelmans J, Smit JV. Radiofrequency Ablation for Inferior Turbinate Hypertrophy: Predictive Factors for Short and Long-Term Outcomes. Ann Otol Rhinol Laryngol 2022:34894221121407. [PMID: 36082420 DOI: 10.1177/00034894221121407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated. METHODS A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use. RESULTS Study A: There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS -1.3, P < .001), trouble exercising (VAS -1.5, P < .001), trouble sleeping (VAS -0.9, P < .001), snoring (VAS -1.1, P< .001), and hyposmia (VAS -0.6, P = .004). Smoking (R2 = .065, P = .047) was a predictor for less optimized and previous use of decongestive nasal spray (R2 = .135, P = .005) for better short-term outcome. Study B: Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS -1.5, P < .001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P = .036). Allergy (R2 = .066, P = .006), asthma (R2 = .068, P = .005), and previous use of corticosteroid nasal spray (R2 = .050, P = .016) were associated with a less optimized and older age (R2 = .217, P < .001) with better long-term outcome. CONCLUSION RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome.
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Affiliation(s)
- Kristien Sleurs
- Department of Ear, Nose, Throat, Head and Neck Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Job Postelmans
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jasper V Smit
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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Effectiveness of submucosal turbinoplasty in refractory obstructive rhinitis: a prospective comparative trial. Eur Arch Otorhinolaryngol 2022; 279:4397-4406. [DOI: 10.1007/s00405-022-07267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
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Ravichandran SP, Ramasamy K, Parida PK, Alexander A, Ganesan S, Saxena SK. Comparison of efficacy of potassium titanyl phosphate laser & diode laser in the management of inferior turbinate hypertrophy: A randomized controlled trial. Indian J Med Res 2021; 151:578-584. [PMID: 32719231 PMCID: PMC7602926 DOI: 10.4103/ijmr.ijmr_424_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives: Inferior turbinate hypertrophy (ITH) is a common condition causing nasal obstruction. This study was undertaken to compare the efficacy of potassium titanyl phosphate (KTP) laser and diode laser in the reduction of the turbinate size. Methods: This randomized controlled trial included 209 patients with ITH. Pre-operative symptoms were assessed based on the Nasal Obstruction Symptom Evaluation (NOSE) score. Diagnostic nasal endoscopy was done to rule out other nasal sinuses. Nasal mucociliary clearance was measured by saccharin transit time (STT). Postoperatively, the NOSE score, STT and complications were assessed at days one and two, at one week, one month and three months. Results: Of the 209 patients analyzed at day one, the median NOSE score was 50 in the diode group and 40 in the KTP group, and at three months, 15 in the diode group and five in the KTP group. KTP laser showed a 93 per cent improvement in the NOSE score as compared to 77 per cent improvement shown by diode laser group. Among the intra-operative complications, of the 104 patients in the diode group, 6.73 per cent had burning sensation and 91.43 per cent had bleeding, and of 105 patients in the KTP group, 54.29 per cent had burning sensation and 36.54 per cent had bleeding. Among the post-operative complications in the KTP group, 32 and 34 per cent had bloody nasal discharge on days one and two, compared to 12 and 14 per cent in diode group. Crusting was present in 61 and 49 per cent on days one and two in KTP group as compared to 9 and 15 per cent in diode group, respectively. In the KTP group 30 per cent had synechiae as compared to 10 per cent in diode group. Interpretation & conclusions: KTP laser was more efficacious than diode laser in improving the NOSE scores but with slightly increased rate of complications in early post-operative period. Both the lasers impaired the mucociliary clearance mechanism of the nose till three months of post-operative follow up.
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Affiliation(s)
| | - Karthikeyan Ramasamy
- Department of Otorhinolarngology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Pradipta Kumar Parida
- Department of Otorhinolarngology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Arun Alexander
- Department of Otorhinolarngology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Sivaraman Ganesan
- Department of Otorhinolarngology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Sunil Kumar Saxena
- Department of Otorhinolarngology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Rodrigues MM, Carvalho PHDA, Gabrielli MFR, Lopes RN, Garcia Junior OA, Pereira Filho VA, Passeri LA. How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters. Braz J Otorhinolaryngol 2020; 88:296-302. [PMID: 32782124 PMCID: PMC9422712 DOI: 10.1016/j.bjorl.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/29/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p = 0.02), NOSE instrument (p = 0.033) and inferior turbinate hypertrophy (p = 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p = 0.126) and nasal airway volume evaluation (p = 0.177) showed no significant results. Conclusion Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence 3b - Individual case-control study.
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Affiliation(s)
- Marcos Marques Rodrigues
- Universidade de Araraquara (Uniara), Faculdade de Medicina, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil
| | - Pedro Henrique de Azambuja Carvalho
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Araraquara, SP, Brazil.
| | - Mário Francisco Real Gabrielli
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Divisão de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Ricardo Nasser Lopes
- Universidade de Araraquara (Uniara), Faculdade de Medicina, Divisão de Otorrinolaringologia, Araraquara, SP, Brazil
| | | | - Valfrido Antonio Pereira Filho
- Universidade Estadual de São Paulo (UNESP), Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Divisão de Cirurgia Oral e Maxilofacial, Araraquara, SP, Brazil
| | - Luis Augusto Passeri
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, São Paulo, SP, Brasil
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