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Liu DH, Chen H, Wong BJF. Anatomy and Physiology of the Nasal Valves. Otolaryngol Clin North Am 2024:S0030-6665(24)00161-0. [PMID: 39426874 DOI: 10.1016/j.otc.2024.09.001] [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: 10/21/2024]
Abstract
The nasal valves are not simple, 2-dimensional cross-sections but rather a complex, 3-dimensional, collapsible, and heterogeneous structure. Historically, the internal nasal valve (INV) is defined by the septum medially, the caudal margin of the upper lateral cartilage laterally, and the inferior turbinate inferiorly. Typically located 1.3 cm deep into the nasal cavity, the INV angle delineated by the upper lateral cartilage and septum typically measures 10° to 15° in the Caucasian population. As computational methods reveal new insights into nasal valve function, a new conceptual framework is needed to guide rhinoplasty surgical decision-making.
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Affiliation(s)
- Derek H Liu
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, 101 The City Drive South, ZOT 5386, Orange, CA 92868, USA
| | - Hailey Chen
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, 101 The City Drive South, ZOT 5386, Orange, CA 92868, USA
| | - Brian J-F Wong
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, 101 The City Drive South, ZOT 5386, Orange, CA 92868, USA; Beckman Laser Institute, University of California Irvine, Irvine, CA, USA; Department of Biomedical Engineering, Samueli School of Engineering, University of California Irvine, Irvine, CA, USA; Facial Plastic Surgery.
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Davis GE, Ow RA, Yen DM, O'Malley EM, Del Signore AG. Clinical Outcomes After Innovative Multipoint Impedance-Controlled Radiofrequency Ablation of the Posterior Nasal Nerve for Treatment of Chronic Rhinitis. EAR, NOSE & THROAT JOURNAL 2024:1455613241285134. [PMID: 39315465 DOI: 10.1177/01455613241285134] [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: 09/25/2024] Open
Abstract
Objective: Chronic rhinitis substantially impacts a person's quality of life. We evaluated a novel, multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Methods: This was a prospective, multicenter, single-arm clinical study of posterior nasal nerve ablation in adults with chronic rhinitis. The primary efficacy endpoint was the change in reflective Total Nasal Symptom Score (rTNSS) at 6-month follow-up. Additional assessments included the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), Nasal Obstruction Symptom Evaluation (NOSE), and mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ). The primary safety endpoint was the incidence of related serious adverse events. Results: Seventy-nine of 80 enrolled participants completed 6-month follow-up. Statistically significant improvements were observed for mean change in rTNSS (-4.2), ETDQ-7 (-1.2), NOSE (-33.5), and mini-RQLQ (-1.8; P < .0001 for all). Allergic and nonallergic rhinitis subgroups demonstrated significant improvement in all assessments (P < .0001) with no significant differences between subgroups. Higher baseline rTNSS was associated with greater improvements at follow-up. One serious adverse event of epistaxis was reported. Conclusions: The results of this study demonstrate the efficacy and safety of a multipoint, impedance-controlled, radiofrequency ablation device for the treatment of chronic rhinitis. Significant improvements were observed in rTNSS, ETDQ-7, NOSE, and mini-RQLQ assessments.Study registration: www.clinicaltrials.gov. Unique identifier NCT05591989.
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Affiliation(s)
- Greg E Davis
- Proliance Surgeons, Seattle and Puyallup, WA, USA
| | - Randall A Ow
- Sacramento Ear, Nose, and Throat, Roseville, CA, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, PA, USA
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Takashima M, Stolovitzky JP, Ow RA, Silvers SL, McDuffie CM, Dean M, Sedaghat AR, Tajudeen BA. Temperature-controlled radiofrequency ablation for the treatment of chronic rhinitis: Two-year outcomes from a prospective multicenter trial. Int Forum Allergy Rhinol 2024; 14:1182-1194. [PMID: 38266636 DOI: 10.1002/alr.23315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Minimally invasive temperature-controlled radiofrequency (TCRF) ablation of the posterior nasal nerve (PNN) demonstrated a significant larger treatment effect on the symptom burden of chronic rhinitis patients than a sham control (no energy delivery) at the 3-month primary endpoint of this trial. METHODS Two-year posttreatment outcomes for patients treated in a prospective, multicenter, patient-blinded randomized controlled trial were determined by combining the index active treatment-arm and index control-arm crossover patients into a single group (after the primary endpoint) to evaluate the treatment effect durability and long-term effects on concomitant chronic rhinitis medication usage. RESULTS The mean baseline reflective total nasal symptom score (rTNSS) was 8.2 (95% confidence interval [CI], 7.9-8.6; N = 104). At 2 years (N = 79), the mean change in rTNSS was -5.3 (95% CI, -5.8 to -4.8; p < 0.001; 64.6% improvement). The 2-year responder rate (≥30% improvement in rTNSS) was 87.3% (95% CI, 78.0-93.8). All four components of the rTNSS (rhinorrhea, congestion, sneezing, and nasal itching) showed significant improvement over baseline, with rhinorrhea and congestion showing the most improvement. Postnasal drip and cough symptoms were also significantly improved. At 2 years, 81.0% (95% CI, 70.6-89.0) reported a minimal clinically important difference of ≥0.4-point improvement in the mini-rhinoconjunctivitis quality of life questionnaire score. Of 56 patients using chronic rhinitis medications at baseline, 25 of 56 (44.6%) either stopped all medication use (7/56 [12.5%]) or stopped/decreased (18/56 [32.1%]) use of ≥1 medication class at 2 years. No serious adverse events related to the device/procedure were reported over 2 years. To determine the potential effect of patients who left the trial over 2 years on the responder rate, the responder statuses of the 14 patients with follow-up data who were lost to follow-up/withdrew/died were imputed by the last observation carried forward and the responder statuses of all nine patients who had an additional nasal procedure were imputed to nonresponder, resulting in a 2-year responder rate of 79.4% (95% CI, 70.3-86.8). CONCLUSION TCRF ablation of the PNN is safe and resulted in a significant and sustained reduction in chronic rhinitis symptom burden through 2 years and a substantial reduction in concomitant medication burden.
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Affiliation(s)
- Masayoshi Takashima
- The Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - J Pablo Stolovitzky
- The Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California, USA
| | | | - Chad M McDuffie
- Ear, Nose, and Throat Associates of Texas, McKinney, Texas, USA
| | - Marc Dean
- Ear & Sinus Institute, Fort Worth, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech Health Science Center, Lubbock, Texas, USA
- Otorhinologic Research Institute, Dallas, Texas, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Dhanda AK, Gorelik D, Khan N, Takashima M, Bishara P, McCoul ED, Jafari A, Ahmed OG. Posterior Nasal Nerve Ablation as a Viable Treatment Option for the Primary Symptom of Postnasal Drip. Am J Rhinol Allergy 2024; 38:245-250. [PMID: 38632938 DOI: 10.1177/19458924241247107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Postnasal drip (PND) syndrome is a prevalent complaint encountered in otolaryngology practices. PND may be refractory to medical therapy, and surgical treatments are complicated by side effects. OBJECTIVE While posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis overall, we sought to examine the effect of PNN ablation for patients with PND as their primary complaint. METHODS This is a retrospective case series study of 40 chronic rhinitis (CR) patients with a primary complaint of PND. Included patients had to have failed medical therapy such as anti-cholinergic nasal sprays, reflux treatments, and/or nasal steroids. Primary outcome measures included 22 item Sino-Nasal Outcome Test (SNOT-22) PND component and Total Nasal Symptom Score. Secondary outcome measure was subjective improvement, defined as a > 30% improvement in PND symptoms. RESULTS Median follow-up was 138 days (interquartile range: 72-193). 72.5% (29/40) of patients reported at least a 30% improvement in PND symptoms. Mean PND SNOT-22 scores were 4.2/5 (SD = 0.8) pre-procedure versus 1.9/5 (SD = 1.3) post-procedure (P = .001). PNN ablation response did not correlate to ipratropium bromide nasal spray response, although younger and non-smoker patients had better response rates. CONCLUSION This exploratory study of PNN ablation for the primary symptom of PND demonstrates efficacy as assessed by the PND component of SNOT-22 and subjective improvement. These results can be useful in guiding physician-patient discussions in determining treatment options for medically refractory PND.
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Affiliation(s)
- Aatin K Dhanda
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Daniel Gorelik
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Najm Khan
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Masayoshi Takashima
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Patrick Bishara
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Edward D McCoul
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, Louisiana
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington
| | - Omar G Ahmed
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas
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Reh DD, Lay K, Davis G, Dubin MG, Yen DM, O'Malley EM, Sillers M. Long-term outcomes following impedance-controlled radiofrequency ablation for the treatment of chronic rhinitis. Laryngoscope Investig Otolaryngol 2024; 9:e1286. [PMID: 38835333 PMCID: PMC11149760 DOI: 10.1002/lio2.1286] [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: 02/22/2024] [Revised: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
Objective To assess long-term safety and effectiveness of a multipoint, impedance-controlled, RF ablation device for treatment of chronic rhinitis through 12-month follow-up. Methods A prospective, multicenter study. Bilateral posterior nasal nerve (PNN) ablation was performed on all participants. Assessments at 6-, 9-, and 12-month visits included Visual Analog Scale Nasal Symptom Score (VAS NSS), reflective Total Nasal Symptom Score (rTNSS), mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini RQLQ), and adverse events. Results Thirty-six participants were enrolled and 35 completed the 12-month follow-up. All 5 VAS NSS items demonstrated statistically significant improvement (p < .0001) over baseline at all 3 time points. The total rTNSS improved from 7.9 ± 1.8 at baseline to 4.3 ± 2.1 at 6-months, 3.8 ± 2.4 at 9-months, and 4.0 ± 2.1 at 12-months (all p < .0001). At 12-months, 91% (31/35) of participants had achieved the minimum clinically important difference (MCID) of a reduction from baseline of ≥1 point and 80% (28/35) of the participants met the responder criteria of ≥30% reduction from baseline. The total mean mini RQLQ was reduced from 3.0 ± 1.0 at baseline to 1.4 ± 0.8 at 6-months, 1.4 ± 1.0 at 9-months, and 1.3 ± 0.8 at 12-months (all p < .0001). At 12-months, 86% (30/35) of participants achieved the MCID of a reduction from baseline of ≥0.4 points for the mini RQLQ. No related serious adverse events occurred during the study. Conclusions Impedance-controlled RF ablation of the PNN is safe and resulted in durable, significant improvement in rhinitis symptoms and quality of life through 12-month follow-up. Trial Registration The study is registered at www.clinicaltrials.gov with the unique identifier of NCT05324397. Level of Evidence 4.
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Affiliation(s)
- Douglas D Reh
- Centers for Advanced ENT Care Baltimore Maryland USA
| | | | - Greg Davis
- ENT and Allergy Associates Seattle and Puyallup Washington USA
| | - Marc G Dubin
- Centers for Advanced ENT Care Baltimore Maryland USA
| | - David M Yen
- Specialty Physician Associates Bethlehem Pennsylvania USA
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