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Al-Hilali AMS, Khalaf AQ, Yaseen ET. The Effectiveness of High-Intensity Focused Ultrasound in Treating Nasal Obstruction Caused by Inferior Turbinate Hypertrophy: A Clinical Study. Cureus 2024; 16:e58348. [PMID: 38756284 PMCID: PMC11096638 DOI: 10.7759/cureus.58348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background Nasal obstruction due to inferior turbinate hypertrophy is a common medical complaint among ENT clinic patients, which can significantly affect the patient's quality of life, and some are compelled to use topical intranasal decongestants. Conservative management is the first line of treatment; however, surgical reduction of the inferior turbinate becomes necessary if the symptoms persist after three months of treatment. The optimal surgical technique is controversial. High-intensity focused ultrasound (HIFU) is a minimally invasive surgical option that targets tissue volume precisely and minimally impacts surrounding tissue. This study aimed to assess the effectiveness and safety of HIFU in treating patients suffering from nasal obstruction due to inferior turbinate hypertrophy. Methods This prospective study was conducted from February to December 2016. The study lasted over six months. Patients with a history of allergic and non-allergic rhinitis participated in this study. It included 43 patients who had been experiencing chronic nasal obstruction due to bilateral inferior turbinate hypertrophy and had not shown improvement after three months of medical treatment. The patients underwent Ultrasound Volumetric Tissue Reduction (UVTR) surgery using the D & A Ultrasurg device (Diamant Medical Equipment Ltd., Amman, Jordan) under local anesthesia. The effectiveness, safety, and tolerance of HIFU were assessed subjectively for six months using a well-designed questionnaire utilizing a visual analog scale (VAS) and nasal endoscopy after the surgery. Results The study included 43 patients, 22 male and 21 female, aged 13 to 65 years. The study found that 40 (93%) patients showed significant improvement in nasal obstruction within a month of the surgery. However, three (7%) patients continued to experience persistent nasal obstruction even after six months of follow-up. The procedure was well-tolerated, with low rates of complications after surgery and reasonable pain control. During the surgery, 20 (46.5%) patients reported mild pain described as a pressure-like sensation, and 10 out of 43 patients (23%) required paracetamol after the procedure. Four patients (9.3%) had mild bleeding, which was treated with an ultrasound nasal probe without nasal packing. All patients experienced crusting of the nasal cavity during the first week, but no crustation was observed after the first month. There were no reported cases of synechia among the patients. Conclusion This study confirms that HIFU treatment is a reliable and effective treatment for improving short-term nasal obstruction caused by inferior turbinate hypertrophy. The procedure is easily applied and well-tolerated in outpatient clinics.
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Affiliation(s)
- Ali Muhssin Shnain Al-Hilali
- Department of Head and Neck Surgery - Otolaryngology, Southwest Jutland Hospital, Esbjerg, DNK
- Department of Head and Neck Surgery - Otolaryngology, Al-Yarmouk Teaching Hospital, Baghdad, IRQ
| | - Adnan Qahtan Khalaf
- Department of Head and Neck Surgery - Otolaryngology, Al-Yarmouk Teaching Hospital, Baghdad, IRQ
| | - Ehab T Yaseen
- Department of Head and Neck Surgery - Otolaryngology, Al-Yarmouk Teaching Hospital, College of Medicine, Mustansiriyah University, Baghdad, IRQ
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Muacevic A, Adler JR, Cazzaniga J, Bhandarkar ND. Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease. Cureus 2023; 15:e34280. [PMID: 36855496 PMCID: PMC9968500 DOI: 10.7759/cureus.34280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.
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Muacevic A, Adler JR, Ntarladima V, Catalli B, Kosmidou A, Filippou D, Georgalas C. Inferior Turbinate Hypertrophy: A Comparison of Surgical Techniques. Cureus 2022; 14:e32579. [PMID: 36654608 PMCID: PMC9840750 DOI: 10.7759/cureus.32579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Nasal obstruction is one of the most frequently reported symptoms in clinical practice. The second most common cause of nasal obstruction is inferior turbinate hypertrophy, a nasal pathology for which surgical treatment is often required. This study aims to determine the most effective surgical method in patients with inferior turbinate hypertrophy (ITH). Materials and methods The study was performed from September 2018 to October 2019 in the Otolaryngology-Head and Neck Surgery Department of the Evangelismos Hospital of Athens. The study population comprised 205 patients that underwent surgery and were monitored in the hospital. Radiofrequency ablation (RFA) was the method used in 73 patients, 68 patients were treated with the microdebrider-assisted turbinoplasty (MAT), and the remaining 64 patients were operated on using electrocautery (EC). Following surgery, postoperative complications were assessed and quantified. Results Overall, 205 patients underwent surgery. The first group (n=73) was operated on using radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, consisting of 16 patients with bleeding and six with postnasal drip. The second group (n=68) was treated using the microdebrider method. The complication rate was 26.5%, where 50 patients did not present with any symptoms post-operatively and 18 exhibited symptoms. Specifically, postnasal drip was more prevalent with this method as all 18 patients showed postnasal drip as their complication. The third group (n=64) was treated with electrocautery. Patients in this group had the most complications (n=24), 16 were attributed to postnasal drip and eight to infections, treated promptly with oral antibiotics. The complication rate using this method was 37.5%. Conclusion In our study, the microdebrider-assisted turbinoplasty offered the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods managed to alleviate the nasal obstruction and treat inferior turbinate hypertrophy. More research is needed as a lack of consensus remains regarding the optimal surgical technique for lower turbinate hypertrophy.
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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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Zagólski OM, Gorzędowski P, Stręk P. [Results of inferior nasal turbinate reduction in old and very old patients with chronic rhinitis]. Laryngorhinootologie 2021; 100:460-466. [PMID: 32823369 DOI: 10.1055/a-1226-6960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Symptoms of chronic rhinitis in old and very old populations may result from isolated hyperplasia of nasal inferior turbinates. Turbinoplasty is a possible method of treatment in these individuals. However, preoperative concerns are associated with their poor general condition: tendency to epistaxis, treatment with anticoagulants, hypertension, and less effective healing. OBJECTIVE The aim of this study was to determine differences in results of turbinoplasty obtained in old and very old individuals with chronic rhinitis, compared to young and otherwise healthy patients. MATERIAL AND METHODS We analyzed records of 130 patients with hyperplasia of the inferior turbinates, who had undergone bipolar diathermy turbinoplasty: 82 individuals aged 18-59 (mean = 33.8; SD = 10.2), 30 patients aged 60-74 (mean = 66.0; SD = 3.7) and 18 participants aged 75 + years (mean = 85.3; SD = 6.5). The patients were questioned about the intensity of their symptoms before and one month after the surgery, using the SNOT-20 questionnaire. The duration of wound healing and satisfaction scores were also noted. RESULTS Nasal patency, nasal discharge and post-nasal drip improved in old and very old patients, similarly as in the young ones. Olfactory and taste function improved significantly more in young individuals. Postoperative healing time was significantly longer in very old patients. CONCLUSIONS Some results of turbinoplasty in old and very old patients were significantly worse than in young ones.
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Affiliation(s)
- Olaf M Zagólski
- Otorhinolaryngology, St. John Grande's Hospital, Kraków, Poland
| | | | - Paweł Stręk
- Abteilung für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik der Jagiellonen-Universität, Kraków, Poland
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Pecorari G, Riva G, Bartoli C, Ravera M, Dell'Era V, Barbero E, Aluffi Valletti P, Garzaro M. Nasal Cytology in Radiofrequency Turbinate Volume Reduction. ORL J Otorhinolaryngol Relat Spec 2021; 83:252-257. [PMID: 33677457 DOI: 10.1159/000513629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radiofrequency turbinate volume reduction (RFTVR) is an effective treatment of inferior turbinate hypertrophy. RFTVR can reduce epithelial cell alterations in nasal mucosa. The aim of this observational study was to evaluate the effects of RFTVR on nasal obstruction and cytology, stratifying for different types of rhinitis. METHODS Nasal cytology and subjective nasal obstruction were evaluated on 113 patients before RFTVR (T0) and after 3 months (T1). The patients were divided into groups on the basis of the underlying disease: allergic rhinitis, nonallergic rhinitis, rhinitis medicamentosa, and other diseases (e.g., hormonal-based turbinate hypertrophy). RESULTS Nasal cytology at T0 identified 42 patients with allergic rhinitis, 40 with nonallergic rhinitis, 19 with rhinitis medicamentosa, and 12 with other diseases. An improvement of nasal cytology at T1 was observed in 29.2% of cases. They mainly consisted of patients with nonallergic rhinitis with neutrophils, whose neutrophil infiltrate decreased. Only 2 cases (1.7%) showed a worsening of nasal cytology at T1. A statistically significant decrease in subjective nasal obstruction was observed for every group (p < 0.05). Higher differences of nasal obstruction between T0 and T1 were found in patients with rhinitis medicamentosa or other diseases. CONCLUSION RFTVR represents a safe and effective treatment for turbinate hypertrophy of various etiology. It is not responsible for a worsening of inflammatory infiltrate of the nasal mucosa.
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Affiliation(s)
- Giancarlo Pecorari
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giuseppe Riva
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy,
| | - Claudia Bartoli
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mattia Ravera
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Valeria Dell'Era
- Otorhinolaryngology Division, Department of Surgery, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Emanuela Barbero
- Otorhinolaryngology Division, Department of Surgery, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Paolo Aluffi Valletti
- Otorhinolaryngology Division, Department of Surgery, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Massimiliano Garzaro
- Otorhinolaryngology Division, Department of Surgery, University of Eastern Piedmont "A. Avogadro", Novara, Italy
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Harju T, Honkanen M, Vippola M, Kivekäs I, Rautiainen M. The effect of inferior turbinate surgery on ciliated epithelium: A randomized, blinded study. Laryngoscope 2018; 129:18-24. [PMID: 30151913 DOI: 10.1002/lary.27409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/12/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to evaluate statistically the effects of radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty techniques on ciliated epithelium and mucociliary function. STUDY DESIGN Prospective randomized study. METHODS A total of 66 consecutively randomized adult patients with enlarged inferior turbinates underwent either a radiofrequency ablation, diode laser, or microdebrider-assisted inferior turbinoplasty procedure. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. The effect on ciliated epithelium was evaluated using a score based on the blinded grading of the preoperative and postoperative scanning electron microscopy images of mucosal samples. The effect on mucociliary function, in turn, was evaluated using saccharin transit time measurement. RESULTS The score of the number of cilia increased statistically significantly in the radiofrequency ablation (P = .03) and microdebrider-assisted inferior turbinoplasty (P = .04) groups, but not in the diode laser group. The score of the squamous metaplasia increased statistically significantly in the diode laser group (P = .002), but not in the other two groups. There were no significant changes found between the preoperative and postoperative saccharin transit time values in any of the treatment groups. CONCLUSIONS Radiofrequency ablation and microdebrider-assisted inferior turbinoplasty are more mucosal preserving techniques than the diode laser, which was found to increase the amount of squamous metaplasia at the 3-month follow-up. The number of cilia seemed to even increase after radiofrequency ablation and microdebrider-assisted inferior turbinoplasty procedures, but not after diode laser. Nevertheless, the mucociliary transport was equally preserved in all three groups. LEVEL OF EVIDENCE 1b Laryngoscope, 129:18-24, 2019.
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Affiliation(s)
- Teemu Harju
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Mari Honkanen
- the Laboratory of Materials Science, Tampere University of Technology, Tampere, Finland
| | - Minnamari Vippola
- the Laboratory of Materials Science, Tampere University of Technology, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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Lukka VK, Jacob TM, Jeyaseelan V, Rupa V. Do turbinate reduction procedures restore epithelial integrity in patients with turbinate hypertrophy secondary to allergic rhinitis? A histopathological study. Eur Arch Otorhinolaryngol 2018; 275:1457-1467. [PMID: 29600318 DOI: 10.1007/s00405-018-4955-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Consensus has not been reached regarding the optimal reduction procedure for inferior turbinate hypertrophy in allergic rhinitis and whether such procedures result in improvement in mucosal architecture. METHODS Twenty-nine patients aged 18-45 years (mean 26.8 years), with allergic rhinitis and inferior turbinate hypertrophy not responsive to medical therapy who underwent endoscopic submucosal diathermy (ESMD) (14 patients) or endoscopic submucosal resection (ESMR) (15 patients) with intraoperative and 3-6 months postoperative inferior turbinate biopsies, were included in the study. Epithelial and mucosal architecture was compared between the two groups. RESULTS Both groups showed a significant decrease in epithelial denudation (p < 0.001), reversal of basement membrane thickening (p < 0.001) and increase in density of cilia (p < 0.001). The degree of improvement in histological characteristics between ESMD and ESMR groups was not significant. CONCLUSIONS Surgical intervention for inferior turbinate hypertrophy by both ESMD and ESMR results in significant restoration of nasal mucosal epithelium in patients with allergic rhinitis as early as 3-month postoperatively. There was, however, no significant difference in the histological changes between those who underwent ESMD and ESMR. CLINICAL TRIALS OF INDIA, REGISTRY NUMBER CTRI/2015/01/005373.
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Affiliation(s)
| | - Tripti Meriel Jacob
- Department of Anatomy, Christian Medical College, Vellore, India. .,Department of Anatomy, School of Medical Sciences, UNSW, Sydney, Australia.
| | | | - Vedantam Rupa
- Department of ENT, Christian Medical College, Vellore, India
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El-Anwar MW, Hamed AA, Abdulmonaem G, Elnashar I, Elfiki IM. Computed Tomography Measurement of Inferior Turbinate in Asymptomatic Adult. Int Arch Otorhinolaryngol 2017; 21:366-370. [PMID: 29018500 PMCID: PMC5629090 DOI: 10.1055/s-0037-1598649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction
The inferior turbinate (IT) is the most susceptible turbinate to enlargement causing nasal obstruction. The common belief ascribes most of the enlargement of the IT to mucosal elements.
Objective
This study aimed to investigate the detailed computed tomography (CT) measurement of the IT in asymptomatic adult by determining the thickness of both the non-bony (mucosa) and bony parts and their relation to nasal air space in different related areas of the nose.
Methods
We included in the study paranasal CT scans of 108 individuals (216 IT) that had no paranasal pathology. We acquired axial images with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. We took separate measurements of the thickness of the medial mucosa, bones, and lateral mucosa of the IT on the anterior and posterior portions of ITs. We also measured the air space of the nasal cavity between the septum and IT anteriorly and posteriorly.
Results
The difference in the air space between nasal septum, anterior and posterior ends of IT was extremely statistically significant (P < 0.0001). The thickness of the medial mucosa was extremely significantly more than the lateral mucosa width (P < 0.0001). There was no significant difference in length of IT at both sides (
p
= 0.5781).
Conclusion
The detailed CT measurement of the IT in normal adult is an easy and novel measurement. This study lays the foundation for CT measurement of IT for further work that can describe changes in IT measures after turbinate surgery.
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Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef A Hamed
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ghada Abdulmonaem
- Department of Radio Diagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Elnashar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Inas M Elfiki
- Department of Radio Diagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Somogyvári K, Móricz P, Gerlinger I, Kereskai L, Szanyi I, Takács I. Morphological and Histological Effects of Radiofrequency and Laser (KTP and Nd:YAG) Treatment of the Inferior Turbinates in Animals. Surg Innov 2016; 24:5-14. [PMID: 27733711 DOI: 10.1177/1553350616673452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the short and medium-term effects of radiofrequency (RF) and potassium titanyl phosphate (KTP) and neodymium-yttrium-aluminum garnet (Nd:YAG) laser treatment on the inferior turbinate mucosa in a porcine model. Following randomization, the inferior turbinates were treated either with RF submucosally or with the KTP or the Nd:YAG laser on the surface under videoendoscopic control. Tissue samples were taken at the end of postoperative weeks 1 and 6, and were evaluated macroscopically and histopathologically. Scanning electron microscopy was implemented to demonstrate the morphological changes in the respiratory epithelium. Six weeks following the RF procedure, the mucosa was intact in all cases, and the volume of the inferior turbinates was reduced in the majority of the cases. Although a volume reduction occurred in both laser groups, more complications associated with the healing procedure were noted. With hematoxylin and eosin and periodic acid-Schiff staining, intact epithelium, and submucosal glands remained after the RF procedures at the end of postoperative week 6. Following the KTP-laser intervention, necrotizing sialometaplasia and cartilage destruction occurred, and squamous metaplasia was also apparent in the Nd:YAG group. In both laser groups, dilated glands with excess mucus were seen. The scanning electron microscopic findings demonstrated that cilia were present in all cases. In conclusion, the medium-term macroscopic results were similar in all 3 groups, but the postoperative complications were less following the RF procedure. RF procedure is minimally invasive due to the submucosal intervention that leads to a painless, function preserving recovery.
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Neri G, Cazzato F, Mastronardi V, Pugliese M, Centurione MA, Di Pietro R, Centurione L. Ultrastructural regenerating features of nasal mucosa following microdebrider-assisted turbinoplasty are related to clinical recovery. J Transl Med 2016; 14:164. [PMID: 27277597 PMCID: PMC4898366 DOI: 10.1186/s12967-016-0931-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/31/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The nasal mucosa plays a key role in conditioning the inhaled air and in regulating the immune response. These functions led many authors to recommend mucosal sparing techniques for the surgical management of inferior turbinate hypertrophy. However, the histological modifications of chronic diseases retain the inflammatory activity and prevent the nasal physiology restoration. It has been proved that the basal cells of the nasal mucosa are able to proliferate and to repair after cold-knife incision. The aim of this study was to demonstrate that the healing process after removal of the inferior turbinate mucosa with cold techniques results in a complete structural restoration. METHODS A prospective study was performed in 18 patients who underwent Microdebrider inferior turbinoplasty (cold technique). Subjective and objective improvement of nasal patency was evaluated with visual analogue scale, rhinomanometry, videoendoscopy and mucociliary transport test. Pre- and post-operative biopsy specimens were taken from 7 patients to evaluate the healing process. Two samples were taken from two healthy patients as control. The specimens were processed for transmission electron microscopy analysis. RESULTS Videoendoscopy showed reduction of lower turbinate after surgery. Nasal patency augmented and no adverse consequences were observed. After 4 months the nasal mucosa showed normal appearance, with restoration of the pseudostratified ciliated pattern, intercellular connections and normal cellular morphology. Fibrosis and submucosal edema disappeared. At longer time after operation (4 years) clinical improvement was confirmed. CONCLUSIONS The total removal of the nasal mucosa with cold techniques results in a complete restoration of the normal structure and permanent resolution of the chronic inflammation typical of hypertrophic rhinopathy.
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Affiliation(s)
- Giampiero Neri
- />Department of Neuroscience and Imaging, Faculty of Medicine, University “G. d’Annunzio”, Chieti-Pescara, Italy
| | - Fiorella Cazzato
- />Department of Neuroscience and Imaging, Faculty of Medicine, University “G. d’Annunzio”, Chieti-Pescara, Italy
| | - Valentina Mastronardi
- />Department of Neuroscience and Imaging, Faculty of Medicine, University “G. d’Annunzio”, Chieti-Pescara, Italy
| | - Mara Pugliese
- />Department of Neuroscience and Imaging, Faculty of Medicine, University “G. d’Annunzio”, Chieti-Pescara, Italy
| | | | - Roberta Di Pietro
- />Department of Medicine and Aging Sciences, Section of Human Morphology, University “G. d’Annunzio”, Chieti-Pescara, Italy
| | - Lucia Centurione
- />Department of Medicine and Aging Sciences, Section of Human Morphology, University “G. d’Annunzio”, Chieti-Pescara, Italy
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13
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[Microdebrider-assisted inferior turbinoplasty. Minimally invasive technique for the treatment of nasal airway obstruction caused by enlarged turbinates]. HNO 2013; 61:240-9. [PMID: 23223921 DOI: 10.1007/s00106-012-2553-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Various methods are available for the surgical treatment of nasal airway obstruction caused by enlarged turbinates. These methods include partial turbinectomy, submucosal electrocautery, radiofrequency surgery, and laser turbinoplasty, all of which can have adverse effects such as defects of the mucous lining of the turbinates, prolonged postoperative healing, and bleeding. The purpose of this study was to analyse the effectiveness and potential adverse effects of microdebrider-assisted inferior turbinoplasty (MAIT), which is a less commonly used treatment option. MATERIALS AND METHODS In a prospective randomized study, 35 patients underwent microdebrider-assisted inferior turbinoplasty. Two control groups (35 patients each) underwent conventional partial turbinectomy or submucosal electrocautery. Endoscopic and functional studies (active anterior rhinomanometry, saccharin test) were performed before surgery and 2, 4, and 24 weeks after surgery. Pain and other postoperative problems were assessed using analogue scales. RESULTS After 2 weeks, MAIT patients, unlike the other patients, showed almost no more mucosal lesions. After 4 weeks, mean saccharin clearance time was 11.1 min in the MAIT group, 15.9 min in the partial turbinectomy group, and 13.7 min in the electrocautery group. When the patients were asked to rate their symptoms on a scale of 0-10, the mean score in the fourth postoperative week was 6.1 in the MAIT group, 7.7 in the partial turbinectomy group, and 7.8 in the electrocautery group. Rhinomanometry showed a mean flow rate increase from 178 ml/s to 574 ml/s after MAIT (401 ml/s after partial turbinectomy, 361 ml/s after electrocautery). CONCLUSION Microdebrider-assisted inferior turbinoplasty is a minimally invasive method for reducing inferior turbinate size and maintaining mucosal integrity. It has the advantages of a short healing time, only a mild decrease in mucociliary clearance, only minor postoperative problems, and a good functional outcome.
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Nguyen KH, Suzuki H, Wakasugi T, Hohchi N, Hashida K, Ohbuchi T, Shibata M. Expression of epidermal growth factors and a tight junction protein in the nasal mucosa of patients with chronic hypertrophic rhinitis. Allergol Immunopathol (Madr) 2013; 41:246-54. [PMID: 23137868 DOI: 10.1016/j.aller.2012.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/08/2012] [Accepted: 06/26/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND ErbB family receptors and tight junction proteins participate in the pathologic process including tissue remodelling of inflammatory diseases in the upper and lower respiratory tracts. This study aimed at investigating the expressions of erbB1, 2, 3, 4, and a tight junction protein, claudin-1, in the nasal mucosa of patients with chronic hypertrophic rhinitis. METHODS Inferior turbinates were collected from 10 turbinectomised patients with allergic and non-allergic chronic hypertrophic rhinitis. The expressions of erbB1, 2, 3, 4, and claudin-1 were examined by fluorescence immunohistochemistry and by quantitative real-time transcription-polymerase chain reaction (qRT-PCR). RESULTS All erbB1-4 and claudin-1 were detected, and mainly localised in the epithelial cells and nasal gland cells. The immunoreactivity for claudin-1 was positively correlated with the expressions of erbB1, 2 and 4, but negatively correlated with that of erbB3. The mRNA expressions of erbB1, 2 and 4 were positively correlated with one another, whereas the expression of erbB3 showed negative correlation with the immunoreactivity for erbB2 and 4. CONCLUSIONS These results suggest a possible participation of erbBs and claudin-1 in tissue remodelling in chronic hypertrophic rhinitis.
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Garzaro M, Landolfo V, Pezzoli M, Defilippi S, Campisi P, Giordano C, Pecorari G. Radiofrequency volume turbinate reduction versus partial turbinectomy: clinical and histological features. Am J Rhinol Allergy 2012; 26:321-5. [PMID: 22801021 DOI: 10.2500/ajra.2012.26.3788] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal obstruction is a common symptom related to turbinate hypertrophy in 20% of cases. When medical treatment failed different surgical options were available. Actually, nasal physiology impairment after surgical treatment is not fully clear. This study evaluates microscopic mucosal changes and physiological function, by means of mucociliary transport time (MCT), after radiofrequency volume turbinate reduction and partial inferior turbinectomy. METHODS Forty-eight nonallergic patients were treated for chronic nasal obstruction. Twenty-six patients (group A) underwent radiofrequency turbinate reduction and 22 patients (group B) underwent partial turbinectomy associated with septoplasty. Mucosal specimens obtained before T(0) and 6 months (T(1)) after surgery were compared by means of optical microscope and transmission electron microscope. All patients were evaluated using MCT at T(0) and T(1). RESULTS Optical analysis showed circumscribed squamous metaplasia and fibrosis in specimens obtained from group A. Same changes were more evident in group B. Ultrastructural analysis evidenced loss of ciliated epithelium in group B, whereas in group A a normal number of cilia was found. In all patients at T(1), MCT time was prolonged in comparison with the preoperative values. After surgery, group B showed significantly prolonged MCT in comparison with group A (p < 0.05). CONCLUSION In our study both surgical techniques achieved good clinical outcomes with improved nasal function, although the ciliated epithelium appeared partially impaired. These findings resulted in a prolonged MCT in all patients, especially in those treated with partial turbinectomy. Compared to partial resection, intraturbinal turbinate reduction seems to be the method of choice to better preserve nasal physiology.
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Affiliation(s)
- Massimiliano Garzaro
- Ear, Nose, and Throat Clinic, Department of Head and Neck, University of Turin, Turin, Italy
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Cytology of nasal mucosa, olfactometry and rhinomanometry in patients after CO2 laser mucotomy in inferior turbinate hypertrophy. Folia Histochem Cytobiol 2010; 48:217-21. [PMID: 20675277 DOI: 10.2478/v10042-010-0049-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To evaluate the cytology of nasal mucosa and sense of smell and nasal patency in patients underwent carbon dioxide laser turbinoplasty (CO2 laser mucotomy) due to chronic nasal hypertrophy. 46 patients with inferior turbinate hypertrophy underwent complete laryngological examination, anterior rhinomanometry, olfactory measurements and cytology of nasal mucous which were performed before and 3 months after CO2 laser mucotomy. Laser mucotomy was performed under local anesthesia. Cytograms revealed significant changes in cell proportion before and after the surgery. Goblet cells predominated in nasal smears before the laser mucotomy. An average percentage of eosinophils in evaluated cytograms before the surgery was 2.1%. Three months after laser mucotomy we observed decrease in goblet cells proportion (the mean range of goblet cells was 16.4%) in nasal cytology. We have also observed improvement in olfactory function, however only in 7 patients (20.6%). The mean value of total nasal airway resistance (NAR) before treatment was 0.98+/-0.24 Pa/cm3/s at 75 Pa. Rhinomanometry after 3 months showed a reduction in mean total resistance from the pretreatment level to 0.77 Pa/cm3/s. We believe that CO2 laser mucotomy is an efficacious, minimally invasive and easy to use treatment of inferior turbinate hypertrophy which is performed under local anesthesia with little discomfort for the patient and does not require hospitalization.
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Feldman EM, Koshy JC, Chike-Obi CJ, Hatef DA, Bullocks JM, Stal S. Contemporary techniques in inferior turbinate reduction: survey results of the American Society for Aesthetic Plastic Surgery. Aesthet Surg J 2010; 30:672-9. [PMID: 20884896 DOI: 10.1177/1090820x10381988] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nasal airway obstruction is a frequently-encountered problem, often secondary to inferior turbinate hypertrophy. Medical treatment can be beneficial but is inadequate for many individuals. For these refractory cases, surgical intervention plays a key role in management. OBJECTIVE The authors evaluate the current trends in surgical management of inferior turbinate hypertrophy and review the senior author's (SS) preferred technique. METHODS A questionnaire was devised and sent to members of the American Society for Aesthetic Plastic Surgery (ASAPS) to determine their preferred methods for assessment and treatment of inferior turbinate hypertrophy. RESULTS One hundred and twenty-seven physicians responded to the survey, with 85% of surveys completed fully. Of the responses, 117 (92%) respondents were trained solely in plastic surgery and 108 (86.4%) were in private practice. Roughly 81.6% of respondents employ a clinical exam alone to evaluate for airway issues. The most commonly-preferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision (61.9%) and turbinate outfracture (35.2%). CONCLUSIONS Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonly-used techniques in private practice by plastic surgeons. Newer techniques such as radiofrequency coblation have yet to become prevalent in terms of application, despite their current prevalence within the medical literature. The optimal method of management for inferior turbinate reduction should take into consideration the surgeon's skill and preference, access to surgical instruments, mode of anesthesia, and the current literature.
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Gindros G, Kantas I, Balatsouras DG, Kaidoglou A, Kandiloros D. Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy. Eur Arch Otorhinolaryngol 2010; 267:1727-33. [PMID: 20432043 DOI: 10.1007/s00405-010-1260-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
Chronic nasal obstruction owed to chronic hypertrophic rhinitis is a common cause of nasal airway obstruction. In cases unresponsive to conservative treatment, various surgical techniques are commonly performed, but the issue of the optimal surgical procedure is still controversial. The objective of the present study was to evaluate the effectiveness and safety of ultrasound treatment of the hypertrophied inferior turbinates, which is a technique recently applied in rhinologic surgery. We aimed, also, to compare this method with the radiofrequency cold coblation turbinate reduction and the traditional submucosal monopolar inferior turbinate cauterization. We studied prospectively 60 patients with chronic hypertrophic rhinitis of nonallergic etiology, who underwent different surgical methods of turbinate reduction, divided into two groups: (1) in 30 patients, inferior turbinate volume reduction using ultrasound procedure on the left side and monopolar diathermy on the right was performed; (2) in 30 patients, radiofrequency coblation technique on the left side and ultrasound turbinate reduction on the right side was undertaken. Subjective evaluation of nasal obstruction and pain was performed using visual analog scales and objective evaluation of the surgical outcome was obtained using active anterior rhinomanometry and acoustic rhinometry. Examinations were performed preoperatively, and 1, 3 and 6 months after surgery. Both subjective and objective evaluation showed significant postoperative improvement in all cases. The best results were obtained with the ultrasound procedure, and second with the radiofrequency technique. The least improvement was observed in the electrocautery group, although its results did not differ significantly from the radiofrequency group. It may be, thus, concluded that ultrasound turbinate reduction is an effective and safe procedure for the management of chronic hypertrophic rhinitis, in patients failing to respond to medical treatment. Using this method, better results were obtained in decreasing subjective symptoms and nasal obstruction, in comparison with radiofrequency and electrocautery.
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Affiliation(s)
- George Gindros
- ENT Department, G.Genimmatas General Hospital, Thessaloniki, Greece
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Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2010; 18:60-3. [PMID: 20068410 DOI: 10.1097/moo.0b013e328335385c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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