Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy
Introduction
Chronic nasal obstruction is a common complaint that can result either from septal deformities or from mucosal disease associated with turbinate hypertrophy. Turbinate hypertrophy is usually observed in allergic rhinitis, vasomotor rhinitis and septal deviation (compensatory hypertrophy). It may be treated medically with antihistamines, systemic decongestants, topical decongestants or topical corticosteroids. However, these often provide only slight improvement. Patients often benefit from surgical reduction of the inferior turbinate. A variety of surgical techniques have been reported, including partial turbinectomy, turbinoplasty, submucosal turbinectomy, microdebrider submucosal resection, cryotherapy, submucous electrosurgery and laser turbinectomy [1]. Although these surgical techniques provide relatively satisfactory results, adverse effects such as bleeding, crust formation or inferior turbinate atrophy are frequently observed subsequently. Ideally, turbinate surgery should result in an improvement in nasal breathing without damaging the mucosal lining. Mucosal preservation maintains normal functioning of the turbinate, promotes quicker recovery and reduces the likelihood of atrophic rhinitis developing [2]. Less destructive techniques, such as radiofrequency, have therefore been introduced [3], [4], [5]. Radiofrequency is increasingly used to reduce the volume of turbinate mucosa, and satisfactory results with fewer side effects have been reported [5], [6], [7].
Most studies with radiofrequency volumetric tissue reduction (RFVTR) have mainly focused on subjective symptoms in order to assess its efficacy [8]. However, there have been a few studies on objective changes in nasal functions [5], [6]. In this study, we used not only subjective symptom scores but also an objective test with multidetector CT to assess the short-term efficacy of RFTVR in the treatment of nasal obstruction with turbinate hypertrophy and compared pre- and postoperative results.
Section snippets
Materials and methods
This prospective clinical study was conducted on 35 patients with symptoms and signs of nasal obstruction. Criteria for inclusion consisted of enlarged inferior turbinates without septal deformity. Written informed consent was obtained from all patients, and Ethical Committee approval was granted. Inferior turbinates were evaluated using anterior rhinoscopy and nasal endoscopy. An allergy test (prick) was also performed for differential diagnosis between allergic and non-allergic rhinitis.
Surgical procedure
All surgical procedures were performed under local anesthesia by the same surgeon in an out-patient facility. Initially, a cotton pledget soaked in 4% lidocaine solution was introduced into each nasal cavity and left in place for 5 min. To facilitate effective submucosa reduction, the anterior, middle and posterior parts of the inferior turbinate were injected with 1% lidocaine in 1/100,000 epinephrine. Radiofrequency energy was delivered by a generator (Gyrus ENT radiofrequency control unit,
Evaluation
Surgical outcomes were evaluated with regard to two distinct parameters, visual analogue scale (VAS) and multidetector CT (MDCT). All patients were evaluated prior to and 8 weeks after surgery. A standard 10 cm VAS ranging from 0 (no symptoms) to 10 (the most severe symptoms) was used to assess subjective patient complaints of nasal obstruction. We compared preoperative VAS scores with those determined 8 weeks postsurgically.
Inferior turbinate volumes on both sides of all patients were
Statistics
Results were expressed as mean ± SD. Comparisons of scores of nasal obstruction obtained via VAS before and after surgery were made using the paired t test. Significance was set at p < 0.05. In terms of CT measurements, statistical comparisons of pre- and postoperative volumes were also performed using the paired t test.
Results
Thirty-five patients (25 male and 10 female between 18 and 44 years of age; mean age 31 ± 12.5) were enrolled. All patients completed two months of follow-up. No serious postoperative bleeding was seen at any follow-up. However, intermittent anterior nasal oozing at the site of needle insertion occurred for a few hours in 10 (28.5%) patients. Turbinate edema was observed in five patients (14.2%) at the first week postoperatively. However, this subsided by two weeks after treatment. Mild crusting
Subjective change of symptoms
Among the patients, 91.4% experienced a great improvement in their nasal obstruction symptoms. Mean VAS score was 7.45 ± 1.48 for pretreatment. At 8th-week follow-up, mean VAS score improved to 3.54 ± 1.96 (Fig. 2). This improvement was statistically significant (P < 0.05).
CT evaluation
CT measurement exhibited significant decreases in inferior turbinate volume on both sides after surgery. Mean turbinate volume on the right was 6.55 ± 1.62 cm3 preoperatively. Postoperatively, this decreased to 5.10 ± 1.47 cm3. The average turbinate volume reduction achieved was 1.45 cm3. On the left, the average turbinate volume was 6.72 ± 1.53 cm3 and 5.00 ± 1.37 cm3 pre- and postoperatively, respectively. The average turbinate volume decrease was 1.72 cm3 (Fig. 3). The decrease was statistically
Discussion
Surgical reduction has been proposed in inferior turbinate hypertrophy. Various techniques are employed to reduce the volume of the mucosal and sometimes bony tissues of the inferior turbinates. Radiofrequency tissue reduction has recently become increasingly used in turbinate surgery.
Radiofrequency volumetric tissue reduction (RFVTR) is a surgical procedure that uses radiofrequency heating to induce submucosal tissue destruction. The heat emanates from the tissue and not the electrode because
Conclusion
RFVTR is a safe, less morbid and effective method in reducing turbinate volume with improvement in the symptoms of nasal obstruction. Multidetector CT scanning is a useful tool for determining objective results of turbinate reduction after surgery.
Conflict of interest
Authors declare no conflict of interest with regard to the data presented in the manuscript.
References (22)
Inferior turbinate reduction: an application for the microdebrider
Operative Tech Otolaryngol
(2005)- et al.
Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study
Otolaryngol Head Neck Surg
(1998) - et al.
Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy
Otolaryngol Head Neck Surg
(2005) - et al.
Radiofrequency treatment of turbinate hypertrophy: a randomized, blinded placebo-controlled clinical study
Otolaryngol Head Neck Surg
(2004) Office evaluation of nasal obstruction
Otolaryngol Clin North Am
(1992)- et al.
Correlation between nasal obstruction symptoms and objective parameters of acoustic rhinometry and rhinomanometry
Auris Nasus Larynx
(1998) - et al.
Controversies in the management of inferior turbinate hypertrophy: a comprehensive review
Plast Reconstr Surg
(1999) - et al.
Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy
Laryngoscope
(1999) - et al.
Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate
Laryngoscope
(2001) - et al.
Inferior nasal turbinate wound healing after submucosal radiofrequency tissue ablation and monopolar electrocautery: histologic study in a sheep model
Laryngoscope
(2010)
Radiofrequency tissue ablation of the inferior turbinate using a thermocouple feedback electrode
Laryngoscope
Cited by (8)
A study on the association between the inferior nasal turbinate volume and the maxillary sinus mucosal lining using cone beam tomography
2022, HeliyonCitation Excerpt :Furthermore, studies also reported that the volumes of the inferior turbinate (IT) and the status of the maxillary sinus are important indicators for physicians to evaluate the sino-nasal diseases [11, 12]. In the past, studies have highlighted the importance of volumetric analysis of IT after turbinate reduction procedures [13]. However, to the best of our knowledge, no radiographic studies have evaluated the association or correlation of the volume of IT with the thickness of the maxillary sinus mucosal lining and dental status.
Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients
2019, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Although less invasive methods have become popular over the last 20 years, more invasive procedures, such as turbinoplasty, remain important because of their high success rates. Many studies have examined the effectiveness of radiofrequency application in lower turbinate surgery,10–12 and other techniques have been evaluated in non-septoplasty patients.13–15 Veit et al. did not evaluate lower turbinate volumes despite comparing lower turbinate reduction methods during septoplasty.16
Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report
2016, European Archives of Oto-Rhino-LaryngologyAge-related changes of nasal cavity and conchae volumes and volume fractions in children: A stereological study
2016, Folia Morphologica (Poland)Radiofrequency ablation turbinoplasty versus microdebrider-assisted turbinoplasty: A systematic review and meta-analysis
2015, Otolaryngology - Head and Neck Surgery (United States)