Elsevier

Auris Nasus Larynx

Volume 39, Issue 6, December 2012, Pages 588-592
Auris Nasus Larynx

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy

https://doi.org/10.1016/j.anl.2011.11.003Get rights and content

Abstract

Objective

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy.

Methods

Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides.

Results

The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45 ± 1.48 to 3.54 ± 1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55 ± 1.62 cm3 vs. 5.10 ± 1.47 cm3, (P < 0.01); left: 6.72 ± 1.53 cm3 vs. 5.00 ± 1.37 cm3, (P < 0.01)] respectively.

Conclusion

Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction.

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.

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