Bilateral Inferior Turbinate Hypertrophy Research Articles

The Effectiveness of High-Intensity Focused Ultrasound in Treating Nasal Obstruction Caused by Inferior Turbinate Hypertrophy: A Clinical Study.

Background Nasal obstruction due to inferior turbinate hypertrophy is a common medical complaint among ENT clinic patients, which can significantly affect thepatient'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 Ultrasurgdevice (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.

CONVENTIONAL TURBINOPLASTY AND COBLATION TURBINOPLASTY IN PATIENTS WITH BILATERAL INFERIOR TURBINATE HYPERTROPHY

Objective: The objective of the study was to compare the efficacy of conventional turbinoplasty and coblation turbinoplasty in patients with bilateral inferior turbinate hypertrophy. Methods: A prospective comparative study was conducted on 60 patients undergoing turbinoplasty at the Department of ENT, Sardar Patel Medical College and PBM Hospital, from July1st, 2021, to June 30th, 2022. About 60 patients were randomly divided into two groups, Group A patients were surgically managed by conventional turbinoplasty, and Group B patients by coblation turbinoplasty. Intraoperatively, the time for each surgery was individually calculated from incision to nasal packing. Follow-up was done at 3 months and at 6 months to assess the post-operative efficacy. Results: The mean age of participants was 36.57±8.01 years (21 years–49 years). On comparing the post-operative mean medial mucosal thickness, and mean airway space achieved in 6 months by both the surgeries, a statistically significant difference was found. The mean duration of surgery for coblation turbinoplasty was 435.50 s or 7.25 min (ranging from 6.17 min to 8.33 min) and 1039.33 s or 17.32 min (ranging from 19.16 min to 15.48 min) for conventional turbinoplasty (p<0.001). Conclusion: Coblation has an upper hand in terms of improvement of patient symptoms and reduction in turbinate size. The only and major deterring factor in the regular usage of coblation is its cost.

Management of hypertrophic rhinitis by application of Kadali kshara: An observation

Nasal obstruction is a predominant symptom in hypertrophied inferior turbinate. It can be understood as Nasanaha (~nasal obstruction) in Ayurveda. Even though there are many conditions of the nose causing nasal blockage; inferior turbinate hypertrophy which is a cardinal feature in hypertrophic rhinitis is one of the most common causes of anatomical nasal obstruction, the others being internal nasal valve stenosis and septal deviation. The turbinate hypertrophy in this condition can be managed medically using nasal decongestants and corticosteroids and it can be also managed surgically. Continuous use of nasal decongestants can cause rebound congestion. Surgical management also has limitations such as synechiae formation and postoperative bleeding. Kshara pratisarana (~external application of alkali), which is one among the types of parasurgical procedures explained in Ayurveda, can be used effectively in this condition. Moreover, nasal obstruction is one of the most common symptoms presented to an otorhinolaryngologist and it badly affects the quality of life of the patient. The present case report is a case of a 24-year-old female who was unable to sleep properly due to severe nasal obstruction and chronic rhinitis along with hypertrophy of both inferior turbinates. This also affected her studies badly. She also complains of thick nasal discharge along with obstruction. The patient had the complaints for two years but the symptoms became more severe during the past six months. On anterior rhinoscopic examination using Thudicum's nasal speculum, the presence of bilateral inferior turbinate hypertrophy was observed. The patient was treated with Pratisarana of Kadali kshara (~alkali of Musa paradisiaca Linn.) along with Sigrusimhyadi taila nasya. The treatment was effective in the present case with no recurrence during a follow-up period of 30 days. This case report revealed that nasal obstruction, which is a common problem seen nowadays can be managed effectively using Ayurvedic intervention.

Computed Tomography Evaluation of the Paranasal Sinuses in Adults with Primary Ciliary Dyskinesia.

Introduction Primary ciliary dyskinesia is a rare inherited disease that results in a malfunction of mucociliary clearance and sinonasal complaints. Aplasia/hypoplasia of the frontal and sphenoid sinuses has been described as more frequent in this population. However, to date, no studies have provided a detailed description of computed tomography findings in adult patients with a diagnosis of this condition. Objective To describe the computed tomography (CT) findings of adult patients with primary ciliary dyskinesia. Methods Retrospective observational study of adult patients with primary ciliary dyskinesia who underwent CT. Results Twenty-one adults were included in the study. Aplasia occurred in 38.1% of frontal sinuses and in 14.3% of sphenoid sinuses. Likewise, hypoplasia occurred in 47.6% of the frontal sinuses, in 54.8% of the sphenoid sinuses and in 40.5% of the maxillary sinuses. Furthermore, trabecular loss was identified in 61.9% ethmoidal sinuses. The mean Lund-Mackay score was 13.5. In addition, 9.5% of the patients had concha bullosa, 47.6% had marked bilateral inferior turbinate hypertrophy, 38.1% had marked middle turbinate hypertrophy, and 47.6% had marked septal deviation. Finally, we identified images suggestive of fungus ball, mucocele, osteoma, a possible antrochoanal polyp, and frontal bone erosions. Conclusion The present study provides a detailed description of CT findings in patients with primary ciliary dyskinesia. We also describe abnormalities that must be identified for safer surgical planning and that suggest a diagnosis of primary ciliary dyskinesia if found in patients with a consistent clinical picture.

COMPARISON OF MICRODEBRIDER - ASSISTED TURBINOPLASTY VERSUS ENDOSCOPIC PARTIAL TURBINECTOMY IN CASES OF INFERIOR TURBINATE HYPERTROPHY IN ALLERGIC RHINITIS PATIENTS

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020.
 Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting & synechie/adhesions. All the data was entered on SPSS-17 and analyzed.
 Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting & 3 synechie/adhesions in endoscopic partial turbinectomy group.
 Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy.

English

BACKGROUND Nasal obstruction secondary to inferior turbinate hypertrophy significantly affects the quality of life. Patients refractory to medical treatment are taken up for surgery. Laser turbinate reduction is an effective and simple method for treatment of nasal obstruction due to inferior turbinate hypertrophy. Only a few studies reported on the outcome of laser inferior turbinate reduction in India. The present study was done to assess the clinical outcome of laser inferior turbinate reduction in patients with nasal obstruction due to inferior turbinate hypertrophy. METHODS This prospective observational study was done in 31 patients (18 – 60 years) with nasal obstruction due to inferior turbinate hypertrophy refractory to medical management who underwent laser inferior turbinate reduction in ENT Department, Government Medical College, Thiruvananthapuram from December 2017 to September 2019. RESULTS All patients had bilateral inferior turbinate hypertrophy. 21 out of 31 patients had allergic rhinitis and rest had non-allergic rhinitis. Pre-operatively most patients had symptom score between 15 and 20. After CO2 laser inferior turbinate reduction at the end of 3 months of follow up, subjective assessment by symptom scoring confirmed by objective assessment by flowmetry 29 out of 31 patients had good outcome with relief from nasal obstruction. The success rate was more in nonallergic rhinitis (100 %) than the allergic rhinitis group (90.47 %). CONCLUSIONS CO2 laser inferior turbinate reduction is an effective procedure to relieve nasal obstruction in patients with inferior turbinate hypertrophy refractory to medical treatment, with minimal complications. Post-procedure on follow up significant number of patients had relief from hyposmia, sneezing and running nose. KEYWORDS Nasal Obstruction, Peak Nasal Inspiratory Flowmetry, Symptom Scoring, CO2 Laser, Outcome

Role of Bilateral Inferior Turbinoplasty as an Adjunct to Septoplasty in Improving Nasal Obstruction and Subjective Performance in Patients With Deviated Nasal Septum Associated With Allergic Rhinitis: An Interventional, Prospective Study.

Patients with nasal obstruction due to deviated nasal septum (DNS) often have allergic rhinitis (AR) as contributing factor. When optimal medical therapy for AR fails, septoplasty alone may not adequately treat nasal obstruction. Therefore, with bilateral inferior turbinate hypertrophy representing long-standing AR, adding bilateral inferior turbinoplasty (BIT) to septoplasty might be beneficial. To assess whether septoplasty with/without BIT alleviates nasal obstruction in the above patient cohort and whether adding BIT to septoplasty brings significant benefit. In this interventional, prospective study, patients with nasal obstruction due to DNS and persistent, moderate-severe AR refractory to optimal medication were randomly allocated into group A (septoplasty alone) and group B (septoplasty with BIT). Nasal Obstruction and Symptom Evaluation (NOSE) score, along with Subjective Performance parameters (days-off/month; number of outdoor visits/month; overall satisfaction score [OSS]) were used to assess the symptom and quality of life, respectively, at follow-up. Each group had 40 age/sex-matched patients. Friedman test, and subsequent pair-wise comparison within groups without Bonferroni correction, revealed that septoplasty with/without BIT elicited significant reduction in NOSE scores and in the Subjective Performance parameters (days-off/month; number of outdoor visits/month) at 3 and 6 months. Wilcoxon Signed Rank test revealed that the OSS within groups also improved significantly with time. Further, comparison between groups revealed significant improvement in NOSE scores at all levels of follow-up when BIT was included. However, there were no significant differences between groups in the Subjective Performance parameters at any level of follow-up. Improvement in OSS between groups was significant only at 3 months but not subsequently. Septoplasty with/without BIT is helpful in treating patients with DNS and refractory AR. However, although adding BIT brings significant benefit in decreasing nasal obstruction, it does not significantly improve the Subjective Performance parameters during follow-up, except for OSS at the third month.

Efficacy of Erb-Laser on Inferior Turbinate Hypertrophy: A Retrospective and Cohort Study.

ObjectivesNasal obstruction (NO) is a very common complaint in the practice of otolaryngology. The cause of NO can be due to inferior turbinate hypertrophy (ITH), which may be a result of allergic rhinitis, hyperreactivity, hormonal causes, rhinitis medicamentosa or idiopathic. The most commonly used treatments today include local nasal or systemic corticosteroids, cauterization or microdebrider, or thermal ablation with radiofrequency, coblation or ablative laser (mainly carbon dioxide or diode lasers), and submucosal reduction. Erbium YAG laser in non-ablative and SMOOTH thermal mode is considered as a non-invasive treatment and could be a novel and safe alternative.The aim of this study was to evaluate the safety and performance of a new Erb-laser treatment protocol on bilateral ITH, during and after 3 sessions of treatment throughout 6 months.MethodsThis retrospective study was carried out over 30 patients with complaints of NO, sneezing, itching, discharge, and nasal congestion refractory to medical management from July 2019 to December 2020 in the Department of Otorhinolaryngology of a private hospital in Famagusta, North Cyprus. Symptoms were evaluated subjectively by using NO Score and Visual Analog Scale (VAS). Patients were evaluated at the post-procedural 1st-week, and 1st-, 3rd-, and 6th-month postoperatively. During each follow-up visit, symptoms were reassessed by VAS and NO Score.ResultsDifferences between pre-operative and post-operative VAS and NO Scores were statistically significant. All patients had significant symptomatic improvements, which started from the post-operative 1stweek and persisted throughout the follow-up period. The active laser treatment showed high improvement during and after the procedure, regarding NO, and decreased the nasal burden on quality of life.ConclusionErbium YAG laser treatment is a simple, safe, effective, and non-invasive method effective on ITH, with minimal damage on the nasal mucosa. It can be done as an office procedure, with minimal complications. This method will provide a great advantage in the future treatment of NO.

Mini Inferior Turbinoplasty-Tunneling Technique Versus Conventional Partial Inferior Turbinectomy in Adults: A Comparative Study

Background: Inferior turbinate reduction is a well-described procedure performed whenever medical treatment for patients with hypertrophic inferior turbinates or vasomotor rhinitis fails. There are several techniques of turbinate reduction that include turbinectomy, submucous diathermy, inferior turbinoplasty, cryotherapy, CO2 laser turbinoplasty, Coblation channelling and others. Each technique is associated with its own short-term and long-term complications such as bleeding, crusting and recurring of the turbinate hypertrophy.Materials and Methods: We studied 80 patients attending the ENT department outpatients at Aswan university hospital from June 2018 to June 2019. All patients were clinically and radiologically diagnosed with bilateral inferior turbinate hypertrophy without response to medical treatment. Patients were randomized to two groups: Group A patients that underwent Mini turbinoplasty using tunnelling techniques and Group B patients that had conventional partial inferior turbinectomy Technique.Results: The intraoperative time was longer in group A patients who had turbinoplasty-tunneling technique compared to group B who had conventional partial turbinectomy. However, intraoperative blood loss and nasal Packing were required mostly in group B patients. Postoperative bleeding and crustations were significantly higher in group B patients. There was no significant difference regarding the percentage synechia between both groups. Nasal obstruction symptom markedly improved in group B patients.Conclusion: The current study revealed that Conventional Partial Inferior Turbinectomy is better than Mini Inferior Turbinoplasty Tunneling Technique regarding relief of symptoms of nasal obstruction.

Submucosal diathermy versus coblation for reduction of hypertrophied inferior turbinate:a comparative study

ABSTRACTNasal obstruction is the foremost complaint of a large number of patients. Inferior turbinate hypertrophy can result in a fixed structural obstruction.Various types of turbinate surgery are commonly used , Submucosal techniques have advantages in terms of preserving overall nasal physiology. Aim of the work: This prospective study aimed at comparison between SMD and coblation in reduction of hypertrophied inferior turbinate. It included 30 patients with bilateral inferior turbinate hypertrophy. (21 male and 9 female), their ages ranged between 16-41 years. All patients in this study were subjected to preoperative evaluation by endoscopy and ct scan. All patients underwent SMD in the right side and coblation in the left side. The patients were subjected to post-operative follow up for at least 2 months, CT was done 2 months post-operative to compare the size of inferior turbinate before and after surgery. Results: nasal obstruction and snoring improved obviously by both techniques but more in coblation. Postoperative crustations after coblation occurred in 4 patients only (13.3%) and for SMD occurred in 6 patients (20%), coblation less painful than SMD in the postoperative period as measured by Guttman scale. CT scan proved a significant reduction of the turbinate size using both techniques. Conclusion: Our study showed that both SMD and Coblation are effective in inferior turbinate reduction. Coblation is safe and effective, but it is expensive to somewhat. There are no serious intra-operative and postoperative complications.Key Words: inferior, turbinate, hypertrophy, submucous , diathermy, coblation

Histopathological study of compensated inferior turbinate hypertrophy and its hypertrophy in allergic rhinitis

Background Nasal obstruction resulting from inferior turbinate hypertrophy (ITH) is a common complaint in otorhinolaryngology. Objective Differentiation between compensatory ITH due to deviated nasal septum (DNS) and ITH due to allergic rhinitis in order for the surgeon to choose the proper surgical techniques. Patients and methods This study included 60 patients aged between 18 and 50 years (18 men and 12 women). They suffered from ITH as proven by history and endoscopic examination. Patients were subdivided into two groups. Group A: included 30 patients who were presented by compensated ITH due to DNS. Skin prick test was done for all patients of this group to exclude allergic patients. Group B: included 30 patients who were presented by bilateral ITH due to allergic rhinitis. All patients underwent endoscopic partial inferior turbinectomy under general anesthesia with or without septoplasty, taking care to include all three layers of the turbinate. The turbinate specimens were processed in a standard manner in the Department of Pathology, and slides were prepared, and examined histopathologically and micrometrically. Results The mean thickness of the bony layer of ITH patients in group A was 6.50±1.75 mm, whereas its thickness in group B was 2.25±±1.25 mm with a statistically significant P value=0.001, while the mean thickness of the medial mucosal layer of ITH patients of group A was 2.25±0.5 mm, whereas its thickness (group B) was 4.25±0.75 mm with statistically nonsignificant P value (0.06). Conclusion The bony layer contributes to the main thickness of compensatory ITH due to DNS because of the significant bony expansion; so, it should be a target of surgery, while surgical techniques that aim to remove the mucosa, leaving the bony part of the turbinate in allergic rhinitis are suitable for such patients.

Prevalence of Anatomical Abnormalities of Nose & Paranasal Sinuses in Cases of Rhinogenic Headache Among Sohag University Students

AbstractObjective: to determine the prevalence of anatomical abnormalities of nose and PNS in cases suffering from rhinogenic headache among Sohag University students seeking health services in the ENT outpatient clinic of the Student Hospital in Sohag University along the period starting Oct. 2017 till June 2019. Study design: Across sectional studyResults: 104 students -(59.6 %) females- were enrolled in the study, inhabiting rural and/or slum areas of Sohag (69.2 %). They had a narrow range of ages; 19 – 23 years; X` = 20.13 ± 1.25 years. Frontal site of headache predominated, then the nasal site. These followed by periorbital, tempo parietal, temporal and scalp regions respectively in 32.7, 25, 17.3, 11.5, 7.7 and 5.8 % of the rhinogenic cases. Each attack lasted 3.27± 1.76 days duration with maximum 7 days. Prevalence of rhinogenic headache due to anatomical abnormalities was (26.9 %). over the frontal, glabellar and periorbital regions. A highly significant statistical difference between cases of rhinogenic headache with anatomical abnormalities and those without anatomical abnormalities (p = .004) regarding how the headache was presented; Heaviness (16.2 %), pressure (81 %) and dullness (2.7 %) were the type of such headache. It was found that most of the cases have combined abnormalities.DNS affected 16 cases (43.2 %), a manifestation of concha bellosa in 9 cases(24.3%), bilateral inferior turbinate hypertrophy appeared in 10 cases(27%) . Haller cells was detected in about ( 1.9 % )of the anatomical abnormalities also.

Submucosal Diathermy Versus Coblation For Reduction of Hypertrophied Inferior Turbinate

Background: Nasal obstruction is the foremost complaint of a large number of patients in otolaryngologic practice. Most of those patients have inferior turbinate hypertrophy. Surgery is one of the modalities of treatment to relieve patients of nasal obstruction. The objective of this study was to evaluate the efficacy of submucosal diathermy (SMD) and coblation in the treatment of hypertrophied inferior turbinate. Materials and methods: The study included 30 consecutive adult patients with bilateral inferior turbinate hypertrophy, all patients underwent SMD in the right side and coblation in the left side by using the same device (coblator II, Arthrocare, USA). They were assessed for relief of variable nasal symptoms by subjective and objective methods. Results: According to the results obtained from this study, nasal obstruction improved significantly by both techniques, but more improvement was observed in the side treated by coblation, and coblation was less painful during the procedure and in the post-operative period. Both of the two techniques reduce the hypertrophied inferior turbinate significantly. Conclusions: Both SMD and Coblation of the inferior turbinate are safe and effective methods of relieving nasal obstruction and other associated symptoms due to inferior turbinate hypertrophy, without affecting the turbinate mucosal function.

Bilateral inferior conchae and turbinate hypertrophy causing choanal pseudoatresia

Respiratory distress in neonates is an emergency which requires a thorough investigation to determine the cause, whether it is due to the upper respiratory or lower respiratory entity. Nasal cavity pathologies rarely compromise the neonatal airway. Newborns are obligatory nasal breathers; thus, upper respiratory tract problems could potentially become life-threatening. We report a case of a newborn boy with inferior turbinate hypertrophy (ITH) causing respiratory distress treated successfully by nasal dilatation and posterior septoplasty. Congenital bilateral ITH is rarely seen and can mimic choanal atresia. Congenital ITH would be missed at initial presentation without radiographic imaging and physical evaluation. It should be considered as one of the differential diagnosis in cases suspected for choanal atresia.

REFRACTORY NASAL POLYPOSIS TREATED WITH OMALIZUMAB IN A CHILD

Introduction Current treatment of inflammatory nasal polyposis consists of nasal/oral glucocorticoid therapy and surgical management if unresponsive to pharmacotherapy. The etiology is often multifactorial and requires combination management with both pharmacotherapy and surgery. We present a case of refractory nasal polyposis in a child treated with omalizumab, preventing the need for repeat surgical intervention. Case Description A 12-year old male with history of severe asthma, allergic rhinitis and allergic fungal sinusitis requiring functional endoscopic sinus surgery, developed worsening nasal polyposis despite maximal medical therapy. Physical and endoscopic exam revealed left sided nasal polyps, bilateral inferior turbinate hypertrophy, vocal cord nodules and hoarse voice. FeNO was uptrending, ranging from 98-175 ppb over the past year. Management included allergen immunotherapy, oral leukotriene-receptor antagonist, high-dose inhaled corticosteroid/long-acting beta agonist, oral antihistamine, intranasal antihistamines, high-dose intranasal steroid rinses, and oral steroids. His asthma was well controlled. Repeat surgical intervention was anticipated. Given his rising FeNO levels despite oral steroids, omalizumab was initiated in an attempt to decrease his nasal inflammatory process. Significant symptomatic improvement was noted after two omalizumab injections and his FeNO decreased to 65 ppb, the lowest value in the previous 3 years. Six months later, his FeNO has declined further to 29 ppb. Endoscopic exam showed polyp regression. This has prevented need for nasal surgery with continued use. Discussion Off-label use of omalizumab for atopic nasal polyposis should be considered in patients nonresponsive to traditional pharmacotherapies.

Preoperative levels of inflammatory biomarkers in patients with bilateral inferior turbinate hypertrophy

Objective: The aim of this study was to evaluate preoperative inflammatory biomarkers in patients who underwent surgical treatment with the indication of bilateral inferior turbinate hypertrophy. Materials and Methods: Eighty patients who applied to our otorhinolaryngology clinic with complaints of chronic nasal obstruction and 79 clinically healthy individuals were included in the study. This was a retrospective study. Evaluation was performed on the patient records. Hemogram values of 80 patients were compared with 79 clinically healthy individuals. Both groups were compared with respect to WBC (White Blood Cell), L (Lymphocyte), N (Neutrophil), PLT (Platelet), M (Monocyte) counts, N/L (Neutrophil/Lymphocyte ratio), PLT/L (Platelet/Lymphocyte ratio), M/L (Monocyte/Lymphocyte ratio), M/WBC (Monocyte/leucocyte ratio), and N/WBC (Neutrophil/leucocyte ratio). P<0.05 was accepted as the level of statistical significance. Results: In intergroup evaluation, a statistically significant difference was not found between groups as for WBC, N, and PLT counts. However two groups were statistically significantly different regarding L, and M values (p=0.026, p=0.000, and p<0.05, respectively). Besides a statistically significant difference was not found between two groups as for N/L, PLT/L, and N/WBC ratios. However a statistically significant difference was observed between both groups regarding M/L, and M/WBC ratios (p=0.000, p=0.000, and p<0.05, respectively). Conclusion: Easily calculated M/L, and M/WBC ratios with low cost can be used as auxiliary parameters in the evaluation of patients with inferior turbinate hypertrophy.

Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy.

Intranasal steroid sprays (INSS) are frequently prescribed for treating inferior turbinate hypertrophy (ITH). Complications due to the long-term application of INSS such as crusting, epistaxis, nasal mucosa dryness, and septal perforation may occur. Predicting patients who would benefit from INSS early might lower treatment costs and complication rates. We examined the predictive value of nasal decongestant response rates for the outcomes of INSS in ITH. Fifty patients with bilateral ITH were included in two groups: patients benefiting from INSS and those not benefiting. Nasal airflow was assessed by peak nasal inspiratory flow (PNIF) measurement in all cases. Measurements were taken three times: before and after the application of nasal decongestant sprays and after the application of INSS. In both groups, the nasal air flow rates significantly increased after the application of nasal decongestant sprays; however, the nasal decongestant response rates were higher in the group with patients benefiting from INSS. There was a strong correlation between the nasal air flow rates measured after the application of nasal decongestant sprays and after the application of INSS. The cut-off value for the relationship between increased nasal air flow rates after the application of nasal decongestant sprays and outcomes of INSS was 23%. Measurement of nasal airflow increase rate after the application of nasal decongestant sprays is a simple and easy method for the early prediction of the outcomes of INSS in ITH. A higher than 23% increase in nasal air flow rates after the application of nasal decongestant sprays indicates much better outcomes of INSS for patients.

Comparison of the long term efficacy of radiofrequency ablation and surgical turbinoplasty in inferior turbinate hypertrophy: a randomized clinical study

Objective: To compare the long term effectiveness of radiofrequency thermal ablation with that of surgical turbinoplasty, a prospective, randomized, blinded clinical study was conducted.Methods: Eighty six patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Forty four patients were operated by radiofrequency ablation, while 42 underwent surgical turbinoplasty. The outcomes of both techniques were compared in terms of symptoms using visual analogue score (VAS) and endoscopic scores.Results: A statistically significant difference in the VAS scores existed between the two groups by the 3rd month in terms of nasal obstruction (p=.0002) and headache (p=.0001), by the 6th month in terms of nasal secretions (p=.007), by the end of 1 year in terms of sneezing (p=.023) and no statistically significant difference even till the end of year with respect to hyposmia.Conclusions: Radiofrequency thermal ablation is more effective than surgical turbinoplasty in terms of treating nasal obstruction and equally effective in terms of managing sneezing. Radiofrequency ablation has the advantage of being a day care procedure and minimal complications.

Comparison of Radiofrequency Thermal Ablation and Microdebrider-Assisted Turbinoplasty in Inferior Turbinate Hypertrophy: A Prospective, Randomized, and Clinical Study.

To compare the effectiveness of radiofrequency thermal ablation with those of microdebrider-assisted turbinoplasty, we designed a prospective, randomized clinical study. Forty patients suffering from nasal obstruction due to bilateral inferior turbinate hypertrophy were enrolled. Half of the patients were operated by radiofrequency thermal ablation, while the other half underwent microdebrider-assisted turbinoplasty. The outcomes of both techniques were compared in terms of symptomatology, nasal patency, and mucociliary transport. A statistically significant difference existed between the two groups with respect to nasal obstruction and the frequency of obstruction at the first post-operative week and first and third post-operative months (p<0.05). Rhinomanometry detected a significant decrease in nasal resistance values in both surgical groups compared to the preoperative values. The mucociliary transport time was significantly prolonged in the first postoperative week and first postoperative month in microdebrider-assisted inferior turbinoplasty group. Both radiofrequency thermal ablation and microdebrider-assisted turbinoplasty are effective techniques for treating inferior turbinate hypertrophy. The treatment modality should be individually determined, and parameters such as tissue healing, volume reduction, and mucociliary activity must be taken into account.

The spectrum of nasal involvement in systemic lupus erythematosus and its association with the disease activity.

The purpose of this study was to determine the spectrum of nasal involvement in systemic lupus erythematosus (SLE) and its association with the disease activity of SLE based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). This was a cross-sectional and observational study involving 73 stable SLE patients. All subjects were evaluated for the SLEDAI scores and had nasal endoscopic examination. The most commonly reported symptom was nasal congestion (31.5%) followed by nasal itchiness (26.0%), runny nose (20.5%) and nasal dryness (19.2%). Almost half (42.9%) of the subjects had nasal mucosal abnormalities, which included mucositis, crusting, ulceration, bifid middle turbinate, septal spur, Jacobson's organ, deviated nasal septum, bilateral inferior turbinate hypertrophy, everted uncinate process, nasopharynx cleft and torus palatinus. The median SLEDAI score for subjects with nasal symptoms was significantly higher than subjects without nasal symptoms (p < 0.05). Similarly, subjects with moderate to high activity (SLEDAI scores of 6-19) had a significantly higher frequency of both nasal symptoms and nasal mucosal abnormalities (p < 0.05) compared to subjects with no to mild activity (SLEDAI scores of 0-5).