Coblation Technique Research Articles

„Die Österreichische Tonsillenstudie 2010“ – Teil 1: Statistischer Überblick

Tonsillectomy (TE), tonsillotomy (TO) and adenoidectomy (AE) are surgeries performed routinely by otorhinolaryngologists. There were 5 cases of fatal postoperative bleeding in Austria during the years 2006 and 2007, all in children under 6 years of age. The intensive discussion following these sad events resulted in a Consensus Paper of the Austrian Society of ORL, H&NS with the Austrian Society of Pediatrics with modified recommendations towards indications and surgical techniques in different age groups; in addition, the prospective study presented here was initiated. In Austria for the first time a full census could be performed assessing all TE, TO and AE with standardized definitions. Within the study period of 9 months' from October 1, 2009, to June 30, 2010, data on patients' characteristics, indication for surgery, surgical technique and postoperative haemorrhage were prospectively collected. Postoperative haemorrhage was defined as any bleeding after extubation regardless of whether or not a surgical intervention was required. Postoperative bleeding events were categorised into 7 grades depending on severity. More than one million data of 9,405 patients from 32 ENT-departments in Austria were collected and analysed. One third were children younger than 6 years (n=3,474; 37%) and one third were adults (n=3,507, 37%). A TE ±AE was performed in 48.8% (n=4,594), an AE in 37.1% (n=3,492) and a TO in 14.0% (n=1, 319). For the indication "recurrent tonsillitis and tonsilar hypertrophy" 70% of children had a TO but 95% of adults had a TE (p<0.001). Adults with OSAS had a TE whereas in children aged younger than 6 with the same indication a TO was preferably performed in 90% (p<0.001). For TO the Colorado-needle and the Coblation technique were most commonly used. The Adenotome by La Force and the Adenoid curette by Beckmann, with or without endoscopic control, were most frequently used for AE. For the first time a prospective full survey could be performed in one country assessing all tonsil and adenoid surgeries along standardized criteria. The study gives an overview about the types of surgery, the indications, the operation techniques and the frequency of postoperative haemorrhage. The latter, because of its clinical importance, is dealt with and described in detail in the second part of this publication.

Complications in Tonsillotomy: A Systematic Review

Objective: Intracapsular tonsillectomy (or tonsillotomy) is a technique rapidly gaining acceptance. Multiple individual clinical trials have been performed, but there remains no clear consensus as to how tonsillotomy compares to traditional methods in regard to complication rates. The purpose of this study is to compile and critically analyze this data. Method: MEDLINE was searched using multiple search terms, with the following inclusion criteria: English language, human subjects, and related to complications of tonsillotomy. Multiple tonsillotomy techniques were included. The results of these studies were summated, and the results were analyzed. Random effects modeling was used to calculate summary effect measures. Results: Thirty-three studies met inclusion criteria. The bleeding rate for tonsillectomy was 3.4% ( P &lt; .01, 95% CI=0.027-0.041, k=23) with a dehydration re-visit rate of 3.4% (&lt;0.01, 0.018-0.049, 13). For tonsillotomy, the rates were 1.5% (&lt;0.01, 0.012-0.017, 31) and 1.4% (&lt;0.01, 0.006-0.022, 17), respectively. When stratifying for tonsillotomy technique, the rates were 1.5% (&lt;0.01, 0.014-0.017, 5) and 1.5% (&lt;0.01, 0.014-0.017, 4) for coblation and 0.8% (&lt;0.01, 0.006-0.01, 15) and 1.7% (&lt;0.01, 0.007-0.026, 10) for microdebrider. Number of days receiving analgesia was 7.045 (&lt;0.01, 6.31-7.76, 5) for tonsillectomy and 4.09 (3.19-4.99, 7) for tonsillotomy. There was no difference in blood loss between groups. Conclusion: Tonsillotomy appears to compare favorably with tonsillectomy and may offer a reduction in postoperative complications (bleeding and dehydration), as well as less use of analgesics. Subgroup analysis suggests that microdebrider tonsillotomy may have a lower bleeding rate than the coblation technique.

Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials

After the surgical procedure of tonsillectomy, hemorrhage ranks among its serious postoperative complications. In this systematic review, we analyze hemorrhage following tonsillectomies performed using the coblation technique. 24 prospective, randomized, and controlled studies were included in the meta-analysis. Data of 796 patients who had undergone coblation tonsillectomy were analyzed. Hemorrhages occurred in 33 patients: 2 classified as primary and 26 as secondary hemorrhages. 5 could not be classified into either group. Overall, the total hemorrhage rate for the coblation procedure was 4.1% with a 95% confidence interval from 2.8 to 5.5%. The overall hemorrhage rate of 4.1% found in this meta-analysis shows that coblation is a safe and effective technique for tonsillectomies with a secondary bleeding rate similar to what is reported for comparable techniques such as bipolar diathermia.

Postoperative Morbidity in Traditional versus Coblation Tonsillectomy

The aim of this study was to compare levels of postoperative pain after traditional (cold steel with bipolar cautery) and Coblation tonsillectomies. Patients with recurrent or chronic tonsillitis, including tonsillar hyperplasia, were randomized to undergo tonsillectomies using either a traditional cutting technique or the Coblation technique. Patients and staff on the relevant wards were blinded regarding patient allocation. Pain, odynophagia, and activity limitations were recorded on a visual analog scale. Analgesics were self-administered, and daily analgesic consumption by patients was reported. All complications were also registered. Fifty-seven patients (between 6 and 57 years of age) completed the study. No significant difference was found between the two techniques with regard to reported pain, odynophagia, activity limitations, or use of analgesics. A slight tendency toward decreased pain and decreased use of analgesics in the Coblation group reached statistical significance only when the adult patients were analyzed separately. Two cases of hospital readmission occurred because of postoperative bleeding following Coblation tonsillectomies. Overall,the two methods are equivalent in terms of postoperative pain,including the use of analgesics. The risk of postoperative bleeding after the Coblation method requires further evaluation with specifically designed studies.

Study on hemorrhage following coblation assisted uvulopalatopharyngoplasty

To compare the postoperative hemorrhage between standard uvulopalatopharyngoplasty (UPPP) and coblation assisted UPPP, and to evaluate the related risk factors and preventive measures. Five hundreds and ninety seven patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent UPPP and coblation assisted UPPP between January 1, 1999, and September 30, 2009 were reviewed retrospectively. Two hundred and sixty three patients with coblation assisted UPPP and 334 patients with standard UPPP were treated respectively. Single factor statistic analysis, multiple factors Logistic regress statistic analysis and Wilcoxon test method for related risk factors were applied. A total of 42 patients (7.0%) experienced postoperative bleeding. Among them, 24 patients with coblation assisted UPPP (9.1%) and 18 patients with UPPP (5.4%) had postoperative hemorrhage. Significant difference was not found in the degree of hemorrhage (z = 0.784, P > 0.05), hemorrhage site(χ(2) = 1.387, P > 0.05) and postoperative hemorrhage rates (χ(2) = 3.14, P > 0.05) between the two surgical techniques. Significant difference was found in the interval of hemorrhage after surgery between the two surgical techniques (χ(2) = 9.25, P < 0.01). History of hypertension, smoking, hepatic dysfunction was found to be correlated with the postoperative hemorrhage (Odd-ratio were respectively 7.326, 3.674, 2.707). Coblation technique did not significantly increase UPPP postoperative hemorrhage.

Disc Puncture for TreatmentOF Reflex Pain Syndromesof Lumbar Spine Degenerative Disease

Objective . To compare efficacy of coblation and chemical disc denervation in the treatment of patients with pain syndromes of spine degeneration. Material and Methods. Randomized prospective study was performed to compare treatment results in 58 patients with reflex pain syndromes in the lumbar spine. The study group included 36 patients with reflex pain syndromes of the lumbar spine degenerative disease treated by coblation technique. The control group included 22 patients with similar manifestations of the lumbar degeneration treated by denervation of intervertebral disc with alcohol-novocaine solution. Patients underwent clinical neurological examination, MRI study, and X-ray of the lumbar spine. Pain syndrome was assessed using visual analogue scale. Indication for puncture treatment was a persistent pain syndrome unresponsive to multimodal conservative treatment for 1.5—2 months. Results. Fifty six patients were discharged the day after surgery. Out of them 37 patients had excellent results, 15 — significant improvement, and 4 — satisfactory results. Conclusion. Coblation and chemical disc denervation are effective and safe techniques to treat patients with pain syndromes of spinal degenerative disease which allow achievement of clinical results with minimal traumatizing of surrounding tissues.

Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy

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.

A randomised controlled trial to compare postoperative pain in children undergoing tonsillectomy using cold steel dissection with bipolar haemostasis versus coblation technique

A randomised controlled trial to compare postoperative pain in children undergoing tonsillectomy using cold steel dissection with bipolar haemostasis versus coblation technique

A randomised controlled trial to compare postoperative pain in children undergoing tonsillectomy using cold steel dissection with bipolar haemostasis versus coblation technique

To measure postoperative pain levels in children undergoing tonsillectomy, by two different techniques, cold steel dissection and coblator dissection. The hypothesis - that coblator dissection may be associated with less postoperative pain. Prospective, randomised, double blind trial. Single centre, secondary care Children's Hospital. Children aged between 4 and 16 years, undergoing tonsillectomy, or adeno-tonsillectomy. children already taking regular analgesia and those who experienced postoperative bleeding. Seventy-nine children were recruited, nine were excluded. We compared analgesia requirements during the first 10 days, and also the return to normal eating and drinking. These were assessed, using a validated pain scale. All analgesic administration in hospital and at home was compared. The return to normal eating & drinking patterns, was also compared. Whilst in the 24 h postoperatively there was no significant difference in the pain scores between the two groups, the coblator group required less potent analgesia. No statistical difference was identified between the two groups following discharge, except on the sixth postoperative day, when the coblator group had lower pain scores. This may represent chance, rather than a clear difference. The findings do not confirm the hypothesis that tonsillectomy undertaken in children, with the coblator device, is associated with lower levels of postoperative pain, but do indicate that less analgesia is required by the coblator patients in the first 12 h postoperatively.

Intracapsular coblation tonsillectomy and adenoidectomy for the treatment of pediatric obstructive sleep apnea/hypopnea syndrome

To report the findings of five years' experience using standardized coblation intracapsular tonsillectomy with adenoidectomy for treatment of pediatric sleep apnea. Case series. A five-year retrospective analysis of coblation tonsillectomy performed by a single department for sleep apnea was completed. A total of 159 tonsillectomy and adenoidectomy (T&A) cases performed with coblation technique were reviewed. The mean preoperative apnea-hypopnea index (AHI) was 17.8 and mean postoperative AHI was 3.3. Polysomnogram (PSG) normalization (AHI < 1), was achieved in 54.7% patients. Normalization of PSG data was achieved in only 42.2% of overweight patients (body mass index [BMI] >or= 85th percentile). Based on regression analysis, Friedman tongue position (III and IV) and elevated AHI were determined to be independent predictors of poor response to T&A. Contrary to popular belief, a review of 159 cases demonstrates that T&A does not always result in normalization of polysomnographic data. Although complete resolution is not achieved in most cases, T&A offers significant improvements in AHI. Predictive variables such as BMI, FTP, and AHI should be taken into account when designing a treatment plan. It is important to recognize the need for close follow-up and early detection of residual disease in the pediatric population.

Percutaneous cervical disc decompression

Cervical disc nucleoplasty is a significant and clinically demonstrated innovation in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase. It allows a percutaneous decompression via a 19-gauge needle under utilization of the Coblation technique and under C-arm control. Until now the patients suffering of a cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment. We wanted to demonstrate a new and practicable anatomical pathway for reaching the cervical disc prolapse comparable to the technique for discography of the cervical spine. The introducer needle is advanced into the disc under fluoroscopic guidance using a standard anterior-lateral approach. The controller delivers radiofrequency energy to quickly ablate tissue at temperatures between 50 degrees and 60 degrees C. The decompression will be done in ablation mode by rotating the device through 180 degrees for 5 s in the posterior, medial and ventral third of the cervical disc. After failed conservative treatment over an average time period of 3 months we treated 26 patients with a contained herniated prolapse or protrusion with radicular arm pain by percutaneous decompression under utilization of the Coblation technique with a controlled energy plasma-mediated field. A randomized control group of 30 patients was treated alone conservatively with medical and physical therapy in the same period. The average preoperative VAS was 8.8. With a follow-up time of 2-years we found an average pain reduction with the visual pain score (VAS) of 2.3 who had a further check-up. The VAS was checked 24 h, 1 week, 3, 6, 12 and 24 months postoperatively. No complications with this method were seen. Comparable to the surgically treated group the conservative patients have had a VAS of 8.4. Under using conservative treatment with physical therapy, physiotherapy, analgetics and perineural injections we have had a diminution of the VAS to 5.1 after 2 years. The percutaneous decompression of the cervical disc protrusion with the Perc DC-Spine Wand by using the Coblation mode is a quick and safe procedure. Furthermore, one may state a persistent pain relief in the follow-up time up to 2 years after the percutaneous decompression of the disc.

Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction

Chronic nasal obstruction owed to chronic hypertrophic rhinitis is one of the most common problems encountered in rhinology. Various forms of conservative therapy have been used, but these are often ineffective and surgical reduction techniques have been successfully applied. However, the issue of postoperative histological changes in the nasal mucosa has not been adequately addressed. The aim of the present study was to comparatively evaluate the effect of the methods of submucosal monopolar diathermy, radiofrequency coblation and ultrasounds on the nasal mucosa. Sixty patients with chronic hypertrophic rhinitis of nonallergic etiology underwent different surgical methods of turbinate reduction, divided into two groups: (1) 30 patients underwent tissue volume reduction of the inferior nasal turbinates using ultrasound procedure on the left side and monopolar diathermy on the right; (2) 30 patients underwent radiofrequency coblation technique on the left side and ultrasound reduction on the right. We studied 20 preoperative specimens of the inferior turbinate mucosa taken randomly from both groups of patients, 5 from each side of each group. Normal nasal mucosal specimens taken from ten healthy persons were used as controls. Specimens of the inferior turbinate were taken after 1, 3, and 6 months after surgery, from the same patients. All specimens were examined by electron microscopy. Preoperative observation revealed degeneration of epithelial cells, loss of cilia, disruption of intercellular connections, edema, nasal mucus overproduction and inflammatory infiltration in chorium. Postoperative observations revealed decrease of intercellular edema, reduction of mucus, overproduction of collagen and degeneration of the epithelium to flattened stratified. Only specimens after use of ultrasounds showed islands with normally organized epithelium of columnar ciliated cells. It may be concluded that epithelial changes owed to chronic hypertrophic rhinitis do not significantly improve postoperatively after turbinate tissue volume reduction. Only in several cases operated with ultrasounds, regeneration of epithelium occurs, resulting to anatomical and functional restoration of the nasal physiology.

Post-tonsillectomy hemorrhage: assessment of risk factors with special attention to introduction of coblation technique

Post-tonsillectomy hemorrhage (PTH) is a relatively common and potentially life-threatening complication. The objective of this study was to examine the rate of PTH and identify risk factors. A retrospective cohort study was carried out including all tonsillectomies (430 patients) performed at Odense University Hospital (OUH) or Svendborg Hospital (SH), Denmark. PTH occurred in 52 patients (12.1%). Of the 180 patients treated with coblation technique, 41 (22.7%) had PTH. There were no fatal bleeding episodes. Multiple regression analysis resulted in three significant covariates: "Coblation as surgical technique" [relative risk (RR) = 5.3], "peritonsillar abscess as indication for surgery" (RR = 0.3) and "age equal to or above 15 years at the time of surgery" (RR = 5.4). It is concluded that patient age, PTA as indication for surgery and the use of coblation significantly affect the occurrence of PTH when coblation procedures are performed by non-experienced surgeons. We advise that implementation of coblation tonsillectomy is thoroughly planned with sufficient training of surgeons and continuous surveillance of results. If PTH rates comparable to "cold dissections tonsillectomy" cannot be reached intervention (learning or closing down of coblation tonsillectomy) has to be done.

Does Adenotonsillectomy Cure Pediatric Sleep Apnea?

Objective 1) Perform an updated meta-analysis to determine the cure rate of adenotonsillectomy for pediatric sleep apnea. 2) Report the findings of 5 years of experience with standardized coblation intracapsular tonsillectomy for the treatment of pediatric sleep apnea. Methods A thorough literature search of multiple databases was performed. Inclusion criteria for studies were: 1) Adenotonsillectomy as the primary treatment of sleep apnea (age&lt;18). 2) Pre-and postoperative polysomnography data was included. 20 studies fit the inclusion criteria and a metaanalysis was performed to determine the overall success. A 5–year retrospective analysis of coblation tonsillectomy performed by a single surgeon for sleep apnea was also performed. Results The meta-analysis included 904 subjects with average follow-up time of 21.6 weeks. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k= 20 studies) with T/A based on pre-and postoperative PSG data. Random-effects model estimated the treatment success of adenotonsillectomy was 61.1%. When “cure” was defined as an AHI of &lt;1, the cure rate was 53.8%. 200 adenotonsillectomy cases performed with coblation technique were reviewed. The mean preoperative was AHI 28.3 and mean postoperative AHI was 3.8. Surgical cure, as defined as a postoperative AHI &lt;1, was achieved in 51.7% of patients. Conclusions 1) Contrary to popular belief, meta-analysis of current literature and a review of 200 cases demonstrates that pediatric sleep apnea is often not cured by adenotonsillectomy. 2) Although complete resolution is not achieved in most cases, adenotonsillectomy still offers significant improvements in AHI.

Intracapsular versus subcapsular coblation tonsillectomy

To compare the postoperative recovery of patients who undergo intracapsular to subcapsular Coblation tonsillectomy. This was a prospective, randomized, double-blinded study. A total of 69 children, aged 2 to 16 years, were randomized to intracapsular (n = 34) or subcapsular (n = 35) tonsillectomy. The Coblation technique was used with both groups. Outcomes measures were assessed on postoperative day 1 or 2 and 5 or 6. These included child and parental rating of pain with the Wong Faces pain scale, analgesic use, oral intake, and activity level. Intracapsular tonsillectomy patients had similar levels of pain to subcapsular tonsillectomy patients on day 1 or 2. However, at day 5 or 6, intracapsular tonsillectomy patients had significantly less pain than the subcapsular tonsillectomy patients. Intracapsular patients ate more and were more active at both time points. Children with obstructive sleep apnea who undergo tonsillectomy demonstrate better postoperative recovery after intracapsular tonsillectomy. The intracapsular versus subcapsular difference may be best appreciated at a delayed time point (day 5 or 6) rather than early (day 1 or 2).

Randomized study comparing postoperative pain between coblation and bipolar scissor tonsillectomy

Coblation tonsillectomy has shown promising results with respect to postoperative pain when compared with other techniques. Our study was designed to compare this technique with bipolar scissor tonsillectomy. Forty adult patients with a history of chronic or recurrent tonsillitis referred for standard tonsillectomy were recruited and randomized into two groups. Twenty were operated with Coblator and 20 with bipolar scissors. Exclusion criteria were a history of quinsy, bleeding disorder, or any major health problems. All participants completed the study. Postoperative pain, return to normal diet, and estimated need for sick leave were utilized as parameters. Data on operative time, difficulty of tissue removal, and hemostasis were also analyzed. Operative time was longer (P < 0.001) and tissue removal as well as hemostasis control were more difficult (P = 0.005, P = 0.013) with Coblator than with bipolar scissors. Participants in Coblator group assessed higher pain scores 1 and 3 h postoperatively (P = 0.044, P = 0.036). From the time of extubation, patients had access to an opioid (fentanyl) via a self-controlled analgesia device. The number of doses of analgesics needed during the hospital stay was significantly higher in the Coblator group (P = 0.020). During the 14-day follow-up, no significant differences were found in pain scores, return to solid food or subjective working ability between the groups. Considering the overall outcome of the patients the results did not favor coblation technique over bipolar scissors.

Percutaneous Disc Decompression for the Treatment of Chronic Atypical Cervical Discogenic Pain

Percutaneous disc decompression with the radiofrequency coblation technique has been described to treat contained, symptomatic lumbar disc herniations. In symptomatic cervical disc herniations it has been used very selectively. We report a 42-year-old female with cervical disc pathology, predominantly at C6/C7, treated with percutaneous disc decompression using coblation technology. Her complaint of cervicogenic cephalgia completely resolved, along with an 85% reduction of neck pain and upper extremity pain 6-months post-operatively. This is the first case report of chronic cervical discogenic pain being treated with this technique.

Clinical effectiveness of coblation inferior turbinate reduction

objective We sought to determine the safety and clinical effectiveness of coblation (short for “cold ablation”) inferior turbinate reduction for turbinate hypertrophy. Methods A consecutive series of adult patients with inferior turbinate hypertrophy were treated with the coblation technique in the office setting. Subjective symptoms were assessed prior to treatment and at the 3- and 6-month intervals after treatment with the Rhinosinusitis Symptom Inventory (RSI) and a short nasal symptom questionnaire. Results Twenty-four of 26 treated patients completed the protocol. At the 3-month follow-up, statistically significant decreases in the nasal and overall symptom domains of the RSI were noted (changes of −10.5 and −8.7, with P = 0.018 and P = 0.015, respectively). These improvements were also significant at the 6-month follow-up (−20.1 and −15.8 with, P < 0.001 and P < 0.001, respectively). At the 3-month interval, nasal obstruction and amount of time with nasal obstruction were significantly decreased ( P = 0.006 and P = 0.011, respectively). These decreases remained statistically significant and slightly larger in magnitude at 6 months ( P = 0.001 and P = 0.006, respectively). Postoperative epistaxis occurred in 2 of 24 (8.3%) of patients. Conclusion Coblation inferior turbinate reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit persists at 6 months after the procedure.

Clinical Effectiveness of Coblation Inferior Turbinate Reduction

We sought to determine the safety and clinical effectiveness of coblation (short for "cold ablation") inferior turbinate reduction for turbinate hypertrophy. A consecutive series of adult patients with inferior turbinate hypertrophy were treated with the coblation technique in the office setting. Subjective symptoms were assessed prior to treatment and at the 3- and 6-month intervals after treatment with the Rhinosinusitis Symptom Inventory (RSI) and a short nasal symptom questionnaire. Twenty-four of 26 treated patients completed the protocol. At the 3-month follow-up, statistically significant decreases in the nasal and overall symptom domains of the RSI were noted (changes of -10.5 and -8.7, with P = 0.018 and P = 0.015, respectively). These improvements were also significant at the 6-month follow-up (-20.1 and -15.8 with, P < 0.001 and P < 0.001, respectively). At the 3-month interval, nasal obstruction and amount of time with nasal obstruction were significantly decreased (P = 0.006 and P = 0.011, respectively). These decreases remained statistically significant and slightly larger in magnitude at 6 months (P = 0.001 and P = 0.006, respectively). Postoperative epistaxis occurred in 2 of 24 (8.3%) of patients. Coblation inferior turbinate reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit persists at 6 months after the procedure.

Radiofrequency tonsil reduction: safety, morbidity, and efficacy.

To evaluate the safety, morbidity, and efficacy of radiofrequency tissue volume reduction of tonsils using two different surgical techniques and to compare these two techniques with each other and with classic tonsillectomy. A nonrandomized retrospective review of tonsil reductions was made between 2000 and 2002 using in vivo studies associated with tonsil reduction and tonsillectomy performed either in the hospital operating room or in the outpatient treatment area. We studied 150 patients and divided them into three main groups based on surgical technique. Group A consisted of 50 consecutive patients who underwent tonsil "ablation," Group B contained another 50 consecutive individuals who received tonsil "coblation," and Group C consisted of 50 patients who underwent classic tonsillectomy (cold dissection). Each group consisted of two subcategories of children (age range, 1-12 y) and adults (age range, 12-60 y) with chronic tonsillar hypertrophy. Most of the pediatric patients underwent adenoidectomy during the same surgical procedure. Indications for tonsillectomy were those listed by the American Academy of Otolaryngology-Head and Neck Surgery. A retrospective chart review was used to assess procedures, safety, morbidity, and efficacy of tonsil reduction and tonsillectomy. Four specific end points of morbidity were investigated: pain, return to normal diet, return to normal activity, and use of pain medication. Efficacy of tonsillectomy was determined by the clinical observation of the remaining tonsillar tissue and compared with pretreatment photographs of the tonsils. There were no complications in any of the groups. Efficacy was assessed based on the mean tonsil reduction and was found to be 100% for tonsillectomy, 86% for the tonsil coblation technique, but only 53.6% for the ablation technique. Morbidity was minimal in groups A and B and significantly greater in Group C. The number of pain days, narcotic-use days, and days before return to normal diet and activity were greatly reduced in groups A and B when compared with classic tonsillectomy (group C). Pain levels on day 1 were less than 3 (on a scale of 1-10) in groups A and B. The number of pain days and narcotic-use days was less than 4 days in groups A and B. Similarly, most patients returned to solid diet and normal activity by day 4. Pain levels, number of narcotic-use days, and number of days to return to normal diet and activity were significantly higher for classic tonsillectomy. Tonsil coblation has distinct advantages when compared with tonsil ablation and standard tonsillectomy. Tonsil coblation resulted in greater than 86% elimination of tonsillar tissue in both children and adults. In most patients, pain levels were minimal and limited to the first 48 hours after surgery. Return to normal diet and activity was much earlier in the coblation group versus classic tonsillectomy.