Inferior Turbinate Hypertrophy Research Articles

EVALUATING THE RESULTS OF SEPTOPLASTY AND PARTIAL INFERIOR TURBINOPLASTY

Aims: To study outcomes of septoplasty and partial inferior turbinectomy (PIT) method, expecting leastsurgical equipment, good result, price rationalization. Methods: Prospective, cross-sectional study. Including 40 patients treated by septoplasty and PIT method. Assessment had been made after 3 months post-op. Results: The common symptoms were nasal obstruction (100%), headache (40%). The deformities of nasal septalwere deviation (42.5%), crest (30%). There were 67.5% of patients with severe bilateral hypertrophic inferior turbinate, mostly over grade II, enlargement both soft and bone parts (60%). After 3 months, the nasal obstruction and headache presented good or great results in 90% of patients, 93.7% of patients had straight nasal septaland 90% hadsmall inferior turbinate.VAS: patients’s contentment was 100%. Conclusions: The study showed that septoplasty and partial inferior turbinectomy presented good results with 87.5% after surgery and 90% after 3 months. Key words: septal deformity, hypertrophy inferior turbinate, septoplasty, partial inferior turbinectomy

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 Emla cream and lidocaine injection for local anaesthetic before radiofrequency reduction of the inferior turbinates

We compared the effectiveness of local anaesthetic with Emla cream with that of an injection of lidocaine for radiofrequency reduction of the inferior turbinates. We studied 98 consecutive patients with hypertrophied inferior turbinates, 46 of whom were given Emla cream and 52 lidocaine injection. The procedure began five minutes after the injection of lidocaine and 10minutes after the Emla cream had been applied. Patients were asked to indicate on a visual analogue scale (VAS) the degree of perioperative pain, anxiety, sensation of choking, and discomfort on swallowing that they felt after the procedure. Patients treated with Emla had significantly lower VAS scores for discomfort on swallowing than those treated with lidocaine (p=0.001), but there were no other significant differences between the two groups. We conclude that Emla cream is an efficacious alternative to infiltration of lidocaine for radiofrequency reduction of the inferior turbinates.

Conchal contractility after inferior turbinate hypertrophy treatment:A prospective, randomized clinical trial

ObjectiveThe aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters. Methods82 patients were presented with the complaint of nasal obstruction and diagnosed with inferior turbinate hypertrophy and were included in the study. Patients in Group 1 received NCS for 12weeks. Patients in Group 2 were administered RF to their inferior turbinates. Acoustic rhinometry and rhinomanometry tests with and without decongestant were performed. ResultsIn the evaluation of the contractility difference of rhinometry parameters, there was not a significant difference among pre and postoperative acoustic rhinometric parameters in Group 1. Whereas in Group 2, postoperative contractility difference was significantly decreased compared to preoperative values.In the evaluation of the contractility difference of rhinomanometric parameters, no significant difference was found between pre and postoperative values in Group 1. However, postoperative contractility difference was significantly decreased compared to preoperative values in Group 2 in terms. ConclusionBecause the RF procedure produces fibrosis in the vascular tissues, inferior turbinates do not have a shrinking response to decongestant administration. Administration of NCS administration maintains the contractility function compared to RF application.

Surgical Ultrasound Reduction of Inferior Turbinate Hypertrophy

Surgical Ultrasound Reduction of Inferior Turbinate Hypertrophy

Effect of Radiofrequency on DNA Damage and Oxidative Status in Patients with Turbinate Hypertrophy.

The radiofrequency devices that are used generate radiofrequency in the frequency range of 1.5 and 2.5MHz. This study aims to demonstrate whether systematic oxidative status and DNA are influenced in this frequency range. In study, 27 patients who received radiofrequency treatment on inferior turbinate as they were diagnosed with inferior turbinate hypertrophy. DNA damage was assessed by alkaline comet assay in peripheral lymphocyte cells. Plasma levels of total antioxidant status (TAS), total oxidative status (TOS) were determined by using an automated measurement method and oxidative stress index (OSI) was calculated (OSI was calculated as: OSI=(TOS/TAS)×100). There were increased in the OSI and TOS values on days 1 and 15 as compared to the samples taken before the radiofrequency administration. Significant decreases were seen in TAS values on days 1 and 15. As for the DNA damage, no significant differences were found on day 15 compared to the preoperative values even though there was a statistically insignificant increase on day 1. Administration of radiofrequency radiation on inferior turbinates results in increased oxidative stress in the acute period and a decrease in the anti-oxidative system. Although this effect causes a slight increase in the DNA damage in the early post-operative period, the damage is restored to the pre-operative levels on day 15. Therefore, we believe that a more conservative approach should be selected for radiofrequency treatment instead of using it routinely.

COMPUTED TOMOGRAPHIC EVALUATION OF INFERIOR TURBINATE HYPERTROPHY IN ADULT INDO-DRAVIDIAN PATIENTS WITH DEVIATED NASAL SEPTUM

Objective: Aim of the study was to evaluate the prevalence and significance of inferior turbinate hypertrophy (ITH) in adult indo-dravidian patients with deviated nasal septum (DNS). Methods: Analysis of sinonasal computerized tomography (CT) images of 86 patients having DNS was done during October 2015-December 2016 for evaluation of severity of the associated ITH. Values of maximum width of medial mucosa, bone and total width of the turbinate were measured. Patients with inflammatory or expansile sinonasal masses were excluded. Results: Total 86 patients with varying degrees of septal deviation with ages ranging from 18 to 72 years (mean age of 42.8 years) were distributed as: Group I, mild cases and Group II, moderate and severe DNS cases. Patients having ITH on the contralateral side of deviation were included in the study group. The dimensions of the ITH were evaluated. The medial mucosal component of the ITH underwent maximum hypertrophy as compared to bone and lateral mucosa components. The average medial mucosa, bone and total turbinate widths of the inferior nasal concha as well as lateral offset in Group II DNS cases were 5.21 mm, 1.76 mm, 9.96 mm and 8.74 mm, respectively. Total width and width of medial mucosa of ITH in relation to the severity of septal deviation was statistically significant (p=0.0001 and 0.0098). Conclusion: Present study evaluated the relationship between DNS and compensatory ITH. The findings support the decision to excise the inferior turbinate at the time of septoplasty, because of the significant mucosal expansion.

Inferior turbinectomy - outcome of various surgical modalities: a prospective study

<p class="abstract"><strong>Background:</strong> Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvement. In these circumstances, surgical reduction of inferior turbinate can be proposed. Many different techniques are currently available. The aim of our study is to prospectively evaluate the effectiveness of three techniques i.e., electrocautery, cryotherapy and radio frequency by comparing the response of patients to these surgical modalities of turbinate reduction.</p><p class="abstract"><strong>Methods:</strong> A total of 90 patients presenting with nasal obstruction with or without allergic symptoms, fulfilling the inclusion and exclusion criteria, attending ENT OPD are included in the study. A prospective study was conducted on three groups of thirty patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy of more than 3 months duration. Then the percentage of subjective improvement in nasal airway is used to assess treatment outcomes 1 week, 1, 3, 6, 9 and 12 months after surgery. </p><p class="abstract"><strong>Results:</strong> At the end of 12 months, 56.6% of patients treated with electrocautery and 56.6% of patients treated with cryotherapy showed 75% improvement in nasal obstruction whereas 59.99% of patients treated with radio frequency showed 100% improvement. No statistical difference in the amount of improvement in nasal obstruction was noted between the three treatment groups at the end of 12 months because of relatively small sample size.</p><strong>Conclusions:</strong> On this basis it is evident that clinically radio frequency showed better subjective improvement in nasal obstruction when compared to cryotherapy and electrocautery.

Nasal airway evaluation in obstructive sleep apnoea patients: volumetric tomography and endoscopic findings

Obstructive sleep apnoea (OSA) results from the recurrent collapse of the upper airway during sleep. Nasal abnormalities influence the stability of the pharynx. The aim of this study was to evaluate the volumetric and anatomical changes of the nasal cavity in patients with OSA. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to grade nasal obstruction. Sleep-related breathing disorders were evaluated by polysomnography. The nasal airway volume was obtained from computed tomography scans through volumetric reconstruction of the nasal airway. Alterations to the nasal anatomy were identified by nasal fibre-optic endoscopy. Ninety-four patient charts were analyzed. The final sample comprised 32 patients with severe OSA, 16 with moderate OSA, 23 with mild OSA, and 20 without OSA. Three groups were established based on nasal obstruction and OSA. The groups were compared for nasal airway volume (P=0.464) and body mass index (P=0.001). The presence of nasal septum deviation and inferior turbinate hypertrophy were related to the NOSE score (P=0.05 for both), apnoea–hypopnoea index (P=0.03 and P=0.05, respectively), and nasal airway volume (P=0.71 and P=0.78, respectively). In this nasal airway evaluation of OSA patients, the presence of sites of obstruction was correlated with the severity of OSA; this was not the case for the evaluation of the nasal airway volume dimensions.

Submucosal Inferior Turbinoplasty Using a New Continuous Suction Irrigation Method.

Numerous surgical techniques for inferior turbinate hypertrophy (ITH) have been reported, each with advantages and disadvantages. Submucosal turbinoplasty with removal of the bony component of the inferior turbinate (IT) is an excellent procedure to expand the nasal cavity. However, this procedure requires a large incision to remove the inferior turbinate bone (ITB) and is associated with hemorrhage, crust formation, and adhesion. A smaller incision would avoid such complications. We developed a continuous suction irrigation method that maintains a clear view of the limited surgical field of the IT. Only a single small incision is needed to insert the rigid endoscope. The surgeon can flush blood with continuous water flow and perform IT surgery without difficulty. We performed this method in 39 cases from January 2016 to January 2017. This video article demonstrates our new submucosal inferior turbinoplasty technique. Submucosal turbinoplasty using a continuous suction irrigation method was performed under general anesthesia. An irrigation-suction straw sheath system was used to create an underwater surgical field. The ITB was removed safely with no severe complications. An expanded common nasal cavity was confirmed postoperatively on computed tomographic images. We resected the ITB safely using a continuous suction irrigation method without difficulty or complications. We believe that this method may become one of the best surgical options for ITH.

A Comparitive Study of Outcome of Septoplasty for Nasal Obstruction with and Without Hypertrophied Inferior Turbinate Reduction

A Comparitive Study of Outcome of Septoplasty for Nasal Obstruction with and Without Hypertrophied Inferior Turbinate Reduction

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.

Simulation of inferior turbinate reduction using computational fluid dynamics methods

Objective:Two computational fluid dynamic (CFD) models of unilateral inferior turbinate reductions (ITR) were constructed and investigate the influences of aerodynamic consequences.Method:A unilateral hypertrophic inferior turbinate CFD model wasestablished. Two kinds of methods in removing of tissue bulk along the length of the hypertrophic inferior turbinate were used,and we got the model B and the model C. Nasal airflow distribution were computed before and after simulated unilateral inferior turbinate reduction in use of Fluent 6.3.26.Result:Simulated two kinds of ITR resulted in enlargement in the cross-section area of inferior nasal meatus, 0.36 cm² of the model B and 0.89 cm² of the model C in average. Model C produced a less reduction in intranasal pressures (approximately 3 Pa) than the model B and the original model which are the same as approximately 8 Pa. More air was predicted to flow in the affected nasal passage in the model C (approximately 80 ml/s) than the model B and the original model. Airspeed in the anterior valve region was improved significantly and more vortices happened in the model C.Conclusion:The model C is significantly better than the model B in restoring normal anatomy and ventilation physiological of the nasal cavity. So, in ITR recoverying normal anatomy structure of the nasal has decisive significance.

Radiofrequency turbinate volume reduction vs. radiofrequency-assisted turbinectomy for nasal obstruction caused by inferior turbinate hypertrophy.

Radiofrequency procedures are a well-accepted treatment for nasal obstruction. We conducted a randomized, noncontrolled study to compare the effectiveness of submucosal bipolar radiofrequency turbinate volume reduction (RFTVR) and bipolar radiofrequency-assisted turbinectomy (RFaT) in patients presenting with nasal obstruction caused by inferior turbinate hypertrophy. A total of 30 patients-15 males and 15 females, aged 15 to 60 years (mean: 32)-were randomly divided into one of the two homogeneous treatment groups. Outcomes were determined by comparisons of subjective symptom scores on a visual analog scale and by anterior active rhinomanometry at postoperative days 7, 14, and 28 and again at 6 months postoperatively. Both groups demonstrated significant and similar improvements in nasal airway function both subjectively and objectively. However, we noted that the incidence of adverse effects and postoperative morbidity was higher in the RFaT group. Therefore, we conclude that when surgery is indicated, RFTVR is the preferred treatment for nasal obstruction secondary to inferior turbinate hypertrophy. RFaT is equally effective, but it is associated with a slightly higher incidence of adverse effects.

Does the Effect of Inferior Turbinate Outfracture Persist?

To resolve nasal obstruction in rhinoplasty, inferior turbinate outfracture is performed widely alone or combined with other procedures. There are conflicting reports on the effect of inferior turbinate outfracture. This study evaluated the persistence of morphologic changes after inferior turbinate outfracture. This retrospective study enrolled 55 patients who underwent inferior turbinate outfracture without septal surgery to approach the sphenoid sinus for brain tumor removal. Coronal paranasal sinus computed tomographic images obtained preoperatively and 6 months postoperatively were compared. The authors measured the shortest distance from the median line to the medial border of the conchal bone and the shortest distance from the medial border of the conchal bone to the lateral nasal line. The authors also gauged the projection angle of the conchal bone and constitutional thickness of the inferior turbinate. After inferior turbinate outfracture, the shortest distance from the median line to the medial border of the conchal bone increased, and shortest distance from the medial border of the conchal bone to the lateral nasal line decreased. The projection angle decreased significantly by 6 months postoperatively. After outfracture, the thickness of the medial mucosa had increased significantly, wheras the thickness of the conchal bone had decreased significantly (p < 0.05). The effect of inferior turbinate outfracture is preserved for at least 6 months. Moreover, compensatory hypertrophy of the medial mucosa develops in the inferior turbinate after outfracture. Therefore, outfracture with medial submucosal volume reduction would be recommended as the best procedure for treating inferior turbinate hypertrophy. Therapeutic, IV.

Antrochoanal polyp in pediatric age group

Antrochoanal polyp (ACP) is a benign solitary polypoid lesion affecting mainly adults and rarely children. It originates from a hypertrophy of the mucous membrane of the maxillary sinus antrum, and grows through the maxillary sinus ostium towards the nasal cavity and the choana. The clinical data and imaging studies of 39 children with ACP were reviewed. The most commonly affected age group was from 10 to 15years. Clinical presentations included nasal obstruction, rhinorrhea; and rarely, bloody discharge. Ig-E-mediated allergy was established in 61.5% of the patients and only 17.9% of patients had history of asthma. 92.3% of patients had aberrant nasal anatomy, including septal deviation, pneumatized middle turbinate, and inferior turbinate hypertrophy. The development of ACP could be due to an increased pressure level within the maxillary sinus caused by obstruction of the sinus natural ostium and/or anatomical alteration at the ostiomeatal complex at middle meatus level, in a patient with a pre-existing silent antral cyst, subsequently forced to herniate outside, through the sinus fontanelle. For treatment, we suggest performing wide middle meatotomy in addition to correction of all the predisposing anatomical factors.

A Prospective Study of Different Methods of Inferior Turbinate Reduction.

All the functions of nasal cavities are performed through mucosa and contours of the turbinates. Hypertrophied inferior turbinate is one of the major and common causes of nasal obstruction. In these patients nasal obstruction is relieved by inferior turbinate reduction. Many procedures on turbinate reduction have been described earlier. To compare and evaluate the better method for inferior turbinate reduction among submucosal diathermy using monopolar cautery and bipolar cautery, complete turbinectomy, inj. sodium tetradecylsulphate infiltration. Eighty patients of either sex between 17-50 years of age having inferior turbinate hypertrophy were included in the study. The patients were divided into four groups with 20 patients in each group. Each group had 20 patients. Group A was subjected to submucosal diathermy using monopolar cautery, Group B to bipolar cautery, Group C to complete inferior turbinectomy and group D to injection sodium tetradecylsulphate. Patients were assessed for nasal patency and symptomatic relief, postoperative bleeding, pain, crusting and synachiae. Follow up was done on 7th day, 21st day and 3rd month postoperatively. Statistical analysis was carried out using IBM SPSS Version 20.0 for windows. Mean and standard deviations were calculated for quantitative data, for categorical variables frequencies and percentages were calculated, within the group comparisons were done with paired t-tests. The mean reduction in postoperative nasal obstruction was found to be maximum with bipolar cautery when compared with the other modalities and this difference was found to be statistically significant (p<0.001). Bipolar cautery was found to be associated with minimum after effects when compared to other modalities except for postoperative pain which was found more in the patients operated by the bipolar cautery method. We found inferior turbinate reduction using bipolar cautery was better and safe method, when compared to monopolar cautery, complete turbinectomy and inj. sodium tetradecylsulphate, however further studies are required with larger sample size.

Powered turbinoplasty versus powered turbinectomy: a comparative study

ObjectiveThis study aimed to compare the outcomes of powered turbinoplasty with those of powered turbinectomy.Materials and methodsForty patients suffering from hypertrophied inferior turbinate that resisted ordinary medical treatment were randomly divided into two equal groups. One group was managed with powered turbinoplasty and the other with powered turbinectomy. The patients were followed up for 6 weeks postoperatively.ResultsAfter 6 weeks the total success in reducing the size of the turbinate and postoperative blood clots was the same (100%) for both groups but it was 100% for powered turbinoplasty and 80% for powered turbinectomy in the occurrence of postoperative crustations.ConclusionPowered turbinoplasty is a promising surgical procedure for inferior turbinate surgery. This procedure achieves optimum turbinate reduction with less complications in patients with respect to bleeding, occurrence of crustations, blood clots, and nasal discharge postoperatively.

Surgical techniques in the inferior turbinates hypertrophy

In the current medical practice, nasal congestion is one of the most frequent symptoms that bring the patients at doctor. One of the most common causes of chronic nasal obstruction is inferior turbinate hypertrophy. Surgical therapy is reserved for those patients who remain symptomatic despite proper medical therapy. The authors bring into question a number of procedures and surgical techniques addressed to the inferior turbinate hypertrophy, choosing one or another depending on the surgeon’s personal experience, the existing pathology and, not at least, the patient’s wish.

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.