Inferior Turbinate In Patients Research Articles

Objective and Subjective Outcomes Following Radiofrequency of Inferior Turbinates in Patients with Sleep-Disordered Breathing.

Nasal obstruction is a frequent problem amongst patients with sleep-disordered breathing (SDB). Radiofrequency of the inferior turbinates (RFIT) is commonly utilized for inferior turbinate (IT) reduction but its effectiveness in SDB patients remains unproven. We aim to evaluate long-term objective and subjective nasal, olfactory and sleep outcomes following RFIT in SDB patients. Patients were assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 12 months (T3) following RFIT. At T0, T1, T2 and T3, the patients underwent objective assessments of their nasal airways and smell function and an evaluation of their quality-of-life, sinonasal, olfactory and sleep symptoms. Sleep studies were carried out at T0 and T2. Seventeen patients (with a median age of 42 years) underwent RFIT. A statistically significant objective and subjective improvement of the patients' nasal airways was demonstrated at T1. No other statistically significant changes were observed in the patients' nasal airways, smell, sleep study parameters or patient-reported outcomes at the other follow-ups. A multivariate analysis confirmed a statistically significant influence of age (older), sex (male), a higher BMI, the presence of septal deviation and the presence of allergic rhinitis in some of the studies' parameters. A statistically significant objective and subjective improvement of the patients' nasal airways was confirmed in the fitted model when considering the influence of the available variables. Our study confirms that the benefits of RFIT alone in SDB patients are limited and possibly only in the short-term period. Patient-related variables can potentially influence the final outcomes.

Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery.

To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery.

To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD). The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed. The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05). The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.

Radiological Evaluation of Inferior Turbinate in Patients with Deviated Nasal Septum using Computed Tomography

Introduction: Compensatory hypertrophy of inferior turbinate in the contralateral side of the deviated nasal septum is a known phenomenon. The objective of this study was to establish the relationship between the nasal septum and inferior turbinate and to determine the dimension and composition of inferior turbinate hypertrophy.Methods: This prospective, cross-sectional study was performed on 52 patients who were referred for Computed tomography of PNS with deviated nasal septum having compensatory hypertrophy of contralateral inferior turbinate. Non-hypertrophied inferior turbinate on the side of deviation was taken as a control group. Deviation angle, mucosal thickness including medial and lateral and bone thickness were evaluated using three-dimensional CT scan and compared to the control group.Result: Dimensions of the bony and mucosal components of the inferior turbinate were significantly greater than those of the control group. This study included 52 patients (M- 30, F- 22) having a mean age of 37 years. Out of 52, the septum deviated to the left side in 56% and 44% to the right side. The average angle of deviation was 10.12°. There was a statistically significant correlation (p&lt;0.05) between total turbinate thickness and angle of deviation. A statistically significant correlation (p&lt;0.05) was also observed between medial mucosa and bone thickness.Conclusion: Compensatory hypertrophy of inferior turbinate in patients with deviated nasal septum not only involves the mucosal component but also the bone itself. Pre-operative CT scan of PNS helps evaluate dimension and composition of inferior turbinate and assists to decide on surgical technique to fix turbinate.

Changes in substance P levels of inferior turbinate in patients with mucosal contact headache

IntroductionMucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy. ObjectivesThis study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache. Methods28 patients who had contact headaches (study group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit. ResultsIn the study group average substance P levels were 2.65±0.27pg/mg tissue (range: 0.61–5.44) and in the control group it was 1.77±0.27pg/mg tissue (range: 0.11–4.35). The difference was statistically significant between the two groups (p=0.0215). Average preoperative headache group visual analog scale scores was 5.93±0.38 (2–9) and the turbinate volume was 6.56±0.35cm3 (3.50–10.30). The control group turbinate volume was 4.71±0.39cm3 (2.50–7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p=0.001). ConclusionThis study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate.

Baicalin Down-Regulates IL-1β-Stimulated Extracellular Matrix Production in Nasal Fibroblasts.

PurposeBaicalin, a Chinese herbal medicine, has anti-fibrotic and anti-inflammatory effects. The aims of present study were to investigate the effects of baicalin on the myofibroblast differentiation, extracellular matrix production, migration, and collagen contraction of interleukin (IL)-1β-stimulated nasal fibroblasts and to determine the molecular mechanism of baicalin in nasal fibroblasts.MethodsNasal fibroblasts were isolated from the inferior turbinate of patients. Baicalin was used to treat IL-1β-stimulated nasal fibroblasts. To evaluate cytotoxicity, a 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-tetrazolium bromide assay was used. The expression levels of α-smooth muscle actin (SMA), fibronectin, phospho-mitogen-activated protein kinase (p-MAPK), p-Akt, p-p50, p-p65, and p-IκBα were measured by western blotting, reverse transcription-polymerase chain reaction (RT—PCR),or immunofluorescence staining. Fibroblast migration was analyzed with scratch assays and transwell migration assays. Total collagen was evaluated with the Sircol collagen assay. Contractile activity was measured with a collagen gel contraction assay.ResultsBaicalin (0–50 μM) had no significant cytotoxic effects in nasal fibroblasts. The expression of α–SMA and fibronectin were significantly down-regulated in baicalin-treated nasal fibroblasts. Migration, collagen production, and contraction of IL-1β-stimulated nasal fibroblasts were significantly inhibited by baicalin treatment. Baicalin also significantly down-regulated p-MAPK, p-Akt, p-p50, p-p65, and p-IκBα in IL-1β-stimulated nasal fibroblasts.ConclusionsWe showed that baicalin down-regulated myofibroblast differentiation, extracellular matrix production, migration, and collagen contraction via the MAPK and Akt/ NF-κB pathways in IL-1β-stimulated nasal fibroblasts.

A 24-month-follow-up study of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy.

We report a 24-month-follow-up study of argon plasma coagulation of the inferior turbinate (APC) in patients with perennial nasal allergy. This was a retrospective study, in which 41 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. The grades of nasal stuffiness, rhinorrhea, sneezing and the daily activity impairment caused by these nasal symptoms were evaluated before and then 6, 9, 12, 15, 18, 21, and 24 months after APC, using a questionnaire graded on a four-point scale according to the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. Both nasal stuffiness and any daily activity impairment significantly improved 6 months after APC. Twenty four months after APC, 8/10 (80%) of the patients reported mild or no stuffiness and 9/10 (90%) of the patients reported mild or no daily activity impairement. Neither rhinorrhea nor sneezing were significantly improved during this study. Of the 41 patients 18 (43.9%) received no additional treatment. A second APC treatment was administered to 10/41 (24.4%) patients during follow-up period. Additional conservative medications were needed in 15/41 (36.6%) patients. Among the patients uncontrolled by conservative medical treatment, inferior turbinate reduction using APC provides significant relief in a 24-month-follow-up from nasal stuffiness and daily activity impairment.

Radiological Examinations of Inferior Turbinate in Patients with or without Deviated Nasal Septum by Using Computed Tomography

Received August 18, 2015 Revised October 20, 2015 Accepted October 27, 2015 Address for correspondence Byoung-Joon Baek, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Cheonan Hospital, Soonchunhyang University College of Medicine, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Korea Tel +82-41-570-2265 Fax +82-41-579-9022 E-mail bjbaek@schmc.ac.kr Background and ObjectivesZZThe aim of this study was to analyse the radiological anatomic dimensions of the inferior turbinate in patients without deviated nasal septum and compare it to those in the patients with deviated nasal septum using computed tomography. Subjects and MethodZZThe OMU CTs of 98 patients, 196 nostrils with or without deviated nasal septum were evaluated (control group: 42 patients, deviated septum group: 56 patients). The analysis of the CT scans contained the mucosal and bony length, mucosal width of the turbinate and the anterior and posterior mucosal overlay. And also evaluated the cross-sectional area and the type of inferior turbinate bone. ResultsZZAll subjects were divided into three groups: the concave, convex, and control groups. The correlations of fifteen measuring points such as anterior, middle and posterior medial mucosal thickness, total width, bone width, medial mucosa width of inferior turbinate, and area of inferior turbinate bone were significantly different among the groups (concave side>control group>convex side). Of the demographic factors, age was negatively correlated with mucosa and bone length. Types of inferior turbinate bone were as follows: lamella type (38%), combined type (37%), compact type (25%). ConclusionZZThere were statistical differences in some measured anatomical points among the concave, convex, and control groups. Greater septum deviation was correlated with greater degree of hypertrophysm of the inferior turbinate. The age of patients showed negative correlation with inferior turbinate length. Most frequent type of inferior turbinate was lamella type. The results of this study may provide important information when considering turbinate surgery. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(1):28-34

The MEK1/2–ERK1/2 Pathway is Activated in Chronic Rhinosinusitis with Nasal Polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease that has a considerable impact on the quality of life. Alterations in signalling pathways may contribute to the ongoing inflammation and proliferation in CRSwNP. The MEK1/2-ERK1/2 pathway transmits signals from many extracellular molecules to regulate cellular processes. We examined tissue samples from nasal polyps and the inferior turbinate of patients with CRSwNP and the inferior turbinate from subjects with healthy mucosa. The expressions of MEK1/2, ERK1/2, and their active phosphorylated forms pMEK1/2 and pERK1/2 were analysed using DNA microarray, quantitative real-time PCR, protein array, Western hybridisation, and immunohistochemistry. We detected increased MEK1/2 protein expression in nasal polyps compared to the inferior turbinates of patients with CRSwNP or healthy mucosa. We also found a higher amount of MEK1/2 in the inferior turbinates of patients with CRSwNP compared to those with healthy mucosa. Most importantly, we observed a significant increase in the phosphorylation of MEK1/2 and ERK1/2 in nasal polyps compared to both types of controls. We observed activation of the MEK1/2-ERK1/2 pathway in nasal polyps. Interestingly, we did not see the same activation pattern in different tiers of the MEK1/2-ERK1/2 signalling cascade. One explanation for this result is that the components enhance the complex MEK-ERK cascade in a distinct manner, enabling a wide variety of functions. The MEK1/2-ERK1/2 pathway appears to play a pivotal role in the pathogenesis of CRSwNP.

Prevalence of antigen‐specific immunoglobulin E on mucosal brush biopsy of the inferior turbinates in patients with nonallergic rhinitis

This study investigates the prevalence of local, antigen-specific immunoglobulin E (IgE) from mucosal brush biopsy (MBB) of the inferior turbinates in people diagnosed with chronic, idiopathic, nonallergic rhinitis (NAR) based on negative skin and/or in vitro testing. A standard cytology brush was used to harvest epithelial cells from the inferior turbinates of 20 adults. These cells were then processed and tested for the presence of total and antigen-specific IgE to 9 common aeroallergens using immunofluorescence. The relationships between detectable IgE and quality of life (QOL), self-reported seasonal symptoms and season of specimen collection were determined. Antigen-specific IgE for at least 1 antigen was detected on MBB in all of 20 (100%) study participants with a mean of approximately 3 sensitizations per participant. IgE to cockroach was present in 18 of 20 (90%) participants. There was no significant association noted between QOL scores or self-reported seasonal symptoms and the presence of specific IgE to any of the study antigens, although the presence of white oak and ragweed IgE was significantly higher in patients tested during the pollen season. This study demonstrated that, using MBB of the inferior turbinates, antigen-specific IgE to at least 1 airborne allergen is detectable in 100% of the idiopathic, NAR study population. This rate of sensitization is notably higher than previous reports, suggesting that the prevalence of atopic disease in the general population may be higher than current estimates. Testing for local sensitization should be considered as part of the complete evaluation for atopic disease.

A Radiological Analysis of Inferior Turbinate in Patients with Deviated Nasal Septum by Using Computed Tomography

The aim of this study was to evaluate the relationship between nasal septum deviation grade and inferior turbinate hypertrophy with the computed tomography (CT). The paranasal sinus CTs of 82 patients with septum deviation were evaluated. Nonhypertrophied inferior turbinates on the deviated side of the nasal septum were accepted as the control group and hypertrophic inferior turbinates of the other side were taken as the compensatory group in the same patient. The turbinate bone, medial mucosa, lateral mucosa, septal deviation angle, and deviation volume were measured using three-dimensional CT. The study group included 82 patients (M/F, 42/40) and ages ranged from 17 to 79 years (mean, 38.5 ± 14 years). There was a statistically significant positive correlation between the deviation angle and the deviation volume (p < 0.01). The measurements of the inferior turbinate bone and medial and lateral mucosal thickness were statistically different between the compensatory group and the control group (p < 0.01). There were no statistically significant differences in comparisons between the lateral and medial mucosal thickness with the deviation angle and the deviation volume in the two groups (p > 0.05). A positive correlation between the measurements of the deviation angle, deviation volume, and bone thickness was found statistically significant in the compensatory group (p < 0.05). The compensatory hypertrophy of inferior turbinates in patients with nasal septum deviation is not only caused by mucosal hypertrophy, but also by hypertrophy of the inferior turbinate bone itself. The assistance of preoperative CT before septoplasty can be useful when deciding on the surgical technique to fix turbinate.

Increased Activation and Differentiated Localization of Native and Phosphorylated STAT3 in Nasal Polyps

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease; the underlying mechanisms of cell signalling are not fully understood. STAT3 (signal transducer and activator of transcription 3) is a phosphokinase and a key signalling molecule implicated in cell cycle regulation. We studied the distribution and expression of STAT3 to examine the role of STAT3 in the pathogenesis of CRSwNP. Methods: We investigated tissue samples of the nasal polyps and inferior turbinate of patients with CRSwNP as well as samples of the inferior turbinate of subjects without chronic sinusitis. The expression levels of STAT3 and its activated form pSTAT3 were analysed using Western blotting, protein array, DNA microarray and immunohistochemistry. Results: No significant differences were found in STAT3-mRNA levels between the samples of nasal polyps and inferior turbinates of the same patient. However, the amount of pSTAT3 was increased in the polyp tissue compared to the inferior turbinates from both CRSwNP patients and control subjects (p < 0.01), indicating an activation of STAT3 in polyps. We identified a varying distribution pattern of pSTAT3; pSTAT3 was primarily found in superficial epithelial cells but not in the basal layer of the epithelium of the turbinate, whereas pSTAT3 was located in all layers of the epithelium of the polyp and mostly noted in the basal layer. Conclusions: Our results of the activation and varying localisation of STAT3 and its phosphorylated form in nasal polyps suggest that pSTAT3 plays a crucial role in the proliferative development of nasal polyps.

Effects of Interleukin-31 on MUC5AC Gene Expression in Nasal Allergic Inflammation

Background: Interleukin-31 (IL-31) is a newly discovered T helper lymphocyte-derived cytokine that plays an important role in allergic inflammation. However, the effects of IL-31 on mucus production in nasal allergic inflammation are completely unknown. Objective: To investigate the effects of IL-31 on mucin gene expression (MUC5AC) in patients with allergic rhinitis and in human airway epithelial cells. Methods: Expression levels of IL-31 and IL-31 receptor A (IL-31RA) were evaluated in the inferior turbinate of patients with allergic rhinitis and non-allergic rhinitis with immunohistochemistry. IL-31-induced MUC5AC gene expression was measured with a MUC5AC luciferase reporter assay in human epithelial HM3-MUC5AC cells and quantified by quantitative real-time polymerase chain reaction in human airway epithelial A549 cells. Results: IL-31RA was primarily localized in submucosal glands and upregulated in allergic rhinitis. IL-31 was detected in submucosal tissue and increased in allergic inflammation. MUC5AC gene expression was induced by IL-31 stimulation both in HM3-MUC5AC and A549 cells. Additionally, IL-31 cooperated with Th2 cytokines on MUC5AC gene expression in HM3-MUC5AC cells. Conclusion: IL-31 and IL-31RA are upregulated in patients with allergic rhinitis, and induce MUC5AC gene expression in human airway epithelial cells. These findings suggest that IL-31 plays an important role in mucus overproduction in nasal allergic inflammation.

Glycogen synthase kinase 3 in chronic rhinosinusitis: two faces of a single enzyme in one disease

BackgroundThe origin and pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. Glycogen synthase kinase 3 (GSK-3) is a unique multitasking kinase involved in the regulation of inflammation and apoptosis and is an important messenger in the downstream signaling of interleukin 6. ObjectiveTo analyze the possible role of GSK-3 in the pathogenesis of CRSwNP. MethodsWe examined tissue samples of nasal polyps and the inferior turbinate of patients with CRSwNP and the inferior turbinate of individuals without chronic sinusitis (healthy mucosa). Expression levels of GSK-3 and its inactivated form phosphorylated GSK-3 (pGSK-3) were analyzed using DNA microarray, protein array, Western hybridization, and immunohistochemical analysis. ResultsWe found increased expression of GSK-3 in both the nasal polyps and the inferior turbinate of patients with CRSwNP compared with those with healthy mucosa (P < .01). We did not observe a difference between nasal polyps and the inferior turbinate of patients with CRSwNP, but a highly significant increase in the phosphorylation rate of GSK-3 was detected in the tissue of nasal polyps compared with the turbinates of patients with CRSwNP (P < .01). ConclusionGSK-3 may play a crucial role in the inflammatory process in CRSwNP. Nasal polyps originate mainly in the mucosa of the middle meatus of the nose and rarely occur in the region of the inferior turbinate. The inhibition of GSK-3 by phosphorylation in nasal polyps, in contrast to the inferior turbinate, is a possible explanation for the different behavior of the mucosa of the middle meatus and the inferior turbinate.

Radio-wave Therapy of Inferior Turbinates for Treatment of Intractable Vasomotor Rhinitis – a Clinical Study of the Subjective Long-term Outcome

Objective: To evaluate the subjective outcome after treatment with bi-polar radio-wave frequency therapy of the inferior turbinates in patients with vasomotor rhinitis unresponsive to nasal steroid treatment.Material and Methods: Details of 151 patients with vasomotor rhinitis were collected from an electronic patient-record system. The main indication for turbinectomy with radio-wave frequency therapy was nasal congestion. Using a questionnaire with a follow-up time between 9 and 33 months, radio-wave therapy demonstrated good subjective results with respect to nasal congestion and patient relief. No serious side effects were reported.Conclusion: Radio-wave frequency therapy is a low cost procedure suitable for out-patient clinics; the procedure is easy to perform and has a good long term effect on nasal congestion in patients with intractable vasomotor rhinitis.

Bipolar radiofrequency volumetric tissue reduction of the inferior turbinates: evaluation of short-term efficacy in a prospective, randomized, single-blinded, placebo-controlled crossover trial

The objective of the study was to assess the short-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) of the inferior turbinates in patients with nasal obstruction caused by turbinate hypertrophy. The study is a prospective, randomized, single-blinded, placebo-controlled, crossover trial. A total of 22 patients (age range 21-72 years; median age 41 years) were randomized into two treatment arms. Using a bipolar radiofrequency system, the first group (VP-group) received RFVTR (verum = V) first (at t1) followed by a placebo treatment (P) 6-8 weeks later (at t2). The PV-group was treated with placebo first at t1 and received RFVTR at t2. Subjects in both groups underwent identical procedures in an office-based setting. Delivery of radiofrequency energy was the only difference between the two groups. The outcome measures assessed were rhinomanometry, physician's evaluation of the degree of hypertrophy of the inferior turbinates and patients' estimation of nasal obstruction. Physician and patient evaluations were documented using a score ranging from 0 = none to 4 = severe. Evaluation was performed 6-8 weeks after every intervention. No intraoperative or postoperative complications occurred. Inferior turbinate hypertrophy improved significantly in both groups after RFVTR was performed (VP-group: p < 0.001; PV-group: p = 0.002). Nasal obstruction also decreased only after RFVTR (VP-group: p = 0.004, PV-group: p = 0.002). This study confirmed the safety of bipolar RFVTR as an office-based treatment of nasal obstruction due to inferior turbinate hypertrophy. We could prove that RFVTR is superior to placebo for reduction in turbinate hypertrophy and subjective improvement in nasal obstruction. To our knowledge, this is the first level I study proving the short-term efficacy of a bipolar radiofrequency system.

Radiofrequency Reduction of Inferior Turbinates in Allergic and Non Allergic Rhinitis

To evaluate the treatment of hypertrophy of inferior turbinates in patients diagnosed with allergic/non allergic rhinitis with the use of radiofrequency ablation technique. Ablation with radiofrequency was used in this study on the inferior turbinates of 200 patients diagnosed as allergic/non allergic rhinitis at our institution between January 2006 and December 2009. The results were evaluated subjectively by changes in pre and post operative symptoms, size of inferior turbinate, postoperative pain and assessment of ciliary function. Four patients (2%) at the end of 6months and 4 patients (2%) at the end of 12months reported persistent symptom of nasal obstruction. No patient reported nasal discharge, 28 patients (14%) at 6months, 20 patients (10%) at 24months reported persistence of sneezing. 8 patients (4%) at 6months, 4 patients (2%) at 24months reported persistence of snoring, no patient complained of persistence of hyposmia. 4 patients (2%) at 6months, no patient at 24months complained of crusting, no patient complained of bleeding at 6, 24months. No alteration of ciliary function and anatomy of the inferior turbinate mucosa was noticed. These results suggests that ablation with radiofrequency is an easily applied, efficient and reliable technique in the treatment of hypertrophied inferior turbinate in allergic/non allergic rhinitis patients with no changes in the ciliary function and necrosis/atrophy of inferior turbinate.

Effect of septoplasty or in combination with out fracture of the inferior turbinate on the airflow field and nasal airway

To explore the effect of septoplasty or in combination with out fracture of the inferior turbinate in patients with nasal septum deviation on the airflow field and the nasal airway structure. Six patients with nasal septum deviation underwent spiral CT imaging scans before surgery and during the follow-up. The 3D finite element meshes of the nasal airway were developed from the above CT scans. Given three preconditions, the nasal airflow fields were described by the Navier-Stokes and continuity equations at the inspiratory flow rate of 12 L/min. The whole airflow patterns were obtained and then compared with the airflow filed and airway structure changes before and after surgery. SPSS 12.0 software was used to analyze the data. Before surgery, area of the common airway and the middle and ventral medial regions in the concave side were (1.61 ± 0.18), (0.40 ± 0.10), (0.40 ± 0.14) cm(2) respectively, and those of convex side were (1.30 ± 0.18), (0.33 ± 0.05), (0.36 ± 0.10) cm(2) respectively. The differences between both sides were of no statistical significance (Z value was 1.782, 1.363, 0.526 respectively, all P > 0.05). Airflow of the above airways were (361 ± 68), (131 ± 25), (100 ± 28) ml respectively in concave side and (178 ± 33), (59 ± 26), (59 ± 18) ml respectively in convex side, which differences were significant statistically (Z value were 2.207, 2.201, 2.201 respectively, all P < 0.05). The inferior turbinate in concave side [(0.93 ± 0.10) cm] was statistically (Z = 2.214, P < 0.05) bigger than that in convex side [(0.58 ± 0.12) cm] before surgery. The airflow fields were in disorder in both ill-airways. After surgery, area of the common airway was (2.55 ± 0.44) cm(2) in concave side and (2.20 ± 0.72) cm(2) in convex side respectively, and area of the middle and ventral medial regions in the convex side were (0.58 ± 0.13), (0.81 ± 0.26) cm(2) respectively, which differences were of significance statistically when comparing to areas before surgery (Z value were 2.201, 2.201, 2.201, 2.201, P < 0.05). The airflow passed through nasal airway orderly in both sides. But the thickness of inferior turbinate was (0.73 ± 0.08) cm in concave side after surgery, which difference was significant statistically in comparison to that before surgery (Z = 2.264, P < 0.05). Consequently, nasal resistance decreased from (0.41 ± 0.03) kPa×L(-1)×s(-1) to (0.16 ± 0.01) kPa×L(-1)×s(-1) after surgery, the difference was significantly (Z = -2.207, P = 0.027). Septoplasty or in combination with out fracture of the inferior turbinate, followed by the self-adaptation consecutively, could improve the airway and breathing capacity of the nose.

Endoscopic medial maxillectomy with preservation of inferior turbinate: how do we do it?

The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. We retrospectively reviewed the clinical charts and surgical technique in six patients with paranasal sinus inverted papilloma. There were five males and one female, whose mean age at diagnosis was 60 years ranging between 57 and 65 years. No recurrences were diagnosed, and no nasal crusting was evidenced postoperatively. Nasal breathing was satisfying in all cases. Postoperative epistaxis was not observed, and none of the patients refereed to have epiphora after the surgery. This technique has been successfully performed, showing no recurrence to the present and allowing the preservation of a functional inferior turbinate.

Long‐Term Efficacy of Microdebrider‐Assisted Inferior Turbinoplasty With Lateralization for Hypertrophic Inferior Turbinates in Patients With Perennial Allergic Rhinitis

The aim of the study was to evaluate the long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization (MAITL) compared to submucosal resection for hypertrophic inferior turbinates. Surgical outcomes were evaluated with respect to visual analogue scale, anterior rhinomanometry, and saccharin test results. From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR group, each comprised of 80 patients. Ten patients who did not display any nasal discomfort served as normal controls. For the submucosal resection group, patients underwent submucosal resection of the inferior turbinate, whereas patients in the MAITL group underwent microdebrider-assisted inferior turbinoplasty with lateralization. Assessments (visual analogue scale, anterior rhinomanometry, and saccharin test) were conducted prior to the surgery and 1, 2, and 3 years after completion of surgery. Compared to preoperative values, subjective complaints including nasal obstruction, sneezing, rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in both groups (P < .05 for all). Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years postoperatively in both groups (P < .05 for all). Saccharin transit time was significantly decreased (P < .05 for all) compared to preoperative values 1, 2, and 3 years after surgery in both groups. Microdebrider-assisted inferior turbinoplasty with lateralization appears to be as effective as submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have had substantial nasal obstruction.