Radiofrequency Tissue Volume Reduction Research Articles

Long-term effect of radiofrequency turbinoplasty in nasal obstruction

The aim of this retrospective study is to investigate long term (two years) effect of radiofrequency tissue volume reduction (RFVTR) on nasal obstruction associated with inferior turbinate hypertrophy, which is not respond to medical treatment. This retrospective study carried out on 98 patients with nasal obstruction treated by RFVTR (56 males, 42 females, from 17 to 70 years of age). Visual analogue scales (VAS) and nasal endoscopic view score (NES) were used for nasal obstruction to evaluate the efficacy of the treatment. Results of one, three, six, twelve and twenty four months after RFVTR treatment were compared with pre-exposure values. Turbinate edema and nasal obstruction in the treated patients were recovered after one month of treatment (p < 0.01). Maximum improvement were determined at the end of third month (p < 0.01). However, eficacy of RFVTR declined twelve months after treatment. Final percentage of imrovement was found as 51 % at the end of second year of treatment because of co-factors was not eliminated by some patients. On the other hand, no statistical significant difference was observed between the right and left nasal cavity (p < 0.001). In conclusion, the result of this study indicated that patients who have not eliminate co-factors such as smoking, obesity and allergic rhinitis may need re-application of RFTVR. However, further studies on radiofrequecy energy level and elimination of other co-factors are necessary to illuminate the eficacy of RFVTR.

Efficacy Study of Nasal Irrigation after Radiofrequency Tissue Volume Reduction for Inferior Turbinate Hypertrophy: An Equivalence Randomized Controlled Trial

To determine the benefits of nasal irrigation after radiofrequency tissue volume reduction (RFTVR) for inferior turbinate hypertrophy (ITH) in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry. An equivalence randomized controlled trial was performed at the Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Seventy-nine subjects with ITH planned for RFTVR were enrolled consecutively. The intervention was randomized into two groups: with and without nasal saline irrigation. Primary outcome was visual analog scale (VAS; 0-10) of postoperative nasal obstructive symptoms. Rhinorrhea, pain, nasal itching and sneezing, foul odor, bleeding, crusting and discharge, and patient satisfaction were self-assessed by the patients. Findings from endoscopic nasal examination and acoustic rhinometry (total nasal volume and cross-sectional area 2 [CSA2]) were performed before and after the intervention by blinded assessors. The study revealed no difference of nasal obstruction and other symptoms between the saline group and the control group on the 1st postoperative week, except nasal itching and sneezing. The saline group had itching and sneezing symptoms lower than the control group on the 5th-7th postoperative day. All patients had minimal or no postoperative nasal bleeding. There were also no differences of satisfaction and acoustic rhinometry findings between both groups. The nasal irrigation with normal saline had no additional benefits after RFTVR for ITH in terms of nasal obstructive symptoms, endoscopic nasal findings, and acoustic rhinometry except nasal itching and sneezing symptoms.

Long-Term Efficacy of Radiofrequency Treatment of Turbinate Hypertrophy: A Patient Based Point of View

Nasal turbinate hypertrophy is a major cause of nasal airway obstruction that affects up to 20% of the European general population. This study aims to determine the efficacy of radiofrequency treatment as perceived by patients during a 2-years period. From 2007 to 2009, an observational study was conducted on 36 patients who consecutively underwent temperature-controlled radiofrequency tissue volume reduction. A questionnaire was administered to each patient in order to collect demographic data, lifestyle habits, health status and visual analogue scale (VAS) score of perceived symptoms. Mean VAS scores of nasal obstruction, headache, rhinorrhoea and anosmia after treatment were significantly lower than that at baseline. Urban residence and allergic rhinitis were significantly associated with lower mean improvement (2.9 vs. 5.6; P=0.04 and 2.3 vs. 5.3; P=0.01, respectively). A non significant association with scarce nasal obstruction improvement was present in older aged patients, in patients other than students and in active and passive smokers. Our data enrich the general knowledge on radiofrequency treatment of turbinate hypertrophy identifying the rate of long-term efficacy of radiofrequency treatment as perceived by patients and focusing on several risk factors involved in patient prognosis after treatment.

Long-term clinical results of radiofrequency tissue volume reduction for inferior turbinate hypertrophy

To investigate the long-term clinical results of radiofrequency tissue volume reduction for symptomatic inferior turbinate hypertrophy. Patients who were unresponsive to medical treatment (n = 197) received turbinate reduction using radiofrequency energy. Subjective symptoms were assessed using a 10 cm visual analogue scale, and all patients underwent acoustic rhinometry before the procedure and six, 24, 48 and 60 months afterwards. Of the 197 treated patients, 148 completed the protocol. No significant peri-operative complications were observed. Thirty-two patients required follow-up treatment. Significant improvements were seen in nasal obstruction and discharge scores and in acoustic rhinometry values, at six, 24, 48 and 60 months post-operatively, compared with pre-operative values (p < 0.001 and p < 0.05, respectively). Radiofrequency tissue volume reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit of this procedure persisted 60 months after the procedure.

Radiofrequency tissue volume reduction for treatment of auricle keloids

Keloids are often refractive to treatment, and recurrences occur quite frequently. Radiofrequency tissue volume reduction (RFTVR) is a surgical technology that induces extensive fibrosis at the target tissues. We applied RFTVR in 14 patients (19 auricles, 5 patients treated bilaterally; 9 female, 5 male; range, 10-66 years) with keloids of the auricle. Keloids were located at the earlobe in 4 patients (5 auricles), helix in 9 patients (12 auricles), and at both earlobe and helix in 1 patient (2 auricles). In 6 patients (8 auricles) RFTVR was the sole treatment modality applied, and in 7 patients (10 auricles) intralesional steroid injection was also performed. Patients underwent one to seven sessions of RFTVR. Patients were followed up between 2 and 92 months postoperatively (median, 24.5 months). Good cosmetic results were achieved in 10 of 14 patients (13 auricles). Three patients (5 auricles) were refractive to treatment, and 1 patient (1 auricle) showed progressive disease despite treatment. Radiofrequency tissue volume reduction may be considered as a new, minimally invasive treatment option for keloids of the auricle.

First-Choice Treatment in Mild to Moderate Obstructive Sleep Apnea

To compare the efficacy of single-stage, multilevel, temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) for the soft palate and base of the tongue with that of nasal continuous positive airway pressure (CPAP) in primary treatment of mild to moderate obstructive sleep apnea. A prospective nonrandomized clinical study. Tertiary care referral center. Data from 47 patients with mild to moderate obstructive sleep apnea treated between January 1, 2003, and October 31, 2006, were reviewed. Twenty-six patients underwent TCRFTVR and 21 underwent nasal CPAP as a primary treatment modality. Baseline and 12-month posttreatment measurements using the Epworth Sleepiness Scale and polysomnography were compared. The baseline characteristics of the groups were not significantly different. Both methods showed meaningful results for the Epworth Sleepiness Scale and polysomnography variables 12 months after treatment compared with baseline measurements. The results were not significantly different in the posttreatment intergroup comparisons. Treatment success rates were 52.4% for nasal CPAP and 53.8% for TCRFTVR (P = .92). Similar comparison results with nasal CPAP in objective and subjective variables make single-stage, multilevel TCRFTVR a good alternative in primary treatment of mild to moderate obstructive sleep apnea.

Sutter®bipolar radiofrequency volumetric tissue reduction of palate for snoring and mild obstructive sleep apnoea: is one treatment adequate?

To evaluate the efficacy of bipolar radiofrequency volumetric tissue reduction, using Sutter technology, in the treatment of snoring and mild obstructive sleep apnoea. Prospective, non-randomised trial. Fifty-two patients with simple snoring and mild obstructive sleep apnoea underwent bipolar radiofrequency palate reduction under local anaesthesia. All patients were Friedman stage II and III, with tonsil sizes graded as zero, one or two, a mean body mass index of 22.6, and a mean age of 36.2 years. Seventy-seven per cent of patients reported improvement in their snoring; patients' mean snoring level (assessed by visual analogue scale) improved from 8.9 to 3.4 (p < 0.05). Eighty-three per cent of patients reported an improvement in their Epworth sleepiness scale score, from a mean of 14.6 to 9.5. Seven out of the 17 patients (41.2 per cent) met the surgical success criteria (i.e. at least a 50 per cent reduction of the pre-procedure apnoea-hypopnoea index, and a post-procedure apnoea-hypopnoea index of below 15). Patients' mean apnoea-hypopnoea index improved from 13.6 to 9.8, and their mean lowest oxygen saturation improved from 88.3 to 92.5 per cent. Eighty-two per cent of patients reported an improvement in their quality of life as a result of the procedure. One session of Sutter bipolar radiofrequency tissue volume reduction represents a viable method of treating snoring and mild obstructive sleep apnoea, with good results.

Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy

To compare the efficacy of submucosal temperature-controlled radiofrequency tissue volume reduction (TCRFTVR) and resection with microdebrider (SMRM) in chronic inferior turbinate hypertrophy. Prospective, randomized, and single-blinded clinical trial. The study group consisted of 30 symptomatic patients who underwent simultaneous TCRFTVR and SMRM for consecutive sides. Visual analogue scale (VAS) and acoustic rhinometry (ARM) were made preoperatively and at 12th week and 6th month postoperatively; saccharine transport time (STT) and ciliary beat frequency (CBF) were performed at 12th week and 6th month postoperatively. The rate of the need for the revision operation was determined between 6 and 12 months period postoperatively. Significant improvement was achieved in VAS scores and ARM measurements after both procedures, whereas both parameters did not differ significantly between two procedures postoperatively. STT and CBF showed no significant post-treatment variation in comparison of the intergroup measurements. The rates of the need for revision operation were not significantly different. Identical results in objective and subjective parameters were observed for both techniques.

Radiofrequency tissue volume reduction of the soft palate and UPPP in the treatment of snoring

The purpose of this study was to evaluate the efficiency of radiofrequency tissue volume reduction (RFTVR) and uvulopalatopharyngoplasty (UPPP) in the treatment of snoring in a prospective clinical trial of 79 patients consecutively undergoing surgery for snoring. Seventy-nine patients with primary snoring or mild OSAS (obstructive sleep apnea syndrome) were enrolled in this clinical trial (66 males and 13 females). According to the anatomical findings (the size of the tonsils and uvula), the patients underwent UPPP/TE of the RFTVR of the soft palate. Forty-seven patients had UPPP/TE (age 45.81+/-12.11 years; median AHI: 8; range 1-29). Thirty-two patients were treated with RFTVR of the soft palate (age 48.10+/-10.92; median AHI: 5.0; range 0-26). The average number of treatments was 2.2. All patients underwent preoperative polysomnography to exclude severe OSAS. Pre- and postoperative snoring scores were evaluated from the patients with bed partners. Postoperative follow-up data were collected at a median of 4 months after treatment; 85.1% of the UPPP group and 53.1% of the RFTVR group underwent postoperative polysomnography. Subjective snoring scores of all study participants were evaluated. Preoperatively, there was no statistically significant difference of subjective symptoms, age and BMI between the two groups. The snoring scores improved statistically significantly in both groups (P <0.001 in the UPPP group; P =0.001 in the RFTVR group). After UPPP/TE snoring improved in 37 patients (78.7%), and 29 (61.7%) thereof were free of bothersome snoring; no change was found in 9 patients (19.2%), and 1 (2.1%) worsened. In the RFTVR group, snoring improved in 15 (46.9%), and 9 (28.1%) thereof were free of bothersome snoring; no change was found in 13 patients (50%), and 1 worsened (3.1%). Preoperative AHI was statistically higher (P =0.016) and mean minimal oxygen saturation significantly lower (P =0.002) in the UPPP group. In the UPPP group AHI and HI showed statistically significant improvement postoperatively (P =0.025 and P =0.034, respectively). After RFTVR, no statistically significant change of AHI, HI or oxygen saturation was found. Besides limited mucosal erosions (15%) after RFTVR and foreign body sensations (<10%) after UPPP/TE, no side effects were observed. The success rate of RFTVR of the soft palate is lower compared to the more invasive technique of UPPP. Due to its minimally invasive character, RFTVR is suitable as first-step treatment for snoring, but patients should be counseled about possible success rates and different treatment options.

Postoperative pain and side effects after uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, and radiofrequency tissue volume reduction in primary snoring.

We compared, in a prospective study, the side effects and the postoperative complications of three procedures commonly used for the treatment of primary snoring. Forty-nine patients underwent velopharyngeal surgery for primary snoring (17 for uvulopalatopharyngoplasty [UPPP]; 15 for laser-assisted uvulopalatoplasty [LAUP], and 17 for radiofrequency tissue volume reduction [RFTVR]). Preoperative full polysomnographic studies ruled out obstructive sleep apnea syndrome. Each patient's evaluation encompassed postoperative pharyngeal pain (as measured by a 5-point visual analogue scale) and use of narcotic drugs in the early postoperative period as well as a subjective evaluation of late postoperative complaints. A surgeon's examination was performed to report postoperative complications in the oropharynx. Postoperative pharyngeal pain was less important in the RFTVR group than in the UPPP and LAUP groups. Mean scores at days 3, 7, 16 were as follows: 4.2, 4.0, and 2.4, respectively, for UPPP; 4.6, 3.8, and 1.6 for LAUP; and 2.4, 2.0, and 0.7 for RFTVR. Mean duration of pain with a score greater than 2 was calculated as follows: UPPP, 21.3 days; LAUP, 15.1 days; and RFTVR, 6.1 days. Mean duration of narcotic drug use for the patients who needed this medication was 10.1 days for UPPP, 7.2 days for LAUP, and 1.3 for RFTVR. Postoperative side effects (trouble with smell and taste, pharyngeal dryness, globus sensation, voice change, and pharyngonasal reflux) were more present in the UPPP and LAUP groups than in the RFTVR group. Surgeon's assessment for postoperative complications reported more wound infection, dehiscence, and posterior pillar narrowing in the UPPP and LAUP groups than in the RFTVR group. RFTVR is a safer and less painful procedure than UPPP and LAUP for the treatment of primary snoring. Postoperative discomfort after LAUP and after UPPP appears to be very similar.

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.

Temperature-controlled radiofrequency tissue volume reduction in the human soft palate

Objective: To validate the use of temperature-controlled radiofrequency energy applied to the soft palate in a multicenter setting for reduction of snoring in a minimally morbid manner. Methods: Prospective, nonrandomized multicenter study of 113 patients who had a respiratory disturbance index less than 15 and minimum oxygen saturation not less than 85% and who were seeking treatment for habitual disruptive snoring. Patients were given either single or multiple lesions to the soft palate during each treatment session. Results: Patients received 1978 J on average with an overall average of 2.4 treatments. Snoring scores went from an average of 7.8 (visual analog scale (VAS), 0-10) pretreatment to 3.2 posttreatment. Pain was minimal, averaging 1.7 (VAS 0-10) on days 1 to 6. Complications were few and transient, and mild. Conclusions: The multiple lesion protocol was the most successful; reducing snoring from 7.6 to 2.7, on a VAS with an average of 1232 J delivered over 1.6 treatments. Temperature-controlled radiofrequency was found to be a minimally invasive, well-tolerated procedure that was safe and efficacious in this study group. (Otolaryngol Head Neck Surg 2001;125:312-8.)

Temperature-controlled Radiofrequency Tissue Volume Reduction of the Soft Palate (Somnoplasty®) in the Treatment of Habitual Snoring: Results of a European Multicenter Trial

Temperature-controlled radiofrequency tissue volume reduction of the soft palate has been introduced as a minimally invasive, outpatient procedure for the treatment of habitual snoring and mild obstructive sleep apnea. A prospective, non-randomized multi-center European clinical study was conducted to investigate the efficacy of Somnoplasty®