Submucosal Diathermy Research Articles

A Comparative Study of Outcomes of Submucosal Diathermy Versus Inferior Turbinoplasty in Patients With Deviated Nasal Septum With Inferior Turbinate Hypertrophy.

Introduction Nasal obstruction due to deviated nasal septum (DNS) and inferior turbinate hypertrophy (ITH) is a common problem necessitating surgical intervention. Submucosal diathermy (SMD) and inferior turbinoplasty (IT) are two commonly performed procedures aimed at improving nasal patency. Methods A prospective comparative study was conducted on 56 patients with DNS and inferior turbinate hypertrophy, divided into SMD and inferior turbinoplasty groups. Preoperative and postoperative assessments included symptom assessment using the 22-itemSinonasalOutcomeTest(SNOT-22) questionnaire. Results Both procedures led to significant improvements in nasal symptoms and quality of life. Inferior turbinoplasty showed slightly better outcomes in symptom improvement compared to submucosal diathermy. Conclusions Inferior turbinoplasty appears to offer slightly better outcomes in improving nasal symptoms compared to SMD in patients with DNS and inferior turbinate hypertrophy. However, both procedures are effective and safe options for surgical management. Individualized treatment decisions should consider patient preferences and surgeon expertise.

Observational Study on the Effects of Submucosal Diathermy on Chronic Nasal Obstruction in Allergic Rhinitis

Observational Study on the Effects of Submucosal Diathermy on Chronic Nasal Obstruction in Allergic Rhinitis

Comparison of the post-operative outcomes between different surgical techniques for inferior turbinate reduction surgery: A cross sectional study.

To compare and measure post-operative outcomes among various surgical techniques for reducing inferior turbinate hypertrophy (ITH), and to identify the factors associated with the clinical outcomes of turbinoplasty in patients with this condition. A cross-sectional study was carried out from January 2021 to December 2022 at the Otorhinolaryngology Department of King Abdulaziz Medical City in Riyadh, Saudi Arabia. A total of 301 adult patients with ITH were included and were divided into different groups. Postoperative follow-up assessments were completed after one week, one month, and 6 months to evaluate outcomes and complications associated with each surgical technique; descriptive analysis, cross-tabulation, and exact logistic regression were utilized as data analysis methods. Most patients in both groups experienced partial or complete improvement after surgery, with 92% showing positive outcomes. Common clinical signs included deviated nasal septum deviation and external nasal deformity, while nasal obstruction was most frequently reported as the primary symptom. Post-surgery bleeding occurred in 3.7% of cases; no adhesions were noted. Microdebrider, medial flap, out-fracture, and submucosal diathermy techniques all demonstrated significantly higher improvement rates than others. The identified techniques with higher improvement rates offer evidence-based guidance for selecting optimal surgical approaches, while the study's limitations warrant further prospective research to validate these findings. Ultimately, it contributes valuable knowledge to the field of otorhinolaryngology, aiming to enhance patient outcomes and improve the management of ITH worldwide.

Assessment of the protective role of submucosal saline injection of the inferior turbinates prior to submucosal diathermy or coblation techniques

BackgroundInferior turbinate hypertrophy is a common cause of chronic nasal obstruction with many procedures for management including submucosal diathermy and coblation with a variation in their techniques. The aim of this study was to assess the protective role of submucosal saline injection in the inferior turbinates prior to submucosal diathermy or coblation techniques. A prospective cohort study was conducted on 80 patients diagnosed with bilateral hypertrophied inferior turbinates causing persistent nasal obstruction and not responding to medical treatment. The patients were distributed randomly and equally between 2 groups. Group I included 40 patients operated on with coblation of the inferior turbinates. Group II included 40 patients operated on with submucosal diathermy of the inferior turbinates. The right side of the nose of both groups had a saline injection of the inferior turbinates before the procedure and the left side of the nose did not have such injection. Each side of the nose in every patient was assessed for the degree of nasal crusting at 1 week postoperative, the presence of turbinate gangrene at 3 weeks postoperative, and the visual analog scale (VAS) of four symptoms (nasal discomfort, nasal pain, nasal obstruction, and thick nasal discharge) at 1 week postoperative.ResultsIn the coblation group, there was a significant difference between the right and left sides regarding the degree of crusting at 1 week postoperative, and a non-significant difference between the two sides regarding the presence of gangrene at 3 weeks postoperative. In the diathermy group, there was a significant difference between the right and left sides regarding the same parameters. Comparison between the injection and non-injection sides in each group regarding the nasal symptoms showed a highly significant difference between the two sides in each group favoring the injection side.ConclusionSaline injection prior to inferior turbinate coblation or submucosal diathermy had a protective effect against crusting with both techniques and gangrene formation with submucosal diathermy. This was reflected on better postoperative nasal symptoms.

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 .

Comparison between submucosal resection versus combined submucosal diathermy and out-fracture in the treatment of inferior turbinate hypertrophy

Comparison between submucosal resection versus combined submucosal diathermy and out-fracture in the treatment of inferior turbinate hypertrophy

Inferior Turbinate Surgery: Difficulties Between the Decision-Making and the Selection of Proper Technique

Back ground and Objectives The inferior conchae have important role in the maintenance of nasal airflow via providing the nasal valve mechanism but increase of inferior turbinate bulk may result in significant nasal obstruction. Therefore, this may need further surgical intervention to deal with these bulky conchae but it is very necessary to balance between the mechanical as well as the functional patency of the nose. Thus, through this surgery it become difficult to decide whether the patient is a candidate for surgery and which technique is suitable for that particular patient. Patients and Methods Two- thousands three- hundreds and six patients aged 3-65 years of hypertrophied inferior conchae, had been diagnosed as a cases of mechanical nasal obstruction due to hypertrophied inferior conchae (HIC). The patients operated by two techniques of inferior conchae surgery, which are sub-mucosal diathermy (SMD) and partial inferior turbinectomy (PIT). The outcomes were correlated to different factors to assess as much as possible the clear conclusion for this significant issue in rhinology. Results and Conclusion The proper selection of patient for this pattern of surgery is considered as one of main aspects of this issue and one of significant steps toward the resolving of this dilemma it is very necessary to select the most suitable candidate for this surgery. On the other hand, the type of the technique for this surgery is needed to be selected probably.

Endoscopic Septoturbinoplasty among Patients Undergoing Surgery in the Department of Otolaryngology-Head and Neck of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Septoplasty without turbinoplasty is one of the main reasons for failure of procedure in case of deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty is the procedure of choice for complete treatment. The main objective is to find out the prevalence of endoscopic septoturbinoplasty among patients undergoing surgery in Department of Otolaryngology-Head and Neck of a tertiary care hospital. This was a descriptive cross-sectional study in Department of Otolaryngology-Head and Neck Surgery done over a period of 1 year duration from 1st August 2020 to 31st July 2021 among 1248 patients who underwent surgery in the department. Ethical Approval was taken from Institutional Review Committee of Kathmandu Medical College and Teaching Hospital (Reference number: 2207202004). A convenience sampling technique was used. Two different techniques, Microdebrider Assisted Turbinoplasty and Outfracture with Submucosal Diathermy were used in surgery. Nasal Obstruction and Symptom Evaluation Scale questionnaire was used pre and postoperatively for data collection. Data were analyzed in Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated, with frequency, percentage, mean and standard deviations. Out of 1248 patients, about 92 (7.37%) patients (4.95-10.14 at 95% Confidence Interval) underwent septoturbinoplasty. The mean Nasal Obstruction and Symptom Evaluation Scale before surgery was 75.21±6.19. The prevalence of septoturbinoplasty in our study is similar to other studies done in similar settings. We found almost complete resolution of breathing problems following endoscopic septoturbinoplasty, hence improving quality of life.

Dual Staged Supraglottoplasty for the Treatment of Trapdoor Epiglottis with Underlying Neurodegenerative Disease-Case report and Review of literature.

To describe the technique and outcome of a novel dual staged supraglottoplasty for the treatment of neurological induced adult onset laryngomalacia. A 55year old male had a diagnosed neurodegenerative disorder with suspected Pompe's disease associated with Trap door epiglottis and proximal myopathy.This was complicated with emergency airway distress and subsequent tracheostomy.Trap-door epiglottis (also known as adult-onset laryngomalacia) associated with neurodegenerative disorders constitute a surgical challenge as it is often coupled with failure of tracheostomy decannulation when present. The patient underwent a novel dual staged endoscopic supraglottoplasty whereby an initial stage of epiglottopexy and submucosal diathermy was made at the vallecula.This was then followed by an interval of 6weeks whereby a partial epiglottotectomy was made at the upper 3rd of the epiglottis and reduction of lingual tonsils was done using radiofrequency ablation.Trachesotomy was decannulated 1month after the second stage procedure and his airway remains asymptomatic after 1year of surgical treatment. This case report describes the success of tracheostomy decannulation after a novel dual staged supraglottoplasty for adult onset laryngomalcia (also known as trap-door epiglottis) .

Comparison of Different Surgical Treatment Modalities for Nasal Obstruction Caused by Inferior Turbinate Hypertrophy

Background: Hypertrophied inferior turbinates considered the second most frequent contributor to nasal obstruction after septal defects. Various medical measures can be used to treat inferior turbinate hypertrophy (ITH). After failure of medical methods, surgery becomes the cornerstone of management, which is still a controversial issue in the otorhinolaryngology field. Although these surgeries have been practiced for decades, no conclusion has been drawn about the best and optimal choice. Objectives: The objectives were to compare the results between submucosal diathermy (SMD) and partial inferior turbinectomy (PIT) in terms of postoperative bleeding, crusting, dry throat, voice change, postnasal drip, nasal obstruction, need for re-use of medications, and further need for nasal surgery. Subjects and Methods: A prospective observational study involving 100 patients with ITH. Patients were randomly divided into two groups: Group A underwent SMD and Group B underwent PIT. Postoperative follow-up was done at 1 week, 1 month, and 6 months. Results: At 1-week, nasal crusting, postnasal drip, and dry throat were reported more in SMD. At 1-month, nasal crusting and voice change were experienced more in PIT. At 6-month, nasal crusting and voice change occurred more in PIT. Nasal obstruction occurred more in SMD. Re-use of medications and further nasal surgery were more in SMD. Conclusion: SMD is less invasive with fewer complications regarding bleeding and crusting in comparison to PIT, but its effectiveness compared to PIT in re-use of medications and need for further nasal surgery is less.

Microdebrider-Assisted Turbinoplasty and Submucosal Diathermy for Inferior Turbinate Hypertrophy: A Randomized Clinical Trial

ABSTRACT 
 Background: Nasal obstruction is a common presenting problem which can lead to symptoms like sleep disturbances, mouth breathing, oral cavity dryness. Hypertrophied inferior turbinate is a common cause of nasal obstruction. Microdebrider assisted turbinoplasty and submucosal diathermy are widely used methods for patients who fail to respond to medical therapy to relieve obstruction. The aim of the study was to compare two methods in terms of relief of nasal obstruction, reduction in sneezing and post-operative complications.
 Material & Methods: This randomized clinical trial was conducted at ENT Department, Benazir Bhutto Hospital Rawalpindi, Pakistan for one year from 01-03-2018 to 28-02-2019. One hundred and twenty patients were randomized to into either MAT and SMD groups each with 60 patients. Nasal obstruction symptom evaluation score system (NOSE) was used to access relieve from obstruction and sneezing. SPSS 22, online chai square and fisher exact test calculators were used to analyze the data.
 Results:
 Two groups were comparable for age and gender. After 3 months of treatment, all patients in MAT group and 51 patients in SMD group were completely relieved from obstruction. At two weeks follow up 37(61.57%) patients in MAT group had grade 0 obstruction compared with 14 (23.33%) in SMD group and this difference was significant (p value .000). at one month follow up 55 (91.67%) patients in MAT while 46 (76.67%) had completely relieved obstruction and this difference was significant ( p value .024). Not all patients showed reduction in sneezing in both groups. 37 patients in MAT and 25 patients in SMD group had completely relieved from sneezing at third month follow up with MAT group showing significantly more patients with sneezing reduced at one month follow up. Crust formation was most seen complication in both groups, more with SMD group at two weeks follow up which responded to treatment alkaline nasal douches and crust removal.
 
 Conclusion:
 MAT gives better in terms of nasal obstruction relieved, reduction in sneezing and less complications than SMD procedure.
 KEYWORDS: Microdebrider; Diathermy; Turbinates; Nasal obstruction

Partial inferior turbinectomy versus submucosal diathermy in hypertrophied inferior turbinates

<p><strong>Background:</strong> The study aims to compare the efficacy of submucosal diathermy and partial inferior turbinectomy in terms of improvement in nasal obstruction, pain, haemorrhage, crusting and wound healing.</p><p><strong>Methods: </strong>A prospective sequentially randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent SMD and group B consists of patients who underwent PIT. Post-operative assessment was done at day 1, 2 weeks, 1 month, 3 months and 6 months.</p><p><strong>Results: </strong>Post-operative improvement in nasal obstruction was seen in both groups. 80% showed significant improvement in SMD and 32% in PIT group at the end of second week. By sixth month, 40% in SMD group and 80% in PIT group showed significant improvement. Mild pain was observed in 12% of PIT group at 2 weeks. In SMD group, 8% developed reactionary haemorrhage. In PIT group, 24% developed minimal soakage and 12% developed moderate soakage. Severe nasal crusting was seen in 64% of the cases in PIT group and in 40% of the cases in SMD group at second week. By 1 month, 44% in PIT group and 12% in SMD group showed severe crusting.</p><p><strong>Conclusions: </strong>Short term complications like pain, obstruction and haemorrhage was noted to be higher with PIT. On long term evaluation, PIT showed better results in terms of improvement in nasal obstruction scores.</p>

Electrosurgery Turbinate Reduction Revisited: Can Comparable Volumetric Heating be Achieved Without Feedback Control?

Temperature-controlled radiofrequency inferior turbinate ablation (TCRFA) uses a feedback system to control thermal injury and achieve precise volumetric heating to induce specific scar formation. However, it requires costly single-use proprietary consumables. Comparable volumetric tissue heating may be achieved for a fraction of the cost by adjusting the power settings on traditional monopolar electrosurgery devices that use low-cost needle tips. This pre-clinical study aims to determine the optimized power parameters to achieve electrosurgical coagulum volume similar to that of TCRFA. An electrosurgery submucosal diathermy (SMD) system (cut mode, 4-32 W, 5-120 seconds) and a temperature-controlled radiofrequency ablation system (standard clinical parameters for treating inferior turbinate hypertrophy) were used to coagulate egg white and chicken breast. Coagulum major and minor axis were measured, and lesion volume was approximated as prolate spheroid. No significant difference in volume was found between the temperature-controlled system and the electrosurgery system at 8 W for 30 seconds, 8 W for 60 seconds, 16 W for 30 seconds, 32 W for 5 seconds, and 32 W for 15 seconds. The time to achieve equivalent lesion size was significantly less in the SMD system when compared to the temperature-controlled system (P < 0.05). Electrosurgery handpieces may achieve similar lesion volume effects as the temperature feedback-controlled, single-use handpieces when set to the optimized parameters. SMD handpieces are significantly more cost and time effective than proprietary devices, and they are easily used in the office. SMD devices may be a more affordable alternative to temperature-controlled systems with comparable lesion volume effect and may be valuable for office-based therapy. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

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

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

Submucosal Diathermy Versus Coblation For Reduction of Hypertrophied Inferior Turbinate

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

Comparative Study between Submucosal Diathermy and Endoscopic Partial Turbinectomy in Hypertrophied Inferior Turbinate

Comparative Study between Submucosal Diathermy and Endoscopic Partial Turbinectomy in Hypertrophied Inferior Turbinate

Comparative Study between Submucosal Diathermy and Endoscopic Partial Turbinectomy in Hypertrophied Inferior Turbinate

Background:Chronic nasal obstruction is a common subjective complaint seen by otolaryngologists; turbinate hypertrophy is one of its causes. There are various treatment options for enlarged turbinates, the method of treatment depends on the size of the enlarged turbinates. Objective:To evaluate the effectiveness of submucosal diathermy of inferior turbinate versus endoscopic partial turbinectomy in patients with inferior turbinate hypertrophy. Patients and methods:A total of sixty patients of different age groups and both sexes were involved in the study. Patients were divided in two groups; group (I), which included 30 patients, had submucosal diathermy of both inferior turbinates and group (II); which included 30 patients had surgical endoscopic partial turbinectomy of both inferior turbinates. Patients were followed up for 6 months postoperatively and nasal obstruction was analyzed according to (NOSE) scale. Results: there were no significant differences between both groups in nasal score mean at pre-operative, 1 week and 1 month (post-operative), however, group (II) had significantly (p<0.01) lower nasal score mean at 6 months compared to group (I),. In addition, there were a significant post-operative improvement in nasal obstruction in both used techniques at 1 week and 1 month. However, this significant improvement continued to 6 months in group II While, a type of recurrence was happened in group I at 6 months. Conclusion: both of the used surgical techniques were found to be effective in reducing nasal obstruction but endoscopic partial turbinectomy was more effective in reducing nasal obstruction for longer duration.

A case of angiosarcoma of the nasal cavity

&lt;p class="abstract"&gt;Angiosarcoma of the nasal cavity is extremely uncommon accounting for less than 0.1% of all sinonasal malignancies. Here we report a case of angiosarcoma of nasal cavity. A 45 year old male patient with c/o right sided nasal bleeding since 20days, on examination showed mass in nasal cavity. Patient underwent septoplasty with right inferior turbinectomy with submucosal diathermy. The histological examination showed features of angiosarcoma epitheloid variation of nasal cavity, diagnosis was confirmed by immunohistological stain with factor CD 31 and cytokeratin.&lt;/p&gt;

Do turbinate reduction procedures restore epithelial integrity in patients with turbinate hypertrophy secondary to allergic rhinitis? A histopathological study.

Consensus has not been reached regarding the optimal reduction procedure for inferior turbinate hypertrophy in allergic rhinitis and whether such procedures result in improvement in mucosal architecture. Twenty-nine patients aged 18-45years (mean 26.8years), with allergic rhinitis and inferior turbinate hypertrophy not responsive to medical therapy who underwent endoscopic submucosal diathermy (ESMD) (14 patients) or endoscopic submucosal resection (ESMR) (15 patients) with intraoperative and 3-6months postoperative inferior turbinate biopsies, were included in the study. Epithelial and mucosal architecture was compared between the two groups. Both groups showed a significant decrease in epithelial denudation (p < 0.001), reversal of basement membrane thickening (p < 0.001) and increase in density of cilia (p < 0.001). The degree of improvement in histological characteristics between ESMD and ESMR groups was not significant. Surgical intervention for inferior turbinate hypertrophy by both ESMD and ESMR results in significant restoration of nasal mucosal epithelium in patients with allergic rhinitis as early as 3-month postoperatively. There was, however, no significant difference in the histological changes between those who underwent ESMD and ESMR. CTRI/2015/01/005373.

Comparative study between partial inferior turbinectomy and submucosal diathermy for treatment of inferior turbinate hypertrophy due to allergic rhinitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nasal obstruction due to inferior turbinate hypertrophy is one of the most common symptoms of Allergic rhinitis (AR) which causes significant debility. Surgery is one of the modalities of treatment to relieve patients of nasal obstruction. Objective of the study was to evaluate the efficacy of submucosal diathermy (SMD) and partial inferior turbinectomy (PIT) in the treatment of hypertrophied inferior turbinate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients with allergic rhinitis and hypertrophied inferior turbinates were randomised into two groups with thirty patients each (group I underwent SMD and group II underwent PIT). They were assessed for relief of nasal obstruction by subjective and objective methods. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Nasal obstruction due to hypertrophy of inferior turbinate was the main symptom with 45 (75%) patients having severe obstruction and 15 (25%) patients moderate obstruction. Both the surgical procedures were effective in reducing nasal obstruction &amp;amp; other symptoms of AR. Though the total symptom score was significantly reduced by both the methods (p=0.001) SMD was superior in relieving nasal obstruction at 3months follow up while PIT was more effective at 6 months follow up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; SMD is an easier, less invasive method with lesser postoperative discomfort and complications as compared to PIT. Our study recommends SMD as an effective technique for relief of nasal obstruction in allergic rhinitis.&lt;/p&gt;