Turbinate Enlargement Research Articles

Two-year outcomes of radiofrequency device treatment of the nasal valve for nasal airway obstruction.

Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT). Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥ 20 reduction in NOSE score or 1 reduction in severity class. The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was -41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in >=1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤ 25 at 2 years. TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

Two-year outcomes of radiofrequency device treatment of the nasal valve for nasal airway obstruction

BACKGROUND: Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT). METHODOLOGY: Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥20% reduction in NOSE score or ≥1 reduction in severity class. RESULTS: The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was −41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in ≥1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤25 at 2 years. CONCLUSIONS: TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

Two-year outcomes of temperature-controlled radiofrequency device treatment of the nasal valve for patients with nasal airway obstruction.

The objective of this study was to evaluate long-term symptom improvements in patients with nasal airway obstruction (NAO) secondary to nasal valve collapse (NVC) following minimally invasive temperature-controlled radiofrequency (TCRF) treatment. A prospective, single-arm, multicenter study in patients >18 years with NAO due to NVC. Inclusion criteria were response to nasal valve dilation (e.g., modified Cottle maneuver) and baseline Nasal Obstruction Symptom Evaluation (NOSE) Scale score ≥60. Patients were treated in the nasal valve region with a TCRF device and followed through 2 years. A responder was ≥20% reduction NOSE Scale score or ≥1 reduction in severity class. A total of 122 patients were treated and 91 reached 2 years. The mean baseline NOSE Scale score was 80.3 (95% CI, 78.1-82.6). The adjusted mean change in score at 2 years was -45.8 (95% CI, -53.5 to -38.1), p < 0.001; a 57.0% improvement. The 2-year responder rate was 90.1% (95% CI, 82.3%-94.7%). Significant and sustained symptom improvement was achieved in subpopulations based on sex, age, body mass index, baseline NAO severity, nasal surgery history, NVC mechanism, septal deviation, and other anatomic contributors of NAO. No serious adverse events with a relationship to the study device and/or procedure were reported. Minimally invasive TCRF device treatment of the internal nasal valve for NAO is well tolerated and leads to significant and sustained improvement in NAO symptom severity through 2 years, including in patients with both static and dynamic NVC, septal deviation, turbinate enlargement, or prior nasal surgery. 2b.

Assessing the ability of children and parents to rate their nasal patency. A cross sectional study

ObjectiveNasal obstruction is a common complaint in pediatric otolaryngology. There are several concerns about how nasal obstruction should be measured. This debate is even more important in children, as they can experience difficulties in being sensitive to their symptoms or even expressing them. In this research we aim to explore the ability of children (and their parents) to assess their nasal obstruction. ParticipantsAND METHODS: An observational cross-sectional study was performed. Four cohorts of children were consecutively selected from a third level referral Hospital. Cohort A (children suffering solely turbinate enlargement), B (adenoid enlargement only), and C (adenoid and turbinate enlargement), while cohort D were healthy controls. Children and parents were asked to rate nasal patency through a Likert scale from 0 (no patency, complete obstruction of the nose) to 10 (complete patency, it is easy to breathe through the nose). All participants underwent rhinomanometry. Results of nasal resistance were relativized according to pediatric reference values per each age subgroup. Results146 participants were included. Cohort A (54), B (40), C (28), D (24). There is a poor but significant correlation between parents’ assessment and nasal resistance (rho = −0.28; p = 0.004). In children, there is no significant correlation with nasal resistance (rho = −0.14; p = 0.17). Stratified by severity, only children (and their parents) with good nasal breathing demonstrated good correlation values with the visual analogue score (VAS). Stratified by age, the correlation is only significant for parents of children older than 12 years old. ConclusionsThis study has demonstrated a good ability to rate nasal patency by healthy children and their parents, but a poor ability for children suffering from impaired nasal breathing. We suggest combining subjective assessment of nasal patency with objective measurements such as rhinomanometry in children.

Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients

The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Radiofrequency ablation turbinoplasty improves the sense of smell in pediatric patients: A prospective study

IntroductionThe olfactory sense is of paramount importance for the adequate development of a child. Olfactory loss in children might have different origins. One of the most common is conductive, when nasal obstruction prevents odorants from reaching the olfactory epithelium. Rhinitis and turbinate enlargement have been proven to diminish the sense of smell in pediatric patients. A common treatment for resistant rhinitis in these patients is turbinate radiofrequency ablation (TRA). However, despite an increasing research effort in this field, there are no studies instrumentally assessing olfaction in children undergoing turbinate surgery to date. This study was designed with the aim of assessing changes in olfaction through validated instrumental tools in pediatric patients undergoing TRA for the first time. MethodsA prospective uncontrolled intervention clinical trial design was conducted. Two cohorts of children ranging 4–15 years old were consecutively selected from a third level referral Hospital and subjected to the universal sniff test (U-Sniff), alcohol sniff test (AST), and sniffin sticks threshold test (SST) before and 1, 3 and 6 months after surgery. Cohort A consisted of children solely undergoing TRA. Cohort B consisted of children on whom adenoidectomy and TRA had been performed. Additionally, a cohort of Spanish healthy controls, paired by sex and age, were asked to perform the U-Sniff. ResultsA total of 81 participants with a mean age of 10.31 ± 2.56 years were included. Fifty-three patients underwent TRA exclusively and 28 were subjected to associated adenoidectomy. Despite a tendency toward improvement in the U-sniff scores, there were no statistically significant differences after surgery. However, statistically significant differences were obtained for threshold tasks measured with SST and AST, revealing differences at 1, 3 and 6 months after surgery compared to preoperative scores. ConclusionsIn summary, this research demonstrated adequate levels in the sense of smell regarding identification tasks, but decreased olfactory threshold scores in pediatric patients suffering from TE. TRA, alone or with adenoidectomy, improved smell threshold scores, but had no significant effect on identification tasks.

Normal anatomic variants of paranasal sinus region studied by computed tomography

Background and objective: Variation in paranasal sinus anatomy, as shown on computed tomographic scans, is of potential significance as it may pose risks during surgery or predispose to certain pathologic conditions. This study aimed to investigate the frequency of anatomic variants of the nasal cavity and paranasal sinuses in our population and determine their relationship with gender and find out the association of these variants with mucosal abnormalities. Methods: This was a cross-sectional study conducted at the College of Medicine, Hawler Medical University from October 2017 to January 2019. A review of computed tomography scans of the paranasal sinuses of 300 patients was done; special attention was directed toward identifying bony anatomic variants and mucosal abnormalities. Results: Frequent variants were: Agger nasi cells (72%), nasal septal deviation (71.7%), Haller cells (70.7%), concha bullosa (61%), elongation of uncinate process (69.7%) and different variants of the sphenoidal sinus (78.8%). The frequency of variants did not differ significantly with respect to gender, except for sphenoidal variants along with Keros types and asymmetry of the ethmoidal roof. A significant association was found between middle concha variants and inferior turbinate enlargement (P <0.001). Conclusion: Anatomic variants of the paranasal sinus region were common in our population; the most frequent ones were those involving the nasal septum, ethmoid air cells, sphenoid sinuses, and middle turbinates. The study of these variants is important for the management of paranasal sinus region disease.

A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty

AimsThe surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty. Material and methodsOne hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n=66) or septoplasty combined with turbinoplasty arm (n=71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively. ResultsWith regard to the findings obtained from both scales, both interventions successfully relieved the patients’ complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P˂0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P˂0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study. ConclusionsA turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.

Multimorbidities of Pediatric Allergic Rhinitis.

Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities. The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.

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 prospective, randomized, placebo-controlled study of inferior turbinate surgery.

The purpose of this study was to compare radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty techniques in the treatment of chronic nasal obstruction caused by inferior turbinate enlargement, and to compare these techniques with a placebo procedure. Prospective, randomized, single-blinded, placebo-controlled study. A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into a placebo, radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty groups in a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. The severity of nasal obstruction measured by visual analog scale score decreased statistically significantly in all the groups, including placebo. Radiofrequency ablation (P = .03), diode laser (P = .02), and microdebrider-assisted inferior turbinoplasty (P = .04) all decreased the symptom score of the severity of nasal obstruction statistically significantly more compared to the placebo procedure. The placebo effect had a large role in the overall improvement of the severity of nasal obstruction after the inferior turbinate surgery. However, all three techniques provided a statistically significant additional reduction of the severity of nasal obstruction compared to the placebo procedure. 1b. Laryngoscope, 128:1997-2003, 2018.

Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement

The aim of this study was to evaluate the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and Eustachian tube dysfunction-related symptoms using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) as an assessment method. A total of 80 adults were enrolled. Group 1 comprised consecutive patients with enlarged inferior turbinates and group 2 comprised healthy controls. The ETDQ-7 scores and tympanometry results of both groups were analyzed and compared. The median total scores of the ETDQ-7 in groups 1 and 2 were 1.9 (interquartile range, 1.4-2.8) and 1.1 (interquartile range, 1.0-1.7), respectively ( P < .001). There was no significant difference in the abnormal tympanometry results between the groups. There was no significant difference in the ETDQ-7 total score between the patients with allergic sensitization and other patients in group 1. Patients with inferior turbinate enlargement have more symptoms related to Eustachian tube dysfunction than healthy controls. Most patients with Eustachian tube dysfunction had normal tympanometry and normal otoscopy, which indicates a baro-challenge-induced Eustachian tube dysfunction. Whether the patient has allergic sensitization or not does not seem to cause a difference in symptoms related to Eustachian tube dysfunction.

Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis

ObjectiveTo evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients. MethodsIn a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analog scale score (VAS). ResultsMost patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology. ConclusionNasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life.

Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study).

Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). In a prospective, real-life study, 130 paediatric PER patients (13.1±2.8years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). After 2months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.

Surgery for nasal obstruction in inferior turbinate hypertrophy

Abstract In the international literature, there is no consensus on patient selection for turbinate surgery. Surgery is usually indicated to the patients on the basis of subjective complaint of nasal obstruction and surgeon´s clinical examination. Although most surgical techniques demonstrate a subjective and objective improvement in postoperative nasal airflow and subjective scores, it is hard to say which technique is best suited for treating inferior turbinate enlargement. Inferior turbinate reduction for nasal obstructive symptoms caused by enlarged turbinates is a useful procedure and is reserved for patients who are not responding to medical treatment or in whom the medical management is contraindicated.

Inferior turbinate reduction

The inferior turbinate is an important structure serving a vital role in nasal physiology. However, inferior turbinate enlargement can lead to decreased nasal airflow and a sensation of nasal obstruction. Chronic nasal obstruction can substantially affect quality of life, productivity, and finances, and when medical therapies fail, surgical management is often recommended. Many techniques for inferior turbinate reduction exist, including outfracturing, submucosal soft tissue reduction (ie, electrocautery, radiofrequency coblation, and powered microdebrider), submucosal bone removal, argon plasma coagulation, laser reduction, partial turbinectomy, and total turbinectomy. These techniques have demonstrated varied long-term results, and there remains a lack of consensus as to the optimal surgical technique. However, given the important role the inferior turbinates play in nasal physiology, many contemporary surgeons aim to strike a balance between adequate tissue resection for symptom improvement and preservation of functional turbinate tissue and its contribution to normal nasal physiology.

English

OBJECTIVE : To determine the success rate of inferior turbinectomy for nasal obstruction. To study complications of inferior turbinectomy. To study the histopathological changes in the inferior turbinate specimens. METHOD : This prospective, single blinded, randomized study of 219 consecutive patients carried out in two tertiary level centres from January 2010 to October 2011. The patients were assessed preoperatively and postoperatively both subjectively and objectively. The patients who were refractory to the directed conservative treatment for chronic nasal obstruction underwent inferior turbinectomy on both sides and septoplasty if required. The inferior turbinectomy specimen was sent for histopathological examination. NOSE Questionnaires were used for subjective assessment and rigid nasal endoscopy used for objective assessment. Follow up done at 1 week, 1 month and 6 months after surgery. Friedman test applied for assessment of the improvement. RESULTS : 92 % (n=203) of patients relieved of nasal obstruction for which they approached. The improvement is statistically significant both subjectively and objectively. The common complications in present study is postoperative nasal synechia which occurred in 5% (n=10). Bleeding occurred in 4%(n=8). Dryness and crusting occurred in 2%(n=4) and foul odour in 2% (n=4). The present study also showed that most common cause for turbinate enlargement is chronic nonspecific inflammatory hypertrophy followed by allergic turbinate hypertrophy. CONCLUSION : -The results show that inferior turbinectomy is the good method of achieving relief from the nasal obstruction with minimal morbidity. Histopathological examination showed that most common cause of turbinate enlargement is chronic non specific turbinate hypertrophy and it proves beyond doubt that unnecessary excessive antiallergic treatment should be avoided in patients with chronic nasal obstruction.

Submucosal diatermia conch/turbinektomia with partial resection of the septum, yes or no?

There are many authors advocating this surgical procedure in cases where septoplasty alone isn't efficient enough. We made short prospective study in which we approved joined surgical procedures for improving nasal function. Study was done with 2 groups of patients. In first group of patients (A) septoplasty alone was done, in second (group B) we done partial turbinectomy too. Preoperative there were significant difference in rhinomanometic readings between these two groups, but postoperatively there were not, which lead us to the conclusion that use of this method is justified in cases where turbinate enlargement is significant. In both groups there were significant (p<0, 01) improving in postoperative rhinomanometric results.

Shaver-Turbinoplastik

Various methods are available for the surgical treatment of nasal airway obstruction caused by enlarged turbinates. These methods include partial turbinectomy, submucosal electrocautery, radiofrequency surgery, and laser turbinoplasty, all of which can have adverse effects such as defects of the mucous lining of the turbinates, prolonged postoperative healing, and bleeding. The purpose of this study was to analyse the effectiveness and potential adverse effects of microdebrider-assisted inferior turbinoplasty (MAIT), which is a less commonly used treatment option. In a prospective randomized study, 35 patients underwent microdebrider-assisted inferior turbinoplasty. Two control groups (35 patients each) underwent conventional partial turbinectomy or submucosal electrocautery. Endoscopic and functional studies (active anterior rhinomanometry, saccharin test) were performed before surgery and 2, 4, and 24 weeks after surgery. Pain and other postoperative problems were assessed using analogue scales. After 2 weeks, MAIT patients, unlike the other patients, showed almost no more mucosal lesions. After 4 weeks, mean saccharin clearance time was 11.1 min in the MAIT group, 15.9 min in the partial turbinectomy group, and 13.7 min in the electrocautery group. When the patients were asked to rate their symptoms on a scale of 0-10, the mean score in the fourth postoperative week was 6.1 in the MAIT group, 7.7 in the partial turbinectomy group, and 7.8 in the electrocautery group. Rhinomanometry showed a mean flow rate increase from 178 ml/s to 574 ml/s after MAIT (401 ml/s after partial turbinectomy, 361 ml/s after electrocautery). Microdebrider-assisted inferior turbinoplasty is a minimally invasive method for reducing inferior turbinate size and maintaining mucosal integrity. It has the advantages of a short healing time, only a mild decrease in mucociliary clearance, only minor postoperative problems, and a good functional outcome.

Letter to the Editor

To the Editor: My message is prompted by the Sinus Issue of Implant Dentistry that appeared in volume 20/number 6/December 2011, which was directed only toward the maxillary sinuses. It encouraged me to introduce our experience with diagnoses and evaluation of cases. For any given case, before any dental or implant procedure to be done, we definitely need to include the nasal cavity in our examination procedures. Through the past 5 years, and in cooperation with an ear, nose, and throat (ENT) specialist from my hometown, we noticed the following: Oral examination and panoramic radiographic evaluation of cases were not carried out in an efficient way by most dentists. Radiographically, most dentists do not even take the time to look in the nasal area. The nose, being opened all the time, is the main connecting organ of the body with the outside environment. Its normal and pathological anatomy is neglected by most dentists. However, its role in creating sinus and oral problems is huge. Clinically, many cases with hypertrophied uvula are not even noticed by both dentist and ENT practitioners. Case histories taken by dentists usually take information in a light way when related to rhinitis, and it is usually believed to be a sort of allergy! Most ENT specialists do accuse (sic) the maxillary sinuses (only), forgetting about the nasal cavity. Conventionally, they treat cases with long-term antihistamines. Patients get bored, and after they start feeling a little bit better, they quit using such medications, and the cycle starts all over again. THE NASAL PROBLEM In an extremely wide range of cases, and with a quick look at a panoramic radiograph, enlargement of the nasal turbinates and/or deviated nasal septum should be noticed. The etiology of turbinate enlargement is multifactorial involving congenital, allergic, hormonal, and environmental factors. THE NOSE AND ORAL CAVITY Mouth breathing, sinus infections, ostium stenosis, and disturbances of the gastrointestinal system are all etiologic factors for teeth, mucoperiosteal, and healing problems. However, they are caused by enlarged nasal turbinates. Many cases do have teeth problems due to these factors, and many dentists treat the teeth and forget about the cause. Placing implants with sinus lift procedures under these circumstances would definitely involve complications arising from the nose that would remain unexplained. Ostium stenosis (narrowing or closure of the sinus draining opening from the nasal cavity) is a common problem causing blockage of the maxillary sinus and subsequent thickening of the sinus mucosa. THE NOSE AND STOMACH Abnormal swelling of the nasal and sinus membranes causes the production of thick abnormal mucus. This thick mucus can drain into the back of the throat to the digestive system, causing symptoms that mimic the gastroesophageal reflux disease including repeated bouts of heartburn, difficulty swallowing, hoarseness, lump-in-the-throat sensation, and chronic cough. Moreover, a significant change in the salivary pH leads to tooth decay and calculus deposition. PROGNOSIS AND TREATMENT OF THE NOSE A wide variety of laser methods have been developed for surgery in the nose. Cases that went through restoring normal size of turbinate and/or correction of deviated nasal septum would eventually restore normal body health. Normal breathing and the stoppage of the postnasal discharge would improve patient's physiology and, accordingly, the oral cavity. In dentistry, close cooperation with ENT specialist is a must. The oral and nasal cavities work as a team. Careful nose and sinus examination is an ENT responsibility and must be requested by dentist.