Evaluation of efficacy of radiofrequency thermal ablation technique by computed tomography and visual analog scale in treatment of isolated inferior turbinate hypertrophy

Abstract

Objectives: This study aims to evaluate the efficacy of radiofrequency thermal ablation RFTA technique by computed tomography CT and visual analog scale VAS in patients with isolated inferior turbinate hypertrophy. Patients and Methods: Between May 2009 and December 2009, 30 patients 10 females, 20 males; mean age 31.0±12.0 years; range 18 to 61 years who were diagnosed with an isolated inferior turbinate hypertrophy were included in this study. As a treatment, RFTA was applied to the inferior turbinate on three separate points. Evaluation of turbinate dimensions was performed by CT in pre- and postoperative period. Also, the evaluation of turbinate dimension by another otorhinolaryngologist and of the nasal obstruction by the patients in pre- and postoperative period through VAS were asked. Results: The mean dimensions of the left and right inferior turbinate on CT in pre- and postoperative period were 112.42±28.41 / 81.53±22.57 and 117.72±27.85 / 86.53±23.66 mm2 , respectively. The mean VAS values of the left and right turbinate dimensions were determined by another otorhinolaryngologist in pre- and postoperative period as 6.60±2.48 / 4.30±1.47 and 7.60±1.67 / 4.63±1.40, respectively. The mean VAS values of nasal obstruction in pre- and postoperative period were 6.77±1.19 and 3.57±1.46, respectively. Conclusion: Radiofrequency thermal ablation technique used for the treatment of the inferior turbinate hypertrophy is an effective procedure in the light of the CT and VAS evaluation results.

Keywords

• Computed tomography, nasal obstruction, radiofrequency thermal ablation, turbinate hypertrophy

İzole alt konka hipertrofisi tedavisinde radyofrekans termal ablasyon tekniği etkinliğinin bilgisayarlı tomografi ve görsel analog ölçeği ile değerlendirilmesi

Abstract

Amaç: İzole alt konka hipertrofili hastalarda, radyofrekans termal ablasyonu RFTA tekniği etkinliğinin, bilgisayarlı tomografi BT ve görsel analog ölçeği GAÖ ile değerlendirilmesi amaçlandı.Hastalar ve Yöntemler: Mayıs 2009 - Aralık 2009 tarihleri arasında kliniğimizde izole alt konka hipertrofisi tanısı konulan 30 hasta 10 kadın, 20 erkek; ort. yaş 31.0±12.0 yıl; dağılım 18-61 yıl çalışmaya alındı. Tedavi olarak, alt konkaya üç farklı noktada RFTA uygulandı. Konka boyutu değerlendirilmesi, ameliyat öncesi ve sonrası dönemde BT ile yapıldı. Ayrıca, GAÖ ile ameliyat öncesi ve sonrası dönemde, farklı bir kulak burun boğaz KBB uzmanının konka boyutlarını ve hastanın burun tıkanıklığını değerlendirmesi istendi.Bulgular: Ameliyat öncesi ve sonrası BT incelemesinde sol ve sağ alt konka ortalama kesit alanı değerleri sırasıyla 112.42±28.41 / 81.53±22.57 ve 117.72±27.85 / 86.53±23.66 mm2 idi. Farklı bir KBB uzmanı tarafından sol ve sağ alt konka boyutlarının ameliyat öncesi ve sonrası ortalama GAÖ değerleri, sırasıyla 6.60±2.48 / 4.30±1.47 ve 7.60±1.67 / 4.63±1.40 olarak belirlendi. Burun tıkanıklığının ameliyat öncesi ve sonrası ortalama GAÖ değerleri ise sırasıyla 6.77±1.19 ve 3.57±1.46 idi.Sonuç: Alt konka hipertrofisi tedavisinde kullanılan RFTA tekniği, BT ve GAÖ değerlendirme sonuçları ışığında etkin bir yöntemdir

Keywords

• Bilgisayarlı tomografi, burun tıkanıklığı, radyofrekans termal ablasyon, konka hipertrofisi

References

1. Gindros G, Kantas I, Balatsouras DG, Kandiloros D, Manthos AK, Kaidoglou A. Mucosal changes in chronic hypertrophic rhinitis after surgical turbinate reduction. Eur Arch Otorhinolaryngol 2009;266:1409-16.
2. Cavaliere M, Mottola G, Iemma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy. Otolaryngol Head Neck Surg 2005;133:972-8.
3. Cavaliere M, Mottola G, Iemma M. Monopolar and bipolar radiofrequency thermal ablation of inferior turbinates: 20-month follow-up. Otolaryngol Head Neck Surg 2007;137:256-63.
4. Willatt D. The evidence for reducing inferior turbinates. Rhinology 2009;47:227-36.
5. Gupta A, Mercurio E, Bielamowicz S. Endoscopic inferior turbinate reduction: an outcomes analysis. Laryngoscope 2001;111:1957-9.
6. Porter MW, Hales NW, Nease CJ, Krempl GA. Long- term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care? Laryngoscope 2006;116:554-7.
7. Nurse LA, Duncavage JA. Surgery of the inferior and middle turbinates. Otolaryngol Clin North Am 2009;42:295-309.
8. Barbosa Ade A, Caldas N, Morais AX, Campos AJ, Caldas S, Lessa F. Assessment of pre and postoperative symptomatology in patients undergoing inferior turbinectomy. Braz J Otorhinolaryngol 2005;71:468-71.

9. Chang CW, Ries WR. Surgical treatment of the inferior turbinate: new techniques. Curr Opin Otolaryngol Head Neck Surg 2004;12:53-7.
10. Hol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology 2000;38:157-66.
11. Ikeda K, Oshima T, Suzuki M, Suzuki H, Shimomura A. Functional inferior turbinosurgery (FITS) for the treatment of resistant chronic rhinitis. Acta Otolaryngol 2006;126:739-45.
12. Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg 1999;103:300-12.
13. Ferri E, García Purriños FJ, Ianniello F, Armato E, Cavaleri S, Capuzzo P. Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients. Acta Otorrinolaringol Esp 2004;55:277-81. [Abstract]
14. Won CH, Li KK, Guilleminault C. Surgical treatment of obstructive sleep apnea: upper airway and maxillomandibular surgery. Proc Am Thorac Soc 2008;5:193-9.
15. Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study. Otolaryngol Head Neck Surg 1998;119:569-73.
16. Harrill WC, Pillsbury HC 3rd, McGuirt WF, Stewart MG. Radiofrequency turbinate reduction: a NOSE evaluation. Laryngoscope 2007;117:1912-9.
17. Sargon MF, Celik HH, Uslu SS, Yücel OT, Denk CC, Ceylan A. Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy. Eur Otorhinolaryngol 2009;266:231-5. Arch
18. Oztürk A, Alataş N, Oztürk E, San I, Sirmatel O, Kat N. Pneumatization of the inferior turbinates: incidence and radiologic appearance. J Comput Assist Tomogr 2005;29:311-4.
19. Kim DH, Park HY, Kim HS, Kang SO, Park JS, Han NS, et al. Effect of septoplasty on inferior turbinate hypertrophy. Arch Otolaryngol Head Neck Surg 2008;134:419-23.
20. Mayerhoff WL, Schaeffer S. Physiology of the nose and paranasal sinuses. In: Paperalla MM, editor. Otolaryngology. Vol 2. Philadelphia: W.B. Saunders; 1980. p. 315-33.
21. Neskey D, Eloy JA, Casiano RR. Nasal, septal, and turbinate anatomy and embryology. Otolaryngol Clin North Am 2009;42:193-205.
22. Corey JP. Acoustic rhinometry: should we be using it? Curr Opin Otolaryngol Head Neck Surg 2006;14:29-34.
23. Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin North Am 2009;42:207-25.
24. Wheeler SM, Corey JP. Evaluation of upper airway obstruction--an ENT perspective. Pulm Pharmacol Ther 2008;21:433-41.
25. Pirilä T, Nuutinen J. Acoustic rhinometry, rhinomanometry and the amount of nasal secretion in the clinical monitoring of the nasal provocation test. Clin Exp Allergy 1998;28:468-77.
26. Ozcan KM, Selcuk A, Ozcan I, Akdogan O, Dere H. Anatomical variations of nasal turbinates. J Craniofac Surg 2008;19:1678-82.
27. Akoğlu E, Karazincir S, Balci A, Okuyucu S, Sumbas H, Dağli AS. Evaluation of the turbinate hypertrophy by computed tomography in patients with deviated nasal septum. Otolaryngol Head Neck Surg 2007;136:380-4.
28. Yang BT, Chong VF, Wang ZC, Xian JF, Chen QH. CT appearance of pneumatized inferior turbinate. Clin Radiol 2008;63:901-5.
29. Ozcan KM, Gedikli Y, Ozcan I, Pasaoglu L, Dere H. Microdebrider for reduction of inferior turbinate: evaluation of effectiveness by computed tomography. J Otolaryngol Head Neck Surg 2008;37:463-8.
30. Sapci T, Usta C, Evcimik MF, Bozkurt Z, Aygun E, Karavus A, et al. Evaluation of radiofrequency thermal ablation results in inferior turbinate hypertrophies by magnetic resonance imaging. Laryngoscope 2007;117:623-7.
31. Deniz M, Uslu C, Ogredik EA, Akduman D, Gursan SO. Nasal mucociliary clearance in total laryngectomized patients. Eur Arch Otorhinolaryngol 2006;263:1099-104.
32. Yildirim B, Uysal IO, Polat C, Gök C. The efficacy of radiofrequency ablation technique in patients with inferior turbinate hypertrophy. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2008;18:90-6.
33. Kizilkaya Z, Ceylan K, Emir H, Yavanoglu A, Unlu I, Samim E, et al. Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy. Otolaryngol Head Neck Surg 2008;138:176-81.
34. Tanyeri H, Boyaci Z. Reduction of the inferior turbinates with a microdebrider. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2008;18:69-73.
35. Mabry RL. Corticosteroids in rhinology. Otolaryngol Head Neck Surg 1993;108:768-70.
36. Gupta A, Mercurio E, Bielamowicz S. Endoscopic inferior turbinate reduction: an outcomes analysis. Laryngoscope 2001;111:1957-9.
37. Nease CJ, Krempl GA. Radiofrequency treatment of turbinate hypertrophy: a randomized, blinded, placebo-controlled clinical trial. Otolaryngol Head Neck Surg 2004;130:291-9.
38. Maskell S, Eze N, Patel P, Hosni A. Laser inferior turbinectomy under local anaesthetic: a well tolerated out-patient procedure. J Laryngol Otol 2007;121:957-61.
39. Smith TL, Correa AJ, Kuo T, Reinisch L. Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode. Laryngoscope 1999;109:1760-5.
40. Coste A, Yona L, Blumen M, Louis B, Zerah F, Rugina M, et al. Radiofrequency is a safe and effective treatment of turbinate hypertrophy. Laryngoscope 2001;111:894-9.
41. Shryock TR, Losonsky JM, Smith WC, Gatlin CL, Francisco CJ, Kuriashkin IV, et al. Computed axial tomography of the porcine nasal cavity and a morphometric comparison of the nasal turbinates with other visualization techniques. Can J Vet Res 1998;62:287-92.