Cavaliere Matteo, Mottola Giampiero, Iemma Maurizio
Department of Otorhinolaryngology, Moscati Hospital, Avellino, Italy.
Otolaryngol Head Neck Surg. 2005 Dec;133(6):972-8. doi: 10.1016/j.otohns.2005.08.006.
Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Many different techniques are currently available. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) compared with the traditional surgical technique.
The study was conducted on 3 groups of 75 patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy refractory to medical therapy. In group A, the turbinoplasty (TP) was performed using the classical surgical submucosal resection; in group B, the RFVTR was applied to inferior turbinate; and group C patients were not treated and served as control subjects. Nasal endoscopy, visual analogue scale (VAS), anterior active positional rhinomanometry, and saccharin tests were used to assess treatment outcomes at the end of week 1 and months 1 and 3 after surgery.
Turbinate edema and secretions decreased significantly (P < 0.05) in groups A and B from 1 month after surgery. The secretions in group A increased temporarily on the seventh day after surgery. Concerning the nasal obstruction and related symptoms, significant improvement was observed at 1 month after treatment in all patients (P < 0.05) and continued up to 3 months after surgery (P < 0.0001). Rhinomanometric measurements demonstrated a significant nasal flow increase at 3 months (P < 0.0001). The nasal mucociliary transport time increased in group A at week 1. The difference among the 3 groups at month 1 was observed not significant.
In this study, we demonstrated that both RFVTR and TP are effective in improving nasal obstruction and related nasal symptoms. In support of the RFVTR, different factors are important: it can be performed in local anaesthesia; it does not require a nasal package; it does not cause either a change of mucociliary function or an increase of secretions and crusts; and the patient can be discharged immediately after treatment. Therefore, we suggest that the RFVTR offers an efficient, gentle, and function-maintaining alternative to TP. However, because of the short follow-up, future investigations are needed for a more exhaustive evaluation of equivalency of the 2 turbinate procedures.
下鼻甲肥大是鼻气道阻塞的主要原因之一。药物治疗往往改善效果不佳。在这些情况下，可考虑行下鼻甲手术缩小术。目前有许多不同的技术。我们前瞻性地评估了射频容积性组织减容术（RFVTR）与传统手术技术相比的安全性和有效性。
该研究针对3组共75例有鼻阻塞症状和体征且药物治疗难以缓解的下鼻甲肥大患者进行。A组采用经典的手术黏膜下切除术进行鼻甲成形术（TP）；B组对下鼻甲应用RFVTR；C组患者未接受治疗，作为对照。在术后第1周、1个月和3个月结束时，使用鼻内镜检查、视觉模拟量表（VAS）、前鼻主动位鼻阻力测量和糖精试验来评估治疗效果。
术后1个月起，A组和B组的鼻甲水肿和分泌物显著减少（P < 0.05）。A组术后第7天分泌物暂时增加。关于鼻阻塞及相关症状，所有患者在治疗后1个月均有显著改善（P < 0.05），且持续至术后3个月（P < 0.0001）。鼻阻力测量显示术后3个月鼻气流显著增加（P < 0.0001）。A组在第1周时鼻黏膜纤毛传输时间增加。1个月时3组之间的差异无统计学意义。
在本研究中，我们证明RFVTR和TP在改善鼻阻塞及相关鼻部症状方面均有效。支持RFVTR的不同因素很重要：它可在局部麻醉下进行；不需要鼻腔填塞；不会引起黏液纤毛功能改变或分泌物及痂皮增加；患者治疗后可立即出院。因此，我们认为RFVTR为TP提供了一种有效、温和且能维持功能的替代方法。然而，由于随访时间短，需要进一步研究以更全面地评估这两种鼻甲手术的等效性。
