Comparison of radiofrequency applied to the total inferior choncha with application to its anterior third
Introduction
The nasal valve area is the narrowest portion of the upper nasal airway and is solely responsible for 50% of total airway resistance. It is formed by the caudal margin of the upper lateral cartilage, anterior portion of the inferior choncha, the septum and base of the aperture pyriformis. Airflow speed is 2–3 m/s in the nostril and increases to 12–18 m/s at the nasal valve area. This results in the laminar airflow forming into a turbulent form, which in turn allows for more inhaled air to come into contact with nasal mucosa creating more warm and conditioned air [1], [2].
In practice nasal obstruction is observed to be caused by structural problems of components of this area. The inferior turbinate, as the predominant structure in this part of the nose, therefore plays a central role in conditioning of nasal air and in nasal obstruction [2], [3], [4].
In isolated inferior choncha hypertrophy the first approach should be medical with drugs including local and systemic steroids, oral and nasal decongestants and allergic desensitization [4]. Although medical treatments (i.e., local corticosteroids, antihistamines, decongestants) are frequently effective to restore comfortable nasal breathing, nasal obstruction is sometimes only slightly improved, leading some patients to increase their consumption of local decongestants with a high risk of iatrogenic effects [5]. Other than medical control a number of surgical interventions have been proposed. Several different techniques are currently available including total or partial turbinectomy, turbinoplasty, submucous resection, laser-assisted turbinoplasty, cryosurgery, treatment with infrared light, argon plasma surgery, topical application of AgNO3, corticosteroid injections, and electrocautery with monopolar and bipolar technique [6], [7]. Unfortunately many of these techniques, especially the ones that are used on the total of the choncha may lead to serious complications like bleeding, scabbing, pain, hyposmia, synechia formation, bone necrosis and more mild complications including nasal mucosal damage which causes disruption of the mucociliary transport [7], [9].
This has lead to widespread use of radiofrequency thermal ablation which causes minimal disruption of mucociliary clearance [8], [9]. In this technique the total of the choncha is generally treated to decrease nasal airflow resistance. Our aim in this study was to state the efficacy of radiofrequency (RF) application to only the anterior 1/3 of the inferior choncha using objective and subjective measures.
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Material and method
This study was carried out at the 1st clinic of otorhinolaryngology, Sisli Etfal Education and Research Hospital, and included 40 patients that applied to our clinic during November 2004 to March 2005 complaining of nasal obstruction and upon examination were observed to have isolated inferior turbinate hypertrophy as a causative factor. The age range of the study group was between 18 and 57 with a mean of 25. Of these patients 32 were male (80%) and 8 were female (20%). All patients underwent
Discussion
When performing surgical treatment for choncha hypertrophy the main goal is to decrease the volume of the choncha with minimal damage to the nasal mucosa and nasal physiology. Parameters including patient comfort and minimal hospital stay are also taken into consideration as with every surgical procedure. These aside the procedure used must also be as effective if not more then conventional procedures. Taking all these factors into consideration we used radiofrequency ablation, a treatment
Conclusion
Nasal obstruction is a frequently encountered problem in otolaryngology clinics and the patology is usually associated with the nasal valve area. The anterior 1/3 of the inferior choncha is the main component of the inferior turbinate included in this area. Surgical procedures towards the inferior turbinate are now more than ever concentrating on minimal disturbance towards the nasal mucosa. This is why minimally invasive surgical procedures are being preferred today. In this study we were able
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