Efectividad de la turbinoplastia inferior con radiofrecuencia en el tratamiento de la rinitis crónica hipertrófica

Abstract

Introduction The turbinates are structures that are located inside of the nose whose functions are to humidify, filter and warm the air that reaches the lungs for comfort. The inferior turbinates increase and decrease in size several times a day, but when there is nasal congestion, the enlarged size of the entire turbinate partially obstructs airflow through the nose and when this clogging becomes permanent is called turbinal hypertrophy. Traditional treatment options include nasal sprays, nasal decongestants, mucolytics, antihistamines, and surgical procedures such as partial excision or ablation of the turbinate using various techniques, such us electrocautery, LASER, radiofrequency (RF) or criosurgery. The objective of the present research is to study the effectiveness of the volumetric tissue reduction by RF, which consists on the reduction in size of the inferior turbinates. The surgery is performed under local anesthesia and sedation in the operating room on an outpatient basis. To evaluate the effectiveness of this technique an objective diagnostic method, Acoustic Rhinometry (AR), and two subjective methods, an analogue visual scale (AVS) for symptom score analysis and the Spanish validated version of the Rinoconjunctivitis Quality of Life Questionaire (RQLQ), both completed by each patient are used. The three tests were performed before the surgery and six months following it. RA is a method of objective scanning of the nasal cavity, based on the analysis of the reflection of sound wave which provides an estimate of the cross-sectional area of the nasal cavity as a function of the distance (D) from the nostril. It is a method for assessing certain areas, D and nasal volume, which is achieved through an audible acoustic pulse propagating through a tube of constant section. The sound wave enters the nostrils and is reflected as anatomical accident on his way. This information is collected by a microphone located at the distal end of the tube, expanded and processed in a computer, and the data displayed in a chart. Two measurements are always made: one at baseline and another fifteen minutes after applying in both nostrils a topical vasoconstrictor spray (oxymetazoline hydrochloride 0.5 mg/ml). Material and method Two groups are conformed, with certain inclusion and exclusion criteria: a control group, consisting of 76 healthy patients with neither clinical rhinometric findings of chronic nasal obstruction (CNO) nor chronic hipertrophic rhinitis (CHR); and the group of patients with CHR that indeed met these two criteria, consisting of 200 patients. In both groups, at the first visit, a thorough medical history, meticulous ENT examination (nasal inspection orofaringoscopy, anterior rhinoscopy, rhinofibroscopy) and request for additional evidence, namely allergic rinitis, skin prick tests and blood analysis (IgE) of common aeroallergens -if this testing wasn´t previously performed- and finally CT scan of the nasal passages and sinuses, were performed to all patientes included in the study. The AVS and RQLQ were only completed by patients with CHR patients, prior to the RA at a later date, and yes that was done for the two groups. All data collected (medical history, AVS, AR) was introduced into an Excel database. For the statistical analysys of the data the program used was SPSS 18.0. Results After turbinoplasty (TP) regarding AVS a considerable decrease is observed in variables mean of severity and frequency of CNO, although mucus is not reduced and as well the rest of symptoms remain virtually unchanged. Regarding the RQLQ, a large proportion of patients (67%) undergo changes from the subjective standpoint. Comparing the group of patients with allergic rhinitis (Ar) with the group of patients with nonallergic rhinitis (nAr) in the first group improvement is obtained after the surgery in all dimensions but for "eye symptoms" and "emotional" where there are no changes, while in the second group improvement is obtained in all dimensions except on "practical problems" and "eye symptoms". When analyzing the AR at baseline situation after the surgery in the area of the second recess (A2E) a general increase is observed with respect to the basline situation observed before the intervention, in both nasal fossae. As the volume of the first five centimeters within the nasal fosase (V0-5), the total value is considerably higher than that obtained at the baseline situation before the surgery. After vasoconstriction (VC) both parameters increased significantly. Finally, after both situations baseline and VC the minimum cross section area (ATM) follows locating more often in the second recess (2e). Conclusions Inferior TP by RF achieves a decrease in the severity and frequency of the main symptom of the CON in CHR. CHR not only physically affects patients, but also carries an additional psychological component. Surgery produces subjective improvement in patients performing their daily activities most affected by CHR symptoms. There is a certain rhinometric pattern in patients with CHR that corresponds to changes of some parameters in the basal situation and after VC. After the surgery AR values increase with respect to those obtained preoperatively, approaching to those obtained in the group of patients without CHR.