Diode laser treatment of hyperplastic inferior nasal turbinates

Diode Laser Therapy for Radiation-Induced Vascular Ectasia: Long-Term Results and Cost Analysis

BACKGROUND

Collateral damage to surrounding healthy tissues has been reported in patients who undergo radiation therapy for pelvic malignancies. This study aimed to evaluate the safety, efficacy and cost efficiency of endoscopic diode laser therapy in patients diagnosed with chronic radiation proctitis (CRP).

METHODS

The data of 24 patients (median age 78, range 67-90 years) who presented rectal bleeding and were diagnosed with CRP after undergoing high-dose radiotherapy for prostatic cancer and underwent diode laser therapy were evaluated retrospectively. Non-contact fibers were used in the patients who underwent the procedure without sedation in an outpatient setting.

RESULTS

The patients underwent a median of two sessions; overall, a mean of 1591 J of laser energy per session was used. No complications were noted during or after the procedures. Bleeding was completely resolved in 21/24 (88%) patients, and two patients showed improvement (96%). It was not necessary to suspend antiplatelet (six patients) or anticoagulant (four patients) therapy during the treatment course. The mean cost per session was EUR 473.4.

CONCLUSIONS

The study findings demonstrated that endoscopic non-contact diode laser treatment in CRP patients is safe, effective and cost efficient. For this procedure, antiplatelet and anticoagulant therapy suspension, intraprocedural sedation and hospital admission are not required.

Using thermal effect of 970 nm diode laser to reduce nasal swell body

In recent decades, semiconductor lasers have been successfully used in rhinology. However, their usage in the reduction of the nasal swell body (NSB) is barely studied. Our research aimed to conduct an experimental selection of the laser exposure mode in the NSB zone using a 970 nm diode laser for safe and effective NSB reduction. The thermometric parameters of a diode laser with a wavelength of 970 nm were evaluated in a continuous contact mode of exposure at the power from 2 W to 10 W with 2 W step. The laser was targeted at the liver of cattle, given its similar optical properties to the NSB region. After a series of experiments with every power rate and the analysis of temperature data, we estimated an optimal exposure mode at a power of 4 W. The collected thermometric data demonstrate the safety of this mode in a clinical setting for NSB reduction due to causing no thermal damage to the adjacent tissue. Based on the experiment, a technique for laser reduction of the NSB was developed to improve nasal breathing in patients with severe hypertrophy of this area. The proposed technique was applied to 39 patients with chronic vasomotor rhinitis and the NSB. All patients were divided into 2 groups. Group 1 consisted of 20 patients who underwent surface contact laser-turbinectomy and the NSB reduction using a 970 nm diode laser. Group 2 included 19 patients with the same pathology who underwent laser-turbinectomy, without reduction of the NSB. No statistically significant difference was observed during the dynamic observation with an objective assessment of nasal respiration according to active anterior rhinomanometry when comparing these subgroups with each other according to the t-criterion for independent samples (p > 0.05). As a result of comparing the data obtained on the NOSE scale using the Student's t-test, a statistically significant difference is observed (p < 0.001). Thus, patients who did not perform the reduction of the NSB subjectively noted the insufficiency of nasal breathing. This fact indicates that the NSB is involved in the regulation of airflow.

The Long-term Effect of Inferior Turbinate Surgery Techniques on Nasal Obstruction and Quality of Life

OBJECTIVE

The aim of the study was to compare the long-term effects of radiofrequency ablation (RFA), microdebrider-assisted inferior turbinoplasty (MAIT), and diode laser techniques on the severity of nasal obstruction and quality of life (QOL) in a 3-year follow-up.

METHODS

The patients filled a Visual Analog Scale (VAS) regarding the severity of nasal obstruction and the Glasgow Health Status Inventory (GHSI) questionnaire preoperatively and during the control visits at 3 months and 3 years. Acoustic rhinometry was also performed. A total of 78 patients attended both control visits.

RESULTS

All 3 techniques improved the VAS score for the severity of nasal obstruction and the GHSI total score significantly compared to the preoperative values at both 3 months and 3 years. Compared to the preoperative values, all 3 techniques increased the V2 to 5 cm values significantly at 3 months. After 3 years, compared to the preoperative values, the MAIT (P = .005) and diode laser (P < .001) still had a statistically significant volume increase in V2 to 5 cm, whereas the RFA (P = .06) did not achieve a statistically significant effect.

CONCLUSION

The RFA, MAIT, and diode laser all improved both the patients' subjective sensation of the severity of nasal obstruction and QOL significantly. The response was sustained during the 3-year follow-up period with all 3 techniques. A weakening in the objective treatment response to RFA was found in the longer follow-up, but that did not cause a weakening of the patients' subjective treatment response.

Inferior Turbinate Reduction: Diode LASER or Conventional Partial Turbinectomy?

Hypertrophy of inferior nasal turbinate is one of the most common causes for nasal obstruction (NO). As diode laser has proven to be as effective as any other lasers, our objective was to study various primary outcomes of its use of diode laser like improvement in NO, intraoperative bleeding, postoperative pain, and rapidity of healing. The study was undertaken to compare the various outcomes by diode laser turbinate reduction (LTR) and conventional partial inferior turbinectomy (PIT). A nonrandomized controlled trial was conducted on 2 groups: One group (30 cases) underwent LTR and PIT was performed in the other group (30 cases). The improvement in NO was measured postoperatively up to 6 months. Intraoperative bleeding was measured and postoperative pain scores were assessed each day up to fifth postoperative day. Lastly, rapidity of healing was evaluated until 6 months. Subjective relief of NO was 90.8% in LTR group, whereas it was 65% in PIT group at 6-month follow-up, which was statistically significant (P < .05). Pain scores were higher until 5 days in PIT group compared to LTR group (P = .0001). Intraoperative bleeding mean scores (milliliters) were 8.03 in LTR group compared to 23.29 in PIT group (P = .00001). Rapidity of healing was faster in LTR group with mean scores of 3.03 weeks in comparison to PIT group where it was 6.33 weeks (P = .00001). Compared to the conventional technique, the outcomes were better with diode laser and caused less morbidity.

[Experimental research of the diode 970 nm laser thermal effect in order to develop a method for reduction of nasal swell body]

OBJECTIVE

To evaluate the thermal effects of a 970 nm diode laser and select the modes necessary for the safe and effective use of this laser to reduce the nasal septum elevation (NSB) in volume in vitro.

MATERIAL AND METHODS

Laser exposure was carried out through a quartz fiber with a diameter of 400 μm in a continuous contact mode at a power from 2 W to 10 W with a step of 2 W. Three linear cuts 1 cm long were applied to the specimens. The distance between the cuts was 0.5 cm. The initial temperature of the fragments was 25.6±1.6°C. Temperature control was carried out from the side of the fragments opposite to the laser action using a certified and verified thermometer with a contact sensor.

RESULTS

In the course of the experiment, it was noted that the optimal power for effectively and safely reducing the area of the nasal septum elevation is 4 W. The maximum heating temperature reached 38.6±4.7°C.

CONCLUSIONS

A semiconductor laser with a wavelength of 970 nm can be used to reduce the elevation of the nasal septum, as it leads to predictable results, allowing you to control thermal effects and damage to surrounding tissues.

The effect of inferior turbinate surgery on nasal symptoms and inferior turbinate contractility

OBJECTIVES

The aim of this study was to compare radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) in the treatment of chronic nasal obstruction in a one-year follow-up, and to pay special attention to the effect of the procedures on the contractility capacity of the inferior turbinates.

METHODS

The patients filled a Visual Analogue Scale (VAS) questionnaire regarding nasal symptoms pre- and postoperatively. Saccharin transit time (STT) evaluation and acoustic rhinometry were also performed. A total of 77 patients attended the one-year control visit and had technically reliable acoustic rhinometry results.

RESULTS

All the examined techniques decreased the VAS score for the severity of nasal obstruction statistically significantly. There was no deterioration found in the symptoms of crusting, nasal discharge, and sneezing, nor in mucociliary function in any of the groups. All the three techniques increased the non-decongested total V2-5 cm values and decreased the decongested total V2-5 cm values statistically significantly. The V2-5 cm change (%) values decreased statistically significantly in the RFA, diode laser, and the MAIT groups following the operations, the mean changes being -57 percentage points (pp), -53 pp, and -73 pp respectively.

CONCLUSION

All three techniques decreased the severity of nasal obstruction significantly in the one-year follow-up. Although submucosal fibrosis seemed to increase, all the techniques increased the anterior nasal cavity volume significantly. Inferior turbinate contractility decreased to the normal level from the preoperative congested state following the surgery with every examined technique.

Factors Predictive of Outcome in Inferior Turbinate Surgery

OBJECTIVES

The purpose of the study was to examine the various preoperative predictive factors of inferior turbinate surgery and to find possible factors that predict an optimal subjective response using 3 common surgical techniques-radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT)-in a randomized, prospective study with a 1-year follow-up.

METHODS

The patients filled a visual analogue scale (VAS) questionnaire regarding the severity of nasal obstruction prior to and 1 year after surgery. A VAS score improvement of 3 points or more was chosen as an optimal subjective response. Univariate and multivariate regressions were used to evaluate the effect of the predictive factors. In total, 80 patients attended a 1-year control visit.

RESULTS

In the multivariate analysis, patients without anterior septal deviation had a statistically significantly higher odds ratio of a satisfactory subjective response compared to patients with anterior septal deviation (5.6; 95% CI: 1.4-23.1; P = .02). Patients treated with RFA had a statistically significantly higher odds ratio of an optimal subjective response compared to patients treated with MAIT (9.0; 95% CI: 1.5-54.2; P = .02).

CONCLUSIONS

Anterior septal deviation seems to decrease the likelihood of an optimal subjective response to inferior turbinate surgery, which supports the consideration of concomitant septoplasty at least in clear cases to optimize the subjective response. Radiofrequency ablation had a significantly higher likelihood of an optimal subjective response compared to MAIT. Further investigations regarding the findings are needed.

The Effect of Inferior Turbinate Surgery on Quality of Life: A Randomized, Placebo-Controlled Study

OBJECTIVE

The purpose of this prospective, randomized, single-blinded, placebo-controlled study was to investigate the effects of radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) techniques on patients' quality of life (QOL) and to compare the techniques with a placebo procedure.

METHODS

A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into placebo, RFA, diode laser, and MAIT groups at 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. Quality of life was assessed with the Glasgow Health Status Inventory (GHSI).

RESULTS

The GHSI total score increased statistically significantly in all the groups, including placebo. There were no significant differences in the GHSI total score change between RFA, diode laser, and MAIT groups. The MAIT procedure improved the GHSI total score significantly more than the placebo procedure (P = .04).

CONCLUSION

All inferior turbinate surgery techniques lead to a significant improvement in the patients' QOL, and no significant differences were found between the techniques. The placebo treatment also improved the QOL significantly. Only the MAIT technique improved the QOL significantly more compared to placebo.

The effect of inferior turbinate surgery on ciliated epithelium: A randomized, blinded study

OBJECTIVES/HYPOTHESIS

The aim of this study was to evaluate statistically the effects of radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty techniques on ciliated epithelium and mucociliary function.

STUDY DESIGN

Prospective randomized study.

METHODS

A total of 66 consecutively randomized adult patients with enlarged inferior turbinates underwent either a radiofrequency ablation, diode laser, or microdebrider-assisted inferior turbinoplasty procedure. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. The effect on ciliated epithelium was evaluated using a score based on the blinded grading of the preoperative and postoperative scanning electron microscopy images of mucosal samples. The effect on mucociliary function, in turn, was evaluated using saccharin transit time measurement.

RESULTS

The score of the number of cilia increased statistically significantly in the radiofrequency ablation (P = .03) and microdebrider-assisted inferior turbinoplasty (P = .04) groups, but not in the diode laser group. The score of the squamous metaplasia increased statistically significantly in the diode laser group (P = .002), but not in the other two groups. There were no significant changes found between the preoperative and postoperative saccharin transit time values in any of the treatment groups.

CONCLUSIONS

Radiofrequency ablation and microdebrider-assisted inferior turbinoplasty are more mucosal preserving techniques than the diode laser, which was found to increase the amount of squamous metaplasia at the 3-month follow-up. The number of cilia seemed to even increase after radiofrequency ablation and microdebrider-assisted inferior turbinoplasty procedures, but not after diode laser. Nevertheless, the mucociliary transport was equally preserved in all three groups.

LEVEL OF EVIDENCE

1b Laryngoscope, 129:18-24, 2019.

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

OBJECTIVES/HYPOTHESIS

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.

STUDY DESIGN

Prospective, randomized, single-blinded, placebo-controlled study.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

LEVEL OF EVIDENCE

1b. Laryngoscope, 128:1997-2003, 2018.

Determination of temperature and residual laser energy on film fiber-optic thermal converter for diode laser surgery

BACKGROUND

The diode laser was utilized in soft tissue incision of oral surgery based on the photothermic effect. The contradiction between the ablation efficiency and the thermal damage has always been in diode laser surgery, due to low absorption of its radiation in the near infrared region by biological tissues. Fiber-optic thermal converters (FOTCs) were used to improve efficiency for diode laser surgery. The purpose of this study was to determine the photothermic effect by the temperature and residual laser energy on film FOTCs.

METHODS

The film FOTC was made by a distal end of optical fiber impacting on paper. The external surface of the converter is covered by a film contained amorphous carbon. The diode laser with 810 nm worked at the different rated power of 1.0 W, 1.5 W, 2.0 W, 3.0 W, 4.0 W, 5.0 W, 6.0 W, 7.0 W, 8.0 W in continuous wave (CW)and pulse mode. The temperature of the distal end of optical fiber was recorded and the power of the residual laser energy from the film FOTC was measured synchronously. The temperature, residual power and the output power were analyzed by linear or exponential regression model and Pearson correlations analysis.

RESULTS

The residual power has good linearity versus output power in CW and pulse modes (R² = 0.963, P < 0.01 for both). The temperature on film FOTCs increases exponentially with adjusted R² = 0.959 in continuous wave mode, while in pulsed mode with adjusted R² = 0.934. The temperature was elevated up to about 210 °C and eventually to be a stable state. Film FOTCs centralized approximately 50% of laser energy on the fiber tip both in CW and pulsed mode while limiting the ability of the laser light to interact directly with target tissue.

CONCLUSIONS

Film FOTCs can concentrate part of laser energy transferred to heat on distal end of optical fiber, which have the feasibility of improving efficiency and reducing thermal damage of deep tissue.

Inferior Turbinate Hypertrophy in Rhinoplasty: Systematic Review of Surgical Techniques

BACKGROUND

Inferior turbinate hypertrophy is often encountered by plastic surgeons who perform rhinoplasty. Many treatment options are available to treat the inferior turbinate. The objective of this study was to systematically review outcomes of available techniques and provide guidance to surgical turbinate management.

METHODS

A MEDLINE search was performed for means of treating inferior turbinate hypertrophy. Studies selected focused on treatment of the inferior turbinate in isolation and excluding patients with refractory allergic rhinitis, vasomotor rhinitis, or hypertrophic rhinitis.

RESULTS

Fifty-eight articles were identified, collectively including the following surgical treatments of inferior turbinate hypertrophy: total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryotherapy, electrocautery, radiofrequency ablation, and turbinate outfracture. Outcomes and complications were collected from all studies. Procedures such as turbinectomy (partial/total) and submucosal resection showed crusting and epistaxis at comparatively higher rates, whereas more conservative treatments such as cryotherapy and submucous diathermy failed to provide long-term results. Submucosal resection and radiofrequency ablation were shown to decrease nasal resistance and preserve mucosal function. No literature exists to support the belief that turbinate outfracture alone is an effective treatment for turbinate hypertrophy.

CONCLUSIONS

Treatment of inferior turbinate hypertrophy is best accomplished with modalities that provide long-lasting results, preservation of turbinate function, and low complication rates. Submucosal resection and radiofrequency ablation appear to best fulfill these criteria. Turbinate outfracture should only be considered in combination with tissue-reduction procedures.

Three different turbinoplasty techniques combined with septoplasty: Prospective randomized trial

OBJECTIVES/HYPOTHESIS

Septal deviation and hypertrophic inferior turbinates are a frequent cause of nasal breathing disorders. The goal of this study was to prove the effectiveness and safety of three current turbinoplasty techniques.

STUDY DESIGN

This is a prospective, three-arm, single-blinded, single-center, randomized controlled trial.

METHODS

Sixty patients were randomly assigned to either anterior turbinoplasty (ATP) (n = 20), radiofrequency ablation (RFA) (n = 19; Celon Pro Breath), or novel submucous radial diode laser ablation (DLA) (n = 21; ELVeS Radial PainLess, wavelength = 1,470 nm), each in combination with standard septoplasty. Acoustic rhinometry, rhinomanometry, subjective nose questionnaire, and saccharin test served as outcome parameters for preoperative and 3-month, 1-year, and 2-year postoperative examinations.

RESULTS

After 3 months 47/60 patients were evaluated, 28/60 patients were evaluated after 1 year, and 26/60 patients were evaluated in the 2-year follow-up visit. An improvement of nasal breathing was observed in all three groups in all follow-up visits. The increase of endonasal volume 2 (volume between the nasal valve and body of the inferior turbinate) was statistically significant in the ATP and RFA group after 3 months and 2 years, and in the RFA group also after 1 year. The DLA group failed to reach significance level in all follow-up visits. Subjective evaluation of nasal breathing improved in all three groups.

CONCLUSIONS

In this trial, three different current techniques of turbinate surgery in combination with standard septoplasty were effective for the improvement of nasal breathing. The ATP and RFA techniques were more effective in the long term than DLA.

LEVEL OF EVIDENCE

1b. Laryngoscope, 2016 127:303-308, 2017.

Carbon Dioxide Laser Vaporization of the Inferior Turbinate for Allergic Rhinitis: Short-Term Results

Carbon dioxide laser vaporization of the turbinate has recently become accepted as a common treatment for allergic rhinitis. Usually, only a single procedure is applied to minimize trauma. However, repeated procedures on separate days are often required to achieve an adequate effect. Therefore, we attempted a new method of vaporization and evaluated the outcome, and also tried to determine which patients have good indications for laser treatment. To widely and deeply vaporize the inferior turbinate, we repeated the procedure 3 times in 1 session after removing the carbon coating from the previous vaporization under nasal endoscopic observation. After the procedure, most patients experienced complete nasal obstruction for 2 or 3 days, but there was no intraoperative or postoperative bleeding or severe pain. All patients obtained improvement of their chief complaints and were satisfied 2 months after the operation. In particular, 60% of the patients were completely relieved of refractory nasal obstruction. Most patients were more satisfied with the effects than are those treated by the usual methods. Completely successful cases (improvement in all symptoms and complete satisfaction obtained) were selected and were compared with other cases. Favorable prognostic factors are more severe complaints, longer symptomatic periods, stronger allergic reactions, and worse nasal resistance and its greater improvement with administration of decongestant nasal drops. This method may be especially accepted by patients with severe complaints, in particular nasal obstruction, who do not experience enough relief with conservative therapies or have enough time to make frequent visits to an outpatient clinic over a period of several weeks.

Potassium titanyl phosphate laser turbinate reduction in the management of allergic inferior turbinate hypertrophy: Our experience

Background:

Allergic inferior turbinate hypertrophy is one of the most common causes of nasal obstruction. Several surgical methods can be used for the reduction of allergic inferior turbinate hypertrophy refractory to medical management. Herein, we share our experience with a potassium titanyl phosphate (KTP) laser, which is a relatively novel technique for turbinate reduction.

Objectives:

To evaluate the efficacy of KTP laser turbinate reduction in terms of symptomatic improvement and its effect on nasal mucociliary clearance.

Methods:

This study was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from November 2012 to July 2013. Thirty patients with inferior turbinate hypertrophy refractory to medical management were selected. A KTP laser was used at 6 W in continuous mode, with a spot size of 0.6–1 mm, and energy delivered through a 400-μm optical fiber. A follow-up was done at 1 week, 1 month, and 3 months. All the values (both by the Sino Nasal Outcome Test scoring system and saccharine transit time) were assessed before surgery and at each follow-up visit.

Results:

The patients showed significant differences in the symptoms (p < 0.0001) at each follow-up. The mean saccharin transit time showed significant prolongation during the first week and first month after surgery, which indicated adverse effects on the mucociliary system (p < 0.0001). This, however, was a temporary effect, and the mean saccharin time returned to normal limits (17.96 minutes) at the third postoperative month. The mean operative time was 11.62 minutes. The procedure was not associated with any serious intra- or postoperative complications.

Conclusion:

KTP laser turbinate reduction is a safe, effective, and minimally invasive procedure in the treatment of allergic inferior turbinate hypertrophy, with a minimal effect on the nasal mucosa. It can be done as an office procedure, with minimal complications.

Diode laser-induced tissue effects: in vitro tissue model study and in vivo evaluation of wound healing following non-contact application

INTRODUCTION

The basic difference between the various common medical laser systems is the wavelength of the emitted light, leading to altered light-tissue interactions due to the optical parameters of the tissue. This study examines laser induced tissue effects in an in vitro tissue model using 1,470 nm diode laser compared to our standard practice for endonasal applications (940 nm diode laser) under standardised and reproducible conditions. Additionally, in vivo induced tissue effects following non-contact application with focus on mucosal healing were investigated in a controlled intra-individual design in patients treated for hypertrophy of nasal turbinate.

METHODS

A certified diode laser system emitting the light of λ = 1470 nm was evaluated with regards to its tissue effects (ablation, coagulation) in an in vitro setup on porcine liver and turkey muscle tissue model. To achieve comparable macroscopic tissue effects the laser fibres (600 µm core diameter) were fixed to a computer controlled stepper motor and the laser light was applied in a reproducible procedure under constant conditions. For the in vivo evaluation, 20 patients with nasal obstruction due to hyperplasia of inferior nasal turbinates were included in this prospective randomised double-blinded comparative trial. The endoscopic controlled endonasal application of λ = 1470 nm on the one and λ = 940 nm on the other side, both in 'non-contact' mode, was carried out as an outpatient procedure under local anaesthesia. The postoperative wound healing process (mucosal swelling, scab formation, bleeding, infection) was endoscopically documented and assessed by an independent physician.

RESULTS

In the experimental setup, the 1,470 nm laser diode system proved to be efficient in inducing tissue effects in non-contact mode with a reduced energy factor of 5-10 for highly perfused liver tissue to 10-20 for muscle tissue as compared to the 940 nm diode laser system. In the in vivo evaluation scab formation following laser surgery as assessed clinically on endonasal endoscopy was significantly reduced on 1,470 nm treated site compared to 940 nm diode laser treated site.

CONCLUSIONS

Diode laser system (1,470 nm) induces efficient tissue effects compared to 940 nm diode laser system as shown in the tissue model experiment. From the clinical point of view, the healing process following non-contact diode laser application revealed to be improved using 1,470 nm diode laser compared to our standard diode laser practise with 940 nm.

[Microdebrider-assisted inferior turbinoplasty. Minimally invasive technique for the treatment of nasal airway obstruction caused by enlarged turbinates]

BACKGROUND

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser

OBJECTIVE

This study aimed to compare the outcomes of turbinoplasty assisted by microdebrider and by diode laser (980 nm wavelength).

METHODS

Forty patients suffering from bilateral nasal obstruction were randomly divided into two equal groups. One group was managed with microdebrider-assisted turbinoplasty and the other with diode laser assisted turbinoplasty. The patients were followed up for six months post-operatively.

RESULTS

After six months, total success rates were 90 per cent for the microdebrider group and 85 per cent for the diode laser group. There were no significant differences between the two groups regarding success rate, post-operative complications or operative time.

CONCLUSION

These two techniques are equally safe, reliable, successful and non-invasive.

A double-blind, randomized, intra-individual controlled feasibility trial comparing the use of 1,470 and 940 nm diode laser for the treatment of hyperplastic inferior nasal turbinates

INTRODUCTION

Various laser systems have been used for volume reduction of hyperplastic nasal turbinates. For endonasal application, fiber controlled diode lasers are preferred over conventional laser systems for reasons of cost and practicability. This study compares coagulative tissue effects using λ = 1,470 nm and λ = 940 nm lasers in treatment of hyperplastic inferior nasal turbinates in an intraindividual manner.

METHODS

Twenty patients underwent laser coagulation for hyperplastic inferior nasal turbinates in this prospective, randomized, double-blind, clinical feasibility trial. In each case, one nasal cavity was treated using 1,470 nm laser (4-5 W power), the other one with 940 nm laser (12 W power), endoscopically controlled in noncontact mode. Clinical presentation and patients symptoms were documented preoperatively and on day 1, 3, 7, 14, and 21 postoperatively using rhinomanometry, standardized questionnaires including SNOT 20 GAV (German adapted version), and separate endoscopic examination, respectively.

RESULTS

No infections, hemorrhages, or other complications occurred intra- or postoperatively. The mean operation time was significantly shorter using the 1,470 nm diode laser as compared to the 940 nm laser. There was a significant reduction of nasal obstruction on day 21 postoperatively compared to the preoperative condition on both sides regardless of the laser system used. Evaluation of the SNOT-Scores as assessed before and 3 weeks after surgery showed significant subjective improvements.

CONCLUSIONS

1,470 nm diode laser system offers an efficient method for tissue reduction in hyperplasia of inferior nasal turbinate. Compared with our standard practice (940 nm diode laser), 1,470 nm diode laser application provides an equivalent tissue reduction in shorter operation time using less total energy and a comparable relief of nasal obstruction postoperatively.

Diode laser treatment of hypertrophic inferior turbinates and evaluation of the results with acoustic rhinometry

Inferior turbinate hypertrophy is the most common cause of chronic nasal obstruction. When conservative medical treatment options fail in patients with inferior turbinate hypertrophy, reduction of the inferior turbinate can be performed using surgical techniques. Laser-assisted turbinate surgery has the advantages of limited tissue trauma and reduced bleeding. We evaluated the effectiveness and outcomes of using a diode laser (λ = 980 nm) in turbinate reduction. Our study included 62 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates, who did not respond to medical treatment (≥ 1 year). Patients were treated with diode laser between January 2009 and December 2010 in our ENT (ear, nose, and throat) department. Subjective outcome of severity of nasal obstruction was assessed on a standard 10-cm visual analog scale (VAS). Acoustic rhinometry was used to measure nasal patency. The cross-sectional areas 1, 2, and 3 and the volumes between 2.5 and 5.5 cm were measured. VAS scores and acoustic rhinometry measurements were performed preoperatively and 1, 6, and 12 months after surgery. The mean follow-up was 13.1 ± 1 months. The mean operation time was 3 min per turbinate; no nasal packing was necessary. We did not observe any major complications. Both subjective and objective evaluations showed significant improvement. VAS scores improved, the mean MCA2, MCA3, and V2-5 measurements increased significantly 1 year after surgery. In the first year after surgery, 53 of 62 (85.4%) patients reported marked improvements in nasal breathing. Our results showed that, objectively and subjectively, the success rates in diode laser-assisted turbinate reduction were satisfactory. The diode laser, being one of the most portable and least expensive of the lasers available for turbinate surgery, makes it possible for turbinate reduction to be performed under topical anesthesia within a short period of time with excellent patient acceptance.

Surgery of the turbinates and "empty nose" syndrome

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The "empty nose" syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in "empty nose" patients are presented.

Surgical management of adult inferior turbinate hypertrophy: a systematic review of the evidence

OBJECTIVES/HYPOTHESIS

The evidence-based medicine (EBM) schema advocates critical appraisal of the scientific literature for treatment of diseases. The objective of this review was to analyze the role of surgery for symptomatic adult inferior turbinate hypertrophy (ITH) by focusing on the following question: In adults with nasal airway obstruction (NAO) from documented ITH having failed medical therapy, does inferior turbinate surgery improve disease-specific quality of life, symptoms, and/or objective parameters with minimum 6-month follow-up?.

STUDY DESIGN

Evidence-based review.

METHODS

Articles for inclusion were identified by query of appropriate search terms in the PubMed database. The articles were reviewed independently by two authors and assigned an evidence level based on standard EBM guidelines.

RESULTS

The search yielded 514 abstracts for review, retrieved 143 abstracts for full review, and included 96 articles in the report. The majority of the articles were assigned level 4 (75) or level 5 (18) evidence. One report was assigned level 1 and two reports were assigned level 2. Median number of patients reported was 50 (range, 1-533). Subjective assessment parameters were reported in 80 studies. Objective parameters were evaluated in 36 studies, including acoustic rhinometry or rhinomanometry (26) and mucociliary function (8). Overwhelming data supported efficacy of surgery for NAO from ITH with positive results reported in 93 studies.

CONCLUSIONS

The literature provides considerable level 4 and 5 evidence for efficacy of surgery for adult symptomatic ITH. Given the paucity of level 1 and 2 data, future studies should focus on prospective studies with matched control groups for comparison.

Histomorphologic study of nasal turbinates after surgical treatment: a comparison of laser surgery and radiofrequency-induced thermotherapy effects in animals

CONCLUSIONS

From the clinical point of view, the healing process following radiofrequency-induced thermotherapy (RFITT) is faster and less painful for the patient. This corresponds with the histopathological findings, as in a case of diode laser treatment, the damage to the tissue was greater, and the regenerative and reparative processes were less prominent.

OBJECTIVE

Comparison of histopathologic changes and the healing process in the turbinate tissue regarding the kind of treatment and intensity of energy used for surgery.

MATERIALS AND METHODS

Pigs were chosen as laboratory animals for this study. The animals were divided into two groups. Two different techniques were used: treatment with diode laser fiber applied submucosally in contact mode and RFITT. The first tissue samples were taken on the third postoperative day; further sampling was done on the eight postoperative day.

RESULTS

Histological features of the specimens taken from turbinates 8 days after the surgery included necrosis and ulceration, fibrin deposition in the mucosa, necrotizing sialometaplasia, as well as proliferation of the granulation tissue. Generally, the changes found in the turbinates treated by diode laser were more severe, with more intensive tissue damage and less prominent regenerative and reparative changes.

[Selected applications of diode laser in laryngological surgery]

Diode laser due to emitted wavelength and achieved tissue effect appear to be universal tool for broad range of applications in laryngological surgery. The aim of the study was to present variety of applications of this type of laser in the treatment of selected pathologies of the nose, pharynx and oral cavity.

MATERIAL AND METHOD

45 patients with various pathologies of the nose, pharynx and oral cavity were subjected to diode laser treatment under control of endoscopes and video routing system. In the studied group diode laser was used for hyperplastic turbinates treatment, correction of concha bullosa and septum deformations, ablation of nasal polyps and synechiae inside nasal cavity including cicatrical stenoses in the orifice of common lacrimal canalliculus, coagulation of vascular hemorrhagic diathesis, ablation of bleeding granulomas and polyps and treatment of vascular malformations. Results. Endoscopic diode laser surgery enabled for precise and save removal of the pathology accompanied only by minimal intraoperative bleeding. Healing and reepithelization process were normal and even in large postoperative defects do not exceeded 12 weeks. Postoperative complications in the form of cicatrix and synechiae were found in 3 patients.

CONCLUSIONS

Various pathologies may be treated effectively with diode laser if appropriate laser beam parameters and surgical technique is applied.

Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse

BACKGROUND

The purpose of this study was to evaluate long-term outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in therapy-refractory rhinitis medicamentosa (RM).

METHODS

In a prospective clinical investigation, 42 consecutive RM patients underwent videoendoscopic ITR with a diode laser after topical anesthetic preparation. Intra- and perioperative details were recorded including the occurrence of bleeding, crusting, pain, or discomfort. Treatment efficiency was assessed by follow-ups 1 and 6 weeks as well as 6 and 12 months after surgery. Subjective pre- and posttherapeutic nasal airflow (NA) and patient satisfaction were rated on visual analog scales (VASs). Assessment of the long-term objective clinical effectiveness was based on rhinomanometry, IT photodocumentation, and the recurrent need for decongestants.

RESULTS

Preoperative addiction to decongestants lasted 5 +/- 2 years (mean +/- SD). There was no major bleeding requiring nasal packing, and there were no other perioperative complications. Postoperative edema disappeared within the 1st week and crusting within 6 weeks after surgery. VAS was characterized by very low values for intraoperative pain and discomfort and high postoperative patient satisfaction. After 6 months, NA data revealed a significant improvement of subjective VAS and objective rhinomanometry (250.4-413.9 cm3/s inspiration at 150 Pa). A total of 88% of patients managed to successfully stop decongestant abuse after 6 months (74% after 1 year).

CONCLUSION

In therapy-refractory RM, outpatient diode laser ITR of hyperplastic IT represents a highly effective, safe, and well-tolerated treatment option that provides long-lasting recovery by markedly improving NA and stopping addiction to nasal decongestants.

Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates

BACKGROUND AND OBJECTIVE

Various laser systems have been used to reduce the volume of hyperplastic inferior nasal turbinates during the last 25 years. Although there are many studies reporting the clinical results immediately after laser treatment, there are only a few describing long-term results. Therefore, a clinical study was performed to assess and to compare the long-term outcome of both endonasal Ho:YAG and endonasal diode laser-assisted turbinate surgery.

STUDY DESIGN/MATERIALS AND METHODS

In the first treatment group, a total of 80 patients (allergic rhinitis (46%) and vasomotor rhinitis (54%)) suffering from nasal obstruction due to hyperplastic inferior nasal turbinates were treated by a pulsed Ho:YAG laser emitting light at a wavelength of lambda = 2,100 nm (pulse energy: 0.8-1.2 J/pulse, repetition rate: 4-8 Hz) under local anesthesia. In the second group, an additional 113 patients (allergic rhinitis (52%) and vasomotor rhinitis (48%)) were treated by means of a continuous wave GaAlAs-diode laser emitting light at a wavelength of lambda = 940 nm (power: 8-10 W). The treatment time was 3-10 minutes per turbinate and the nasal cavities were left unpacked following the procedure. The study concerning long-term effects was conducted using a standardized questionnaire, allergy test, and rhinomanometry within a follow-up period of 6 month and after 3 years. All patients were refractory to conservative medical treatment prior to laser treatment.

RESULTS

Three years after laser treatment, a subjective improvement of nasal airflow had been described by the patients in 67.5% after Ho:YAG- and in 74.4% after diode laser treatment. Rhinomanometry revealed a significant improvement of the nasal airflow at both 6 months and 3 years after the laser treatment as compared to the preoperative data. Side effects like nasal dryness and pain were rare (<5%) and occurred only during the first weeks after the intervention. After diode laser treatment, patients showed nasal obstruction due to postoperative edema and nasal crusting during the first 3-4 weeks, whereas patients from the Ho:YAG laser group described these symptoms only for a period of 1-2 weeks.

CONCLUSION

Both Ho:YAG- and diode laser treatment, which are performed as an outpatient procedure under local anesthesia, show promising long-term results. It has therefore, developed to become a time and cost-effective treatment modality in endonasal laser surgery at our institution. While short-term differences concerning the healing process after Ho:YAG- compared to diode-laser treatment could be ascertained according to the subjective and objective evaluation, no significant long-term differences between the two investigated groups could be observed.

Patient satisfaction survey of outpatient-based topical local anesthetic KTP laser inferior turbinectomy: a prospective study

BACKGROUND

The aim of this study was to determine patient satisfaction and feasibility of performing KTP laser inferior turbinectomy under topical anesthetic/decongestant spray. A prospective survey study was performed in the Outpatients' Department of a District General Hospital.

METHODS

Thirty-nine consecutive patients suffering from allergic or nonallergic vasomotor rhinitis were prospectively entered into the study. Preoperative details were gathered including current nasal obstruction score as indicated on a visual analog score (VAS). Lidocaine hydrochloride 5% w/v and phenylephrine hydrochloride 0.5% w/v was applied via topical spray to anesthetize and decongest the nose. The inferior turbinates (ITs) were reduced by parallel mucosal cuts using the KTP laser. Intraoperative details were recorded included pain experienced and bleeding. We studied the subjective clinical effectiveness and patient satisfaction.

RESULTS

All patients were followed up at standard intervals by telephone over a 6-month period. At each interval, current nasal obstruction, pain, bleeding, and crusting on VAS were collected. Morbidity was determined in terms of return to work, return to hospital, or recurrence of symptoms. At the end of 6 months all patients were asked if they would have the procedure repeated again and/or recommend it to a friend. Reduction of ITs under topical anesthesia was acceptable to 83% of all patients. Eighty-seven percent of all patients felt they would recommend the procedure and mode of anesthesia to a friend. Our patients obtained the maximum subjective benefit at 6 weeks postoperatively. A significant improvement in nasal obstruction was achieved. There was subjective improvement in associated symptoms including hyposmia/anosmia, rhinorrhea, and sneezing. Only 28% of all patients required medication again to aid symptom control. Postoperative bleeding was insignificant. The return to a ward or clinic was minimal and 82% of all employed patients were back at work within a week.

CONCLUSION

Our study showed that KTP laser inferior turbinectomy is suitable to be performed in the outpatient department under topical anesthetic/decongestant spray and provides excellent relief for nasal obstruction and high patient compliance and satisfaction.

Comparison of thermal tissue effects induced by contact application of fiber guided laser systems

BACKGROUND AND OBJECTIVES

Laser light of various wavelengths is being used for surgical procedures in otolaryngology. Apart from well-known fiber guided laser systems such as Nd:YAG- and Ho:YAG-lasers, newly developed diode-laser systems of different wavelengths have recently become popular in surgery. In order to compare the effects of fiber guided laser light with respect to their induced tissue effects, these laser systems have been studied and compared under reproducible test conditions.

STUDY DESIGN/MATERIALS AND METHODS

The laser fibers of four common medical laser systems (Ho:YAG- (lambda = 2,080 nm), Nd:YAG- (lambda = 1,064 nm), and diode-laser (lambda = 830 and 940 nm)) were fixed to a computer controlled stepper motor. The laser light was applied in contact mode onto ex vivo muscle tissue, using identical power settings and a reproducible application procedure (application velocity, application angle) under constant conditions (temperature of tissue and volume). The size of the thermal effects on the tissue (e.g., coagulation, ablation, and carbonization zones) were measured and photographed via optical microscopy.

RESULTS

Depending on the laser wavelength used, the experimental results proved different degrees of tissue responses. Nd:YAG- and diode-lasers provided for only low coagulation effects in the depth of the tissue, but produced severe carbonization at the surface. Ho:YAG-laser light revealed the highest ablation capabilities of the lasers investigated in addition to large coagulation zones which were of larger extent than those produced by Nd:YAG- and diode-laser light.

CONCLUSIONS

Contact treatment by Ho:YAG-laser light might provide for a precise and effective tissue reduction in a bloodless manner because of its high ablation and coagulation capabilities, especially if large volumes are treated and structures beneath are non-critical. In comparison, Nd:YAG- and diode-laser treatment in contact application showed low thermal tissue effects (i.e., coagulation) in the depth, resulting from a high power loss caused by the development of large carbonization zones at the surface of the tissue. Therefore, the degree of blood-perfusion and the capability of vessel-closure induced by these lasers should be taken into account. The presented investigation also revealed that in contact mode, the tested laser systems produced tissue effects, which were highly different from those already described for applications in non-contact mode. Physicians who are performing laser treatments in close boundaries must be aware that changing from non-contact to contact mode in laser application greatly influences the resulting tissue effects.

Argon plasma coagulation in the treatment of nonallergic hypertrophic inferior nasal turbinates

PURPOSE

Various surgical procedures have been recently proposed for the treatment of hypertrophic inferior nasal turbinates as a result of the advances made in medical technology and growing public demand for minimally invasive therapies. The aim of this study was to evaluate the safety and efficacy of the argon plasma coagulation technique for inferior turbinate reduction in a homogeneous series of patients with nonallergic inferior turbinate hypertrophy.

MATERIAL AND METHODS

Twenty symptomatic patients underwent argon plasma coagulation surgical treatment under local anesthesia and were clinically followed up after 1 month and then every 3 months (anterior rhinoscopy and nasal endoscopy). Diagnostic evaluations using active anterior rhinomanometry were made after 3 and 12 months.

RESULTS

All of the patients reported a postoperative improvement in nasal swelling and patency. No postoperative complications were observed. Rhinomanometry after 12 months showed a reduction in mean total resistance from the pretreatment level of 1.06 Pa s/cm(3) to 0.49 Pa s/cm(3). There was also a statistically significant reduction in nasal resistance for each of the investigated conditions (inspiration and expiration in orthostatism and clinostatism).

CONCLUSIONS

Argon plasma coagulation is a safe and efficacious procedure for the minimally invasive treatment of inferior turbinate hypertrophy, which can be performed under local anesthesia in an outpatient setting with little discomfort for the patient.

Laser surgery of the inferior turbinate for allergic rhinitis with seasonal exacerbation: an acoustic rhinometry study

Laser surgery has been used to successfully treat patients with perennial allergic rhinitis. We examined whether the numbers and types of sensitized allergens influence the effects of surgery. Two different groups (those allergic to house dust mites only, and those allergic to house dust mites and Japanese cedar pollen) prospectively underwent the same course of laser turbinectomy during the pollen dispersion season. The symptom scores for nasal obstruction significantly decreased in both groups, but the improvement of sneezing and rhinorrhea was less pronounced in the pollen group. We used acoustic rhinometry to measure postoperative changes in the nasal dimensions. Four months after treatment, the minimum cross-sectional area and nasal cavity volume had increased, respectively, by 61.7% and 30.7% in the house dust group, and by 30.7% and 16.2% in the pollen group. We conclude that laser surgery can be successfully applied to patients whose allergies show seasonal exacerbation by airborne pollen.

Comparison of laser induced effects on hyperplastic inferior nasal turbinates by means of scanning electron microscopy

BACKGROUND AND OBJECTIVE

Various laser systems have been used for volume reduction of hyperplastic inferior nasal turbinates. Many studies have thus reported about clinical experiences concerning short and long term results. Although there are also some clinical investigations on histological changes after laser treatment, there is a lack of examinations by means of scanning electron microscopy (SEM) in order to especially investigate laser induced superficial tissue effects (ablation, carbonization, and coagulation).

MATERIALS AND METHODS

Directly following operative excision, three hyperplastic nasal turbinates were treated by laser light of five common medical laser systems and their corresponding wavelengths, using identical laser parameters (irradiance, laser spot diameter) and a reproducible application procedure. After passing through an ethanol dehydration process, the thermal effects on the tissue (carbonization, coagulation, and ablation) were investigated and photographed via SEM.

RESULTS

Depending on the laser wavelength used, tissue responses which could be observed by SEM greatly differ with respect to ablation, coagulation, and carbonization zones. While the CO(2) laser showed a precise cutting of tissue via ablation with only slight thermal effects on the adjoining tissue, Argon-ion-, Nd:YAG-, and diode-lasers provided for an intense destruction of both the surrounding, superficial respiratory epithelium, and the tissue in the depth of the turbinates, resulting from the development of rather large carbonization and coagulation zones. Ho:YAG-laser light induced precise vaporization in addition to remarkable superficial coagulation of the tissue, which was of smaller extent than after treatment with Nd:YAG- and diode-laser, but comparable to the Argon-ion-laser.

CONCLUSIONS

In the course of this study SEM proved to be especially suitable for the examination of tissue changes on the surface of laser treated turbinates (i.g., destruction of respiratory epithelium). According to our results, Argon-ion-, Nd:YAG-, and diode-lasers seem to be useful for an effective and bloodless reduction of hyperplastic turbinates. However, broad coagulation zones may lead to consecutive complications and side effects. Due to its good ablation and superficial coagulation capabilities, Ho:YAG-laser light also seems to be usable for an effective turbinate reduction, but its low thermal effects in the depth of the tissue may lead to bleedings during treatment. Laser light of the CO(2) laser showed the lowest thermal tissue effects of the lasers investigated and therefore holds the risk of bleedings during treatment and the need of more than one therapeutic session to get a sufficient result. This investigation revealed that physicians, who are performing endonasal laser treatment, must be aware of the varying tissue effects of different medical laser systems to get a more aimed effect and to avoid intra- and post-operative complications (e.g., Rhinitis sicca, bone sequestration of the turbinate, bleedings, ...).

Laser treatment of hyperplastic inferior nasal turbinates: a review

BACKGROUND AND OBJECTIVE

Since the early 80s various types of lasers have been used for the reduction of hyperplastic inferior nasal turbinates. Up to now many studies have revealed a variety of important information. To summarize these findings and to determine the value of laser treatment of hyperplastic inferior nasal turbinates, a comparative review of the literature was performed.

STUDY DESIGN/MATERIALS AND METHODS

The study of the literature revealed that hyperplastic inferior turbinates of more than 2,000 patients have been treated and followed up. Treatment was performed with the CO2 (10,600 nm), diode (805/810/940 nm), Argon-ion (488/514 nm), KTP (532 nm), Nd:YAG (1,064 nm), and Ho:YAG (2,080 nm) laser in more than 20 studies so far. Generally, the authors of the trials used different laser parameters (power, energy) and application modalities (contact, non-contact, interstitial, superficial). To determine the long-term results objective (active anterior rhinomanometry, acoustic rhinometry, mucociliary function tests, allergy tests) as well as subjective parameters (questionnaire) were recorded and evaluated. In some cases morphological changes of the turbinate tissue were studied by light and scanning electron microscopy (SEM).

RESULTS

Laser surgery of inferior turbinates can be performed as an outpatient procedure under local anesthesia. Due to a minimally invasive and controllable coagulation and ablation of soft tissue, almost no complications or bleedings were observed during the operation or postoperatively. Depending on the chosen parameters (power, energy) and the application modalities (contact, non-contact, superficial, interstitial) laser treatment of hyperplastic inferior nasal turbinates achieved comparable or better results than most of the conventional techniques for turbinate surgery like conchotomy, electrocautery, cryotherapy, chemical cauterization, and vidian neurectomy. More invasive (radical) operative methods, such as inferior turbinoplasty, submucous turbinectomy, lateral outfracture, partial and total turbinectomy, seemed to be more effective than laser surgery in the long-term.

CONCLUSIONS

Laser treatment of hyperplastic inferior nasal turbinates can be considered as a useful, cost-effective, and time-saving procedure for the reduction of hyperplastic inferior nasal turbinates. Short operation time, good results, and minor side effects compared to other surgical methods provide an excellent clinical response of the patients.