Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost-effective compared with other available treatments.

METHODS

We conducted a cost-effectiveness analysis comparing the following treatment combinations over a 5-year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost-effectiveness ratios (ICERs).

RESULTS

For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider-assisting submucous resection or radiofrequency ablation, before SCIT was the most cost-effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost-effective option in 95.4% of scenarios. ITR remained cost-effective even with the addition of concurrent septoplasty.

CONCLUSION

For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost-effective treatment that should be considered prior to immunotherapy.

LEVEL OF EVIDENCE

NA - Laryngoscope, 2023 Laryngoscope, 134:1572-1580, 2024.

Treatment of inferior turbinate hypertrophy by plasma turbinate reduction with onepointthreeside way

OBJECTIVES

Nasal congestion is often the main symptom of the patients with non-allergic rhinitis, who have inferior turbinate hypertrophy if getting poor treatment effect. Plasma treatment for inferior turbinate hypertrophy can effectively improve nasal obstruction. Generally, plasma treatment with multiple puncture sites, makes patients intraoperative painful and postoperative bleeding, which let patients often fear of surgery. Postoperative nasal adhesion or lower turbinate scar and other complications sometimes happened, and some patients still feel nasal obstruction due to severe mucosal damage and scar formation. We innovatively used one-point-three-side plasma turbinate volume reduction in the treatment of inferior turbinate hypertrophy, in order to reduce complication, improve symptoms, and enhance curative effect.

METHODS

A total of 111 patients with non-allergic rhinitis with complete data due to hypertrophy of inferior turbinate and poor drug treatment from Nov. 2011 to Oct. 2019. The hypertrophic inferior turbinate of patients with non-allergic rhinitis was ablated by plasma turbinate volume reduction, and the symptom scores of patients were evaluated by visual analog scales (VAS) before surgery, 1 week, 1 month, 3 months, and 6 months after surgery. The intraoperative pain was scored by VAS. The pathological morphology of nasal mucosa was observed before and after operation in some patients.

RESULTS

The nasal obstruction score of the patients was significantly lower at 1 week, 1 month, 3 months and 6 months after the operation (all P<0.05). The distribution of submucosal blood vessels and glands was improved by postoperative pathological observation.

CONCLUSIONS

Plasma turbinate volume reduction with one-point-three-side is effective with minimally invasion, and less complication, which is worthy of clinical promotion.

Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies

Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.

Comparison of efficacy of potassium titanyl phosphate laser & diode laser in the management of inferior turbinate hypertrophy: A randomized controlled trial

Background & objectives:

Inferior turbinate hypertrophy (ITH) is a common condition causing nasal obstruction. This study was undertaken to compare the efficacy of potassium titanyl phosphate (KTP) laser and diode laser in the reduction of the turbinate size.

Methods:

This randomized controlled trial included 209 patients with ITH. Pre-operative symptoms were assessed based on the Nasal Obstruction Symptom Evaluation (NOSE) score. Diagnostic nasal endoscopy was done to rule out other nasal sinuses. Nasal mucociliary clearance was measured by saccharin transit time (STT). Postoperatively, the NOSE score, STT and complications were assessed at days one and two, at one week, one month and three months.

Results:

Of the 209 patients analyzed at day one, the median NOSE score was 50 in the diode group and 40 in the KTP group, and at three months, 15 in the diode group and five in the KTP group. KTP laser showed a 93 per cent improvement in the NOSE score as compared to 77 per cent improvement shown by diode laser group. Among the intra-operative complications, of the 104 patients in the diode group, 6.73 per cent had burning sensation and 91.43 per cent had bleeding, and of 105 patients in the KTP group, 54.29 per cent had burning sensation and 36.54 per cent had bleeding. Among the post-operative complications in the KTP group, 32 and 34 per cent had bloody nasal discharge on days one and two, compared to 12 and 14 per cent in diode group. Crusting was present in 61 and 49 per cent on days one and two in KTP group as compared to 9 and 15 per cent in diode group, respectively. In the KTP group 30 per cent had synechiae as compared to 10 per cent in diode group.

Interpretation & conclusions:

KTP laser was more efficacious than diode laser in improving the NOSE scores but with slightly increased rate of complications in early post-operative period. Both the lasers impaired the mucociliary clearance mechanism of the nose till three months of post-operative follow up.

Inflammatory Profile of Antrochoanal Polyps in the Caucasian Population - A Histologic Study

BACKGROUND

Antrochoanal polyp (ACP) is a rare and unique unilateral nasal polyp. In contrast to diffuse primary chronic rhinosinusitis (d-CRS) the inflammatory profile of ACP in the Caucasian population have not been determined.

OBJECTIVE

The purpose of the study is to describe and differentiate the inflammatory features of ACP compared with d-CRS and its phenotypic subgroups and hypertrophic turbinates (HT) in the Caucasian population, and compare the mast and plasma cell marker expression of each pathology.

METHODS

A retrospective case control study of 96 patients operated on between the years 2005-2017. Nasal biopsies of ACPs, d-CRS and HTs were compared. A comparison of the different phenotypic subgroups of d-CRS was made as well. Demographics, comorbidities, and histologic and immunohistochemical (IHC) staining of mast (CD117) and plasma cell (CD138) receptor antibodies, were compared and analyzed.

RESULTS

A total of 96 patients were included, consisting of 40 (41.6%) ACP, 36 (37.5%) d-CRS and 20 (20.8%) HT patients. ACPs displayed a significantly higher level of edema and intramural cysts compared to the other groups. Squamous metaplasia was demonstrated in ACP (27.5%) and d-CRS (25.6%), but not in HT. The ACP group was characterized by neutrophilic predominant infiltrates as opposed to the eosinophilic predominance in the d-CRS group, especially in eosinophilic CRS and central compartment allergic disease. ACP presented lower levels of both mast and plasma cells compared to d-CRS and HT in IHC staining.

CONCLUSIONS

ACP in the Caucasian population has unique features of cyst formation and edema which is compatible with its clinical presentation. It is characterized by neutrophilic predominant infiltrates and expresses lower levels of mast and plasma cells as demonstrated by IHC.

Electrosurgery Turbinate Reduction Revisited: Can Comparable Volumetric Heating be Achieved Without Feedback Control?

BACKGROUND AND OBJECTIVES

Temperature-controlled radiofrequency inferior turbinate ablation (TCRFA) uses a feedback system to control thermal injury and achieve precise volumetric heating to induce specific scar formation. However, it requires costly single-use proprietary consumables. Comparable volumetric tissue heating may be achieved for a fraction of the cost by adjusting the power settings on traditional monopolar electrosurgery devices that use low-cost needle tips. This pre-clinical study aims to determine the optimized power parameters to achieve electrosurgical coagulum volume similar to that of TCRFA.

STUDY DESIGN/MATERIALS AND METHODS

An electrosurgery submucosal diathermy (SMD) system (cut mode, 4-32 W, 5-120 seconds) and a temperature-controlled radiofrequency ablation system (standard clinical parameters for treating inferior turbinate hypertrophy) were used to coagulate egg white and chicken breast. Coagulum major and minor axis were measured, and lesion volume was approximated as prolate spheroid.

RESULTS

No significant difference in volume was found between the temperature-controlled system and the electrosurgery system at 8 W for 30 seconds, 8 W for 60 seconds, 16 W for 30 seconds, 32 W for 5 seconds, and 32 W for 15 seconds. The time to achieve equivalent lesion size was significantly less in the SMD system when compared to the temperature-controlled system (P < 0.05).

CONCLUSION

Electrosurgery handpieces may achieve similar lesion volume effects as the temperature feedback-controlled, single-use handpieces when set to the optimized parameters. SMD handpieces are significantly more cost and time effective than proprietary devices, and they are easily used in the office. SMD devices may be a more affordable alternative to temperature-controlled systems with comparable lesion volume effect and may be valuable for office-based therapy. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Association Between Deviated Nasal Septum With Inferior Turbinate Hypertrophy and the Risk of Male Infertility

OBJECTIVES

Obstructive sleep apnea is associated with an increased risk of male infertility, and one of its causes is deviated nasal septum with inferior turbinate hypertrophy (DNS/ITH). However, the risk of male infertility associated with DNS/ITH remains unclear.

METHODS

Using the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched cohort study to investigate the risk of infertility in male patients diagnosed with DNS/ITH (N = 61,761) from 2000 to 2015 in comparison with matched controls without DNS/ITH (N = 247,044). We further analyzed the effect of septoturbinoplasty (STP), including septoplasty and turbinoplasty, on the risk of male infertility in DNS/ITH patients.

RESULTS

At the end of the follow-up period, 46 (0.07%, 46/61,761, incidence rate: 6.25 per 100,000 person-years) patients developed infertility in the DNS/ITH group versus 72 (0.03%, 72/247,044, incidence rate: 2.28 per 100,000 person-years) in the control group; the incidence rate was 2.740-fold higher in the DNS/ITH group (log-rank P < 0.001). Cox proportional hazards regression revealed that the risk of infertility increased in the DNS/ITH group [adjusted hazard ratio (HR): 1.080, 95% confidence interval (CI), 1.049-1.514, P = 0.001]. Compared with the control group, the risk of infertility was highest in the DNS/ITH group without STP (adjusted HR: 2.842, 95% CI, 1.715-4.082, P < 0.001), followed by the DNS/ITH group with STP (adjusted HR: 1.074, 95% CI, 1.035-1.488, P = 0.012). The intervention of STP reduced the risk of infertility in the DNS/ITH group by 45.1% compared with those without STP (P = 0.033).

CONCLUSION

Clinicians should be aware of the risk of infertility in male patients presenting with DNS/ITH. Improving the nasal airway by STP may decrease the risk of male infertility.

Correlations between computational fluid dynamics and clinical evaluation of nasal airway obstruction due to septal deviation: An observational study

OBJECTIVES

The primary objective of this study was to determine how computational fluid dynamics (CFD) could be correlated to clinical evaluation of nasal airway obstruction (NAO) in a population of patients with symptomatic septal deviation (SD). The secondary objective was to determine whether CFD could define which side was the more obstructed.

DESIGN

This was an observational study.

SETTINGS

Few publications have attempted to correlate CFD with clinical evaluation of NAO. This correlation would permit validation and improved interpretation. This study was performed in a university research laboratory specialised in fluid mechanics.

PARTICIPANTS

We included patients referred for septal surgery at our centre. Age range was 19-58 years. Preoperative CT scans were performed. All patients with non-structural causes of NAO such as rhinitis, sinusitis or tumoral/autoimmune processes (ie, not due to anatomic obstruction) were excluded.

MAIN OUTCOME MEASUREMENT

For each nasal fossa, we compared CFD data (total pressure, heat flux, wall shear stress, temperatures, velocity and nasal resistances) with both patient perception scores and rhinomanometry using the Spearman correlation test (r_s ). Perception scores were graded from 0/4 to 4/4 on each side, based on the patient interview. We also compared CFD-derived nasal resistances with rhinomanometry-derived nasal resistances.

RESULTS

Twenty-two patients complaining of NAO with SD were analysed, and 44 analyses were performed comparing each side with its CFD data. Regarding correlations with patient perception scores, the best values we found were heat flux measures (r_s  = 0.86). Both rhinomanometry and CFD-calculated nasal resistances had strong correlations with subjective perception scores (r_s  = 0.75, P < 0.001 and r_s  = 0.6, P < 0.001, respectively). We found a statistically significant difference between RMM-NR and CFD-NR (P = 0.003). Heat flux analysis allowed us to distinguish the more obstructed side (MOS) and the less obstructed side (LOS) in 100% of patients.

CONCLUSION

This study aimed to enhance our ability to interpret CFD-calculated data in the nasal airway. It highlights and confirms that heat flux measures are very closely correlated to patient perception in cases of SD. It also helps to distinguish the more obstructed side from the less obstructed side and could contribute to further CFD studies.

Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy

Objective

Intranasal steroid sprays (INSS) are frequently prescribed for treating inferior turbinate hypertrophy (ITH). Complications due to the long-term application of INSS such as crusting, epistaxis, nasal mucosa dryness, and septal perforation may occur. Predicting patients who would benefit from INSS early might lower treatment costs and complication rates. We examined the predictive value of nasal decongestant response rates for the outcomes of INSS in ITH.

Methods

Fifty patients with bilateral ITH were included in two groups: patients benefiting from INSS and those not benefiting. Nasal airflow was assessed by peak nasal inspiratory flow (PNIF) measurement in all cases. Measurements were taken three times: before and after the application of nasal decongestant sprays and after the application of INSS.

Results

In both groups, the nasal air flow rates significantly increased after the application of nasal decongestant sprays; however, the nasal decongestant response rates were higher in the group with patients benefiting from INSS. There was a strong correlation between the nasal air flow rates measured after the application of nasal decongestant sprays and after the application of INSS. The cut-off value for the relationship between increased nasal air flow rates after the application of nasal decongestant sprays and outcomes of INSS was 23%.

Conclusion

Measurement of nasal airflow increase rate after the application of nasal decongestant sprays is a simple and easy method for the early prediction of the outcomes of INSS in ITH. A higher than 23% increase in nasal air flow rates after the application of nasal decongestant sprays indicates much better outcomes of INSS for patients.

Does an Otolaryngology-Specific Database Have Added Value? A Comparative Feasibility Analysis

OBJECTIVES

There are multiple nationally representative databases that support epidemiologic and outcomes research, and it is unknown whether an otolaryngology-specific resource would prove indispensable or superfluous. Therefore, our objective was to determine the feasibility of analyses in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases as compared with the otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) database.

STUDY DESIGN

Parallel analyses in 2 data sets.

SETTING

Ambulatory visits in the United States.

SUBJECTS AND METHODS

To test a fixed hypothesis that could be directly compared between data sets, we focused on a condition with expected prevalence high enough to substantiate availability in both. This query also encompassed a broad span of diagnoses to sample the breadth of available information. Specifically, we compared an assessment of suspected risk factors for sensorineural hearing loss in subjects 0 to 21 years of age, according to a predetermined protocol. We also assessed the feasibility of 6 additional diagnostic queries among all age groups.

RESULTS

In the NAMCS/NHAMCS data set, the number of measured observations was not sufficient to support reliable numeric conclusions (percentage standard error among risk factors: 38.6-92.1). Analysis of the CHEER database demonstrated that age, sex, meningitis, and cytomegalovirus were statistically significant factors associated with pediatric sensorineural hearing loss (P < .01). Among the 6 additional diagnostic queries assessed, NAMCS/NHAMCS usage was also infeasible; the CHEER database contained 1585 to 212,521 more observations per annum.

CONCLUSION

An otolaryngology-specific database has added utility when compared with already available national ambulatory databases.

Submucosal Inferior Turbinoplasty Using a New Continuous Suction Irrigation Method

Introduction

Numerous surgical techniques for inferior turbinate hypertrophy (ITH) have been reported, each with advantages and disadvantages. Submucosal turbinoplasty with removal of the bony component of the inferior turbinate (IT) is an excellent procedure to expand the nasal cavity. However, this procedure requires a large incision to remove the inferior turbinate bone (ITB) and is associated with hemorrhage, crust formation, and adhesion. A smaller incision would avoid such complications. We developed a continuous suction irrigation method that maintains a clear view of the limited surgical field of the IT. Only a single small incision is needed to insert the rigid endoscope. The surgeon can flush blood with continuous water flow and perform IT surgery without difficulty. We performed this method in 39 cases from January 2016 to January 2017. This video article demonstrates our new submucosal inferior turbinoplasty technique.

Methods

Submucosal turbinoplasty using a continuous suction irrigation method was performed under general anesthesia. An irrigation-suction straw sheath system was used to create an underwater surgical field.

Results

The ITB was removed safely with no severe complications. An expanded common nasal cavity was confirmed postoperatively on computed tomographic images.

Conclusion

We resected the ITB safely using a continuous suction irrigation method without difficulty or complications. We believe that this method may become one of the best surgical options for ITH.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy

OBJECTIVE

To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored.

STUDY DESIGN

Prospective, single-group, pretest-posttest design.

SETTING

Academic tertiary care medical center.

SUBJECTS AND METHODS

This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility.

RESULTS

Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up.

CONCLUSIONS

The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.

Radiofrequency Coblation Versus Intramural Bipolar Cautery for the Treatment of Inferior Turbinate Hypertrophy

OBJECTIVE

Compare intramural bipolar electrocautery and radiofrequency coblation in the treatment of inferior turbinate hypertrophy with regards to objective and subjective improvement in nasal obstruction, rate and type of complications, experience during the procedure, and rate of recovery.

STUDY DESIGN

Prospective, single-blinded study.

SETTING

Single tertiary medical center from 2008 to 2010.

SUBJECTS AND METHODS

Forty-one adult patients with inferior turbinate hypertrophy refractory to medical management were treated with radiofrequency coblation in one nostril and intramural bipolar cautery in the other. Subjective and objective data, including use of a Visual Analog Scale (VAS) for subjective outcomes, acoustic rhinometry, and nasal endoscopy, were then obtained from each patient comparing the 2 techniques.

RESULTS

Radiofrequency coblation was significantly less painful than intramural bipolar cautery during the procedure (P = .03) and during the early postoperative period (P < .02) and produced less crusting at 3 weeks (P = .009). Both interventions were similar in subjective and objective improvements in nasal obstruction as measured by acoustic rhinometry and subjective VAS outcomes.

CONCLUSION

Radiofrequency coblation seems to offer an equivalent alternative to bipolar electrocautery for the treatment of inferior turbinate hypertrophy with less discomfort during the procedure and early post-operative period.

Feasibility of septal body volume reduction for patients with nasal obstruction

OBJECTIVE

Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross-sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction.

STUDY DESIGN

Prospective randomized study.

METHODS

The study was conducted on two groups (51 patients) with symptoms and signs of nasal obstruction associated with septal body and inferior turbinate hypertrophy that were refractory to medical therapy. In the turbinoplasty only (ITR) group (n = 25), conventional turbinoplasty was only performed on the inferior turbinate. In the septal body reduction (SBR) group (n = 26), concurrent bilateral microdebrider-assisted SBVR was performed during the turbinate surgery.

RESULTS

The nasal symptoms, including nasal obstruction, rhinorrhea, itching, and sneezing, had significantly improved at 3 months after treatment in both groups (P < 0.001). Improvement of nasal obstruction in the SBR group was greater than that in the ITR group at 3 months (P < 0.05). Acoustic rhinometry demonstrated a significant increase in the cross-sectional area and nasal volume in both groups 3 months after surgery. The postoperative change in nasal volume was higher in the SBR group (P < 0.05). No adverse reactions such as bleeding, infection, adhesions, or olfactory changes were encountered in the SBR group.

CONCLUSIONS

Combined SBVR and turbinoplasty appears to be more effective than turbinoplasty alone for the treatment of nasal obstruction in patients with inferior turbinate and septal body hypertrophy.

Prediction of outcome of radiofrequency ablation of the inferior turbinates

BACKGROUND

Radiofrequency ablation (RFA) of the turbinates is used commonly for nasal obstruction; however, there is no consensus on patient selection for this surgery.

METHODS

In a prospective clinical study, 53 adult subjects with bilateral turbinate hypertrophy were evaluated subjectively and objectively with anterior rhinomanometry at baseline and at 1, 3, and 6 months post-RFA of turbinates.

RESULTS

RFA of the turbinates resulted in a significant decrease in predecongestant and postdecongestant visual analogue scale (VAS) scores and resistance measurements at postoperative months 1, 3, and 6 (p < 0.001 for all). Preoperative baseline subjective response to the decongestant showed a positive correlation with postoperative first month subjective and objective outcome (p < 0.05). Preoperative baseline objective response to the decongestant showed a highly significant correlation with postoperative 1-month, 3-month, and 6-month objective outcomes of surgery (p < 0.05 for all).

CONCLUSION

Objective measures do not correlate with long-term subjective satisfaction even when the nose is objectively patent in subjects who underwent inferior turbinate RFA. The patients' long-term subjective benefit from RFA surgery cannot be estimated after a rhinomanometry with topical decongestion is performed. Performing a rhinomanometry with topical decongestion may help only to estimate the patients' objective benefit from RFA surgery.

Postnasal drip due to inferior turbinate perforation after radiofrequency turbinate surgery: A case report

Management of inferior turbinate hypertrophy includes surgical options in case of failure with medical treatment and the main goal of turbinate surgery is to relieve the patient's symptoms of chronic nasal congestion while preserving mucosal surfaces with reduction of the submucosal and bony tissue. In this regard, radiofrequency volumetric tissue reduction has been a thermal technique associated with satisfactory results and fewer side effects. Historical detail on onset, timing, duration, and severity of symptoms and aggravating and relieving factors are important in the differential diagnosis of postnasal drip (PND). Here, we report development of intractable PND due to inferior turbinate perforation after radiofrequency turbinate surgery for the first time in the literature and the successful improvement via removal of pathological anatomic structure under nasal endoscopy–directed surgery in a 35-year-old female patient. The patient had a good functional outcome postoperatively with no further complications or signs of recurrence occurring, to date, within a postoperative follow-up period of 1 year.

Intra turbinate diathermy cautery V/S high frequency in inferior turbinate hypertrophy

OBJECTIVE

To compare the efficacy of intraturbinate monopolar cautery, bipolar cautery, high frequency monopolar and high frequency bipolar cautery in inferior turbinate hypertrophy.

STUDY DESIGN

Prospective randomized single blinded clinical study

METHOD

The study comprised of 80 patients divided in 4 groups each of 20 patients who underwent monopolar cautery, Bipolar cautery, high frequency monopolar and bipolar intra-turbinate cautery. Patients were evaluated on the 7th post operative day and 1 year after the surgery & saccharine transit time test also performed and compared.

RESULTS

Remarkable improvement was recorded in nasal obstruction and quality of life. The Saccharine transit time test showed a comparable frequency and confirmed maintenance of mucociliary mechanism.