Ali Osman UZ, Fethullah KENAR, Hüseyin YILDIZ, Abidin DURAN, Mustafa Said TEKİN, Abdullah AYÇİÇEK

Alt konka hipertrofisi olan hastalarda radyofrekans termal ablasyon yönteminin nazal mukosiliyer aktivite üzerine etkisi

Amaç: Bu çalışmada alt konka hipertrofisinde radyofrekans termal ablasyon RFTA tedavisinin tedavi öncesi ve sonrası nazal mukosiliyer aktivite üzerine etkisi araştırıldı.Hastalar ve Yöntemler: Kliniğimize burun tıkanıklığı yakınması ile başvuran ve stromal alt konka hipertrofisi tanısı konulan 39 hasta 21 erkek, 18 kadın; ort. yaş 36.3±13.9 yıl; dağılım 16-67 yıl çalışmaya alındı. Radyofrekans termal ablasyon tedavisinin nazal mukosiliyer aktivite üzerine etkisi, tedavi öncesi ve tedaviden iki ay sonra sakarin testi ile araştırıldı. Burun tıkanıklığının derecesi görsel analog ölçeği GAÖ ile tedavi öncesi ve tedaviden iki ay sonra değerlendirildi. Sonuçlar eşleştirmeli t-testi ile karşılaştırıldı.Bulgular: Ortalama mukosiliyer aktivite süreleri tedavi öncesi 9.8±4.4 dakika, tedaviden iki ay sonra 9.6±4.1 dakika idi ve iki test arasındaki farklılık istatistiksel olarak anlamlı değildi p=0.3 . Burun tıkanıklığı için ortalama GAÖ değeri tedavi öncesi 6.5±1.2, tedaviden iki ay sonra 3.8±1.0 idi ve sonuçlar arasındaki farklılık istatistiksel olarak anlamlıydı p=0.001 . Tedavi öncesi ve sonrası sakarin geçiş zamanı ve GAÖ değerleri açısından cinsiyetler arasındaki farklılık istatistiksel olarak anlamlı değildi p>0.05 .Sonuç: Alt konka hipertrofisinin tedavisinde RFTA’nın mukosiliyer aktivite üzerinde olumsuz etkisinin olmadığı ve bu yöntemin alt konka hipertrofisinin neden olduğu burun tıkanıklığını gidermede oldukça etkili olduğu saptandı

Anahtar Kelimeler:

Hipertrofi, alt konka, mukosiliyer aktivite, radyofrekans, sakarin testi

The effect of radiofrequency thermal ablation method on nasal mucociliary activity in patients with inferior turbinate hypertrophy

Objectives: This study aims to investigate the effect of radiofrequency thermal ablation RFTA treatment on nasal mucociliary activity before and after treatment in inferior turbinate hypertrophy. Patients and Methods: Thirty-nine patients 21 males, 18 females; mean age 36.3±13.9 years; range 16 to 67 years admitted to our clinic with complaint of nasal obstruction and diagnosed with stromal inferior turbinate hypertrophy were included in this study. Effect of RFTA treatment on nasal mucociliary activity was investigated by saccharine test before treatment and two months after treatment. Grade of nasal obstruction was evaluated by visual analog scale VAS before treatment and two months after treatment. Results were compared with paired t-test. Results: Mean mucociliary activity times were 9.8±4.4 minutes before treatment and 9.6±4.1 minutes two months after treatment, and the difference between two tests was not statistically significant p=0.3 . Mean VAS scores for nasal obstruction were 6.5±1.2 before treatment and 3.8±1.0 two months after treatment, and the difference between two results was statistically significant p=0.001 . Difference between sexes in terms of saccharine transit time and VAS values before and after treatment was not statistically significant p>0.05 . Conclusion: It was detected that RFTA has no adverse effect on mucociliary activity in the treatment of inferior turbinate hypertrophy, and this method is notably effective in relieving the nasal obstruction caused by inferior turbinate hypertrophy.

Keywords:

Hypertrophy, inferior turbinate, mucociliary activity, radiofrequency, saccharine test,

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Yıldırım B, Uysal İÖ, Polat C, Gök C. The efficacy of radiofrequency ablation technique in patients with inferior turbinate hypertrophy. Kulak Burun Bogaz Ihtis Derg 2008;18:90-6.
Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study. Otolaryngol Head Neck Surg 1998;119:569-73.
Lai VW, Corey JP. The objective assessment of nasal patency. Ear Nose Throat J 1993;72:395-400.
Ophir D, Shapira A, Marshak G. Total inferior turbinectomy for nasal airway obstruction. Arch Otolaryngol 1985;111:93-5.
Fanous N. Anterior turbinectomy. A new surgical approach to turbinate hypertrophy: a review of 220 cases. Arch Otolaryngol Head Neck Surg 1986;112:850-2.
Selkin SG. Pitfalls in intranasal surgery and how to avoid them. Arch Otolaryngol Head Neck Surg 1986;112:285-9.
Utley DS, Goode RL, Hakim I. Radiofrequency energy tissue ablation for the treatment of nasal obstruction secondary to turbinate hypertrophy. Laryngoscope 1999;109:683-6.
Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg 1999;103:300-12.
Pinczower EF. Snoring. In: Gates GA, editor. Current Therapy in Otolaryngology-Head and Neck Surgery. 6th ed. Washington: Mosby-Year Book; 1998. p. 485-90.
Archer SM. Turbinate dysfunction. Available from: http://www.emedicine.com/ent/topic129.htm
Leong SC, Eccles R. Inferior turbinate surgery and nasal airflow: evidence-based management. Curr Opin Otolaryngol Head Neck Surg 2010;18:54-9
Cavaliere M, Mottola G, Iemma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy. Otolaryngol Head Neck Surg. 2005;133:972-8.
Passali D, Lauriello M, Anselmi M, Bellussi L. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol 1999;108:569-75.
Nuutinen J. Asymmetry in the nasal mucociliary transport rate. Laryngoscope 1996;106:1424-8.
Sapci T, Sahin B, Karavus A, Akbulut UG. Comparasion of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions. Laryngoscope 2003;113:514-9.
Coste A, Yona L, Blumen M, Louis B, Zerah F, Rugina M, et al. Radiofrequency is a safe and effective treatment of turbinate hyperthrophy. Laryngoscope 2001;111:894-9.
Rhee CS, Kim DY, Won TB, Lee HJ, Park SW, Kwon TY, et al. Changes of nasal function after temperature- controlled radiofrequency tissue volume reduction for the turbinate. Laryngoscope 2001;111:153-8.
Asai K, Haruna S, Otori N, Yanagi K, Fukami M, Moriyama H. Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery. Laryngoscope 2000;110:117-22.
Kızılay A, Akarçay M, Miman MC, Özturan O. Septum deviasyonlu hastalarda mukosiliyer klirens. (Article in Turkish) KBB Klinikleri 2003;5:79-82.
Elwany S, Gaimaee R, Fattah HA. Radiofrequency bipolar submucosal diathermy of the inferior turbinates. Am J Rhinol 1999;13:145-9.
Back L, Palomaki M, Piilonen A, Ylikoski J. Sleep- disordered breathing: radiofrequency thermal ablation is a promising new treatment possibility. Laryngoscope 2001;111:464-71.
Karadeniz H, Birkent AH, Karahatay S, Durmaz A, Akçam MT, Gerek M. Alt konka hipertrofisi tedavisinde radyofrekans doku ablasyonunun etkinliği. (Article in Turkish) KBB ve BBC Dergisi 2007;15:18-26.
Powell NB, Riley RW, Troell RJ, Li K, Blumen MB, Guilleminault C. Radiofrequency volumetric tissue reduction of the palate in subjects with sleep- disordered breathing. Chest 1998;113:1163-74.
Porter MW, Hales NW, Nease CJ, Krempl GA. Long- term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care? Laryngoscope 2006;116:554-7.
Seeger J, Zenev E, Gundlach P, Stein T, Müller G. Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months' follow-up. Laryngoscope 2003;113:130-5.
Süslü AE, Şanal SK, Biçer YÖ, Ongun Y. Alt konka hipertrofilerinde radyofrekans tedavisinin uzun dönem sonuçları. KBB-Forum 2008;7:71-74.
Lin HC, Lin PW, Friedman M, Chang HW, Su YY, Chen YJ, et al. Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg 2010;136:892-5.
Nease CJ, Krempl GA. Radiofrequency treatment of turbinate hypertrophy: a randomized, blinded, placebo-controlled clinical trial. Otolaryngol Head Neck Surg 2004;130:291-9.
Lin HC, Lin PW, Su CY, Chang HW. Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy. Laryngoscope 2003;113:673-8.
Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study. Otolaryngol Head Neck Surg 1998;119:569-73.