A medline search was performed for means of treating inferior turbinate hypertrophy. Chronic nasal obstruction, or a stuffy nose, is often caused by. Turbinate hypertrophy refers to an excessive growth or enlargement of the turbinates, which are bony structures located inside the nose. The turbinates play a critical role in the nasal cycle. Numerous medical conditions can make this happen, such as vasomotor rhinitis, an abnormal nerve innervation that causes the inferior turbinate to increase in size. The primary symptom of inferior turbinate hypertrophy is nasal obstruction, meaning that airflow is blocked through either one or both of the nostrils.
Inferior turbinate reduction surgery patient information. Its findings need to be validated by future studies with larger sample size and longer followup. Under guide of karlstorz rigid endoscope 0 degree 4mm the medial surface of the inferior nasal concha has been touched to site of introduction to. Turbinate hypertrophy can develop in response to various environmental factors and infections snoring is one of the most common symptoms of turbinate hypertophy enlarged turbinates.
Dilemma of inferior turbinate surgery global journals inc. Management of turbinate hypertrophy can be achieved by a variety of surgical techniques, including microdebriderassisted inferior turbinoplasty, turbinate outfracturing, radiofrequency ablation. Enlargement of the inferior turbinate typically occurs in response to inflammation or may be developmental. Histopathological study of hypertrophied inferior turbinate. Several causes may induce significant hypertrophic mucosal changes of the inferior turbinate it, including perennial allergic rhinitis and nonallergic vasomotor rhinitis. Various etiologies for the hypertrophy of inferior turbinates include allergic reactions, nonallergic rhinitis, chronic hypertrophic rhinitis, and compensatory hypertrophy as seen in septal deviation. Treatment may involve medications, allergy therapy and surgery. Paranasal computed tomography ct showed that the bony mass originated from the anterior part of the left inferior turbinate. When septal deviations do cause problems, they are largely due to airway obstruction. These include chronic nasal allergies and vasomotor rhinitis which is abnormal nerve innervation that results in enlargement of the inferior turbinate.
Key words hypertrophy, inferior turbinate, submucosal resection. If the inferior turbinates are too large called inferior turbinate hypertrophy, they can cause nasal obstruction in one or both sides of the nose. We define, by acoustic rhinometry, the characteristics of the obstructed nose and define mucosal turbinate hypertrophy. Each is related to wellestablished complications, but still there is a lack of consensus on the optimal technique. Turbinoplasty two different procedures can be placed in the cat. Inferior turbinate reduction by coblation is effective for inferior turbinate hypertrophy clinical benefit persists for at least 6 months clinical effectiveness of coblation inferior turbinate reduction bhattacharyya n, kepnes lj. Radiofrequency treatment for inferior turbinate hypertrophy. Colds and infections cold or infection may cause congestion due to enlarged turbinates. Jun 11, 2019 a deviation of the nasal septum which divides the nasal turbinates is yet another cause for nasal turbinate hypertrophy. Hypertrophy of the inferior turbinate is a common cause.
Inferior turbinate hypertrophy the sinus center of south. Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonlyused techniques in private practice by plastic. Bilateral hypertrophic inferior turbinate hypertrophic nasal concha or enlargement of the concha is a common sign in subjective bilateral nasal obstruction in adults 1. The most commonlypreferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision 61. Comparative study of management of inferior turbinate. Surgical ultrasound reduction of inferior turbinate hypertrophy. Turbinate hypertrophy refers to the enlargement of the inferior turbinate. Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser volume 126 issue 12 a n kassab, m rifaat, y madian. Turbinate hypertrophy uci health otolaryngology ear, nose. The most common symptoms of septal deviations and turbinate hypertrophy are congested or blocked nasal breathing, breathing trouble at night and snoring, chronic nosebleeds and chronic sinus infections. A 57yearold woman applied to our department with a 5year history of leftsided nasal obstruction without history of epistaxis, nasal packaging, or. Studies selected focused on treatment of the inferior turbinate in isolation and excluding patients with refractory allergic rhinitis, vasomotor rhinitis, or hypertrophic rhinitis.
An ideal procedure for turbinate reduction should be performed with minimal discomfort or adverse reactions and should preserve the physiologic function of the turbinate, such as regulation of. Inferior turbinate hypertrophy ent services in arizona. The surgeon should remember that the anteriormost 2 cm of the inferior turbinate account for the majority of its impact on patency of the nasal airway. We have three occasionally 4 turbinates on each side wall of our nose. Severe nasal allergies and a deviated septum can also cause turbinate hypertrophy. In the management of nasal obstruction, identification and treatment of inferior turbinate hypertrophy remains an important consideration for longterm.
Prolonged perceived nasal obstruction resulting from inferior turbinate hypertrophy ith is a common complaint encountered in. A common type of situational turbinate hypertrophy is the nasal cycle, in which the turbinates on one side of the nose will swell for four to six hours before returning to their normal size, at which point the turbinates on the other side will begin to swell. They are covered with a special skin called mucosa, and they help filter, warm, and humidify the air as you breathe. With followup ranging from 6 months and beyond, the vast majority of patients perceive significant benefit from coblation.
Turbinate hypertrophy makes it harder for you to breathe through your nose. The thicknesses and crosssectional areas of mucosa and conchal bones were. Inferior turbinate hypertrophy and concha bullosa often occur opposite the direction of nasal septal deviation. Outfracture of the inferior turbinate is thought to be a minimally destructive procedure among all other reductive turbinate interventions. Nasal obstruction may also be due to a deviated nasal septum, and these two conditions frequently occur together. Design in this retrospective analysis, patients who underwent septoplasty without turbinate surgery from may 1, 2003, through april 30, 2006, were studied. Radiofrequency tissue reduction for turbinate hypertrophy. Scribd is the worlds largest social reading and publishing site. The incidence of inferior turbinate hypertrophy in a. The addition of lateral displacement of the inferior turbinate improved the longterm results.
The impact of middle turbinate concha bullosa on the severity. Inferior turbinate hypertrophy ith is a common cause of nasal breathing impairment. Persistent inflammation, infection, or irritation may lead to the chronic engorgement of inferior turbinates and irreversible hypertrophy. Objective to measure the effect of septoplasty on the volume of inferior turbinate in patients with a deviated nasal septum design in this retrospective analysis, patients who underwent septoplasty without turbinate surgery from may 1, 2003, through april 30, 2006, were studied. Success of inferior turbinate reduction may be measured on many scales including degree of relief in terms of structuring, time spent with nasal obstruction, nasal stuffiness, mucus production, postnasal discharge, snoring and overall symptoms. Improved objective outcomes and quality of life after adenotonsillectomy with inferior turbinate reduction in pediatric obstructive sleep apnea with inferior turbinate hypertrophy. Turbinate hypertrophy and treatment dr garrett bennett. Evidence on efficacy in the short and medium term to about 2years is also adequate. Excessive resection generates atrophy, crusting, bleeding. Nasal turbinate reduction is a procedure that is done through the nose. The inferior turbinate is the largest of the turbinates, and plays the most significant role in normal nasal respiratory function. The incision could be made using a scalpel or by using the inferior turbinate blade itself. The histopathology of the hypertrophic inferior turbinate.
Management of turbinate hypertrophy can be achieved by a variety of surgical techniques, including microdebriderassisted inferior turbinoplasty, turbinate outfracturing, radiofrequency. Turbinates are bony structures covered with soft tissue on the sides of the inner nose that regulate airflow and protect the inner nasal anatomy. The cause of the hypertrophy or enlargement can be of various reasons such as allergic. Know the causes, signs, symptoms and diagnosis of turbinate hypertrophy. Turbinate hypertrophy uci health otolaryngology ear. Pdf radiofrequency treatment for inferior turbinate. Inferior turbinate classification system, grades 1 to 4. The microdebriderassisted turbinoplasty technique is performed by making an incision on the anterior inferior aspect of the inferior turbinate and inserting the 2mm inferior turbinate blade microdebrider to submucosally remove tissue fig. Article information, pdf download for inferior turbinate hypertrophy. This is an important feature of normal nasal physiology. Nasal turbinate reduction nationwide childrens hospital.
Intraosseous cavernous hemangioma of inferior turbinate. The medial surface of the inferior turbinate was coagulated from behind forward, 2 to 4 times, 10 seconds each time. The major function of the turbinates is to control airflow. Turbinate hypertrophy can occur as a result of number of medical conditions. Pdf radiofrequency treatment for inferior turbinate hypertrophy. Objective to measure the effect of septoplasty on the volume of inferior turbinate in patients with a deviated nasal septum. The objective of this retrospective study was to determine whether a concha bullosa impacts inferior turbinate hypertrophy in patients who have nasal septal deviation. Inferior turbinate outfracture does not address the vasoactive components of turbinate hypertrophy and is generally not sufficient as a standalone procedure. In some cases, compensatory turbinate hypertrophy is developed due to a deviated nasal septum in which when one pair of nasal turbinate stops functioning the other pair tries to function on its behalf resulting in severely blocked nose as one side of the nose is blocked due. Preoperative computed tomographic evaluation of inferior turbinate hypertrophy and its role in deciding surgical.
Saulescu et al surgery for nasal obstruction in inferior turbinate hypertrophy 27 nasal surgery18. Pdf radiofrequency ablation rfa is a technique which causes a reduction in tissue amount using ablation by highfrequency current. Surrounding tissues were normal, and there was not any erosion or destruction. Allergies allergies can cause swelling, often leading to turbinate hypertrophy.
Grade 1 is 025% of the airway, grade 2 is 2650% of the airway, grade 3 is 5175% of the airway and grade 4. The impact of middle turbinate concha bullosa on the. Turbinate surgery can be performed in conjunction with septum surgery or sinus surgery when needed. The 25% grades 14 inferior turbinate classification system is a validated grading scale with high intrarater and inter. Inferior turbinate hypertrophy simply means that the turbinate has increased in size. Up to 25 % of the general population report nonallergic nasal obstruction symptoms, and inferior turbinate hypertrophy is a common cause of this complaint. In some cases, compensatory turbinate hypertrophy is developed due to a deviated nasal septum in which when one pair of nasal turbinate stops functioning the other pair tries to function on its behalf resulting in severely blocked nose as. Inferior turbinate hypertrophy ith has received much attention in the literature in the debate over optimal surgical management of nasal obstruction. Mar 26, 2018 turbinate hypertrophy makes it harder for you to breathe through your nose. The signs and symptoms of turbinate hypertrophy range depending on the severity of the obstruction. When the inferior turbinates become enlarged it is referred to as inferior turbinate hypertrophy. Prolonged perceived nasal obstruction resulting from inferior turbinate hypertrophy ith is a common complaint encountered in the practice of rhinology. Nov 27, 2017 the causes for turbinate hypertrophy are not only restricted to the allergy based symptoms but also incorporate allergic rhinitis, hormones, drugs etc.
Therefore, abnormal enlargement of these two structures can be a culprit cause of nasal obstruction. Preoperative computed tomographic evaluation of inferior. The inferior conchae are graded 14 based on the inferior concha classification system known as the inferior turbinate classification system in which the total amount of the airway space that the inferior concha takes up is estimated. Pdf there are numerous surgical managements of hypertrophic inferior. This system can facilitate future research by tracking the effect of interventions on inferior turbinates. A deviation of the nasal septum which divides the nasal turbinates is yet another cause for nasal turbinate hypertrophy. Hypertrophy of the inferior turbinate is a common cause of chronic nasal obstruction. Inferior turbinate reduction surgery patient information and. The role of inferior turbinate hypertrophy in the reduction. Septoplasty and compensatory inferior turbinate hypertrophy. This condition is caused by an airfilled turbinate called concha bullosa cb. Fiftyeight articles were identified, collectively including the following surgical. The doctor will then shrink the turbinates with a special instrument.
Approximately 50 percent of nasal airflow passes between the middle and inferior turbinates. Effects of turbinoplasty versus outfracture and bipolar. Turbinate hypertrophy and treatment dr garrett bennett ny. Mucosal membranes covering the turbinates contain a large supply of blood vessels and can easily shrink or swell in response to various factors. Powered microdebrider turbinoplasty for inferior turbinate. Inferior turbinate hypertrophy is when inferior turbinates become enlarged. There is no agreement on how to deal with this problem. Surgical ultrasound reduction of inferior turbinate. This enlargement can be caused by swelling of the mucosa due to various forms of rhinitis, but can also be due to thickened or abnormally positioned turbinate bones. Longterm outcomes of radiofrequency ablation of the inferior. Inferior turbinate hypertrophy sinus care henry ford.
It simply feels as though you cannot breathe well through. From the bottom to the top of the nose, there are three sometimes four levels of turbinate structures. Your childs doctor will place a camera into the nose to see the turbinates. Beside other surgical tools, rfa has become quite popular over the past decade. However, this is the first randomized study that demonstrates that rfvtr is significantly better than placebo in treating nasal obstruction due to inferior turbinate hypertrophy. Inferior turbinates are often a source of breathing difficulties. Surgical management of inferior turbinate hypertrophy operative. Inferior turbinate hypertrophy is a common cause of chronic nasal obstruction. Nasal obstruction with hypertrophic inferior turbinate.
Some patients have congenital enlargement of the middle turbinates that then obstructsrestricts the major sinus outflow tract. Longterm outcomes of radiofrequency ablation of the. Effect of septoplasty on inferior turbinate hypertrophy. The causes for turbinate hypertrophy are not only restricted to the allergy based symptoms but also incorporate allergic rhinitis, hormones, drugs etc.
Inferior turbinate reduction surgery patient information and informed consent the nasal turbinates are the primary controller of nasal airflow. Various surgical treatment modalities are available for inferior turbinate hypertrophy. Turbinate hypertrophy, inferior turbinate hypertrophy, and nasal turbinate hypertrophy are all descriptions of a similar condition where the tissue on the lateral outside walls of the nose are too large, causing nasal obstruction. The present study deals with the indication for inferior turbinate surgery in cases of concomitant anterior septal deviation. The inferior turbinates, the largest pair, are often the source of breathing problems.
Turbinate hypertrophy can be situational or chronic. Evaluation by magnetic resonance imaging, indian j otolaryngol head neck surg 663. Ercan c, imre a, pinar e, erdogan n, umut sakarya e, et al. Pdf update on surgical management of adult inferior turbinate. Inferior turbinate cauterization was done by applying a highfrequency coagulation current via a roundpoint electrode at constant power introduced as far as the posterior end of the nasal cavity. Contemporary techniques in inferior turbinate reduction. Radiofrequency turbinate reduction radiofrequency turbinate procedure, also known as somnoplasty, can provide significant relief from many symptoms of turbinate hypertrophy. Radiofrequency of the turbinates is a quick procedure with minimal. Paradoxically, the nasal breathing is impaired and the patient. A common scenario would be that one side of the nose is blocked from the deviated septum and on the other from inferior turbinate hypertrophy. Chronic nasal obstruction, or a stuffy nose, is often caused by enlargement hypertrophy of the inferior turbinate. This document replaces previous guidance on radiofrequency tissue reduction for turbinate hypertrophy interventional procedure guidance 36. Anterior rhinoscopic examination revealed a mass originating from inferior turbinate that completely obstructs the left nasal cavity. It affects the most important and narrow part of the upper airway 2.
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