Treatment of nasal obstruction due to hypertrophic turbinates

The treatment of Swollen (hypertrophic) inferior turbinates can be classified into conservative (non-surgical) and surgical.

The conservative treatment includes medication as well as avoidance of allergens and irritations ( eg dust mites, pollen, dogs, cats) that caused the swelling.

Surgical treatment can be further divided into invasive and non-invasive procedures.

Invasive surgeries would include partial and total resection of the turbinates ( ie Inferior Turbinectomy) and these entail General Anaesthesia and hospitalisation.

Non-invasive ( minially invasive) procedures are more popular now as they can be done in the clinic under local anaesthesia and the patient does not suffer any signficant down-time.

Sutter's minimal invasive radio-frequency (RF) turbinate reduction

Sutter Medizintechnik GmbH of Freiburg Germany has successfully produced a radio-frequency device with "Binner" bipolar probes that is ideal for the treatment of the swollen turbinates. Sutter has the AutoRF™ technology which has a function that constantly controls and adjusts the power output of the radiofrequency unit to prevent undesired tissue damage. If radiofrequency is applied for too long, the system automatically adjusts and reduces the output by up to 65 %.

This is especially important to the nasal mucosa as each of the cells has a special feet-like cilia which functions like a conveyor belt that moves mucus and other foreign particles for natural drainage.

Clinical research has shown that the Sutter RF turbinate reduction gives result that is almost comparable with more invasive surgeries.

Below is an example of a recent publication:

Submucosal Radio Frequency of the Inferior Turbinates using BM 780 II RF Generator and'Binner' Bipolar Electrode (Medical Digest)

by :Dr. R. Al-Hilou MB. ChB, D.L.O. (Lon) FRCS (Ed)
Ear, Nose & Throat Surgeon
Dubai, UAE

Inferior Turbinate surgery including functional Procedure and Invasion procedure. Recently the functional procedure involves Radio Frequency energy for submucosal tissue ablation, which preserves the service function of the inferior Turbinate mucosa.

Preliminary personal experience involving 45 patients. Procedures performed over a period of six months (February to July 03)
using the Select-Sutter BM 780 II RF Generator (0.46 Mhz, power 70 watts in bipolar mode). All patients were sufferers of
nasal obstruction due to vasomotor rhinitis or allergic rhinitis refractory to medical therapy.

We used 4% xylocain (occasional 10%) as local anaesthesia and subsequent infiltration of 2% xylocaine without adrenaline.
We used the 15mm 'Binner' bipolar electrode with an exposed active tip of 10mm in length. The BM 780 II was set at
level 2 (6 watts) in bipolar mode and radio frequency energy was administered into the Turbinate for 9 to 10 seconds.

With the aid of a 0° endoscope, especially in the case of severe hypertrophy of both inferior Turbinates, the Bipolar needle was
inserted 3 or 5 times at various points along the Turbinate bone including the hypertrophied tail of the Turbinate.
Ablation of the inferior Turbinate using radio frequency energy was well tolerated by the majority of patients under local
anaesthesia. In only a few cases we reported slight, bearable pain or pressure.

Inserting gauze tamponade for 3 to 5 minutes controlled the slight exudation. No epistaxis was reported with exception to one
patient who reported epistaxis after 3 weeks. This was controlled with silver nitrate cauterisation and an Entocel nasal packing sponge, which was kept in place for two days. The patients were advised to use normal saline as nasal irrigation for one
week after the procedure.All the patients attended two followed-up visits during a period of 3 to 4 weeks for nasal cleaning of any crust, which was minimal.

Nearly 90% of the patients reported good improvement in nasal breathing, which was improving further with time. Only 11% of
the patients (5 cases) reported unsatisfactory nasal patency in one side and therefore required repeated ablation in one side only
and the results of the second session were satisfactory in all 5 cases.There was no report of Turbinate necrosis or atrophy with severe crust formation and we did not notice any post-operative synechea.

To date we have found the results satisfactory from both a subjective and endoscopic point of view in nearly 90% of the cases treated.