Functional and Olfactory Outcomes of Inferior Turbinate Hypertrophy Reduction with Laser, Radiofrequency, and Bipolar

Year 2023, Volume: 33 Issue: 3, 94 - 98, 04.10.2023

Mustafa Caner Kesimli , Eren Yılmaz , Aytuğ Altundağ

https://doi.org/10.26650/Tr-ENT.2023.1312539

Abstract

Objective: This study aims to compare the effects of bipolar cauterization, radiofrequency ablation, and laser reduction methods, which are frequently used for turbinate reduction, on recovery times and olfactory functions in the early postoperative period.

Materials and Methods: The olfactory functions of all patients were preoperatively evaluated with the Sniffin’ Sticks test. To assess the effects on olfactory functions, olfactory tests were repeated in the third month after the operation. The patients were examined weekly, and the resolving time of the crusts was recorded.

Results: The endoscopic turbinate reduction was performed with bipolar cautery in 50 patients, with radiofrequency ablation in 50 patients, and with laser ablation in 50 patients. There was no statistically significant difference between the techniques used regarding the severity of the olfactory function loss in the third month (p=0.546). It was observed that the resolving time of the crusts was the shortest in the group treated with the Holmium-YAG laser and the longest in the patients who underwent bipolar cautery (p<0.001). Parosmia persisted in only 9 patients in the postoperative third month (BP:7, RF:2, L:0) (p=0.049). In addition, it was determined that nasal dryness and pain (as assessed by visual analog score) were the most in the bipolar group (p=0.001 and p=0.005, respectively), and there was no significant difference between the laser and radiofrequency groups in terms of these symptoms (p=0.53 and P=0.96, respectively).

Conclusion: Patients who underwent Holmium laser turbinate ablation had less crusting and less olfactory function loss in the early period compared to those who underwent radiofrequency and bipolar turbinate reduction.

Keywords

Smell disorder, inferior turbinate surgery, sniffin sticks, turbinate

References

• Van Egmond M, Rovers M, Tillema A, Heerbeek Nv. Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review. Rhinology 2018;56(3):195-208. google scholar
• Smith TD, Bhatnagar KP. Anatomy of the olfactory system. Handb Clin Neurol 2019;164:17-28. google scholar
• Brunworth J, Holmes J, Sindwani R. Inferior turbinate hypertrophy: review and graduated approach to surgical management. Am J Rhinol Allergy 2013;27(5):411-5. google scholar
• Altunay ZÖ, Yaşar H, Catalano P. Surgical Treatment for Inferior Turbinate Hypertrophy. In: Challenges in Rhinology. Editors: Cemal Cingi, Nuray Bayar Muluk, Glenis K Scadding, Ranko Mladina Springer, 2021:317-24. google scholar
• Batra PS, Seiden AM, Smith TL. Surgical management of adult inferior turbinate hypertrophy: a systematic review of the evidence. Laryngoscope 2009;119(9):1819-27. google scholar
• 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(6):972-8. google scholar
• Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19: diagnosis and management. Jama 2020;323(24):2512-4. google scholar
• Garzaro M, Pezzoli M, Pecorari G, Landolfo V, Defilippi S, Giordano C. Radiofrequency inferior turbinate reduction: an evaluation of olfactory and respiratory function. Otolaryngol Head Neck Surg 2010;143(3):348-52. google scholar
• Serrano E, Percodani J, Yardeni E, Lombard L, Laffitte F, Pessey J. The holmium: YAG laser for treatment of inferior turbinate hypertrophy. Rhinology 1998;36(2):77-80. google scholar
• Chang CD, Ries WR. Surgical treatment of the inferior turbinate: new techniques. Curr Opin Otolaryngol Head Neck Surg 2004;12(1):53-7. google scholar
• Harju T, Numminen J, Kivekäs I, Rautiainen M. A prospective, randomized, placebo‐controlled study of inferior turbinate surgery. Laryngoscope 2018;128(9):1997-2003. google scholar
• Janda P, Sroka R, Baumgartner R, Grevers G, Leunig A. Laser treatment of hyperplastic inferior nasal turbinates: a review. Lasers Surg Med 2001;28(5):404-13. google scholar
• Bäck LJ, Hytönen ML, Malmberg HO, Ylikoski JS. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long‐term follow‐up with subjective and objective assessment. Laryngoscope 2002;112(10):1806-12. google scholar
• Koskinen K, Reichert JL, Hoier S, Schachenreiter J, Duller S, Moissl- Eichinger M, et al. The nasal microbiome mirrors and potentially shapes olfactory function. Sci Rep 2018;8(1):1-11. google scholar
• Lou Z. Inferior turbinate reduction using bipolar cautery would increase the nasal dryness. Am J Otolaryngol 2020;41(4):102519. google scholar