Turbinate - Radiofrequency Treatment of Chronic Obstruction
Important Facts about Chronic Nasal Obstruction and Enlarged Turbinates
A stuffy nose is often caused by an enlargement of the inferior nasal turbinates. These are small, shelf-like structures composed of thin bone and covered by mucous membranes. They protrude into the nasal airway and help to warm, humidify and cleanse air as it is inhaled before it reaches the lungs. Chronic stuffy nose can impair normal breathing, forcing patients to breathe through the mouth and often affecting their daily activities.
Enlarged turbinates and nasal congestion can also contribute to headaches and sleep disorders such as snoring and Obstructive Sleep Apnea Syndrome ( OSAS ). Chronic stuffy nose is often unresponsive to medical treatment such as nasal sprays; thus surgical treatment is required. This is commonly associated with rhinitis, the inflammation of the mucous membranes of the nose. When the mucosa becomes inflamed, the blood vessels inside the membrane swell and expand, causing the turbinates to become enlarged and obstruct the flow of air through the nose.
More than 50 million Americans suffer from some type of chronic rhinitis.
The Current Treatment Regimen
The Current Treatment Regimen
Current treatments for a chronic stuffy nose range from behavioral changes such as avoiding exposure to the triggers that cause rhinitis) to invasive surgery. Medical therapy offers only temporary relief, but it can also be associated with significant side effects. Surgical treatments sometimes result in lengthy recovery periods and significant patient discomfort.
Surgical treatment is indicated only after patients fail to respond to medical therapy. Turbinate surgery can be performed as an office procedure under local anesthesia or in the operating room under general anesthesia.
Cautery (burning) of enlarged turbinates can be done with an electrosurgical probe or a laser and is usually performed as an office procedure. Both electrocautery and laser surgery are performed on either the surface of the turbinate tissue or sub-mucosally.
Surface cautery results in edema and crusting in the nose that can last three weeks or longer, while sub-mucosal cautery can cause swelling for up to 10 days. Another method for improving nasal obstruction is outward fracture of the turbinate bone(s), which moves the turbinate away from its obstructive position in the airway. This approach, however, does not address the usual source of obstruction. Enlarged sub-mucosal tissue, and the fractured turbinate often returns to its previous position.
Bleeding, which can usually be managed by packing the nose, is the greatest risk for patients undergoing standard turbinate resection. Over-resection of the turbinates has been reported as the cause of excessive, irreversible drying of the turbinates. Resection, excision and surface cautery can all be associated with prolonged crusting and healing, which occurs over a four to six-week period.
Newer Technology for Patients with Persistant Nasal Obstruction
A non-surgical, minimally invasive technique using the application of temperature controlled radiofrequency ( TCRF ) to the nasal region has been developed at our center to give significant relief for those that suffer from nasal obstruction due to allergic rhinitis (swelling of the soft tissues of the inner nose).
Overview: The Problem
Causes and Conventional Treatment
Allergies can lead to symptoms by stimulating the nasal tissue to release chemicals that cause swelling and drainage. If these stimulants can be identified, avoidance may be attempted. Medications such as antihistamines, decongestants, and nasals steroids are often used and can be successful. However, some patients experience side effects and variable success rates. Finally, immunotherapy (allergy shots) is excellent for many allergy symptoms, but less effective for pure nasal obstruction. In addition, it may take a prolonged period of treatment to see benefits.
Individuals without true allergies may also suffer from nasal obstruction. In these cases environmental stimuli such as a change in humidity or temperature, or even a reaction to some foods cause swelling through a slightly different mechanism. Unfortunately for the patient, the symptoms are the same and the treatments are generally similar but less effective.
Although some patients may have anatomic abnormalities such as a deviated septum, the main cause of the majority of nasal obstruction is enlargement of structures known as turbinates. The turbinates are on the lateral walls on each side of the nose. They are made up of tiny layers of bone much like a sponge and are covered with a very vascular layer of soft tissue. These essential structures provide a necessary function in the warming and humidification of the air entering the airway. However, when chronically stimulated the soft vascular tissues surrounding the spongy bone of the turbinates enlarge and actually block nasal airflow. Anyone that has ever suffered a stuffy nose from a common cold has experienced nasal obstruction and a runny nose as a result of turbinate swelling.
As mentioned above, conservative treatments such as medications can be attempted, however if unsuccessful, direct reduction of the turbinates may be required to relieve the symptoms. Surgical turbinate reduction where the leading one-third to one-half of the turbinate is actually removed is effective but invariably results in crusting and bleeding from the nose during the recovery period. It is also commonly performed in an operating room. Other treatments such as laser reduction still have similar side effects.
Newer Non-Surgical Technology
Temperature Controlled Radiofrequency is a recently developed non-surgical approach researched and developed by our group. It uses a tiny electrode to heat the turbinate tissue from within, eventually causing reduction of the size of the turbinate as the body reabsorbs the treated tissue. Since no “cutting” of the tissue is done, there is little or no bleeding, crusting, or pain. The use of radiofrequency is not new to medicine, as it has been used for decades in the fields of neurology, cardiology, urology and surgery. However, it was not previously used for the shrinkage of soft tissue in the upper airway until our group scientifically investigated this technology and added special thermocouples to the electrodes to monitor temperature delivery. These temperature control applications allowed for a safe delivery of energy and the ability to precisely select and treat the delicate tissues of the nose. Temperature controlled radiofrequency is minimally invasive and can be done in the office with only local anesthesia (much like your dentist would use) and the patient can resume normal activity almost immediately. This method also preserves the normal function of the turbinate, but usually results in excellent airflow to the patient.
Although this method of treatment can be very effective, a thorough evaluation and examination is performed to correctly confirm the suspected diagnosis and to determine the appropriateness of this choice. For questions regarding this treatment, or to schedule an appointment for evaluation please contact our office at (650) 328-0511.
References on research completed in this area:
Diagrams of the Temperature Controlled Radiofrequency Procedure to Relieve Chronic Nasal Obstruction