The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p<0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial.

OBJECTIVE: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. METHODS: Between July 2018-February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. RESULTS: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p < 0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p > 0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p < 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p > 0.05). CONCLUSION: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. LEVEL OF EVIDENCE: 1B.

Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate in the treatment of chronic rhinitis: short-term and long-term outcome.

BACKGROUND: Radiofrequency volumetric tissue reduction (RFVTR) of hypertrophic inferior turbinate (IT) is an effective way to treat patients with intractable nasal mucosal obstruction. We evaluated the effectiveness of combined RFVTR and lateral outfracture (LO) of hypertrophic IT in chronic rhinitis (CR) patients on reduction of nasal obstruction, rhinorrhea, and nasal pruritus both short and long term. METHODS: Seventy-three patients with CR who failed medical treatment were recruited to undergo combined RFVTR and LO of hypertrophic IT. Nasal congestion scores were recorded before the operation, and immediately, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. Rhinorrhea and pruritic score as well as total nasal airway resistance (TNAR) and total nasal airflow (TNAF) (measured by active anterior rhinomanometry) were recorded before the operation, and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. RESULTS: Forty-five patients completed the follow-up period of 3 years. Subjects consisted of 25 male and 20 female patients, with an average age of 31 years. Nasal congestion scores were significantly improved immediately after the operation. Nasal congestion scores and TNAR values were significantly decreased whereas TNAF values were significantly increased at every time point postoperatively. Rhinorrhea and pruritic scores were also significantly improved at every time point after 2 weeks postoperatively. CONCLUSION: Combined RFVTR and LO of hypertrophic IT is an effective treatment for nasal obstruction, rhinorrhea, and nasal pruritus in CR and the result lasts up to 3 years postoperatively.