Using thermal effect of 970 nm diode laser to reduce nasal swell body.

In recent decades, semiconductor lasers have been successfully used in rhinology. However, their usage in the reduction of the nasal swell body (NSB) is barely studied. Our research aimed to conduct an experimental selection of the laser exposure mode in the NSB zone using a 970 nm diode laser for safe and effective NSB reduction. The thermometric parameters of a diode laser with a wavelength of 970 nm were evaluated in a continuous contact mode of exposure at the power from 2 W to 10 W with 2 W step. The laser was targeted at the liver of cattle, given its similar optical properties to the NSB region. After a series of experiments with every power rate and the analysis of temperature data, we estimated an optimal exposure mode at a power of 4 W. The collected thermometric data demonstrate the safety of this mode in a clinical setting for NSB reduction due to causing no thermal damage to the adjacent tissue. Based on the experiment, a technique for laser reduction of the NSB was developed to improve nasal breathing in patients with severe hypertrophy of this area. The proposed technique was applied to 39 patients with chronic vasomotor rhinitis and the NSB. All patients were divided into 2 groups. Group 1 consisted of 20 patients who underwent surface contact laser-turbinectomy and the NSB reduction using a 970 nm diode laser. Group 2 included 19 patients with the same pathology who underwent laser-turbinectomy, without reduction of the NSB. No statistically significant difference was observed during the dynamic observation with an objective assessment of nasal respiration according to active anterior rhinomanometry when comparing these subgroups with each other according to the t-criterion for independent samples (p > 0.05). As a result of comparing the data obtained on the NOSE scale using the Student's t-test, a statistically significant difference is observed (p < 0.001). Thus, patients who did not perform the reduction of the NSB subjectively noted the insufficiency of nasal breathing. This fact indicates that the NSB is involved in the regulation of airflow.

Surgical Management of Nonallergic Rhinitis.

Nonallergic rhinitis (NAR) describes chronic symptoms of nasal congestion, obstruction, and rhinorrhea unrelated to a specific allergen based on skin or serum testing. Vasomotor rhinitis is the most frequent subtype of NAR. Although medical management is the first-line treatment of NAR, there is a role for surgical therapy when medications fail to improve symptoms. Surgical options for NAR include inferior turbinate reduction and botulinum toxin injection as well as more directed targeting of the autonomic nerve supply to the nasal cavity through vidian neurectomy, posterior nasal neurectomy, and cryoablation of the posterior nerve.

A systematic review of the evidence base for vidian neurectomy in managing rhinitis.

BACKGROUND: Vidian neurectomy has been proposed as a surgical option for rhinitis refractory to medical treatment. However, the evidence base for its benefit remains controversial. METHODS: A systematic review was performed. Studies reporting original data on patients with rhinitis treated by vidian neurectomy were included. Patient-reported outcome measures were the primary outcome investigated; specific peri-operative morbidities were the secondary outcome. RESULTS: A total of 1012 articles fulfilled the search criteria, 32 of which were included in the study. Patient-reported outcome measures were compared before and after surgery in eight studies. There were 529 patients represented in these trials. Significant improvement in rhinorrhoea was reported in all eight studies. Temporary dry eyes was reported in 24.63 per cent of cases (272 out of 1104 cases). There was no report of cranial nerve deficit or eye movement disturbance. CONCLUSION: Endoscopic vidian neurectomy does have a role in the surgical management of refractory rhinitis, particularly in patients with non-allergic rhinitis, but a well-designed cohort trial would be advantageous to clarify long-term outcomes.

[The modern approach to the treatment of the patients presenting with vasomotor rhinitis with the use of the electrosurgical technique].

The objective of the present study was to compare, based on the clinical data, the effectiveness of the electrosurgical techniques of the molecular resonance and radio-wave ranges used to perform vasotomy in 64 patients presenting with vasomotor rhinitis. The short-term results of the treatment suggest the higher effectiveness and safety of radio-wave surgery in comparison with the molecular resonance treatment in the patients with the above condition. This observation was confirmed in the objective studies with the use of endoscopic and cytological methods, anterior active rhinomanometry, and determination of mucociliary clearance.

Endoscopic vidian neurectomy: a prospective case series.

BACKGROUND: Chronic refractory vasomotor rhinitis (VMR) is a debilitating condition that causes significant impairment of quality of life. The purpose of this study is to investigate the efficacy and potential side effects of endoscopic vidian neurectomy as treatment for patients with VMR. METHODS: This study was a prospective, intent-to-follow case series. Inclusion criteria were as follows: (1) patients with debilitating VMR refractory to medical therapy and with significant impact on quality of life; (2) negative allergy history and skin testing; and (3) negative computed tomography (CT) scan to rule out skull-base defect or cerebrospinal fluid (CSF) fistula. Patients underwent bilateral vidian neurectomy via a pterygomaxillary approach. Prior to surgery all patients underwent formal ophthalmologic testing to quantify preoperative ocular and lacrimal function. Ophthalmologic testing was repeated postoperatively at approximately 3 months. Patients also completed surveys regarding rhinologic outcomes including the Sinusitis Symptom Questionnaire (SSQ) and the 22-item Sino-Nasal Outcome Test (SNOT-22) at the following time points: preoperatively, and 1 week, 4 weeks, 12 weeks, 6 months, 1 year, and 2 years postsurgery. Descriptive statistics and analysis of variance (ANOVA) were undertaken. RESULTS: Eleven patients (22 sides) underwent bilateral vidian neurectomy with pathologic confirmation of nerve section in all cases. Average follow-up was 19.4 months. Statistically and clinically significant improvement was measured for both the SSQ and the SNOT-22 and compared with the patients' baseline scores (p < 0.0001). Subscores for rhinorrhea and nasal congestions were also statistically significantly improved (p < 0.05). No incidence of permanent or measureable dry eye has been reported. CONCLUSION: The data suggests that vidian neurectomy is an effective, safe, and definitive treatment for most patients with VMR refractory to medical treatment.

Surgical management of vasomotor rhinitis: a systematic review.

BACKGROUND: Vasomotor rhinitis (VMR) is one of the most prevalent forms of nonallergic rhinitis. In the past, when maximal medical therapy failed, surgical options were limited. Vidian neurectomy (VN) was one option; however, it was fraught with complications and limited success. The advent of endoscopic sinus surgery revitalized interest in surgical procedures for VMR. This study was designed to review the available literature and assess the safety and efficacy of surgery on the vidian and posterior nasal nerves for treatment of VMR and when possible, compare the different approaches to one another in regard to safety and efficacy. METHODS: A systematic review was performed of English language articles using Ovid and PubMed. Search terms included "endoscopic vidian neurectomy," "vidian neurectomy," "endoscopic posterior nasal neurectomy" (EPNN), and "posterior nasal neurectomy." Only clinical trials performed on humans with safety and or efficacy data were included. Independent extraction of articles by two authors using predefined data fields was performed. Safety defined by complication rates and efficacy defined as objective improvement on outcomes scores along with the overall length of benefit were the primary measures of treatment effect. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement for reporting systematic reviews was followed. RESULTS: In comparison with open VN, endoscopic techniques were not associated with any long-term sequelae. Rhinorrhea and nasal obstruction were shown to improve after endoscopic VN (EVN) and the benefits were maintained for several years after surgery. CONCLUSION: EVN is well tolerated, safe, and effective in a majority of patients. Overall, the literature has shown that the endoscopic approach is associated with less morbidity than the traditional transantral approach. Currently, no literature exists on the effect of EPNN in patients with vasomotor rhinitis and further study is needed to elucidate the efficacy of this procedure in this subset of patients.

Therapeutic effectiveness of endoscopic vidian neurectomy for the treatment of vasomotor rhinitis.

CONCLUSION: Our results indicate that vidian neurectomy may be recommended as an effective method for the treatment of vasomotor rhinitis (VMR). OBJECTIVE: The aim of this work was to study the feasibility and effectiveness of vidian neurectomy treatment under the nasal endoscope for VMR. METHODS: The study included 45 patients with VMR. They were all assigned to functional endoscopic surgery with vidian neurectomy. RESULTS: The obtained data showed that, using the rhinoconjunctivitis quality of life questionnaire, vidian neurectomy treatment relieved the symptoms of VMR in 82.2% of the patients. Vidian neurectomy also led to the reduction of expression of several cytokines, including vasoactive intestinal polypeptide, calcitonin gene-related peptide, substance P, interleukin (IL)-4, and IL-5.

Endoscopic vidian neurectomy assisted by power instrumentation and coblation.

Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the introduction of endoscopic sinus surgery in the 1980s, transnasal endoscopic vidian neurectomy (EVN) was subsequently reported. The most common problem in performing EVN was excessive bleeding from the pterygopalatine fossa. The complexity and vascularity of the pterygopalatine fossa can cause bloody surgical fields and prevent complete neurectomy. In response to this surgical problem, a procedure was developed to use powered instrumentation and coblation during EVN. There were eight cases of EVNs (16 neurectomies) assisted by power instrumentation and coblation from December 2011 to May 2012. The average blood loss of these cases was 37.5 mL (range, 25-50 mL). The average surgical time of each neurectomy was 27.4 minutes (range, 20-35 minutes). No complications occurred in any of the eight cases. Very limited bleeding and less thermal damage were noted while achieving a complete neurectomy.

[Effect of posterior nasal neurectomy combined with the inferior turbinate surgery for the patients with perennial allergic rhinitis or vasomotor rhinitis].

INTRODUCTION: Until recently, Vidian neurectomy had been applied mainly in intractable vasomotor rhinitis and severe perennial allergic rhinitis. Although the results were excellent, the operation has not been applied recently because of the adverse events such as xerophthalmia and trigeminal neuralgia. To resolve these problems, a new surgical technique, posterior nasal neurectomy, was developed. In this report, we examined the effectiveness of posterior nasal neurectomy combined with the inferior turbinate surgery for severe perennial allergic rhinitis and intrinsic rhinitis by questionnaire. PATIENTS AND METHODS: Twenty patients who had undergone posterior nasal neurectomy combined with the inferior turbinate surgery between April in 2005 and March in 2009 were enrolled. Numeric Rating Scale was used to evaluate clinical symptoms and quality of life (QOL) of pre- and postsurgery. Frequency of medication (oral administration and nasal spray) was also evaluated. RESULTS: Questionnaires were collected from 17 patients. As for all patients but one, the surgery significantly reduced rhinorrhea, nasal obstruction, and sneezing. Furthermore, QOL for many symptoms such as sleep disorder and malaise/feebleness was also significantly improved after the surgery. Eighty-one percent of patients were satisfied with the surgery. CONCLUSION: Posterior nasal neurectomy combined with the inferior turbinate surgery is effective in alleviating clinical symptoms and improving QOL in the patients with severe perennial allergic rhinitis and intrinsic rhinitis, although a longer follow-up is needed.

[The complications of laser surgery for the treatment of chronic vasomotor rhinitis].

The objective of the present study was to reveal cases of complications developing after laser coagulation of inferior turbinated bones. This treatment was given to 322 patients presenting with vasomotor rhinitis. A surgical ND:YAG laser with a quartz light guide 400 mcm in diameter was used for the purpose. In the majority of the cases, a single irradiation session produced a persistent positive effect, both functional and morphological. At the same time, two patients developed an unusual complication in the form of osteomyelitis of an inferior turbinated bone with its sequestration.

Cytologic alterations in nasal mucosa after sphenopalatine artery ligation in patients with vasomotor rhinitis.

BACKGROUND: Vasomotor rhinitis (VR) seems to be related to an imbalance between cholinergic and adrenergic activity in the autonomic nervous system. The nerve fibers of the sympathetic and parasympathetic nervous systems reach the nose through the posterior nasal nerve, which, after crossing the sphenopalatine foramen, distributes to the mucosa following the branches of the sphenopalatine vessels. This study was designed to evaluate the effect of sphenopalatine artery ligation on nasal function and nasal cytology in patients with VR. METHODS: Thirty patients with VR and bilateral inferior turbinate hypertrophy (ITH) were randomly assigned to receive endoscopic inferior turbinoplasty either with or without sphenopalatine artery ligation. Pre- (baseline) and postsurgical (1-year follow-up) assessment included fiber endoscopy, active anterior rhinomanometry, measurement of mucociliary transport time (MTt), and nasal cytology examination. RESULTS: At 1-year follow-up there was a statistically significant improvement in nasal resistances in both groups but not on intergroup comparison; MTt significantly decreased in both groups (p < 0.01) and was significantly better (p < 0.05) in the group that had undergone sphenopalatine artery ligation. Among the patients in this group, significantly fewer were found to have altered ciliated cells (p < 0.005) or a hyperchromatic supranuclear stria (p < 0.005) on nasal cytology; the differences were statistically significant also on intergroup comparison (p < 0.005 and p < 0.001, respectively). CONCLUSION: In patients with vasomotor rhinopathy and ITH, improvement in symptoms, nasal resistance, ciliated cell trophism, and MTt was observed after sphenopalatine artery ligation.

Sphenopalatine artery ligation with nerve resection in patients with vasomotor rhinitis and polyposis: a prospective, randomized, double-blind investigation.

CONCLUSIONS: Sphenopalatine artery ligation relieves symptoms of rhinorrhea, sneezing, and nasal itching in patients with vasomotor rhinitis associated with nasal polyps. OBJECTIVES: Nasal polyps often arise in a setting of vasomotor rhinitis. Dysfunctions in nerve fiber activity of the sympathetic and parasympathetic systems are responsible for the accompanying symptoms of rhinorrhea, sneezing, and nasal itching. Sphenopalatine pedicle resection with autonomic denervation could potentially reduce related symptoms. METHODS: In a prospective, double-blind setting, 60 patients with vasomotor rhinitis and bilateral nasal polyps randomly assigned to functional endoscopic surgery either with (group A) or without (group B) sphenopalatine artery ligation completed a 3-year follow-up. Preoperative and postoperative (at 1 and 3 years) evaluations included symptom score, fiberendoscopy, and active anterior rhinomanometry. RESULTS: In both treatment groups nasal breathing had improved at 1-year and 3-year follow-up (p < 0.001), whereas an improvement in rhinorrhea (p < 0.001) and sneezing and itching (p < 0.01) was attained only in group A. The inter-group comparison showed that a statistically significant improvement in rhinorrhea and nasal itching (p = 0.002) and in sneezing (p < 0.001) was present in group A at both follow-up visits. Rhinomanometry improved in both treatment groups (p < 0.01). Inter-group comparison showed a significant difference only at the 3-year follow-up visit (p < 0.05).

[Comparative assessment of cryosurgical treatment results in allergic and non-allergic rhinitis]. / Porównawcza ocena wyników leczenia alergicznych i niealergicznych niezytów nosa za pomoca kriochirurgii.

INTRODUCTION: The aim of the work was to assess the treatment efficiency in patients with allergic and non-allergic vasomotor rhinitis after cryoablation procedures. MATERIAL AND METHODS: The study covered 60 patients, including 32 women and 28 men, aged 18-66. The patients were divided into two groups: I - 30 patients with chronic allergic rhinitis, II - 30 patients with non-allergic vasomotor rhinitis. The study methodology involved: an otorhinolaryngological interview with a questionnaire and an allergological interview, an objective otolaryngological and rhinomanometrical examination with Homoth apparatus, a subjective evaluation questionnaire for nasal blockage intensification (the scale ranging from 0 to 10), skin tests to aeorallergens and food allergens (Allergopharma Co.), nasal endoscopy with a straight rigid Eleps endoscope before the treatment and 3 months following it. The cryoablation of nasal conchas was performed under local infiltration anesthesia (1% Xylokaina solution) using the Cryo-S apparatus from CryoFlex Poland Company and a flat probe in a spatula shape (L-50) that was placed on the outer surfaces of the inferior nasal concha. RESULTS: The inferior nasal concha cryoablation resulted in a statistically significant improvement in the subjective assessment scale in group I by 82.6% and group II by 141.2%. In the endoscopic examination 3 months following the cryoablation a good nasal patency was achieved in 63.3% patients from group I and 76.7% patients from group II. The conducted studies show a better nasal passages patency in patients with non-allergic rhinitis than in those with allergic rhinitis. CONCLUSIONS: Cryoablation procedures on the inferior nasal conchas are not the primary therapy, but together with other methods they can immensely improve the life comfort of a rhinitis patient.

[Therapeutic effect of endoscopic vidian neurectomy on moderate-severe persistent allergic rhinitis].

OBJECTIVE: To evaluate the efficacy of endoscopic vidian neurectomy in the management of moderate-severe persistent allergic rhinitis, and to explore its possible mechanism. METHODS: One hundred and ninety-one patients with moderate-severe persistent allergic rhinitis were divided into three groups: endoscopic vidian neurectomy was carried out in 71 patients (group A), partial inferior turbinectomy and/or septal-plasty in 39 patients (group B), and 81 patients were as control (group C). The life quality was assessed at 6 month, 1 year and 3 years after operation using rhinoconjunctivitis quality of life questionnaire (RQLQ) and visual analogue scale (VAS). RESULTS: Among 191 cases, one hundred and forty-five cases had complete follow-up documents. The average score of RQLQ and VAS score (x(-) ± s) were significantly decreased at the time of 6 months (0.84 ± 0.41, 2.55 ± 1.57), 1 year (0.91 ± 0.43, 2.63 ± 1.71) and 3 years (1.03 ± 0.46, 2.81 ± 1.75) after endoscopic vidian neurectomy than scores before operation (2.25 ± 0.49, 7.34 ± 1.11), F = 115.45, 133.09, respectively, P < 0.001, and also significantly lower than scores in patients in group B or control group at the same period after treatment. By patient's self-evaluation, the ratio of greatly-improved, improved and not-improved was respectively, 65.5% (38 cases), 24.1% (14 cases), 10.4% (6 cases), and significantly higher in patients in group A than in patients in group B (U = 237.0, P < 0.001) and group C (U = 246.0, P < 0.001). There was no severe complication in all patients observed. CONCLUSION: Endoscopic vidian neurectomy is an effective and safe technique in the management of moderate-severe persistent allergic rhinitis.

[Therapeutic effect of vadian neurectomy under the nasal endoscope on the vasomotor rhinitis].

OBJECTIVE: To explore the therapeutic effect of vadian neurectomy under the nasal endoscope on the vasomotor rhinitis. METHODS: Anatomic measurements of vadian canal in 14 cadavers were carried out, and vadian neurectomy under the nasal endoscope was performed on 51 patients with vasomotor rhinitis. RESULTS: Anatomic measurements showed vadian canal was located behind the sphenoid-palatine hole, and its external orifice was shaped as infundibular. The vertical diameter was (3.5+/-0.9) mm and the horizontal diameter was (2.9+/-0.5) mm. The distance to the rotundum foramen and nasal septum was (6.1+/-1.2) mm and (10.5+/-5.9) mm. Longitudinal axes of the vadian canal was (27.0+/-9.6) degrees with the horizontal plane, and (7.8+/-2.5) degree with the sagittal plane. Among the 51 patients, 41(80.4%) patients showed complete response and 3(5.9%) partial response at the 5-year follow-up. CONCLUSION: Vadian neurectomy under nasal endoscope is an effective technique for vasomotor rhinitis.

[Otorhinolaringologyc approach of the chronic cough. Clinical case]. / Enfoque otorrinolaringológico de la tos crónica. Caso clínico.

Chronic cough is defined as that which is persisting at least for trhee weeks without an evident cause. It is very common on the otorhinological practice to receive patients with chronic cough in order to rule out that their chronic cough is not produced because of an alteration in the high respiratory system. We show a clinical case with chronic cough and we make reference to the physical exploration, diagnostical method, and possibilities of medical and surgical treatment.

Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates.

BACKGROUND AND OBJECTIVE: Various laser systems have been used to reduce the volume of hyperplastic inferior nasal turbinates during the last 25 years. Although there are many studies reporting the clinical results immediately after laser treatment, there are only a few describing long-term results. Therefore, a clinical study was performed to assess and to compare the long-term outcome of both endonasal Ho:YAG and endonasal diode laser-assisted turbinate surgery. STUDY DESIGN/MATERIALS AND METHODS: In the first treatment group, a total of 80 patients (allergic rhinitis (46%) and vasomotor rhinitis (54%)) suffering from nasal obstruction due to hyperplastic inferior nasal turbinates were treated by a pulsed Ho:YAG laser emitting light at a wavelength of lambda = 2,100 nm (pulse energy: 0.8-1.2 J/pulse, repetition rate: 4-8 Hz) under local anesthesia. In the second group, an additional 113 patients (allergic rhinitis (52%) and vasomotor rhinitis (48%)) were treated by means of a continuous wave GaAlAs-diode laser emitting light at a wavelength of lambda = 940 nm (power: 8-10 W). The treatment time was 3-10 minutes per turbinate and the nasal cavities were left unpacked following the procedure. The study concerning long-term effects was conducted using a standardized questionnaire, allergy test, and rhinomanometry within a follow-up period of 6 month and after 3 years. All patients were refractory to conservative medical treatment prior to laser treatment. RESULTS: Three years after laser treatment, a subjective improvement of nasal airflow had been described by the patients in 67.5% after Ho:YAG- and in 74.4% after diode laser treatment. Rhinomanometry revealed a significant improvement of the nasal airflow at both 6 months and 3 years after the laser treatment as compared to the preoperative data. Side effects like nasal dryness and pain were rare (<5%) and occurred only during the first weeks after the intervention. After diode laser treatment, patients showed nasal obstruction due to postoperative edema and nasal crusting during the first 3-4 weeks, whereas patients from the Ho:YAG laser group described these symptoms only for a period of 1-2 weeks. CONCLUSION: Both Ho:YAG- and diode laser treatment, which are performed as an outpatient procedure under local anesthesia, show promising long-term results. It has therefore, developed to become a time and cost-effective treatment modality in endonasal laser surgery at our institution. While short-term differences concerning the healing process after Ho:YAG- compared to diode-laser treatment could be ascertained according to the subjective and objective evaluation, no significant long-term differences between the two investigated groups could be observed.

Enfoque otorrinolaringológico de la tos crónica. Caso clínico / Otorhinolaingology approach of the chronic cough. Clinical case

La tos crónica se define como aquella que persiste al menos tres semanas sin tener una causa evidente. En la práctica Otorrinolaringológica se hace muy habitual recibir enfermos con tos crónica para descartar que su causa no sea una alteración en el aparato respiratorio alto. Presentamos un caso clínico con tos crónica y hacemos referencia a la exploración física, metodología diagnóstica y posibilidades de tratamiento médico y quirúrgico

Chronic cough is defined as that which is persisting at least for trhee weeks without an evident cause. It is very common on the otorhinological practice to receive patients with chronic cough in order to rule out that their chronic cough is not produced because of an alteration in the high respiratory system. We show a clinical case with chronic cough and we make reference to the physical exploration, diagnostical method, and possibilities of medical and surgical treatment