Treatment for enlarged inferior turbinates

"Hot poker" methods
"Hot poker" is a general term surgeons use to describe the following techniques:

Radiofrequency methods
To describe this group of techniques, your surgeon may use one of the terms below:

• Electrocautery

• Radiofrequency (RF) ablation

• Bipolar ablation

All of these methods aim to shrink the underlying turbinate by applying heat to the surface lining of the turbinate and creating a lesion. A probe is inserted into the turbinate tissue between one and six times, while the needle is heated and the underlying tissue is shrunk.

Ideally, the overlying mucous membrane is preserved and thermal injury (heat damage) to the turbinate bone underneath is avoided. But because the effects of heat are harder to control or predict, "hot poker" surgery methods can be problematic.

A prospective, randomized, double-blinded study presented at the May 2005 American Rhinologic Society meeting suggested that more than 50 percent of patients suffer from dry nose/crusting after surgery with an electrocautery technique. The report also indicated that within 12 months after surgery, more than 50 percent of electrocautery patients relapsed and their obstruction recurred.

Not all of the various "hot" techniques were explored in this study. Yet it seems likely that results are inferior with these methods as a whole, since tissue removal is incomplete and heat damage to the mucous lining is probable when heat is used to perform the surgery.

The advantages of radiofrequency techniques include:

• Minimally invasive

• Fast

• Easy to re-do, even in your doctor's office

• Doesn't require cutting

The disadvantages of radiofrequency techniques include:

• Limited reduction in turbinate size. Turbinate reduction is limited by the size of the lesion(s) created by the radiofrequency. Any viable tissue left behind outside of the created lesion provides an opportunity for recurrence of the problem. Additionally, the shrinkage of the tissue is limited to the volume reduction caused by the lesion. 

• Poor long-term results; may require repeated procedures. Radiofrequency techniques do not produce effective, long-term results for treating nasal obstruction. A 2005 randomized, controlled, prospective, double-blinded study by Sacks et al1 compared several methods of turbinate surgery. Patients in the study had a different technique performed on each side of the nose and results were compared at one month, four months, and 12 months postoperatively.
  
  Initially, the radiofrequency surgery results seemed positive. Yet follow-up objective evaluations at four months and 12 months showed that patients who underwent radiofrequency procedures had poorer outcomes. In fact, at 12 months after their radiofrequency procedures, more than 50 percent of patients relapsed and their obstruction had returned.

• Higher rate of complications from surgery. Patients who undergo radiofrequency procedures are more likely to experience unpleasant complications from surgery, such as crusting (an excessively dry nose) and pain. 
       • Crusting/dryness is more likely to occur with radiofrequency techniques. In fact, 
          greater than 50 percent of radiofrequency patients experience crusting. It happens 
          more frequently with this surgery probably as a consequence of the heat generated 
          by the radiofrequency energy. 
       • This can be minimized by delivering less energy to the turbinate, but may result in 
          less initial turbinate reduction. Surgeons may also suggest postoperative nasal 
          douches. In any case, nasal crusting should resolve after four to eight weeks.
       • Pain occurred more frequently after the radiofrequency procedure described in 
          this study compared to the other turbinate reduction techniques.

• Unpredictable damage to surrounding tissue. All of the radiofrequency techniques use surgery tools that may cause collateral thermal damage. This makes it easier for nearby tissue to be accidentally injured during your procedure, which can cause problems such as: 
       • Chronic inflammation of the turbinate bone. Too much heat can damage the 
          turbinate bone and cause it to become chronically inflamed and painful.
       • Destruction of the surface lining of the turbinate. By using heat to burn and fry 
          the turbinate tissue, radiofrequency methods can easily destroy too much of 
          the important surface lining of the turbinate. As previously mentioned, you need 
          to have as much intact mucous lining as possible because it contains the air 
          flow receptors, cilia and secretes vital mucus.

• Not effective at reducing an enlarged turbinate bone. Radiofrequency techniques are ineffective when you have an enlarged turbinate bone, which occurs in about 10 to 15 percent of obstruction patients. These tools can only be used on soft tissue, not hard bone.

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