|Year : 2015 | Volume
| Issue : 2 | Page : 71-73
Submucosal diathermy in inferior turbinate hypertrophy: Review of 12 cases in Benin City
Amina Lami Okhakhu, Festus Oritsemajemite Ogisi
Department of Ear, Nose and Throat, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||14-Jul-2015|
Dr. Amina Lami Okhakhu
Department of Ear, Nose and Throat, University of Benin Teaching Hospital, Benin City, Edo State
Background: Nasal obstruction is a very common Ear, Nose, and Throat outpatient problem. We report a case series illustrating the safety and clinical effectiveness of submucous diathermy (SMD) in the treatment of medically refractory nasal obstruction caused by hypertrophy of the inferior turbinate. Methods: Consecutive patients presenting over a 5-year period with medically refractory nasal obstruction secondary to hypertrophy of the inferior turbinate were offered SMD as a technique for turbinate reduction. Subjective symptom score of the degree of obstruction was assessed preoperatively and 3 and 12 months postoperatively. Results: A total of 12 adults aged between 18 and 42 years with a mean age of 27.8 years, consented to SMD for turbinate reduction. The patients all had subjective improvement in their nasal airways postoperatively. Subjective symptom score declined to 66.7% by the 1 st postoperative year. Recurrence of symptoms of nasal obstruction occurred earlier in patients with allergy. The complications encountered included intranasal adhesions and crusting which was amenable to adhesiolysis with stenting and regular saline douching of the nasal cavity. Conclusion: SMD of the inferior turbinate is an effective and safe way of treating nasal obstruction secondary to hypertrophy of the inferior turbinate.
Keywords: Allergy, inferior turbinate hypertrophy, nasal obstruction, submucosal diathermy
|How to cite this article:|
Okhakhu AL, Ogisi FO. Submucosal diathermy in inferior turbinate hypertrophy: Review of 12 cases in Benin City. Sahel Med J 2015;18:71-3
| Introduction|| |
Chronic nasal obstruction is one of the most common nasal complaints for which otorhinolaryngologic consultation is sought.  Nasal obstruction is associated with mouth breathing, oropharyngeal dryness, disordered sleep, and adversely affects the quality-of-life. , Causes of chronic nasal obstruction include deviated nasal septum, hypertrophic inferior turbinate, allergies, rhinitis, vasomotor rhinitis, and rhinitis medicamentosa. Nasal obstruction as a result of hypertrophic inferior turbinate is a major cause of nasal obstruction ,, and forms the focus of the present paper. Most cases of inferior turbinate hypertrophy are amenable to medical treatment including decongestants, antihistamines, topical steroid sprays. There, however, remains a small proportion of patients who do not respond to medical measures and are candidates for inferior turbinate reduction surgery. A variety of different surgical techniques have been described for the treatment of inferior turbinate hypertrophy. , These include partial or total turbinectomy, turbinoplasty, submucous resection, electrocautery, chemical cautery, coblation, and laser.  Traditional turbinectomy is associated with excessive bleeding which may necessitate the use of nasal packs for several days or blood transfusion. Other complications associated with traditional turbinectomy such as excessive crusting, empty nose syndrome, rhinitis sicca, atrophic rhinitis, and ozena have brought the procedure into disrepute. More current techniques are associated with very minimal blood loss and preservation of the nasal mucosa. Many of these more recent techniques like the laser and radiofrequency ablation require expensive equipment which are not readily affordable in our locale. Submucous diathermy (SMD) is a simple and effective way of carrying out reduction surgery on the hypertrophied inferior turbinate. It was found to be very effective in alleviating chronic nasal obstruction due to hypertrophy of the inferior turbinate.  SMD of inferior turbinates was first documented in 1907. It works by shrinking the bulky space occupying hypertrophied inferior in the nasal cavity.
Submucous diathermy requires the use of diathermy machines which are readily available in most operating theatres. It can be performed under local or general anesthesia. SMD of the inferior turbinate induces the shrinkage of engorged turbinates by means of a coagulative current applied to three or more points on the inferior turbinate which causes tissue necrosis. There is a dearth of information about the use of SMD locally. Hence, the need for us to evaluate our experience at the Ear, Nose, and Throat (ENT) Department of the University of Benin Teaching Hospital using SMD for inferior turbinate reduction.
| Methods|| |
This is an observational retrospective review of the medical records of patients who had SMD of the inferior turbinate at the ENT Department of the University of Benin Teaching Hospital Benin City during a 5-year period (February 2008-January 2013). The information obtained from the case notes included age, sex, nasal symptoms, examination findings, surgery done, operative findings, and symptoms reevaluation at 3 and 12 months postoperative clinic visits. Having obtained a written informed consent from the patient, the procedure was carried out under general anesthesia via orotracheal intubation. No prior nasal preparation was carried out. Monopolar diathermy was used, and a spinal needle was improvised as an isolated cautery needle was not available to deliver the coagulative current. Care was taken to avoid injury to the vestibule and skin. The nose was packed lightly with sofratulle gauze for 24 h. Decrusting was performed 1-week postoperatively at the outpatient clinic and patient continued nasal douching with saline for another 2 weeks. All patients who had other nasal procedures in combination with SMD were excluded from the study. This represents the exclusion criteria to enable us ascertain the effectiveness of SMD in relieving obstruction caused by inferior turbinate hypertrophy as against improvement in nasal airway current occasioned by other procedures such as septoplasty or polypectomy.
The absence of an objective means of assessing the nasal airflow preoperatively and postoperatively was a major limitation of this study. Ethical clearance was obtained from the Hospital's Research and Ethics Committee.
| Results|| |
A total of 12 patients had inferior turbinate reduction using the technique of SMD. There were 7 males and 5 females [Table 1]. Their ages ranged from 18 to 42 years with a mean age of 27.8 years. The common nasal symptoms were nasal obstruction 12 (100%), watery nasal discharge 4 (33.3%), and hyposmia 2 (16.7%). Allergic symptoms were present in 2 (16.7%) patients [Table 2].
| Discussion|| |
Nasal obstruction was the symptom present in all the patients studied. Medically refractory inferior turbinate hypertrophy was the etiological factor in our patients, and this is similar to findings by other studies in which inferior turbinate hypertrophy was a major cause of nasal obstruction. ,, Hypertrophy of the inferior turbinate can result from either mucosal hypertrophy or bone hypertrophy or both.  Our patients all had mucosal hypertrophy of the inferior turbinate hence SMD was effective in ameliorating their symptoms. Traditional turbinectomy is associated with excessive bleeding necessitating the use of nasal packs for days. Bleeding may be severe enough to necessitate blood transfusion, the intraoperative blood loss in our patients was insignificant, and the sofratulle nasal packs were removed after 24 h with minimal soilage and none of them required blood transfusion.
Submucous diathermy of the inferior turbinate was found to be very effective in relieving symptoms of nasal obstruction in our patients and this is comparable to findings by Fradis, et al. who recorded alleviation of symptoms in up to 78% of their patients.  A study comparing inferior turbinectomy with SMD for hypertrophy of the inferior turbinate showed that although the relieve of nasal obstruction was better with the inferior turbinectomy group, postoperative bleeding was also higher in this group.  Total turbinectomy results in significant crusting while partial turbinectomy results in significant postoperative bleeding which may require the cautery for control. Some studies have queried the long-term efficacy of SMD.  There is controversy as regards how sustainable the improvement in the nasal airway following SMD to the inferior turbinate is Irfan and Jihan reported a 60% improvement in their patients after 1-year and 36% after 2 years post-SMD.  Our study revealed a 66.7% sustained alleviation of nasal obstruction after 1-year post-SMD.
The two patients with features of allergy developed significant nasal obstruction by 1-year postoperatively and required maintenance with topical nasal corticosteroid spray while two nonallergic patients also had complaints of nasal obstruction 1-year post-SMD and were scheduled for revision surgery. This is in keeping with findings by other studies which revealed that SMD gives better postoperative results in nonallergic patients.  The complications associated with this procedure include discomfort in the nasal cavity which is usually transient, crusting requiring regular nasal douching with saline and intranasal adhesions which were amenable to adhesiolysis and intranasal stenting. A major limitation of this study is the small sample size and the absence in our center of an acoustic rhino manometer for the objective assessment of nasal airway patency. Further studies are required to ascertain the long-term efficacy of SMD on nasal airway current.
| Conclusion|| |
Submucous diathermy is an effective and safe technique to alleviate refractory nasal obstruction secondary to inferior turbinate hypertrophy.
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[Table 1], [Table 2]