Carbon Dioxide Laser Vaporization of the Inferior Turbinate for Allergic Rhinitis: Short-Term Results

Abstract

Carbon dioxide laser vaporization of the turbinate has recently become accepted as a common treatment for allergic rhinitis. Usually, only a single procedure is applied to minimize trauma. However, repeated procedures on separate days are often required to achieve an adequate effect. Therefore, we attempted a new method of vaporization and evaluated the outcome, and also tried to determine which patients have good indications for laser treatment. To widely and deeply vaporize the inferior turbinate, we repeated the procedure 3 times in 1 session after removing the carbon coating from the previous vaporization under nasal endoscopic observation. After the procedure, most patients experienced complete nasal obstruction for 2 or 3 days, but there was no intraoperative or postoperative bleeding or severe pain. All patients obtained improvement of their chief complaints and were satisfied 2 months after the operation. In particular, 60% of the patients were completely relieved of refractory nasal obstruction. Most patients were more satisfied with the effects than are those treated by the usual methods. Completely successful cases (improvement in all symptoms and complete satisfaction obtained) were selected and were compared with other cases. Favorable prognostic factors are more severe complaints, longer symptomatic periods, stronger allergic reactions, and worse nasal resistance and its greater improvement with administration of decongestant nasal drops. This method may be especially accepted by patients with severe complaints, in particular nasal obstruction, who do not experience enough relief with conservative therapies or have enough time to make frequent visits to an outpatient clinic over a period of several weeks.

Clinical Characteristics, Health Care Resource Utilization, and Prescription Patterns of Japanese Patients with Physician-Diagnosed Allergic Rhinitis: A Secondary Use of Database Study

“…Nonetheless, operative procedure and related costs, which were reasonably driven by AR-related surgery, were higher in comparison cohort 1 than in comparison cohort 2-s. Notably, 13.5% of patients in comparison cohort 1 had one or more additional surgeries within 1 year from the index date, indicating that the effect of surgery may not continue in the following season as previously reported [35]. It is known that the effect of laser surgery, the most popular day surgery, is not sustained for years.…”

Dilemma of Inferior Turbinate Surgery

“…c) CO 2 laser vaporization of hypertrophied inferior turbinate, this technique was confirmed to be very effective with minimal post-operative local atrophic changes as compared to other previously mentioned two techniques. It acts by same mechanism of submucosal diathermy through its penetration effect into sub-mucosal layer of hypertrophied inferior turbinate and as compared to submucosal diathermy technique it has less destructive effect on the mucosal glandular acini as well as venous sinusoids therefore the incidence of post-operative atrophic rhinitis after CO 2 laser vaporization is limited but in the same time its action to relief the mechanical nasal obstruction due to hypertrophied inferior turbinate will be lesser as compared to other techniques (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) . d) turbinoplasty, simplythis technique can be described as that inferior turbinate surgical modality which is conducted via the reduction of bone bulk of inferior concha.…”

“…As it was illustrated at the results of this serial study the power of 3-4 watts were associated with lower incidence of post-operative atrophic rhinitis as well as persistence or recurrence of nasal obstruction as compared to lower powers which had been proved with significantly high incidence of post-operative persistent or recurrent nasal obstruction and higher powers which showed significant raising in the incidence of both post-operative atrophic rhinitis as well as persistence or recurrence of nasal obstruction. These observations can be explained by inability of low powers to destroy sufficient number of sub-mucosal venous sinusoids that may increase the risk of persistence and recurrence of mechanical nasal obstruction due to the inferior turbinate congestion and hyperemia and on the other hand the high powers are more destructive powers that lead to extensive venous sinusoids and glandular acini loss this will result in higher incidence of local atrophic changes after the surgery which can be considered as main cause for persistence or recurrence of functional nasal obstruction (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) .…”

“…This can be achieved by committing the normal nasal valve mechanism at the most anterior part of nasal cavity facilitatingeddy current type flow of the air (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) . Therefore the difficulties for preservation of unique size of inferior turbinatesisthe primary reason for this dilemma (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) .…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Bony outfracture, the most atraumatic and conservative IT surgery, 2301 can reduce the distance between IT and lateral nasal wall and enlarge the dimensions of the nasal airway when performed alone 2302,2303 or in conjunction with other techniques 2304,2305 . IT surgery via energy‐related techniques 2304–2363 and via direct tissue removal 1093,2296,2299,2303,2307,2310,2331,2332,2335,2336,2338,2344,2364–2376 have both been extensively studied, with reported high efficacy in reducing symptoms and increasing nasal volume and airflow with minimal complications. Of note, botulinum toxin injection 2377–2379 and high‐intensity focused ultrasound may also provide symptomatic relief, 2380,2381 though there remains limited evidence for their utility.…”