radiofrequency surgery for nasal congestion

Treatment for enlarged inferior turbinates

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.

Thanks for that. My new sleep Dr. suggested this be done by a Dr. down the hall from her if I continue to have issues. As if it were not a serious procedure. I really think all these Docs are in "cahoots". I already told her I had very serious surgery to remove a growth many years ago and my entire right sinus is empty now. I could literally stick my pinky in it through my nostril. What is there to shrink on that side?

Browser,

I thought that this might be of help to someone who may be thinking about this procedure.The doc did not tell me about the downside when we talked about doing it. Fortunately, I did not consent to have it done.

Gary

I did it and so far so good.