Allergy Asthma Respir Dis.  2013 Mar;1(1):29-34. 10.4168/aard.2013.1.1.29.

Surgical treatment for allergic rhinitis

• Dhong HJ

• KMID: 2263056
• DOI: http://doi.org/10.4168/aard.2013.1.1.29

Abstract

Allergic rhinitis refractory to medical therapy may be challenging. Inferior turbinate hypertrophy has been suggested as a major cause of nasal obstruction. In addition, nasal septal deviation and chronic rhinosinusitis are possible causes. Various procedures exist for surgical reduction of inferior turbinate volume, including lateral out fracture, partial turbinectomy, submucosal resection, laser-assisted turbinoplasty, radiofrequency-assisted turbinoplasty, and microdebrider-assisted turbinoplasty. In recent years, conservative turbinate surgery has been widely applied to decrease the risk of complications such as empty nose syndrome, crust formation, osteitis, and synechia. In some cases, septoplasty would be an important treatment method for allergic rhinitis when patients have coexisting nasal septal deviation. Recently, highly selective neurectomy to reduce the function of inferior turbinate is being implemented. Standard surgical treatment for allergic rhinitis has not been established, But a variety of surgery for patients who do not respond to appropriate medication can help relieve allergic symptoms. Because surgical management for allergic rhinitis may cause troublesome complications, these effective but invasive procedures should be chosen carefully.

Keyword

Allergic rhinitis; Turbinate; Hypertrophy; Surgery

MeSH Terms

Humans
Hypertrophy
Nasal Obstruction
Nose
Osteitis
Rhinitis
Rhinitis, Allergic, Perennial
Turbinates

Reference

1. Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med. 2005. 4:439–446.

2. Lee S, Kundaria S, Ferguson BJ. Practical clinical management strategies for the allergic patient with chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2012. 20:179–187.

3. Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg. 1999. 103:300–312.

4. Chhabra N, Houser SM. The surgical management of allergic rhinitis. Otolaryngol Clin North Am. 2011. 44:779–795. xi

5. Wang DY, Raza MT, Gordon BR. Control of nasal obstruction in perennial allergic rhinitis. Curr Opin Allergy Clin Immunol. 2004. 4:165–170.

6. Lang C, Grutzenmacher S, Mlynski B, Plontke S, Mlynski G. Investigating the nasal cycle using endoscopy, rhinoresistometry, and acoustic rhinometry. Laryngoscope. 2003. 113:284–289.

7. Aksoy F, Yıldırım YS, Veyseller B, Ozturan O, Demirhan H. Midterm outcomes of outfracture of the inferior turbinate. Otolaryngol Head Neck Surg. 2010. 143:579–584.

8. Kim SW, Mo JH, Kim JW, Kim DY, Rhee CS, Lee CH, et al. Change of nasal function with aging in Korean. Acta Otolaryngol Suppl. 2007. (558):90–94.

9. Millas I, Liquidato BM, Dolci JE, Fregnani JH, Macea JR. Histological analysis of the distribution pattern of glandular tissue in normal inferior nasal turbinates. Braz J Otorhinolaryngol. 2009. 75:507–510.

10. Ishida H, Yoshida T, Hasegawa T, Mohri M, Amatsu M. Submucous electrocautery following submucous resection of turbinate bone: a rationale of surgical treatment for allergic rhinitis. Auris Nasus Larynx. 2003. 30:147–152.

11. Houser SM. Surgical treatment for empty nose syndrome. Arch Otolaryngol Head Neck Surg. 2007. 133:858–863.

12. Hol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology. 2000. 38:157–166.

13. Davis WE, Nishioka GJ. Endoscopic partial inferior turbinectomy using a power microcutting instrument. Ear Nose Throat J. 1996. 75:49–50.

14. Batra PS, Seiden AM, Smith TL. Surgical management of adult inferior turbinate hypertrophy: a systematic review of the evidence. Laryngoscope. 2009. 119:1819–1827.

15. Bhandarkar ND, Smith TL. Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg. 2010. 18:49–53.

16. Greywoode JD, Van Abel K, Pribitkin EA. Ultrasonic bone aspirator turbinoplasty: a novel approach for management of inferior turbinate hypertrophy. Laryngoscope. 2010. 120:Suppl 4. S239.

17. Chang CW, Ries WR. Surgical treatment of the inferior turbinate: new techniques. Curr Opin Otolaryngol Head Neck Surg. 2004. 12:53–57.

18. Garzaro M, Landolfo V, Pezzoli M, Defilippi S, Campisi P, Giordano C, et al. Radiofrequency volume turbinate reduction versus partial turbinectomy: clinical and histological features. Am J Rhinol Allergy. 2012. 26:321–325.

19. Passali D, Passali FM, Damiani V, Passali GC, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol. 2003. 112:683–688.

20. Mori S, Fujieda S, Igarashi M, Fan GK, Saito H. Submucous turbinectomy decreases not only nasal stiffness but also sneezing and rhinorrhea in patients with perennial allergic rhinitis. Clin Exp Allergy. 1999. 29:1542–1548.

21. Mori S, Fujieda S, Yamada T, Kimura Y, Takahashi N, Saito H. Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis. Laryngoscope. 2002. 112:865–869.

22. Sapci T, Sahin B, Karavus A, Akbulut UG. Comparison of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions. Laryngoscope. 2003. 113:514–519.

23. Elwany S, Abel Salaam S. Laser surgery for allergic rhinitis: the effect on seromucinous glands. Otolaryngol Head Neck Surg. 1999. 120:742–744.

24. Fukutake T, Kumazawa T, Nakamura A. Laser surgery for allergic rhinitis. AORN J. 1987. 46:756–761.

25. Supiyaphun P, Aramwatanapong P, Kerekhanjanarong V, Sastarasadhit V. KTP laser inferior turbinoplasty: an alternative procedure to treat the nasal obstruction. Auris Nasus Larynx. 2003. 30:59–64.

26. Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Radiofrequency volumetric tissue reduction for treatment of turbinate hypertrophy: a pilot study. Otolaryngol Head Neck Surg. 1998. 119:569–573.

27. Hytonen ML, Back LJ, Malmivaara AV, Roine RP. Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications. Eur Arch Otorhinolaryngol. 2009. 266:1257–1266.

28. Lin HC, Lin PW, Friedman M, Chang HW, Su YY, Chen YJ, et al. Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg. 2010. 136:892–895.

29. Simeon R, Soufflet B, Souchal Delacour I. Coblation turbinate reduction in childhood allergic rhinitis. Eur Ann Otorhinolaryngol Head Neck Dis. 2010. 127:77–82.

30. Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008. 118:1270–1274.

31. Cingi C, Ure B, Cakli H, Ozudogru E. Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty: a prospective study with objective and subjective outcome measures. Acta Otorhinolaryngol Ital. 2010. 30:138–143.

32. Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty. Laryngoscope. 2006. 116:729–734.

33. Liu CM, Tan CD, Lee FP, Lin KN, Huang HM. Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty. Laryngoscope. 2009. 119:414–418.

34. Fjermedal O, Saunte C, Pedersen S. Septoplasty and/or submucous resection? 5 years nasal septum operations. J Laryngol Otol. 1988. 102:796–798.

35. Karatzanis AD, Fragiadakis G, Moshandrea J, Zenk J, Iro H, Velegrakis GA. Septoplasty outcome in patients with and without allergic rhinitis. Rhinology. 2009. 47:444–449.

36. Golding-Wood PH. Observations on petrosal and vidian neurectomy in chronic vasomotor rhinitis. J Laryngol Otol. 1961. 75:232–247.

37. Konno A. Historical, pathophysiological, and therapeutic aspects of vidian neurectomy. Curr Allergy Asthma Rep. 2010. 10:105–112.

38. Sadanaga M. Clinical evaluation of vidian neurectomy for nasal allergy. Auris Nasus Larynx. 1989. 16:Suppl 1. S53–S57.

39. Kobayashi T, Hyodo M, Nakamura K, Komobuchi H, Honda N. Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis. Auris Nasus Larynx. 2012. 39:593–596.