Chapter 23 Bipolar radiofrequency cold ablation turbinate reduction for obstructive inferior turbinate hypertrophy
1 INTRODUCTION
Nasal obstruction secondary to inferior turbinate hypertrophy is a common compounding problem for many patients with obstructive sleep apnea and/or snoring (OSA/S).
2 PATIENT SELECTION
With respect to inferior turbinate hypertrophy, the relative size of the inferior turbinate along its full length must be assessed. It is not uncommon to find patients with relatively normal-appearing anterior inferior turbinates, but with very pronounced posterior (tail) cobblestoned turbinate hypertrophy. The relationship of the inferior turbinate hypertrophy to nasal septal deviation in particular should be assessed. Some patients with septal deviation may yet still be candidates for inferior turbinate reduction alone if the turbinate component is felt to contribute substantially more to the nasal obstruction. Unfortunately, no clear-cut testing modality will define the individual contributions to nasal obstruction for these anatomic factors. However, we and others have found that a topical nasal decongestant test with neosynephrine or oxymetazoline may help identify patients more likely to benefit from inferior turbinate reduction. Patients must be cautioned that this pharmacologic turbinate reduction is supraphysiological and may exaggerate what is achievable with mechanical inferior turbinate reduction. Those patients who demonstrate an improvement in their subjective sense of nasal breathing and/or objectively demonstrate improvement in their nasal patency (as measured by acoustic rhinometry or nasal endoscopy) are more likely to achieve benefit with inferior turbinate reduction alone. We avoid mixing topical lidocaine in conjunction with topical decongestants because it may confound the patient’s subjective assessment of their nasal breathing. A small fraction of patients will have limited improvement with topical decongestion, still demonstrating large inferior turbinates. These patients often have a large bony (concha) inferior turbinate and may be better candidates for submucous resection techniques. Patients with significant nasal septal deviation (especially in the anterior or mid-nasal cavity), sinonasal polyposis or adenoid hypertrophy are often not good candidates for inferior turbinate reduction alone.