COMPARISON OF MICRODEBRIDER - ASSISTED TURBINOPLASTY VERSUS ENDOSCOPIC PARTIAL TURBINECTOMY IN CASES OF INFERIOR TURBINATE HYPERTROPHY IN ALLERGIC RHINITIS PATIENTS

Objective: To compare microdebrider-assisted turbinoplasty versus endoscopic partial turbinectomy in cases of inferior turbinate hypertrophy in allergic rhinitis patients in terms of relief/improvement of nasal obstruction, post operative bleeding, crusting and synechie formation. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Mardan and Combined Military Hospital Malir, from Jan 2019 to Jan 2020. Methodology: A total of 90 patients of allergic rhinitis with severe nasal obstruction due to bilateral inferior turbinate hypertrophy fulfilling the inclusion exclusion criteria were selected. Cases were randomly divided into two groups of 45 each. Group A cases underwent microdebrider assisted turbinoplasty and Group B cases underwent partial turbinectomy via endoscpic approach. They were comparedin terms of post op bleeding, relief of nasal obstruction, post op crusting & synechie/adhesions. All the data was entered on SPSS-17 and analyzed. Results: Out of 90 cases, there were 43 (47.8%) females and 47 (52.2%) males with age range from 15-65, mean age 37.68 ± 11.56 Years. There was only 1 case of post op bleeding after microdebrider assisted turbinoplasty requiring nasal packing in contrast to 6 cases of post op bleeding after endoscopic partial turbinectomy. On one month post op visit, there was no case of nasal crusting in turbinoplasty group in contrast to 7 of mild and 1 of moderate crusting & 3 synechie/adhesions in endoscopic partial turbinectomy group. Conclusion: Microdebrider-assisted turbinoplasty is associated with less post operative bleeding and synechie formation as compared to endoscopic turbinectomy.

COMPARATIVE STUDY BETWEEN CONVENTIONAL INFERIOR TURBINECTOMY AND ENDOSCOPIC INFERIOR TURBINOPLASTY FOR TREATMENT OF INFERIOR TURBINATE HYPERTROPHY

Objective: To compare efficacy of endoscopic turbinoplasty versus conventional inferior turbinectomy for hypertrophy of inferior turbinate. Study Design: Comparative prospective study. Place and Duration of Study: Ear, Nose and Throat (ENT) Department Combined Military Hospital (CMH) Multan, from Jun 2019 to May 2020. Methodology: This study comprised of 50 patients of various age groups and both genders. Patients were grouped into two groups A and B, each group having 25 patients through random sampling. Patients in group A had endoscopic turbinoplasty whereas patients in group B had partial turbinectomy through conventional surgical method. Patients were followed regularly in both groups and were inspected postoperatively at 2 weeks, after 1 month and after 3 months. Results: Patients who underwent Endoscopic turbinoplasty experienced less pain (p˂0.05) postoperatively at 2 weeks compared to conventional surgical turbinectomy. In addition, these patients showed statistically significant healing and reduced crusting at 1 month postoperatively. At 3 months post operatively all patients had healed completely as opposed to only 72% with surgical turbinectomy. Conclusion: Endoscopic turbinoplasty is more effective than conventional surgical technique for inferior turbinate hypertrophy as it leads to less post-operative pain, reduced nasal crusting and earlier healing.

Benefits of Turbinectomy vs Turbinoplasty – A Prospective Study

Introduction Inferior turbinate hypertrophy (ITH) is one of the major causes of nasal airway obstruction. Nasal obstruction due to inferior turbinate hypertrophy is noted in around 20% of the population. Surgical reduction of the hypertrophied inferior turbinate is required when medical treatment fails. This study aimed to compare the Nasal obstruction symptom evaluation (NOSE) scores and complications of inferior turbinate reduction by turbinectomy and turbinoplasty. Materials and Methods In this prospective observational randomized controlled study, 30 patients underwent turbinectomy and 30 underwent turbinoplasty. Pre and postoperative NOSE scores and incidence of postoperative bleeding and crusting were compared at first week and six months. Results The mean preoperative NOSE score of turbinectomy group was 75.83 and that of turbinoplasty group was 76.83. Both the groups showed statistically significant improvement (p< 0.05) in NOSE score post-operatively. Functional outcome is achieved with turbinoplasty by sparing the nasal mucosa and submucosa along with retention of function bearing structures (inferior turbinate). Though not statistically significant, the incidence of post-operative bleeding and crusting were lower after turbinoplasty, in comparison to turbinectomy. Conclusion Inferior turbinoplasty provides excellent outcome in a wide variety of patients with minimal morbidity. Turbinoplasty is associated with lesser mucosal injury, post-operative bleeding and crusting, and excellent outcome in terms of symptomatic relief and functionality. Hence, we recommend that it can be done for the treatment of ITH.

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

Aim: To govern the incidence of allergic fungal sinusitis in patients with nasal polyposis. Various anatomical risk factors were also investigated, including turbinate hypertrophy, deviated nasal septum and comorbidities such as asthma and diabetes. Study Design: This is a Descriptive cross-sectional study. Place and duration of study:The study was conducted at ENT Head &Neck Surgery department, Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for the duration of six months from May 2020 to October 2020. Methods: 110 patients with nasal polyps were evaluated and operated on. Samples were sent for histopathological examination and culture. All patients were assessed with clinical examination and detailed history. Laboratory tests were performed including complete blood counts, urea, electrolytes, ECG and chest radiographs for the suitability of general anesthesia as a prerequisite for surgery. In 95% of cases, computed tomography was recommended to check for sinus involvement, bone erosion, osteo-hypertrophic complex, turbinate hypertrophy, nasal septal deviation, and intracranial and intra-orbital enlargement. MRI examinations were also recommended in cases of suspected intraocular and intracranial disease (5%). Data was scrutinized on a computer using SPSS version 22.0. Results:Of the 110 patients, 65 were male and 45 were female, with a mean age of 1and ranged from 7 to 80 years. All patients had nasal polyps. The incidence of AFS was approximately 29.1% and the remaining 78 had a different pathology. Major deviation of the nasal septum and bilateral hypertrophy of the inferior turbinate’s were observed in 6 (18.7%) and 4 (12.5%) patients, respectively. Unilateral nasal polyps were observed in 7 (21.9%) patients and bilateral nasal polyps in 18 (52.3%). 19/32 (59.4%) of the cases underwent functional endoscopic surgery of the paranasal sinuses, and in 6 (18.7%) external fronto-ethmoidectomy. Two patients underwent nasal ethmoidectomy. Septoplasty and endoscopic sinus surgery were performed in a total of 3 (9.37%) cases. Key words:Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal sinusitis (AFS).

Clinical Outcome of CO2 Laser Inferior Turbinate Reduction in Patients with Nasal Obstruction Due to Inferior Turbinate Hypertrophy in a Tertiary Care Centre, Thiruvananthapuram, Kerala

BACKGROUND Nasal obstruction secondary to inferior turbinate hypertrophy significantly affects the quality of life. Patients refractory to medical treatment are taken up for surgery. Laser turbinate reduction is an effective and simple method for treatment of nasal obstruction due to inferior turbinate hypertrophy. Only a few studies reported on the outcome of laser inferior turbinate reduction in India. The present study was done to assess the clinical outcome of laser inferior turbinate reduction in patients with nasal obstruction due to inferior turbinate hypertrophy. METHODS This prospective observational study was done in 31 patients (18 – 60 years) with nasal obstruction due to inferior turbinate hypertrophy refractory to medical management who underwent laser inferior turbinate reduction in ENT Department, Government Medical College, Thiruvananthapuram from December 2017 to September 2019. RESULTS All patients had bilateral inferior turbinate hypertrophy. 21 out of 31 patients had allergic rhinitis and rest had non-allergic rhinitis. Pre-operatively most patients had symptom score between 15 and 20. After CO2 laser inferior turbinate reduction at the end of 3 months of follow up, subjective assessment by symptom scoring confirmed by objective assessment by flowmetry 29 out of 31 patients had good outcome with relief from nasal obstruction. The success rate was more in nonallergic rhinitis (100 %) than the allergic rhinitis group (90.47 %). CONCLUSIONS CO2 laser inferior turbinate reduction is an effective procedure to relieve nasal obstruction in patients with inferior turbinate hypertrophy refractory to medical treatment, with minimal complications. Post-procedure on follow up significant number of patients had relief from hyposmia, sneezing and running nose. KEYWORDS Nasal Obstruction, Peak Nasal Inspiratory Flowmetry, Symptom Scoring, CO2 Laser, Outcome