178 RUSSIAN RHINOLOGY, 3, V. 30, 2022
Original articles
Russian Rhinology
2022, Vol. 30, No. 3, pp. 178-182
https://doi.org/10.17116/rosrino202230031178
Current approach to surgical treatment of patients with hypertrophic rhinitis
© E.M. POKROVSKAYA¹,², V.N. KRASNOZHEN¹,², S.A. POLISHCHUK², T.R. KARIMOV¹, E.F. MANNANOVA¹,²
¹Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan, Russia;
²Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
Abstract
Recently, surgical radio wave and coblation techniques have taken a significant place in the treatment of chronic hypertrophic rhinitis. The article discusses methods of surgical treatment of hypertrophic rhinitis using the ESG-01-"ElePS" electrosurgical system.
Objective. To study the results of clinical application of the ESG-01-"ElePS" electrosurgical system in chronic hypertrophic rhinitis.
Material and methods. The study included 32 patients aged 25 to 42 years with hypertrophic rhinitis who underwent radiofrequency coagulation and coblation of the inferior nasal turbinates using the ESG-01-"ElePS" device. In the postoperative period, reactive phenomena in the surgical area were assessed using nasal endoscopy, and nasal cavity patency was assessed using active anterior rhinomanometry.
Results. One month after the intervention, completion of regeneration processes of the nasal mucosa and restoration of respiratory function to physiological normal values were observed.
Conclusion. The conducted study demonstrated good clinical and functional effect of using the ESG-01-"ElePS" electrosurgical system, indicating the advisability of using the device in the surgical treatment of hypertrophic rhinitis.
Keywords: chronic rhinitis, hypertrophic rhinitis, radiofrequency coagulation of the inferior nasal turbinates, coblation of the inferior nasal turbinates.
Information about the authors:
Pokrovskaya E.M. — https://orcid.org/0000-0001-9437-4895
Krasnozhen V.N. — https://orcid.org/0000-0002-1564-7726
Polishchuk S.A. — https://orcid.org/0000-0001-8680-7662
Karimov T.R. — https://orcid.org/0000-0002-8698-9774
Mannanova E.F. — https://orcid.org/0000-0002-6085-1275
Corresponding author: Pokrovskaya E.M. — e-mail: epokrunia@inbox.ru
For citation:
Pokrovskaya EM, Krasnozhen VN, Polishchuk SA, Karimov TR, Mannanova EF. Current approach to surgical treatment of hypertrophic rhinitis. Russian Rhinology. 2022;30(3):178–182. https://doi.org/10.17116/rosrino202230031178
Current approach to surgical treatment of hypertrophic rhinitis
© E.M. POKROVSKAYA¹,², V.N. KRASNOZHEN¹,², S.A. POLISHCHUK², T.R. KARIMOV¹, E.F. MANNANOVA¹,²
¹Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan, Russia;
²Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
Abstract
Recently, surgical radio wave and coblation techniques have taken a significant place in the treatment of chronic hypertrophic rhinitis. The article discusses methods of surgical treatment of hypertrophic rhinitis using the ESG-01-"ElePS" electrosurgical system.
Objective. To study the results of clinical application of the ESG-01-"ElePS" electrosurgical system in chronic hypertrophic rhinitis.
Material and methods. The study included 32 patients aged 25 to 42 years with hypertrophic rhinitis who underwent radiofrequency coagulation and coblation of the inferior nasal turbinates using the ESG-01-"ElePS" device. In the postoperative period, reactive phenomena in the surgical area were assessed using nasal endoscopy, and nasal cavity patency was assessed using active anterior rhinomanometry.
Results. One month after the intervention, completion of regeneration processes of the nasal mucosa and restoration of respiratory function to physiological normal values were observed.
Conclusion. The conducted study demonstrated good clinical and functional effect of using the ESG-01-"ElePS" electrosurgical system, indicating the advisability of using the device in the surgical treatment of hypertrophic rhinitis.
Keywords: chronic rhinitis, hypertrophic rhinitis, radiofrequency coagulation of the inferior nasal turbinates, coblation of the inferior nasal turbinates.
INTRODUCTION
The relevance of issues related to the choice of method for surgical intervention on the inferior nasal turbinates is determined, on one hand, by the high prevalence of nasal breathing disorders in patients with chronic rhinitis, and on the other hand, by the insufficient effectiveness of drug therapy for this disease [1-4].
Currently, various surgical interventions are widely used in the treatment of patients with chronic rhinitis, particularly radiofrequency coagulation [5, 6]. Cold-plasma surgery — coblation (from English: cold ablation) — is a unique method of delivering radiofrequency energy to soft tissues for use in otorhinolaryngology. When using radiofrequency in bipolar mode with a conductive solution such as saline, ions are excited in the solution, resulting in the formation of a small plasma field. The coblation technique is of great scientific and practical interest because it has several advantages over other methods: low impact temperature (40-70°C), good hemostatic effect and, accordingly, minimal risk of postoperative bleeding, small and precisely dosed depth of tissue evaporation, and absence of damaging effects on adjacent tissues. The therapeutic effect achieved one month after radiosurgical intervention and coblation is associated with the development of submucosal fibrosis and scarring in the stroma of the nasal turbinate tissue, reduction of stromal edema with intact basement membrane and ciliated epithelium, which indicates minimal concomitant thermal damage [7-10].
Unfortunately, the high cost of devices with cold-plasma surgery function makes this method still largely inaccessible to most medical institutions, which suggests the use of import-substituting technologies.
Objective of the study — to study the results of clinical application of the ESG-01-"ElePS" electrosurgical system in chronic hypertrophic rhinitis.
MATERIAL AND METHODS
The study included 32 patients aged 25 to 42 years with hypertrophic rhinitis who were hospitalized in the otorhinolaryngology department of the "Family Health" clinic (Kazan).
The diagnosis of "hypertrophic rhinitis" was established based on complaints, medical history data, nasal endoscopy, and computed tomography of the paranasal sinuses (CT PNS).
All patients presented with characteristic complaints of persistent difficulty in nasal breathing, rhinorrhea, and lack of effect from previously conducted conservative therapy. Diagnostic endoscopy and CT PNS revealed the cavernous form of hypertrophic rhinitis in 20 patients, and the papillary form, characterized by proliferation of the posterior ends of the inferior nasal turbinates, in 12 patients.
Objective assessment of respiratory function in the preoperative and postoperative periods was performed using a "Rhinolan" PTS-14P-01 rhinomanometer ("Lanamedica", St. Petersburg). The clinically established diagnosis of "hypertrophic rhinitis" was additionally confirmed by the results of active anterior rhinomanometry (AAR) after a test with decongestants. The classification of obstruction degree is presented in Table 1 [11].
All patients underwent surgical intervention using the ESG-01-"ElePS" device (Fig. 1), which is a new development of the research and production company "ElePS". The device supports the following operating modes: "Coagulation", "Cutting", "Coagulation in NaCl solution", "Cutting in NaCl solution". The working attachments of the device are similar to those of the Coblator II device.
Under infiltration anesthesia, all patients underwent intraturbinal radiofrequency coagulation of the inferior nasal turbinates. For this purpose, a straight bipolar electrode was inserted into the anterior end of the inferior nasal turbinate up to its posterior sections (Fig. 2). The electrode was advanced submucosally, applying the "Coagulation" mode, from the posterior to the anterior end of the turbinate. In 12 patients with the papillary form of hypertrophic rhinitis, intraturbinal radiofrequency coagulation was supplemented with coblation of the posterior ends of the inferior nasal turbinates. For this, an extraturbinal technique was used employing bipolar cold-plasma electrodes with irrigation in the "Ablation in NaCl solution" mode (Fig. 3). No packing was performed after the intervention.
Results were evaluated on the first day after surgery, after 3 days, and after 1 month based on analysis of patient complaints, nasal endoscopy, and AAR data.
Data analysis was performed using Jamovi 2.2.3 software. Quantitative variable data were presented in tables showing the mean value, median, standard deviation, and interquartile range. Distribution analysis was performed using the Shapiro-Wilk test. For analysis of quantitative variables for two groups, the Wilcoxon test for related samples was used, as well as the exact probability value of type I error (p). The value of exact two-sided significance was examined; results were considered statistically significant at p<0.05. Visualization of quantitative variables was performed using box plots.
RESULTS
On the first day after surgical intervention, the number of complaints about difficulty in nasal breathing and rhinorrhea increased slightly compared to the preoperative period. Postoperative edema of the nasal mucosa was moderately expressed. In the posterior parts of the nasal cavity, fibrinous deposits were detected in 12 patients after coblation of the posterior ends of the inferior nasal turbinates. Three days after surgery, all patients showed positive dynamics, expressed in a decrease in the number of complaints, reduction in the severity of reactive phenomena from the nasal mucosa, and significant improvement in nasal respiratory function.
On the 30th day after radiofrequency coagulation, most subjects had no complaints, the nasal mucosa was completely cleared of fibrinous deposits, and the rhinoscopic picture corresponded to normal.
According to the results of AAR performed one month after surgery, a significant improvement in total flow (Fig. 4) and total resistance (Fig. 5) was revealed. While in the preoperative period total flow and total resistance corresponded to a moderate degree of obstruction, one month after surgical intervention they reached normative values (Table 2).
CONCLUSION
Thus, the results of the study demonstrated good clinical and functional effect of using the ESG-01-"ElePS" electrosurgical system, which indicates the advisability of using this technology in the surgical treatment of patients with hypertrophic rhinitis.
Author contributions: Concept and design of the study — V.N. Krasnozhen, E.M. Pokrovskaya; Collection and processing of material — S.A. Polishchuk, T.R. Karimov, E.F. Mannanova; Writing the text — E.M. Pokrovskaya; Editing — E.M. Pokrovskaya.
