Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Cryosurgery Vs Trichloroacetic Acid Chemical Cautery for the Treatment of Hypertrophied Nasal Turbinate: A Comparative Study

Document Type : Original

Authors
Satish S. Satpute 1
Samir V. Joshi 2
Ripudaman Arora 1
Neel Prabha 3
Prashant Keche 4
Nitin M.Nagarkar 1
1 Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
2 Department of Otorhinolaryngology and Head and Neck Surgery, BJ Government Medical College, Pune, India.
3 Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
4 Department of Otorhinolaryngology and Head and Neck Surgery, SVN Govt Medical College, Yavatmal, India.
10.22038/ijorl.2019.39039.2293
Abstract
Introduction:
The Study Aimed To Compare The Results of Cryosurgery With Trichloroacetic Acid Chemical (TCA) Cautery For The Treatment of Hypertrophied Nasal Turbinates.
 
Materials and Methods:
This was a prospective study of 70 patients with nasal obstruction due to hypertrophied nasal turbinates who were randomly divided in 2 groups of 35 each. In group 1, patients underwent inferior nasal turbinate reduction by cryosurgery and in group 2 patients with cautery by 50 % TCA. The patients were evaluated using SNOT-20 score pre and postoperatively on 6th month.
 
Results:
Significant improvement in symptoms was seen in 28 patients (80 %) in group 1 and in 10 patients (28.57%) in group 2..Improvement in average SNOT Score after cauterization of hypertrophied nasal turbinates by cryosurgery was from 55(severe) to 16(mild) and by TCA was from 54(severe) to 32(mod) in 6 months and this was statistically significant (p <0.001). Complications like bleeding, scarring, infection and adhesion formation were more with TCA than that of cryosurgery group and among these complications scarring was statistically significant (P =0.003).
 
Conclusion:
The use of cryosurgical treatment for hypertrophied nasal turbinates is a safe, curative method as compared to that of TCA cautery which is less curative and with more complications.
Keywords
Cryosurgery
Inferior turbinate hypertrophy
Trichloroacetic acid
  1. Yoseph R, Gabriel R. A comparison of partial inferior turbinectomy and cryosurgery for hypertrophied inferior nasal turbinate. J LaryngoloOtol 1996; 110:732-735.
  2. Elwany S, Harrison R; Inferior turbinectomy: comparison of four techniques J LaryngolOtol 1990; 104:206-209.
  3. Piccirillo JF, Merritt MG, Richards ML. Psychometric and clinimetric validity of the 20-item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 2002;126:41-47.
  4. Ozenberger JM. Cryosurgery in chronic rhinitis. Laryngoscope. 1970;80;723-734.
  5. Varshney S, Chandra K. Cryosurgery in allergic rhinitis. Indian J Otolaryngol Head Neck Surg 1997; 49:66–69.
  6. Strome M. A long-term assessment of cryotherapy for treating vasomotor instability. Ear Nose Throat J 1990;69:839–842.
  7. Kajra J, Jokien K, Palva A. Experiences with cryotherapy in otolaryngologicalpractice.JLaryngol Otol. 1975; 89:519-526.
  8. Molony TJ.Cryosurgery in chronic nasal obstruction. J Otolaryngol. 1976;5:156-158.
  9. Mehra YN, Mann SB, Mehta S.Cryosurgery in vasomotor rhinitis: A analysis of 156 patients. Indian J Otolarynangol 1990;92: 95–98.
  10. Bumsted RM. Cryotherapy for chronic vasomotor rhinitis: technique and patient selection for improved results. Laryngoscope 1984;94:539-44.
  11. Chiossone E, Gutierrez JR, Emmanuelli JL. Cryosurgery of the inferior nasal turbinates. Auris Nasus Larynx 1990;17:87-93.
  12.  Ozenberger JM. Cryosurgery in chronic rhinitis. Laryngoscope 1970;80:723-734.
  13. Hartely C, Willatt DJ. Cryotherapy in the treatment of nasal obstruction: indications in adults. Journal of laryngolotol 1995;109:729-732.
  14. Warwick-Brown NP, Marks NJ. Turbinate surgery: How effective is it? J Otol Rhinol Laryngol 1987;49:314-320.
  15. Puhakka H, Rantanen T. Cryotherapy as a method of treatment in allergic and vasomotor rhinitis. J Laryngol Otol. 1977;91:535–539.
  16. Principato JJ. Chronic vasomotor rhinitis: cryogenic and other surgical modes of treatment. Laryngoscope.1979;89:619–638.
  17. Scoppa J. Vasomotor rhinitis. A review and management by intranasal cryotherapy. Med J Aust1985;143:448–450.
  18. Hwang PH, Lin B, Weiss R, Atkins J, Johnson J. Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis. Int Forum Allergy Rhinol 2017;7:952–956.
  19. Anand CS, Agarwal SR, Halla ASB, Verma SK, Saksena AK. A comparative study of cryosurgery and submucos dithermy in vasomotor rhinitis. Indian J Otolarynangol 1986;38:39–40.
  20. Elwany S, Harrison R. Inferior turbinectomy : comparison of four techniques. Journal of laryngol and otol 1990;104:206-209.
  21. Yao K, Sato K, Usui D, Kurihara R, Okamoto M, Iguchi Y, et al. Chemosurgery with trichloroacetic acid for allergic rhinitis: evaluation of the efficacy in terms of inhibition of Th2 cell infiltration. Auris Nasus Larynx 2009;36:292-299.
  22. Al-Anbaki F, Al-Sarhan H. Evaluation of treatment of sneezing and rhinorrhoea by local application of trichloroacetic acid in patients with non infective rhinitis. Iraqi J Comm Med 2009;22:192-196.
  23. Unsal Tuna EE, Ozbek C, Koç C, Ozdem C. Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid. Am J Otolaryngol 2008;29:37-41.
  24.  Nemade S, Sampate P, Shinde K. Clinical efficacy of combined treatment with trichloroacetic acid chemical cautery and steroid spray in allergic rhinitis with inferior turbinate hypertrophy. Tr-ENT 2018;28:85-92.
  25. Honda K1, Ooki K, Makishima K. Topical applications of trichloroacetic acid as therapy for nasal allergy.Eur Arch Otorhinolaryngol 1994; 251: S65-67.
  26. Al-Anbaki F, Al-Sarhan H. Evaluation of treatment of sneezing and rhinorrhoea by local application of trichloroacetic acid in patients with non infective rhinitis. Iraqi J Comm Med 2009; 22:192-196.
  27. Azevedo AF, Martins DA, Cardoso CG, Moraes IFC, Michel LMP, Leite LHR, et al. Chemical cautery of the inferior turbinates with trichloroacetic acid. Int Arch Otorhinolaryngol 2011;15:475-477.

 

Iranian Journal of Otorhinolaryngology
Volume 32, Issue 5 - Serial Number 112
September and October 2020
Pages 303-309