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Background and Objective Radiofrequency (RF) turbinoplasty may be effective in treating nonallergic rhinitis in elderly patients. The present study evaluated the efficacy of nasal turbinate surgery with RF for the treatment of nonallergic rhinitis in elderly patients refractory to medical therapy. Methods A total of 35 consecutive patients older than 65 years of age (mean subject age, 75.5 ± 9.6 [standard deviation] years) with nonallergic rhinitis refractory to medical therapy who underwent RF turbinate surgery were enrolled in this study. The efficacy of RF turbinoplasty in treating nonallergic rhinitis in elderly patients was evaluated by using rhinoscopy and a visual analog scale score of nasal symptoms. Results The response rate of primary RF turbinate surgery for nonallergic rhinitis refractory to medical therapy was 68.6%. Postoperative symptom scores for rhinorrhea and nasal obstruction were significantly improved. Persistent crust formation developed in seven patients (20.0%). No patient experienced major complications (e.g., septal hematoma, abscess, septal perforation), but partial bone necrosis was observed in one patient. Conclusion RF turbinoplasty appeared to be effective for treating some nonallergic rhinitis symptoms in elderly patients, including rhinorrhea and nasal obstruction. These preliminary results are encouraging and warrant further investigation.

Crushed cartilage grafts are used to conceal irregularities and achieve a smoother nasal surface. They can potentially be stabilized by a fibrin sealant acting as a carrier. The primary purpose of this study was to assess the clinical outcome of crushed cartilage-fibrin sealant combination grafts for radix augmentation performed in Asian patients.This study included 51 patients (38 men and 13 women) who underwent rhinoplasty with radix augmentation using crushed cartilage grafts. The malleable construct used for radix augmentation contained autologous crushed cartilage grafts stabilized with a fibrin sealant. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes. The mean follow-up period was 18.5 months (range, 12 to 25 months).Preoperative and postoperative objective measurements indicated that the mean increment of the radix projection was 28.5 ± 7.9 percent and that of the nasofrontal angle was 11.5 ± 3.8 degrees. Most patients showed prominent radix augmentation and good cosmetic results. Postoperative aesthetic outcomes were graded as excellent in 41.2 percent of cases, good in 37.3 percent, fair in 15.7 percent, and unchanged/poor in 5.9 percent. Complications included one case (2.0 percent) of partial graft resorption and two cases (3.9 percent) of graft visibility.The results show that the use of a crushed cartilage-fibrin sealant graft is a reliable and effective technique of stabilizing grafts for radix augmentation in Asian patients.Therapeutic, IV.

Background The purpose of this study was to investigate the effect of aerosolized fibrin sealant (FS) compared with that of polyvinyl acetal sponge packing on hemostasis and wound healing after functional endoscopic sinus surgery (FESS). Methods We conducted a prospective randomized controlled trial of the use of aerosolized FS in 41 consecutive patients who underwent bilateral FESS between February 2011 and March 2012. The patients were randomized to receive FS applied via an aerosol spray in one nasal cavity and polyvinyl acetal sponge packing in the opposite cavity. The patients were followed up at 1, 2, 4, 8, and 12 weeks postoperatively. Crusting, adhesion, bleeding, granulation tissue formation, infection, and frontal sinus ostium stenosis after endoscopic surgery were assessed using a grading scale. Subjective symptoms related to nasal packing were evaluated using questionnaires quantified by visual analog scales. Results The degree of granulation and crusting was significantly reduced in the side treated with FS compared with the polyvinyl acetal sponge side, as were bleeding and pain during nasal packing removal (p < 0.05). In addition, general satisfaction and willingness to reuse the material were significantly higher for the FS-treated side than for the polyvinyl acetal sponge-packed side (p < 0.001). Conclusions Compared with polyvinyl acetal sponge, aerosolized FS shows beneficial effects on hemostasis and wound healing after FESS. The application of FS resulted in a high degree of patient satisfaction without additional morbidity.

Low-concentration hypochlorous acid (HOCl) is an endogenous antibacterial and antiviral agent. The purpose of this study was to evaluate the effectiveness of HOCl irrigation in patients with chronic rhinosinusitis (CRS) refractory to medical therapy. Forty-three adult patients (mean age 45.5 years) were enrolled in this study. They were randomly chosen to receive nasal irrigation with either low-concentration HOCl generated by a Salicid device (n = 21), or a placebo (saline; n = 22) for 8 weeks. The outcome measures were scores on the 20-Item SinoNasal Outcome Test (SNOT-20), rhinosinusitis disability index (RSDI), nasal endoscopic score, and bacterial cultures. The SNOT-20 scores were significantly lower in the HOCl group than in the placebo group after 2 weeks of treatment (p 0.05) and remained lower after 4 weeks of treatment. With respect to the RSDI scores, there was a significant improvement in the HOCl group at 1 week after treatment and in both groups at 2 weeks after treatment (p 0.05). There were no significant differences in the endoscopic scores between the two groups after the treatment. The bacterial culture rates were lower in the HOCl group than in the placebo group after 4 weeks of treatment, but this was not significant (p 0.05). Our results showed that low-concentration HOCl irrigation resulted in a greater improvement in CRS symptoms as compared to saline irrigation.

Radiofrequency surgery was introduced to minimize thermal damage to the tissue. A radiofrequency electrode can be used to make cuts in the free edge of the soft palate like those done in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. Tonsillectomy can enlarge the lateral diameter of the pharynx. The aim of our study was to evaluate the efficacy of RAUP with tonsillectomy in treatment of obstructive sleep apnea syndrome (OSAS). Ninety-two patients with obstructive sleep apnea were included in this study. Patients were categorized according to disease severity and Friedman's staging system. Patients were assessed with the preoperative visual analog scale (VAS) for snoring, Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) at baseline and repeated at 6 months postoperatively. The intensity of postoperative pain, speech deficits and dysphagia were also recorded. There was a significant improvement in the VAS score for snoring, ESS and AHI before and after surgery. Overall, the results of the present study indicated a surgery success rate (a 50 % decrease in AHI and AHI

Purpose Fibrin sealant (FS) was approved as a hemostatic agent, sealant, and adhesive by the Food and Drug Administration in 1998. Our study sought to determine whether FS also reduced edema and pain in rhinoplasty without osteotomy. Materials and Methods We conducted a prospective randomized trial involving patients who underwent open rhinoplasty without osteotomy. The patients were randomly assigned to 1 of 2 groups: those treated with aerosolized FS (FS group) and those not treated (control group). The effect of FS on edema of the eyelid, edema of the dorsum and tip of the nose, and periorbital ecchymosis was separately rated postoperatively using a scale of 0 to 4 or 0 to 3. Postoperative pain was evaluated using questionnaires quantified with a visual analog scale. The Mann-Whitney U and Wilcoxon tests were used to compare parameters between the groups. Results A total of 41 patients were included in this study. The FS group (n = 20) consisted of 13 male and 7 female patients with a mean age of 34.8 ± 5.8 years. The control group (n = 21) consisted of 15 male and 6 female patients with a mean age of 32.4 ± 4.8 years. There were no statistically significant differences between the 2 groups with respect to age, gender, or combined surgical techniques (P > .05). Aerosolized FS significantly reduced not only ecchymosis and swelling in the periorbital area but also edema of the nasal dorsum (P Conclusions Aerosolized FS can be effective for reducing eyelid edema, dorsal edema, and periorbital ecchymosis after open rhinoplasty. FS may serve as an adhesive for minimizing dead space by promoting adherence of the skin flap and as a hemostatic agent in reducing the amount of postoperative bleeding by sealing capillary vessels.

Laser-assisted uvulopalatoplasty (LAUP) reduces the need for general anesthesia, bleeding and the operation time compared with uvulopalatopharyngoplasty (UPPP), but the postoperative pain is more severe due to the thermal damage to tissues, and the procedure often causes serious scar contracture of the soft palate, with foreign body sensation also occurring occasionally. Radiofrequency-assisted uvulopalatoplasty (RAUP) uses the same surgical method as LAUP, but employs RF instead of laser. RF surgery induces temperatures of 70-85 degrees C, and causes less damage to the surrounding tissues. Thus, on the assumption that it may reduce problems in LAUP, we applied LAUP and RAUP at random to patients with primary snoring, and compared the results of the two types of operation and both their advantages and disadvantages. Forty-four patients with primary snoring but without apnea were prospectively evaluated with a follow-up period of 6 months: 20 patients received LAUP and 24 patients received RAUP. Postoperative changes in the subjective degree of snoring, the Epworth sleepiness scale score, and the operation time, postoperative pain, episodes of delayed bleeding, globus sensation and scar contracture were compared between the two surgical methods. Snoring symptoms, ESS scores and episodes of delayed bleeding did not differ significantly between the two groups. The operation time was shorter in the LAUP group, and the postoperative pain and postoperative complications (globus sensation and scar contracture) were less in the RAUP group. RAUP results in significantly lower postoperative pain, complications and other problems experienced in LAUP, while maintaining the advantages of LAUP.

Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross-sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction.Prospective randomized study.The study was conducted on two groups (51 patients) with symptoms and signs of nasal obstruction associated with septal body and inferior turbinate hypertrophy that were refractory to medical therapy. In the turbinoplasty only (ITR) group (n = 25), conventional turbinoplasty was only performed on the inferior turbinate. In the septal body reduction (SBR) group (n = 26), concurrent bilateral microdebrider-assisted SBVR was performed during the turbinate surgery.The nasal symptoms, including nasal obstruction, rhinorrhea, itching, and sneezing, had significantly improved at 3 months after treatment in both groups (P0.001). Improvement of nasal obstruction in the SBR group was greater than that in the ITR group at 3 months (P0.05). Acoustic rhinometry demonstrated a significant increase in the cross-sectional area and nasal volume in both groups 3 months after surgery. The postoperative change in nasal volume was higher in the SBR group (P0.05). No adverse reactions such as bleeding, infection, adhesions, or olfactory changes were encountered in the SBR group.Combined SBVR and turbinoplasty appears to be more effective than turbinoplasty alone for the treatment of nasal obstruction in patients with inferior turbinate and septal body hypertrophy.

Environmental fungi have been linked to TH2 cell-related airway inflammation and the TH2-associated chronic airway diseases asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown.To determine the frequency of fungus isolation and fungus-specific immunity in patients with TH2-associated and non-TH2-associated airway disease.Sinus lavage fluid and blood were collected from sinus surgery patients (n = 118) including patients with CRSwNP, patients with CRS without nasal polyps, patients with AFRS, and non-CRS/nonasthmatic control patients. Asthma status was determined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. PBMCs were restimulated with fungal antigens in an enzyme-linked immunocell spot assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared with fungus-specific IgE levels measured from plasma by ELISA.Filamentous fungi were significantly more commonly cultured in patients with TH2-associated airway disease (asthma, CRSwNP, or AFRS: n = 68) than in control patients with non-TH2-associated disease (n = 31): 74% vs 16%, respectively (P.001). Both fungus-specific IL-4 enzyme-linked immunocell spot (n = 48) and specific IgE (n = 70) data correlated with TH2-associated diseases (sensitivity 73% and specificity 100% vs 50% and 77%, respectively).The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with TH2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients.