Modified technique improves efficacy for in-office posterior nasal nerve ablation.

Autor: Gorelik D; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston Texas USA., Dhanda AK; Rutgers New Jersey Medical School Newark New Jersey USA., Choi A; Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston Texas USA., Takashima M; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston Texas USA., Khan NS; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston Texas USA., Rowan NR; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA., Jafari A; Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery University of Washington Seattle Washington USA., Syed T; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston Texas USA., Ahmed OG; Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery Houston Methodist Hospital Houston Texas USA.
Jazyk: angličtina
Zdroj: Laryngoscope investigative otolaryngology [Laryngoscope Investig Otolaryngol] 2024 Mar 25; Vol. 9 (2), pp. e1238. Date of Electronic Publication: 2024 Mar 25 (Print Publication: 2024).
DOI: 10.1002/lio2.1238
Abstrakt: Objectives: Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves.
Methods: Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms.
Results: Forty-five patients received treatment and completed 3-month follow-up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p  = .004).
Conclusions: This report suggests improved efficacy with implementation of the modified technique for in-office PNN ablation. Given the extensive nature of the post-ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed.
Level of Evidence: III.
Competing Interests: Masayoshi Takashima: consultant for Aerin® Medical, Medtronic, Acclarent®, and LivaNova. Omar G. Ahmed: consultant for Aerin® Medical and Medtronic.
(© 2024 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje