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Radiofrequency treatment of turbinate hypertrophy to improve nasal CPAP usage
P54
OtolaryngologyHead and Neck Surgery August T999
Scientific Sessions--Sunday
Objective: To evaluate the effect of radiofrequency (RF) volumetric reduction (by Somnus probe) of the palate on snoring, speech, swallowing, taste, and sleep 12 to 18 months following treatment. This investigation is a follow-up of the previously reported study on RF treatment of the palate in subjects with sleep-disordered breathing. Methods: Twenty-two patients with sleep-disordered breathing treated with RF volumetric reduction of the palate 12 to 18 months prior were evaluated by clinical examination, questionnaires, and visual analog scales (VASs) to subjectively assess snoring, speech, swallowing,taste, and sleep. Patients with relapse of snoring were offered further RF treatment. The above variables were evaluated following the completion of retreatment. Results: After a mean follow-up period of 14 months (range 12-18 months), no adverse effect on speech, swallowing, or taste was reported. Subjective snoring score relapsed by a mean of 29% overall. Thirteen patients (59%) demonstrated continual success without relapse of snoring or daytime sleepiness. Nine patients (41%) noted relapse of snoring (VAS 0-10) from 2.1 _+1.1 to 5.7 _+2.8, accompanied by worsening of Epworth sleepiness score (ESS) from 5.4 _+3.2 to 7.8 _+ 5.3. Eight of the patients underwent further RF treatment. Following retreatment, the snoring score fell from 5.8 _+2.9 to 3.3 -+ 3.1, with improved ESS from 7.8 -+ 5.6 to 6.3 _+4.6. No adverse effects on speech, swallowing, or taste were reported following retreatment. Conclusion: This investigation suggests that the success of RFVR of the palate diminishes with time, as with other surgical procedures of the palate. The 12- to 18-month follow-up outcomes variables are comparable with those of laser-assisted uvulopalatoplasty or traditional uvulopalatoplasty. However, the minimal invasiveness of the RF treatment provided a high patient acceptance for retreatment, and relapse of snoring can be improved after retreatment. 11:00 AM
Radlofrequency Treatment of Turbinate Hypertrophy to Improve Nasal CPAP Usage NELSON B POWELL MD; ROBERT W RILEY MD DDS; ADRIANE I ZONATO MD (presenter); KASEY K LI MD DDS; ROBERTJ TROELL MD; Sao Paulo Brazil; Palo Alto CA; Palo Alto CA; Sao Paulo Brazil; Palo Alto CA; Palo Alto CA
Objectives: To investigate the use of radiofrequency (RF) treatment to improve the use of nasal CPAP in subjects complaining of nasal congestion refractory to medical management of diagnosed turbinate hypertrophy. Methods: A prospective randomized double-blindplacebocontrolled study in which 22 subjects underwent pretreatment (2 weeks) and posttreatment (4 weeks) rhinoscopy and visual analog scales (VAS) of nasal obstruction and CPAP tolerance, with metered (objective) compliance of CPAP use time. RF turbinate ablation was via a Somnus instrument for a single outpatient treatment session. Randomized placebos (n = 5)
received blinded treatment without energy delivery. Reevaluation (n = 22) was at 1 day, 2 to 3 days, 1 week, 4 weeks following treatment. Results: Twenty-two patients (12 women, mean age 54.3 years, BM129.3 kg/m2, and RDI 33.5) started and finished the protocol. A mean of 413 J of RF energy was given to each turbinate. Investigators (before and after treatment) found an overall mean clinical change of 27.0% (right and left turbinates) compared with patients' (n = 17) subjective (VAS) change in nasal obstruction, which was 48.0%. The placebo (n = 5) change by investigators was 27.0% and by patients 28.7%, respectively. Tolerance (n = 17) to CPAP improved 28.9% (VAS, 4.92-6.34) versus placebo (n = 5) decrease of 10.4% (VAS, 4.36-3.32). Computer-metered CPAP compliance in treated subjects was pretreatment 5.6 hours/day to post treatment 5.8 hours/day versus the placebo of 4.11 hours/day to 3.75 hours/day. Conclusion: Tolerance of CPAP was subjectively improved 28.9% in patients after treatment. This finding paralleled our anatomic clinical nasal findings and those of patients' VAS scores for nasal turbinate obstruction, suggesting increased airway size may improve ease of CPAP use. This positive outcome was even in light of the fact that objective CPAP compliance in this group was not significantly changed with RF treatment. The outcomes of the placebo controls were further evidence to support our conclusions and strengthen the need to continue usage of randomized placebo-controlled studies for such treatment outcomes. 11:08 AM
Radiofrequency vs. LAUPfor the treatment of Snoring MARC BERNARD BLUMEN MD (presenter); SERGE DAHAN MD; PIERRE DREWSKI MD; FREDERIC CHABOLLE MD; Suresnes France
Objectives: Laser-assisted uvulopalatopharyngoplasty (LAUP) is efficacious in treating snoring but is painful. Radiofrequency (RF) reduces tissue volume and stiffens it. Its application on the soft palate may be as efficacious as LAUP but better tolerated because it spares the mucosa. We prospectively compared RF to LAUP for short-term subjective efficacy on snoring and for tolerance as regards to pain, medication consumption, and diets. Methods: Fourteen consecutive patients were treated with RF, and then 7 consecutive patients were treated with LAUP. All patients underwent preoperative physical examinations and level I or level III polysomnography. The soft palate was the only site of obstruction. Patients were all simple snorers or had mild sleep apnea with an apnea-hypopnea index below 20/hour. Snoring was evaluated on a visual analog scale (VAS) by the bed partner before and 6 weeks after the last procedure. Pain and discomfort were evaluated daily on a VAS, as were medication (analgesics, steroids, antibiotics) and diet (normal, liquid). Patients could not have more than 3 sessions of either treatment. A Mann-Whimey test was used to evaluate efficacy
OtolaryngologyHead and Neck Surgery August T999
Scientific Sessions--Sunday
Objective: To evaluate the effect of radiofrequency (RF) volumetric reduction (by Somnus probe) of the palate on snoring, speech, swallowing, taste, and sleep 12 to 18 months following treatment. This investigation is a follow-up of the previously reported study on RF treatment of the palate in subjects with sleep-disordered breathing. Methods: Twenty-two patients with sleep-disordered breathing treated with RF volumetric reduction of the palate 12 to 18 months prior were evaluated by clinical examination, questionnaires, and visual analog scales (VASs) to subjectively assess snoring, speech, swallowing,taste, and sleep. Patients with relapse of snoring were offered further RF treatment. The above variables were evaluated following the completion of retreatment. Results: After a mean follow-up period of 14 months (range 12-18 months), no adverse effect on speech, swallowing, or taste was reported. Subjective snoring score relapsed by a mean of 29% overall. Thirteen patients (59%) demonstrated continual success without relapse of snoring or daytime sleepiness. Nine patients (41%) noted relapse of snoring (VAS 0-10) from 2.1 _+1.1 to 5.7 _+2.8, accompanied by worsening of Epworth sleepiness score (ESS) from 5.4 _+3.2 to 7.8 _+ 5.3. Eight of the patients underwent further RF treatment. Following retreatment, the snoring score fell from 5.8 _+2.9 to 3.3 -+ 3.1, with improved ESS from 7.8 -+ 5.6 to 6.3 _+4.6. No adverse effects on speech, swallowing, or taste were reported following retreatment. Conclusion: This investigation suggests that the success of RFVR of the palate diminishes with time, as with other surgical procedures of the palate. The 12- to 18-month follow-up outcomes variables are comparable with those of laser-assisted uvulopalatoplasty or traditional uvulopalatoplasty. However, the minimal invasiveness of the RF treatment provided a high patient acceptance for retreatment, and relapse of snoring can be improved after retreatment. 11:00 AM
Radlofrequency Treatment of Turbinate Hypertrophy to Improve Nasal CPAP Usage NELSON B POWELL MD; ROBERT W RILEY MD DDS; ADRIANE I ZONATO MD (presenter); KASEY K LI MD DDS; ROBERTJ TROELL MD; Sao Paulo Brazil; Palo Alto CA; Palo Alto CA; Sao Paulo Brazil; Palo Alto CA; Palo Alto CA
Objectives: To investigate the use of radiofrequency (RF) treatment to improve the use of nasal CPAP in subjects complaining of nasal congestion refractory to medical management of diagnosed turbinate hypertrophy. Methods: A prospective randomized double-blindplacebocontrolled study in which 22 subjects underwent pretreatment (2 weeks) and posttreatment (4 weeks) rhinoscopy and visual analog scales (VAS) of nasal obstruction and CPAP tolerance, with metered (objective) compliance of CPAP use time. RF turbinate ablation was via a Somnus instrument for a single outpatient treatment session. Randomized placebos (n = 5)
received blinded treatment without energy delivery. Reevaluation (n = 22) was at 1 day, 2 to 3 days, 1 week, 4 weeks following treatment. Results: Twenty-two patients (12 women, mean age 54.3 years, BM129.3 kg/m2, and RDI 33.5) started and finished the protocol. A mean of 413 J of RF energy was given to each turbinate. Investigators (before and after treatment) found an overall mean clinical change of 27.0% (right and left turbinates) compared with patients' (n = 17) subjective (VAS) change in nasal obstruction, which was 48.0%. The placebo (n = 5) change by investigators was 27.0% and by patients 28.7%, respectively. Tolerance (n = 17) to CPAP improved 28.9% (VAS, 4.92-6.34) versus placebo (n = 5) decrease of 10.4% (VAS, 4.36-3.32). Computer-metered CPAP compliance in treated subjects was pretreatment 5.6 hours/day to post treatment 5.8 hours/day versus the placebo of 4.11 hours/day to 3.75 hours/day. Conclusion: Tolerance of CPAP was subjectively improved 28.9% in patients after treatment. This finding paralleled our anatomic clinical nasal findings and those of patients' VAS scores for nasal turbinate obstruction, suggesting increased airway size may improve ease of CPAP use. This positive outcome was even in light of the fact that objective CPAP compliance in this group was not significantly changed with RF treatment. The outcomes of the placebo controls were further evidence to support our conclusions and strengthen the need to continue usage of randomized placebo-controlled studies for such treatment outcomes. 11:08 AM
Radiofrequency vs. LAUPfor the treatment of Snoring MARC BERNARD BLUMEN MD (presenter); SERGE DAHAN MD; PIERRE DREWSKI MD; FREDERIC CHABOLLE MD; Suresnes France
Objectives: Laser-assisted uvulopalatopharyngoplasty (LAUP) is efficacious in treating snoring but is painful. Radiofrequency (RF) reduces tissue volume and stiffens it. Its application on the soft palate may be as efficacious as LAUP but better tolerated because it spares the mucosa. We prospectively compared RF to LAUP for short-term subjective efficacy on snoring and for tolerance as regards to pain, medication consumption, and diets. Methods: Fourteen consecutive patients were treated with RF, and then 7 consecutive patients were treated with LAUP. All patients underwent preoperative physical examinations and level I or level III polysomnography. The soft palate was the only site of obstruction. Patients were all simple snorers or had mild sleep apnea with an apnea-hypopnea index below 20/hour. Snoring was evaluated on a visual analog scale (VAS) by the bed partner before and 6 weeks after the last procedure. Pain and discomfort were evaluated daily on a VAS, as were medication (analgesics, steroids, antibiotics) and diet (normal, liquid). Patients could not have more than 3 sessions of either treatment. A Mann-Whimey test was used to evaluate efficacy