Nasal Allergy-Surgical treatment –Coblation vs. Laser
Nasal allergy is a very common problem affecting a large percentage of the population and very difficult to treat. Most of the chronic patients feel frustration even after completing all conventional modalities of treatment.
Various surgical procedures have been recently proposed for the treatment of allergic rhinitis-hypertrophic inferior turbinates.
As a result of the advances made in medical technology and growing public demand for minimally invasive therapies, the recent advances in treatment of nasal allergy are Coblation surgery and Laser surgery.
For many years I have been surgically treating allergic rhinitis with the following modalities-
1- Submucus diathermy of inferior turbinate
2- Cryosurgery of inferior turbinates
3- Partial inferior turbinectomy
4- Laser surgery using Co2 laser
5- Coblation Turbinoplasty.
Submucous diathermy (SMD)
Submucous Diathermy (SMD) involves passing a probe just below the mucosal surface lining of the turbinate bones and cauterizing using heat energy to shrink the size of theses structures. This preserves most of the mucosal lining and allows for preservation of normal function.
Crusting is the most often complication of this procedure. Saline gel or Vaseline can be used to keep it moist post op.
Cryosurgery of the Inferior Turbinates
I have used cryosurgery as an alternative mode of treatment for providing the permanent relief with regards to this disease for many years in 80s and 90s… Cryosurgery basically freezes and debulks the hypertrophied inferior turbinates as well as the destroys the autonomic innervations, by a cryoprobe. But the long term results were not very encouraging.
Partial Turbinectomy
It can be done under GA only and It takes a long time to heal. But it is very effective in relieving nasal obstruction caused by allergic or vasomotor rhinitis. But I must admit, it is a bloody procedure. Submucosal turbinectomy was also attempted, but it\’s not easy to perform, a messy job.
Laser Turbinectomy-Using Co2 Laser
Since mid 90s, I find Laser turbinectomy is the best surgical option and gives very good result for allergic rhinitis .Over a few hundred cases are being performed with very little morbidity and very good results.
It can be done under LA in the minor theatre or in OPD itself. Only disadvantage is the need of safety precautions. Laser has the added advantage of removing small polyps and also septal spur if encountered.
Coblation surgery
Coblation reduction of the inferior turbinate is known as a Coblation Turbinoplasty (submucous turbinate surgery) that may be performed using RF Coblation wands.
This is the latest surgical method I am using now.
Coblation Turbinoplasty is a method of removing internal turbinate tissue as well as shrinking the turbinate ,called submucosal coblation and it can can be done under local anesthesia. There is no packing needed, no pain, and takes only few minutes. From start to finish, the procedure does not exceed 10 minutes. Often patients are able to resume all activities within 15 minutes after the procedure is completed. Both kids as well as adults benefit from this procedure, though kids generally will require general anesthesia as they usually can’t stay absolutely still when having this procedure done.
The Coblation® method (ArthroCare) uses RF energy between electrodes in a saline medium to create a field of ionized sodium molecules capable of ablating tissue. I use the bipolar wand to make 3-4 tunnels on each inferior turbinate. In each tunnel, the wand is advanced along the underlying bone with the Coblation mode activated and then withdrawn slowly with the cautery mode activated. Bleeding from the puncture sites is common, Sicastat®-Feracrylum gel is applied to control bleeding
As it is a submucosal technique, it preserves overall nasal physiologic features and is therefore preferred to turbinectomy or surface methods. Coblation radiofrequency is not appropriate for patients with primarily bony turbinate hypertrophy or extremely narrow piriform apertures or with deviated nasal septum.
I find it is useful in reducing the bulk of the inferior turbinates in cases of Allergic and vasomotor rhinitis, where nasal blockage is the main problem.
Conclusion
Over a period of 32 years of doing various surgical procedures for nasal allergy, I find laser and Coblation surgery are both equally effective, note a complete cure but can make the life of these miserable patients a lot better.