Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse

• Published in: American journal of rhinology 2008-07, Vol.22 (4), p.433-439
• Main Authors: Caffier, Philipp P, Frieler, Katja, Scherer, Hans, Sedlmaier, Benedikt, Göktas, Onder
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Laser Therapy - methods; Lasers, Semiconductor - therapeutic use; Male; Middle Aged; Nasal Decongestants - adverse effects; Nasal Obstruction - etiology; Nasal Obstruction - surgery; Otorhinolaryngologic Surgical Procedures - methods; Patient Satisfaction; Prospective Studies; Rhinitis - chemically induced; Rhinitis - complications; Time Factors; Treatment Outcome; Turbinates - surgery
• ISSN: 1050-6586; 1945-8924; 1539-6290; 1945-8932
• DOI: 10.2500/ajr.2008.22.3199

The purpose of this study was to evaluate long-term outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in therapy-refractory rhinitis medicamentosa (RM). In a prospective clinical investigation, 42 consecutive RM patients underwent videoendoscopic ITR with a diode laser after topical anesthetic preparation. Intra- and perioperative details were recorded including the occurrence of bleeding, crusting, pain, or discomfort. Treatment efficiency was assessed by follow-ups 1 and 6 weeks as well as 6 and 12 months after surgery. Subjective pre- and posttherapeutic nasal airflow (NA) and patient satisfaction were rated on visual analog scales (VASs). Assessment of the long-term objective clinical effectiveness was based on rhinomanometry, IT photodocumentation, and the recurrent need for decongestants. Preoperative addiction to decongestants lasted 5 +/- 2 years (mean +/- SD). There was no major bleeding requiring nasal packing, and there were no other perioperative complications. Postoperative edema disappeared within the 1st week and crusting within 6 weeks after surgery. VAS was characterized by very low values for intraoperative pain and discomfort and high postoperative patient satisfaction. After 6 months, NA data revealed a significant improvement of subjective VAS and objective rhinomanometry (250.4-413.9 cm3/s inspiration at 150 Pa). A total of 88% of patients managed to successfully stop decongestant abuse after 6 months (74% after 1 year). In therapy-refractory RM, outpatient diode laser ITR of hyperplastic IT represents a highly effective, safe, and well-tolerated treatment option that provides long-lasting recovery by markedly improving NA and stopping addiction to nasal decongestants.