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Radiofrequency Treatment Improves Nasal Breathing
by George B. Stoneman, M.D.
New technology has been developed for people with chronic nasal obstruction
that is caused by turbinate enlargement. It uses low-power, low-temperature
radiofrequency energy to gently reduce the tissues in the inferior turbinates.
This office procedure improves breathing through the nose, while minimizing the
risk and discomfort to the patient.The turbinates are projections of soft tissue on the side walls of the nose. They warm, humidify and filter the air we breathe, and are sometimes called the "thermostats" of the nose. They normally enlarge and contract in cycles as they warm, humidify and filter the air. When they become inflamed or enlarged for any reason, nasal blockage occurs.
Nasal congestion and obstruction that alternates from left to right is caused by the turbinates. Turbinate enlargement can also cause a pressure sensation in the nose and face, also altering from one side to the other. Tiredness and fatigue are common symptoms, as well as facial pain and occasionally headaches. A patient with chronic turbinate enlargement can have poor sleep patterns, waking up periodically due to drainage and dry throat. Enlarge turbinates can also block normal sinus drainage, leading to chronic sinus problems.
As we grow older, the turbinates gradually thicken, narrowing the nasal airway. In addition to this normal process, allergies and infections can cause turbinate enlargement. Any chronic irritation or inflammation can cause swelling of the turbinates, including weather and temperature changes, stress, fatigue, medications, and hormone changes from thyroid disorders and pregnancy. Allergies and infections can be treated with specific medications, but other causes of turbinate enlargement often do not respond to medical treatment.
Medical treatment is always tried first, before recommending any surgical procedure. Any irritating factors should be avoided, such as smoke, smog, pollution and fumes. Medications that are used include antihistamines, decongestants, cortisone nasal sprays, and expectorants or mucus thinners. Allergy testing is available in our office, with desensitization injections for those who are found to be allergic.
Long standing swelling of the nasal turbinates may become chronic or irreversible, and medications may no longer be effective. Once the turbinates become unresponsive to medications and there are bothersome symptoms, surgery is usually recommended. Other office surgical options ivolve steroid injections and turbinate freezing. These methods can give improvement for a limited time. A submucous resection (removing the bone and leaving the soft tissue intact) or partial resection of the turbinates are performed in an operating room and require post-operative nasal packing. They are often performed in conjunction with nasal septum surgery for breathing improvement.
The radiofrequency procedure is a safe, fast and effective way to relieve nasal obstruction due to enlarged turbinates. It is performed in our office under local anesthesia, and typically takes less than 30 minutes. The radiofrequency energy is delivered under the surface layer of the turbinates, sparing the mucosa or membrane. The treated tissue is heated just enough to create an area of coagulation. This avoids annoying crusting and bleeding after the procedure and nasal packing is not required. Over the next three to six weeks, patients usually start to experience improved nasal breathing. Pain medication is rarely needed. After a short period of observation, patients can drive home, or resume normal activities.
To date, there have been no significant complications reported. No nasal packing is required, and most patients do not require pain medication. Some patients experience a stuffy nose for up to one week after the procedure. Nasal crusting can occur, which is usually relieved by a saline nasal spray. The turbinates can slowly enlarge after the procedure, especially if there are nasal allergies or infections. Occasionally, a second procedure is needed after 3 months if nasal blockage returns.
The goal of radiofrequency turbinate reduction is to improve breathing through the nose in an office setting with minimal risk to the patient. It is not cosmetic surgery and is covered by most insurance plans. If you have any questions about this procedure, we invite you to make an appointment for an evaluation to determine whether you are a candidate.
