Nasenmuschelchirurgie und „Empty Nose” Syndrom

Zusammenfassung

Die Indikation zur chirurgischen Reduktion der unteren und/oder mittleren Nasenmuscheln ist nach erfolgloser Therapie mit topischen Kortikoiden, Antihistaminika oder systemischer Immuntherapie gegeben. Das angestrebte Ziel ist eine an die individuellen anatomischen Verhältnisse angepasste Volumenreduktion des Nasenmuschelkörpers unter größtmöglicher Schonung der Schleimhaut. Die postoperative Erhaltung des Funktionsorgans Nasenmuschel ist für die Klimatisierung, die Aerodynamik und die Reinigung der Atemluft von entscheidender Bedeutung, da eine unbehinderte Nasenatmung Lebensqualität bedeutet. Die zahlreichen in der Literatur vorgestellten Operationstechniken zur Nasenmuschelreduktion weisen darauf hin, dass eine ideale Standardtechnik bis heute nicht entwickelt wurde. Sowohl die genannte Vielzahl der chirurgischen Techniken als auch die unbefriedigende Studienlage erschweren die objektive Bewertung der Verfahren. Der Mangel an prospektiven, randomisierten, vergleichenden Studien mit hoher Fallzahl und funktionsdiagnostisch geprüften Langzeitergebnissen begründet die Schwierigkeit, evidenzbasierte Operationsmethoden zu empfehlen. Dennoch ist anhand der gegenwärtigen Studienlage die anteriore Turbinoplastik als das Verfahren der Wahl zur chirurgischen Reduktion der Nasenmuscheln anzusehen und zu bewerten. Eine Missachtung des Funktionserhalts der Nasenmuscheln kann zu einer sekundär atrophen Rhinitis führen, aus der sich ein „empty nose” Syndrom entwickeln kann. Veränderungen der intranasalen Luftströmung können zu erheblichen Störungen der Atemluftklimatisierung führen und über eine Senkung des Atemwegswiderstandes auch pulmonale Probleme bedingen. Die im Rahmen einer aktuellen klinischen Studie über das Klimatisierungsverhalten und die Luftströmung in vivo bei „empty nose” Patienten gewonnen Erfahrungen werden präsentiert.

Abstract

Surgery of the Turbinates and “Empty Nose” Syndrome

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The wanted goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings and simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose they take care of climatisation, moistening and cleaning of the inhaled air. Thus a free nasal breathing means a decent quality of life as well. Regarding the multitude of different surgical techniques we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover there is a lack of prospective and comparable long-term studies which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation and therefore it is the method of choice today. Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The “empty nose” syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interferes with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in “empty nose” patients are presented.

Schlüsselwörter

Untere Nasenmuschel - mittlere Nasenmuschel - operative Nasenmuschelreduktion - Laserchirurgie - Nasenmuschelchirurgie im Kindesalter - „empty nose” Syndrom

Key words

Inferior turbinate - middle turbinate - turbinate surgery - laser surgery - pediatric surgery of turbinates - “empty nose” syndrome

Literatur

• 1 Tasman AJ. Die untere Nasenmuschel: Dysregulation und chirurgische Verkleinerung.  Laryngo-Rhino-Otol. 2002;  81 822-833
• 2 Juniper EF. Impact of upper respiratory allergic diseases on quality of life.  J Allergy Clin Immunol. 1998;  101 ((suppl)) 386-391
• 3 Kayser R. Die exakte Messung der Luftdurchgängigkeit der Nase.  Arch Laryng Rhinol (Berl.). 1895;  8 101
• 4 Eccles R. A role for the nasal cycle in respiratory defence.  Eur Repir J. 1996;  9 ((2)) 371-376 review
• 5 Maran AGD, Lund VJ. Nasal Physiology.. In: Maran AGD, Lund VJ (ed) Clinical Rhinology. Stuttgart: Thieme; 1990. 5
• 6 Flanagan P, Eccles R. Spontaneous changes of unilateral nasal airflow in man. A re-examination of the “nasal cycle”.  Arch Otolaryngol. 1997;  117 ((4)) 590-595
• 7 Mlynski G. Surgery of the concha.  Facial Plast Surg. 1995;  2 184-190
• 8 Lippert BM, Werner JA. Die Behandlung der hypertrophen unteren Nasenmuschel, Teil 1.  HNO. 2000;  48 170-181
• 9 Neskey D, Eloy JA, Casiano RR. Nasal, septal and turbinate anatomy and embryology.  Otolaryngol Clin North Am. 2009;  42 ((2)) 193-205
• 10 Lang J, Baumeister R. Über das postnatale Wachstum der Nasenhöhle.  Gegenbaurs Morphol Jb. 1982;  128 354-493
• 11 Ingram WA, Richardson BE. Concha bullosa of an inferior turbinate.  Ear Nose Throat J. 2003;  82 ((2)) 605-607
• 12 Huizing EH, de Groot JA. Surgical anatomy.. In: Huizing EH, de Groot JA (eds). Functional Reconstructive Nasal Surgery. Thieme Medical Publishers, Stuttgart, New York; 2003. 1
• 13 Widdicombe J. Microvascular anatomy of the nose.  Allergy. 1997;  52 (S 40) 7-11
• 14 Matthias C, de Souza P, Merker HJ. Electron microscopic and immunomorphological investigations of the mucosa of the human paranasal sinuses.  Eur Arch Otorhinolaryngol. 1997;  254 230-235
• 15 Dahlström A, Fuxe K. The adrenergic innervation of the nasal mucosa of certain mammals.  Acta Otolaryngol. 1965;  59 65-72
• 16 Lang J. Nasal cavity.. In: Lang J (ed). Clinical anatomy of the nose, the nasal cavity and paranasal sinuses. Thieme Medical Publishers, New York; 31-55
• 17 Swift DL, Proctor DF. Access of air to the respiratory tract.. In: Brain DJ, Proctor DF, Reid LM (eds). Respiratory defence mechanisms. Marcel Dekker, Inc., New York; 63-93
• 18 Rao S, Potdar A. Nasal airflow with body in various positions.  J Appl Physiol. 1970;  28 162-171
• 19 McCaffrey T, Kern E. Response of nasal airway resistance to hypercapnia and hypoxia in man.  Ann Otol Rhinol Laryngol. 1979;  88 247-252
• 20 Drettner B. Vascular reactions of the human nasal mucosa on exposure to cold.  Acta Otolaryngol (Suppl). 1961;  166 1-61
• 21 Matthias C, de Souza P, Merker HJ. Morphological investigations on the epithelium and subepithelial connective tissue of the human paranasal sinus mucosa.  J Rhinol. 1997;  4 ((2)) 129-138
• 22 Lindemann J. Intranasal air temperature and airflow: Numerical simulation compared to in-vivo measurements.. Habilitationsschrift, Universität Ulm, Medizinische Fakultät; 2005
• 23 Mol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques.  Rhinology. 2000;  38 157-166
• 24 Jones AS. et al . Predicting the outcome of submucosal diathermy to the inferior turbinates.  Clin Otolaryngol. 1989;  14 41-44
• 25 Olthoff A, Martin A, Liebermann F. Nd:YAG-laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy.  Laryngorhinootologie. 1999;  78 240-243
• 26 Cole P. Rhinomanometry: practice and trends.  Laryngoscope. 1989;  99 311-315
• 27 Cole P. Stability of nasal airflow resistance.  Clin Otolaryngol. 1989;  14 177-182
• 28 Silkoff PE, Chakravorty S, Chapnik J, Cole P, Zamel N. Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects.  Am J Rhinol. 1999;  13 131-135
• 29 Clement PAR. Committee report on standardization of rhinomanometry.  Rhinology. 1984;  22 151-155
• 30 Hilberg O, Jackson AC, Swift DL, Pederson OF. Acoustic rhinometry: evaluation of nasal cavity geometry by acoustic reflections.  J Appl Physiol. 1989;  66 295-303
• 31 Mlynski G, Loew J. Die Rhinoresistometrie – eine Weiterentwicklung der Rhinomanometrie.  Laryngo-Rhino-Otolo. 1993;  72 608-610
• 32 Graf P, Hallen H. Effect on the nasal mucosa of long-term treatment with oxymetazoline, benzalkonium chloride and placebo nasal sprays.  Laryngoscope. 1996;  106 605-609
• 33 Huizing EH, de Groot JA. Surgical of the nasal cavity.. In: Huizing EH, de Groot JA (eds). Functional Reconstructive Nasal Surgery. Thieme Medical Publishers, Stuttgart, New York; 2003. 8
• 34 Grymer LF, Illum P, Hilberg O. Septoplasty and compensatory inferior turbinate hypertrophy: a randomized study evaluated by acoustic rhinometry.  J Laryngol Otol. 1993;  107 413-417
• 35 Illum P. Septoplasty and compensatory inferior turbinate hypertrophy: long-term results after randomized turbinoplasty.  Eur Arch Otorhinolaryngol Suppl. 1997;  1 89-92
• 36 Berger G, Gass S, Ophir D. The histopathology of the hypertrophic inferior turbinate.  Arch Otolaryngol Head Neck Surg. 2006;  132 588-594
• 37 Heppt W, Renz H, Röcken M. Allergologie.  Springer Verlag, Berlin. 1997; 
• 38 Naclerio RM, Durham SR, Mygind N. Rhinitis – Mechanism and Management. Dekker, New York; 1999
• 39 Bolger EW, Butzin CA, Parsons DS. Paranasal sinus body anatomic variations and mucosal abnormalties: CT analysis for endoscopic sinsus surgery.  Laryngoscope. 1991;  101 56-64
• 40 Mabry RL. Chronic nasal obstruction.. Current therapy in Otorhinolaryngology, Head and Neck Surgery. Dekker, Toronto; 1987: 275-286
• 41 Passali D, Lauriello M, Mezzedimi C, Passali GC, Belussi L. Natural history of allergic rhinitis: a review.  Clin Appl Immunol Rec. 2001;  1 207-216
• 42 Pirisg W. Bewertung der Kaustikverfahren bei Nasenmuschelhyperplasie.  Pädiatrische Praxis. 2008;  72 186
• 43 Joniau S, Wong I, Rajapaksa S, Carney SA; Wormald PJ. Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates.  Laryngoscope. 2006;  116 1612-1616
• 44 Kimmelmann CP, Gamal HA. Vasomotor rhinitis.  Otolaryngol Clin North Am. 1986;  65 65-71
• 45 Mygind N. Nasal inflammation and anti-inflammatory treatment.  Semantics or clinical reality. Rhinology. 2001;  39 61-65
• 46 Weerda H, Siegert R. Komplikationen der Ohrmuschelanlegeplastik und ihre Behandlung.  Laryngo-Rhino-Otol. 1994;  73 394-399
• 47 Passali D, Passali FM, Passali GC, Damiani V, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trail.  Ann Otol Rhinol Laryngol. 2003;  112 683-688
• 48 Philips D. et al . Levels of evidence and grades of recommendations.  Oxford Centre for Evidence-based Medicine Levels of Evidence. 2001; 
• 49 Maran AGD, Molony NC, Armstrong MW. et al . Is there an evidence base for the practice of ENT surgery?.  Clin Otolaryngol. 1997;  22 152-157
• 50 Legler U. Lateroposition of the lower concha – a simple procedure to improve nasal air passage.  Z Laryngol Rhinol Otol. 1970;  49 ((6)) 386-391
• 51 Tolsdorff P. Eingriffe an den Nasenmuscheln unter besonderer Berücksichtigung der subperiostalen Conchektomie.  Laryng.-Rhinol. 1981;  60 615-619
• 52 Courtiss EH, Goldwyn RM, OŽBrien JJ. Resection of obstructing inferior nasal turbinates.  Plast Reconstr Surg. 1978;  62 ((2)) 249-257
• 53 Ophir D, Shapira A, Marshak G. Total inferior turbinectomy for nasal airway obstruction.  Arch Otolaryngol. 1985;  111 93-95
• 54 Pollock RA, Rohrich RJ. Inferior turbinate surgery: an adjust to successful treatment of nasal obstruction in 408 patients.  Plastic and Reconstructive Surgery. 1984;  74 227-234
• 55 Ophir D. Resection of obstructing inferior turbinates following rhinoplasty.  Plast Reconstr Surg. 1990;  85 ((5)) 724-727
• 56 Talmon Y, Samet A, Gilbey P. Total inferior turbinectomy: operative results and technique.  Ann Otol Rhinol Laryngol. 2000;  109 1117-1119
• 57 Eliashar R. Total inferior turbinectomy: operative results and technique.  Ann Otol Rhinol Laryngol. 2001;  110 700
• 58 Moore EJ, Kern EB. Atrophic rhinitis: a review of 242 cases.  Am J Rhinol. 2001;  15 355-361
• 59 Moore GF, Yonkers AJ, Freeman TJ, Ogren FP. Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction.  Laryngoscope. 1985;  95 1095-1099
• 60 Persky MA. Possible hemorrhage after inferior turbinectomy.  Plast Reconstr Surg. 1993;  92 770
• 61 Garth RJ, Cox HJ, Thomas MR. Haemorrhage as a complication of inferior turbinectomy: a comparison of anterior and radical trimming.  Clin Otolaryngol. 1995;  20 236-238
• 62 El-Silimy O. Inferior turbinate resection: the need for a nasal pack.  J Laryngol Otol. 1993;  107 906-907
• 63 Courtiss EH. Diagnosis and treatment of nasal airway obstruction due to inferior turbinate hypertrophy.  Clin Plast Surg. 1988;  15 11-13
• 64 Oburra HO. Complications following bilateral turbinectomy.  East Afr Med J. 1995;  72 101-102
• 65 Ravikumar A, Griffith TD, Flood LM, McNeela BJ. An unusual complication following inferior turbinectomy.  J Laryngol Otol. 1995;  109 ((6)) 559-561
• 66 Mlynski G. Wiederherstellende Verfahren bei gestörter Funktion der oberen Atemwege.  Nasale Atmung. Laryngo-Rhino-Otol. 2005;  84 (S 01) 101-117
• 67 Spector M. Partial resection of the inferior turbinates.  Ear Nose Throat J. 1982;  61 200-203
• 68 Faulcon P, Amanou L, Bonfils P. Treatment of nasal obstruction with subtotal inferior turbinectomy in chronic rhinitis: a retrospective study on 50 patients.  Ann Otolaryngol Chir Cervicofac. 1998;  115 ((4)) 228-233
• 69 Serrano E. et al . Efficacy of partial inferior turbinectomy in the treatment of nasal obstruction. Retrograde study apropos 71 patients.  Ann Otolaryngol Chir Cervicofac. 1996;  113 ((7–8)) 379-383
• 70 Friedman M. et al . A safe, alternative technique for inferior turbinate reduction.  Laryngoscope. 1999;  109 1834-1837
• 71 Fradis M. et al . Inferior turbinectomy versus submucosal diathermy for inferior turbinate hypertrophy.  Ann Otol Rhinol Laryngol. 2000;  109 1040-1045
• 72 Davis WE, Nishioka GJ. Endoscopic partial inferior turbinectomy using a power microcutting instrument.  Ear Nose Throat J. 1996;  75 ((1)) 49-50
• 73 Wexler D, Bravermann I. Partial inferior turbinectomy using the microdebrider.  J Otolaryngol. 2005;  34 ((4)) 189-193
• 74 Gupta A, Mercurio E, Bielamowicz S. Endoscopic inferior turbinate reduction: an outcome analysis.  Laryngoscope. 2001;  111 1957-1959
• 75 Delden MR, van Cook PR, Davis WE. Endoscopic partial inferior turbinoplasty.  Otolaryngol Head Neck Surg. 1999;  121 ((4)) 406-409
• 76 Warwick-Brown NP, Marks NJ. Turbinate surgery: how effective is it? A long-term assessment.  ORL J Otolaryngol Relat Spec. 1987;  49 314-320
• 77 Passali D, Anselmi M, Lauriello M, Bellussi L. Treatment of the hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy.  Ann Otol Rhinol Laryngol. 1999;  108 596-575
• 78 House HP. Submucous resection of the inferior turbinate bone.  Laryngoscope. 1951;  61 637-648
• 79 Mori S. et al . Long-term-effect of submucous turbinectomy in patients with perennial allergic rhinitis.  Laryngoscope. 2002;  112 865-869
• 80 Freer OT. The inferior turbinate: its longitudinal resection for chronic intumescense.  Laryngoscope. 1911;  21 1136-1144
• 81 Gray L. The deviated nasal septum. II. Prevention and treatment.  J Lar. 1965;  79 806-816
• 82 Mabry RL. “How I do it”-Plastic Surgery. Practical suggestions on facial plastic surgery Inferior turbinoplasty.  Laryngoscope. 1982;  92 459-461
• 83 Mabry RL. Surgery of the inferior turbinates: how much and when?.  Otolaryngol Head Neck Surg. 1984;  92 571-577
• 84 Mabry RL. Inferior turbinoplasty.  Arch Otolaryngol Head Neck Surg. 1988;  114 1189
• 85 Lenders H, Pirsig W. Wie ist die hyperreflektorische Rhinopathie chirurgisch zu beeinflussen? I. Teil: Literaturübersicht.  Laryngol Rhinol Otol. 1990;  69 ((5)) 246-254
• 86 Lenders H, Pirsig W. Wie ist die hyperreflektorische Rhinopathie chirurgisch zu beeinflussen? II. Teil: Akustische Rhinometrie und anteriore Turbinoplastik.  Laryngol Rhinol Otol. 1990;  69 291-297
• 87 Grymer LF, Illum P, Hilberg O. Bilateral inferior turbinoplasty in chronic nasal obstruction.  Rhinology. 1996;  34 ((1)) 50-53
• 88 Galetti G, Dallari S, Galetti R. Turbinoplasty: personal technique and long-term results.  ORL J Otorhinolaryngol Relat Spec. 1991;  53 ((2)) 111-115
• 89 Fanous N. Anterior turbinectomy. A new surgical approach to turbinate hypertrophy: a review of 220 cases.  Arch Otolaryngol Head Neck Surg. 1986;  112 ((8)) 850-852
• 90 Katz S, Schmelzer B, Cammaert T, Della Faille D, Leivens J. Our technique of partial inferior turbinoplasty: long-term results evaluated by rhinomanometry.  Acta Otorhinolaryngol Belg. 1996;  5 ((1)) 13-18
• 91 Fateen M. Concho-antropexy (C.A.P.) in vasomotor rhinitis and chronic nasal obstruction.  Int Rhinology. 1967;  1 20-24
• 92 Lannigan FJ, Gleeson MJ. Antroconchopexy for surgical treatment of perennial rhinitis.  Int Rhinology. 1992;  30 183-186
• 93 Salam MA, Wengraf C. Conchantropexy or total turbinectomy for hypertrophy of the inferior turbinates. A prospective randomized study.  J Laryngol Otol. 1993;  107 1123-1128
• 94 Neres FE. Voltaic turbinal puncture for the relief of intumescence and hypertrophic rhinitis.  J Am Med Ass. 1907;  49 1435-1438
• 95 Jones AS, Lancer JM. Does submucosal diathermy to the inferior turbinates reduce nasal resistance to airflow in the long term?.  J Laryngol Otol. 1987;  101 ((5)) 448-451
• 96 Williams HO, Fisher EW, Golding-Wood DG. “Two-stage turbinectomy”: sequestration of the inferior turbinate following submucosal diathermy.  J Laryngol Otol. 1991;  105 14-16
• 97 Elwany S, Gaimaee R, Fattah HA. Radiofrequency bipolar submucosal diathermy of the inferior turbinates.  Am J Rhinol. 1999;  13 145-149
• 98 Woodhead CJ. et al . Some observations on submucous diathermy.  J Laryngol Otol. 1989;  103 1047-1049
• 99 Farmer SE, Quinn SM, Eccles R. Efficacy of inferior turbinate coblation for treatment for nasal obstruction.  J Laryngol Otol. 2009;  123 ((3)) 309-314
• 100 Lippert BM, Werner JA. Comparison of carbon dioxide and neodymium:yttrium-aluminium-garnet lasers in surgery of the inferior turbinate.  Ann Otol Rhinol Laryngol. 1997;  106 ((12)) 1036-1042
• 101 Farmer SE, Eccles R. Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement.  J Laryngol Otol. 2007;  121 ((7)) 615-622
• 102 Wengraf CL, Gleeson MJ, Siodlak MZ. The stuffy nose: a comparative study of two common methods of treatment.  Clin Otolaryngol. 1986;  11 61-68
• 103 Meredith GM 2nd . Surgical reduction of hypertrophied inferior turbinates: a comparison of electrofulguration and partial resection.  Plast Reconstr Surg. 1988;  81 891-899
• 104 Principato JJ. Chronic vasomotor rhinitis: cryogenic and other modes of treatment.  Laryngoscope. 1979;  89 619-638
• 105 Ozenberger JM. Cryosurgery for the treatment of chronic rhinitis.  Laryngoscope. 1973;  83 508-516
• 106 Kärjä J, Jokinen K, Palva A. Experiences with cryotherapy in otolaryngological practice.  J Laryngol Otol. 1984;  89 519-525
• 107 Ozenberger JM. Cryosurgery in chronic rhinitis.  Laryngoscope. 1970;  80 723-734
• 108 Bumstead RM. Cryotherapy for chronic vasomotor rhinitis: technique and patient selection for improved results.  Laryngoscope. 1984;  94 539-544
• 109 Chiossone E, Gutierrez JR, Emmanuelli JL. Cryosurgery of the inferior nasal turbinates.  Auris Nasus Larynx. 1990;  17 87-93
• 110 Hartley C, Willat DJ. Cryotherapy in the treatment of nasal obstruction: indications in adults.  J Laryngol Otol. 1995;  109 ((8)) 729-732
• 111 Rakover Y, Rosen G. A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates.  J Laryngol Otol. 1996;  110 732-735
• 112 Puhakka H, Rantanen T. Cryotherapy as a method of treatment in allergic and vasomotor rhinitis.  J Laryngol Otol. 1977;  91 535-539
• 113 Glover JL, Bendick PJ, Link WJ, Plunkett RJ. The plasma scalpel: a new thermal knife.  Laser Surg Med. 1982;  2 ((1)) 101-106
• 114 Bergler WF. Argon plasma coagulation (APC) surgery in otorhinolaryngology.  Surg Technol Int. 2003;  11 79-84
• 115 Bergler WF, Sadick H, Hammerschmidt N, Oulmi J, Hörmann K. Long-term results of inferior turbinate reduction with argon plasma coagulation.  Laryngoscope. 2001;  41 ((9)) 1593-1598
• 116 Ferri. et al . Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients.  Acta Otorrinolaringol Esp. 2004;  55 ((6)) 277-281
• 117 Gierek T, Jura-Szoltys E. Long-term results after argon plasma coagulation (APC) inferior turbinate reduction.  Otolaryngol Pol. 2007;  61 ((1)) 63-68
• 118 Ottaviani F, Capaccio P, Cesana BM, Manzo R, Pevi A. Argon plasma coagulation in the treatment of nonallergic hypertrophic inferior nasal turbinates.  Am J Otolaryngol. 2003;  24 ((5)) 306-310
• 119 Fischer Y, Gosepath J, Amedee RG, Mann WJ. Radiofrequency volumetrie tissue reduction (RFVTR) of inferior turbinates: a new method in the treatment of chronic nasal obstruction.  Am J Rhinol. 2000;  14 ((6)) 355-360
• 120 Smith TL. et al . Radiofrequency tissue ablation in the inferior turbinates using a thermocouple feedback electrode.  Laryngoscope. 1999;  109 1760-1765
• 121 Cavaliere M, Mottola G, Imma M. Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical techniques in treatment of inferior turbinate hypertrophy.  Otolaryngol Head Neck Surg. 2005;  133 ((6)) 972-978
• 122 Nease CJ, Krempl GA. Radiofrequency treatment of turbinate hypertrophy: a randomized, blinded, placebo-controlled clinical trial.  Otolaryngol Head Neck Surg. 2004;  130 ((3)) 291-299
• 123 Harsten G. How I do it: radiofrequency-turbinectomy for nasal obstruction symptoms.  Clin Otolaryngol. 2005;  30 ((1)) 64-66
• 124 Hytönen ML, Bäck LJ, Malmivaara AV, Roine RP. Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications.  Eur Arch Otorhinolaryngol. 2009 Feb 3;  [Epub ahead of print]
• 125 Lenz H, Eichler J, Schäfer G, Salk J. Parameters for argon laser surgery of the lower human turbinates. In vivo experiments.  Acta Otolaryngol (Stockholm). 1977;  83 360
• 126 Lenz H, Eichler J, Knof J, Salk J, Schäfer G. Endonasal Ar+-laser beam guide system and first clinical application in vasomotor rhinitis.  Laryngol Rhinol Otol (Stuttgart). 1977;  56 749
• 127 Selkin SG. Laser turbinectomy as an adjunct to rhinoplasty.  Arch Otolaryngol. 1985;  111 ((7)) 446-449
• 128 Wolfson S, Wolfson LR, Kaplan I. CO₂ laser inferior turbinectomy: a new surgical approach.  J Clin Laser Med Surg. 1996;  13 81-83
• 129 Futukake T, Yamashita T, Tomoda K, Kumazawa T. Laser surgery for allergic rhinitis.  Arch Otolaryngol Head Neck Surg. 1986;  112 1280-1282
• 130 Englender M. Nasal laser mucotomy (L-mucotomy) of the inferior turbinate.  J Laryngol Otol. 1995;  109 296-299
• 131 Lippert BM, Werner JA. Comparison of carbondioxide and neodymium: yttrium-aluminium-garnet lasers in surgery of the inferior turbinate.  Ann Otol Rhinol Laryngol. 1997;  106 1036-1042
• 132 Lippert BM, Werner JA. CO₂ laser surgery of the hypertrophied inferior turbinates.  Rhinology. 1997;  35 33-36
• 133 Kubota I. Nasal function following carbon dioxide laser turbinate surgery for allergy.  Am J Rhinology. 1995;  9-3 155-161
• 134 Elwany S, Abdel-Moneim MH. Carbon dioxide laser turbinectomy.  An electron microscope study. J Laryngol Otol. 1997;  111 ((10)) 931-934
• 135 Oswal V, Hopf JUG, Hopf M, Scherer H. Endonasal laser applications.. In: Oswal V, Remacle M (eds). Principles and practice of lasers in Otorhinolaryngology and Head and Neck Surgery. The Hague, Holland: Kugler; 2002. 163
• 136 DeRowe A. et al . Subjective comparison of Nd:YAG, diode and CO₂ lasers for endoscopically guided inferior turbinate reduction surgery.  Am J Rhinol. 1998;  12 209-212
• 137 Janda P, Sroka R, Baumgartner R, Grevers G, Leunig A. Laser treatment of hyperplastic inferior turbinates: a review.  Lasers Surg Med. 2001;  28 404-413
• 138 Katz S, Schmelzer B, Vidts G. Treatment of the obstructive nose by CO₂-laser reduction of the inferior turbinates: technique and results.  Am J Rhinol. 2000;  14 ((1)) 51-55
• 139 Takeno S, Osada R, Ishino T, Yajin K. Laser surgery of the inferior turbinate for allergic rhinitis with seasonal exacerbation: an acoustic rhinometry study.  Ann Otol Rhinol Laryngol. 2003;  112 ((5)) 455-460
• 140 Parkin JL, Dixon JA. Laser photocoagulation in hereditary hemorrhagic telangiectasias.  Otolaryngol Head and Neck Surg. 1981;  89 204-208
• 141 Hoffmann JF, Parkin JL. Rhinologic applications of laser surgery.. In: Parkin JL (ed). The Otolarygologic Clinics of North America – Laser in Otolaryngology. WB Saunders; 1990. 23: 19-28
• 142 Lenz H. Acht Jahre Laserchirurgie an den unteren Nasenmuscheln bei Rhinopathia vasomotorica in Form von Laserstrichkarbonisation.  HNO. 1985;  33 ((9)) 422-425
• 143 Enderby CE. Laser instrumentation.. In: Dixon JA (ed). Surgical application of lasers, ed 2. Chicago, Year Book Medical Publishers; 1987: 52-57
• 144 Werner JA, Rudert H. Der Einsatz des Nd:YAG-Lasers in der Hals-Nasen-Ohrenheilkunde.  HNO. 1992;  40 248-258
• 145 Vagnetti A, Golbi E, Algieri GM, DŽAmbrosio L. Wedge turbinectomy: a new combined photocoagulative Nd:YAG-laser technique.  Laryngoscope. 2000;  110 ((6)) 1034-1036
• 146 Olthoff A, Martin A, Liebmann F. Nd:YAG-laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy.  Laryngorhinootology. 1999;  78 ((5)) 740-743
• 147 Wang HK, Tsai YH, Wu YY, Wang PC. Endoscopic potassium-titanyl-phosphate laser treatment for reduction of hypertrophic inferior nasal turbinate.  Photomed Laser Surg. 2004;  22 ((3)) 173-176
• 148 Levine HL. KTP/532 laser for nasal sinus disease.  Ann Otol Rhinol Laryngol. 1989;  98 46-51
• 149 Kumachak S, Kulapaditharom B, Prakumhungsit S. Minimally invasive KTP-laser treatment of perennial allergic rhinitis: a preliminary report.  J Otolaryngol. 2000;  29 ((3)) 139-143
• 150 Orabi AA, Sen A, Timms MS, Morar P. Patient satisfaction survey of outpatient-based topical local anesthetic KTP laser inferior turbinectomy: a prospective study.  Am J Rhinol. 2007;  21 ((2)) 198-202
• 151 Min YG, Kim HS, Yun JS, Kim CS, Jang JY, Jung TG. Contact laser turbinate surgery for the treatment of idiopathic rhinitis.  Clin Otolaryngol Allied Sci. 1996;  21 ((6)) 533-536
• 152 Janda P, Sroka R, Tauber S, Baumgartner R, Grevers G, Leunig A. Diode laser treatment of hyperplastic inferior nasal turbinates.  Laser Surg Med. 2000;  27 ((2)) 129-139
• 153 Caffier PP, Frieler K, Scherer H, Sedlmaier B, Göktas O. Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse.  Am J Rhinol. 2008;  22 ((4)) 433-439
• 154 Janda P, Sroka R, Betz CS, Baumgartner R, Leunig A. Comparison of laser induced effects on hyperplastic inferior nasal turbinates by means of scaninng electron microscope.  Laser Surg Med. 2002;  30 ((1)) 31-39
• 155 Serrano E. et al . The holmium YAG-laser for treatment of the inferior turbinate.  Rhinology. 1998;  36 77-80
• 156 Leunig A, Janda P, Sroka R, Baumgartner R, Grevers G. Ho:YAG-laser treatment of hyperplastic inferior nasal turbinates.  Laryngoscope. 1999;  109 ((10)) 1690-1695
• 157 Sroka R, Janda P, Killian T, Vaz F, Betz CS, Leunig A. Comparison of long-term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates.  Laser Surg Med. 2007;  39 ((4)) 324-331
• 158 Rejali SD, Upile T, McLellan D, Bingham BJ. Inferior turbinate reduction in children using Holmium YAG-laser – a clinical and histological study.  Laser Surg Med. 2004;  34 ((4)) 310-314
• 159 Sapci T, Sahin B, Karavus A, Akbulut UG. Comparison of the effects of radiofrequency tissue ablation, CO₂-laser ablation, and partial turbinectomy applications on nasal mucociliary functions.  Laryngoscope. 2003;  113 514-519
• 160 Lippert BM. Laser in der Rhinologie.  Laryngo-Rhino-Otol. 2003;  82 S54-S76
• 161 Kennedy DW. Middle turbinate resection. Evaluating the issues – should we resect normal middle turbinates?.  Arch Otolaryngol Head Neck Surg. 1998;  124 107
• 162 Courtiss EH, Goldwyn RM. The effects of nasal surgery on airflow.  Plast Reconstr Surg. 1983;  72 9-19
• 163 Haight SJ, Cole PH. The site and function of the nasal valve.  Laryngoscope. 1983;  93 49-55
• 164 Biedlingmaier JF, Whelan P. Histopathology and CT-analysis of partial resected middle turbinate.  Laryngoscope. 1996;  106 102-104
• 165 Cook PR, Begegni A. Effect of partial middle turbinectomy on nasal airflow and resistance.  Otolaryngol Head Neck Surg. 1995;  113 413-419
• 166 Fortune SF, Duncavage JA. Incidence of frontal sinusitis following partial middle turbinectomy.  Ann Otol Rhinol Laryngol. 1998;  107 447-453
• 167 Lamear WR, Davis W. Partial endoscopic middle turbinectomy augmenting functional endoscopic sinus surgery.  Arch Otolaryngol Head Neck Surg. 1992;  107 382-389
• 168 Morgenstein KM, Krieger MK. Experiences in middle turbinectomy.  Laryngoscope. 1980;  90 1596-1603
• 169 Lazar RH, Younis RT, Long TE, Gross CW. Revision functional endonasal sinus surgery.  Ear Nose Throat J. 1992;  71 131-133
• 170 Friedman M, Landsberg R, Tanyeri H. Middle turbinate medialization and preservation in endoscopic sinus surgery.  Otolaryngol Head Neck Surg. 2000;  123 76-80
• 171 Lindemann J, Keck T, Rettinger G. Septal-turbinate-suture in endonasal sinus surgery.  Rhinology. 2002;  40 92-94
• 172 Hewitt KM, Orlandi RR. Suture medialisation of the middle turbinate during endoscopic sinus surgery.  Ear Nose Throat J. 2008;  87 ((12)) E11
• 173 Thornton RS. Middle turbinate stabilization technique in endoscopic sinus surgery.  Arch Otolaryngol Head Neck Surg. 1996;  122 ((8)) 869-872
• 174 Koch T. Medialisierung und Fixierung der mittleren Nasenmuschel bei der endonasalen Siebbeinoperation.  Laryngo-Rhino-Otol. 2008;  87 6-9
• 175 Friedman M, Schalch P. Middle turbinate medialization with bovine serum albumin tissue adhesive (BioGlue).  Laryngoscope. 2008;  118 335-338
• 176 Friedman M, Tanyeri H, Landsberg R, Caldarelli D. Effects of middle turbinate medialization on olfaction.  Laryngoscope. 1998;  109 1442-1445
• 177 Bolger WE, Kuhn FA, Kennedy DW. Middle turbinate stabilization after functional endoscopic sinus surgery: The controlled synechia technique.  Laryngoscope. 1999;  109 1852-1853
• 178 Pirsig W. Reduction of the middle turbinate.  Rhinology. 1972;  10 103-108
• 179 Huizing EH. Functional surgery in inflammation of the nose and paranasal sinuses.  Rhinolgy. 1998;  5 ((Suppl)) 5-15
• 180 Har-el G, Slavit DH. Turbinoplasty for concha bullosa: a non-synechia forming alternative to middle turbinectomy.  Rhinology. 1996;  34 54-56
• 181 Dogru H, Tüz M, Uygur K, Cetin M. A new turbinoplasty technique for the management of concha bullosa: our short-term outcomes.  Laryngoscope. 2001;  111 172-174
• 182 Sigston EA, Iseli CE, Iseli TA. Concha bullosa: reducing middle meatus adhesions by preserving the lateral mucosa as a posterior pedicle flap.  J Laryngol Otol. 2004;  118 ((10)) 799-803
• 183 Wigand ME, Steiner W, Jaumann MP. Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa.  Endoscopy. 1978;  10 255-260
• 184 Biedlingmeier JP. Endoscopic middle turbinate resection: results and complications.  Ear Nose Throat J. 1993;  72 351-355
• 185 Vleming M, Middleweerd RJ, deVries N. Complications of endoscopic sinus surgery.  Arch Otolaryngol Head Neck Surg. 1992;  118 617-623
• 186 Marchioni D. et al . Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyps.  Acta Otolaryngol. 2008;  128 1019-1026
• 187 Messerklinger W. Endoscopic diagnosis and surgery of recurrent sinusitis.. In: Krajira Z (ed). Advances in Nose and Sinus Surgery. Zagreb: Zagreb University; 1985
• 188 Ramadan HH, Allen GC. Complications of endoscopic sinus surgery in a residency training programm.  Laryngoscope. 1995;  105 376-379
• 189 Swanson P, Lanza DC, Kennedy DW, Vining EM. The effect of middle turbinate resection upon frontal sinus disease.  Am J Rhinol. 1995;  9 191-195
• 190 Fortune DS, Duncavage JA. Incidence of frontal sinusitis following partial middle turbinectomy.  Ann Otol Rhinol Laryngol. 1998;  107 447-453
• 191 Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection.  Ann Otol Rhinol Laryngol. 2000;  109 634-640
• 192 Giacchi RJ, Lebowitz RA, Jacobs JB. Middle turbinate resection: issues and controversies.  Am J Rhinol. 2000;  14 ((3)) 193-197
• 193 Shih C, Chin G, Rice DH. Middle turbinate resection: Impact on outcomes in endoscopic sinus surgery.  Ear Nose Throat J. 2003;  82 796-797
• 194 Stewart MG. Middle turbinate resection.  Arch Otolaryngol Head Neck Surg. 1998;  124 104-106
• 195 Kennedy DW. Middle turbinate resection. Evaluating the issues – should we resect normal middle turbinates?.  Arch Otolaryngol Head Neck Surg. 1998;  124 107
• 196 Rice DH. Middle turbinate resection. Weighing the decision.  Arch Otolaryngol Head Neck Surg. 1998;  124 106
• 197 Ducroz U, Girschig H, Roger G. Inferior turbinectomy in asthmatic children.  Ann Otolaryngol Chir Cervicofac. 1997;  114 36-40
• 198 Osquthorpe JD, Shirley R. Neonatal respiratory distress from rhinitis medicamentosa.  Laryngoscope. 1987;  97 829-831
• 199 Shott SR, Myer CM, Willis R, Cotton RT. Nasal obstruction in the neonate.  Rhinology. 1989;  27 91-96
• 200 Passali D. et al . Comparative study of most recent surgical techniques for the treatment of the hypertrophy of inferior turbinates.  Acta Otolaryngol Ital. 1995;  15 219-228
• 201 Willemot J, Pirsig W. Indications, technique, and long-term results of surgery of the nasal pyramid and septum in children.  Acta Otorhinolaryngol Belg. 1984;  38 427-432
• 202 Pirsig W. Zur Chirurgie der Nase im Kindesalter: Wachstum und Spätergebnisse.  Laryngo-Rhino-Otol. 1984;  63 170-180
• 203 Stoll W. Nasenchirurgie im Kindesalter.. Springer Verlag Berlin, Heidleberg; 1999: 59-87
• 204 Thompson AC. Surgical reduction of the inferior turbinate in children: extended follow-up.  J Laryngol Otol. 1989;  193 577-579
• 205 Percodani J. et al . Partial lower turbinectomy in children: indications, technique, results.  Rev Laryngol Otol Rhinol (Brod). 1996;  117 ((3)) 175-178
• 206 Segal. et al . Inferior turbinectomy in children.  Am J Rhinol. 2003;  17 69-73
• 207 Gertner R, Podoshin L, Fradis M. A simple method of measuring the nasal airway in clinical work.  J Laryngol Otol. 1984;  98 351-355
• 208 Weidner DJ, Sulzner SE. Inferior turbinate reduction in children.  Ear Nose Throat J. 1998;  77 ((4)) 304-306
• 209 Ducroz U, Girschig H, Roger G. Inferior turbinectomy in asthmatic children.  Ann Otolaryngol Chir Cervicofac. 1997;  114 36-40
• 210 Jovanovic S, Dokic D. Does laser turbinectomy influence local allergic inflammation in the nose?.  Rhinology. 1996;  34 46-49
• 211 Lippert BM, Werner JA. Long-term results after laser turbinectomy.  Lasers Surg Med. 1998;  22 126-134
• 212 Rejali SD, Upile T, McLellan D, Bingham BJ. Inferior turbinate reduction in children using Holmium YAG-laser – a clinical and histological study.  Laser Surg Med. 2004;  34 ((4)) 310-314
• 213 Lippert BM, Werner JA. Die Behandlung der hypertrophen unteren Nasenmuschel. Teil 2.  HNO. 2000;  48 267-274
• 214 Barton RP, Sibert JR. Primary atrophic rhinitis: an inherited condition.  J Laryngol Otol. 1980;  94 979-983
• 215 Ruskin SL. A differential diagnosis and therapy of atrophic rhinitis and ozena.  Arch Otolaryngol. 1932;  52 96-103
• 216 Chand MS, Macarthur CJ. Primary atrophic rhinits: a summary of four cases and review of literature.  Otolaryngol Head Neck Surg. 1997;  4 554-558
• 217 Pace-Balzan A, Shankar L, Hawke M. Computed tomographic findings in atrophic rhinits.  J Otolaryngol. 1991;  20 428-432
• 218 Garcia GJM, Bailie N, Martins DA, Kimbell JS. Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity.  J Appl Physiol. 2007;  103 1082-1092
• 219 Houser SM. Empty nose syndrome associated with middle turbinate resection.  Otolaryngol Head Neck Surg. 2006;  135 972-973
• 220 Houser SM. Surgical treatment for empty nose syndrome.  Arch Otolaryngol Head Neck Surg. 2007;  133 858-863
• 221 Hilding A. Experimental surgery of the nose and sinuses. Changes in the morphology of epithelium variations in ventilation.  Arch Otolaryngol. 1932;  16 9-18
• 222 Webb P. Air temperatures in respiratory tract of resting subjects in cold.  J Appl Physiol. 1951;  4 378-383
• 223 Mlynski G. Strömung und Konditionierung der Atemluft.  Laryngo-Rhino-Otol. 2000;  79 636-638
• 224 Lindemann J, Keck T, Wiesmiller KM, Rettinger G, Brambs HJ, Pless D. Numerical simulation of intranasal air flow and temperature after resection of the turbinates.  Rhinology. 2005;  43 24-28
• 225 Nishihira S, McCaffrey TV. Reflex control of nasal blood vessels.  Otolaryngology Head Neck Surg. 1987;  96 273-277
• 226 Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y. Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individual.  J Appl Physiol. 1996;  81 1739-1743
• 227 Clarke RW, Jones AS. Nasal airflow sensation.  Clin Otolaryngol Allied Sci. 1995;  20 97-99
• 228 Wrobel BB, Leopold DA. Olfactory and sensory attributes of the nose.  Otolaryngol Clin North Am. 2005;  38 1163-1170
• 229 Elad D, Naftali S, Rosenfeld M, Wolf M. Physical stresses at the air-wall interface of the human nasal cavity during breathing.  J Appl Physiol. 2006;  100 1003-1010
• 230 Naftali S, Rosenfeld M, Wolf M, Elad D. The air-conditioning capacity of the human nose.  Ann Biomed Eng. 2005;  33 545-553
• 231 Xiong G, Zhan J, Zuo K, Li J, Rong L, Xu G. Numerical flow simulation in the post-endoscopic sinus surgery nasal cavity.  Med Biol Eng Comput. 2008;  46 1161-1167
• 232 Xiong G, Zhan J, Jiang H, Li J, Rong L, Xu G. Computational fluid dynamics simulation of airflow in the normal nasal cavity and paranasal sinuses.  Am J Rhinol. 2008;  22 477-482
• 233 Wolf M, Naftali S, Schroter RC, Elad D. Air-conditioning characteristics of the human nose.  J Laryngol Otol. 2004;  118 87-92
• 234 Batchelor GK. Bernoulli's theorem for steady flow of frictionless non-conductiong fluid.. In: Batechelor GK (ed). An introduction to fluid mechanics, 2nd ed. Cambridge university press, Cambridge; 2000: 156-164
• 235 Keck T. Untersuchungen zur Konditionierung der Atemluft der Nase.. Habilitation, Medizinische Fakultät der Universität Ulm; 2001
• 236 Kim KC. et al . Airway goblet cell mucin: its structure and regulation of secretion.  Eur Respir J. 1997;  10 2644-2649
• 237 Rogers DF. Airway goblet cells: responsive and adaptable front-line defenders.  Eur Respir J. 1994;  7 1690-1708
• 238 Houtmeyers E, Gosselink R, Gayan-Ramirez G, Decramer M. Regulation of mucociliary clearance in health and disease.  Eur Respir J. 1999;  13 1177-1188
• 239 Stuart BO. Deposition and clearance of inhaled particles.  Environ Health Persp. 1984;  55 369-390

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