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Wise et al.

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The thermal effect is limited to the submucosal layer, which preserves surface epithelium and ciliary function. 1560 Following RFA, coagulative necrosis occurs first, with scar contracture and tissue retraction occurring later in the healing process. Over time, portions of the fibrotic scar undergo resorption and the submucosal scar will adhere to the bony periosteum, which reduces turbinate bulk and renders it less susceptible to edema and engorgement. 1560,1561 In the first long term study of its kind, Lin et al. 1562 published a report on 101 patients who were followed up to 5 years postoperatively after undergoing RFA turbinoplasty for the treatment of AR. The 6-month and 5-year response rates were 77.3% and 60.5%, respectively, and statistically significant improvement was achieved in nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes. 1562 Coblation™ technology relies on electrodissection by molecular activation. This technology can similarly target the submucosal layers. Siméon et al. 1563 investigated the efficacy of Coblation™ on 9 AR patients with a mean age of 12.7 years. Favorable decreases in nasal resistance, pruritus, sneezing, hyposmia, and rhinorrhea were observed and sustained at 6-month follow-up. 1563 RFA and Coblation™ procedures are well-tolerated with minimal adverse effects and can be safely performed in the operating room or the outpatient office setting. Bony outfracture seeks to shift the bony skeleton of the inferior turbinate laterally into the inferior meatus, thereby creating more breathing space. Aksoy et al. 1564 found statistically significant reductions in the distance between the inferior turbinate and the lateral nasal wall after outfracture in 40 patients. This effect was sustained at 6 months postoperatively, which suggests that lateralization persists. 1564 Radical turbinate excision might overcome obstruction, but, at the cost of dryness and possibly empty nose syndrome. 1565 Vidian neurectomy is an older technique that seeks to damage the parasympathetic nerve impulses to the nasal cavity. Tan et al. 1566 found significant improvement in QOL measures in a prospective group undergoing vidian neurectomy over septoplasty/partial turbinectomy or medical management groups. This technique is considered more effective for non-allergic patients and seeks to primarily address severe rhinitis. 1567 Posterior nasal nerve section may also be considered for recalcitrant rhinorrhea; this technique aims to avoid the dry eye complications of vidian neurectomy. 1568 Recent publications have identified isolated middle turbinate polypoid edema or frank polyps to have a significant correlation with inhalant allergy, especially in more severe cases. 785,786 In cases where the polypoid changes in the middle turbinate are significant enough to cause nasal obstruction, conservative recontouring of the middle turbinate(s) can reduce nasal obstructive symptoms. To summarize, surgical treatment of the septum, inferior and/or middle turbinates, and possibly vidian/posterior nasal neurectomy may be considered in both allergic and non allergic patients. Outcomes of these various techniques are variable in patients with AR. • Aggregate Grade of Evidence: C (Level 1a: 1 study; Level 1b: 1 study; Level 2b: 1 study; Level 3b: 4 studies; Level 4: 5 studies; Table IX.C). • Benefit: Improved postoperative symptoms and nasal airway.

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.