Turkiye Klinikleri Ear Nose and Throat - Special Topics

Steroidlerin Kulak Burun Boğazda Kullanılışı Özel Sayısı
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Alt Konka Hipertrofisi Nedeni ile Burun Tıkanıklığı Olan Hastalarda Radyofrekans Termal Ablasyon Tedavisi ve Steroid Enjeksiyonu Tedavisi Etkinliğinin Bilgisayarlı Tomografi Ölçümü ile Karşılaştırılması
Comparison of Effectiveness of Steroid Injection and Radiofrequency Thermal Ablation Therapies in Patients with Nasal Obstruction Due to Inferior Turbinate Hypertrophy by Computerized Tomography
Ahmet AZİMOVa, Fuat YÖNDEMLİb, Abdullah DEMİRKANc
aKulak Burun Boğaz Hastalıkları Kliniği, Artvin Devlet Hastanesi, Artvin
bKulak Burun Boğaz Hastalıkları AD, Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Konya
cKulak Burun Boğaz Hastalıkları Kliniği, Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi, Şanlıurfa
Turkiye Klinikleri J E.N.T.-Special Topics. 2014;7(4):28-37
Article Language: TR
ÖZET
Amaç: Bu çalışmanın amacı kronik nazal obstrüksiyonun izole submuköz alt konka hipertrofisine bağlı olduğu belirlenen olgularda steroid enjeksiyonu ile radyofrekans termal ablasyonu (RFTA) yöntemlerinin etkinliğini bilgisayarlı tomografi, vizüel analog skala (VAS) ile değerlendirmek ve karşılaştırmaktır. Her iki yöntem uygulanırken duydukları ağrı ve uygulamadan sonra hasta memnuniyeti değerlendirilmiş ve karşılaştırılmıştır. Gereç ve Yöntemler: Bu çalışmaya Haziran-2009 ile Eylül 2010 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı kliniğine kronik nazal tıkanıklık şikayeti ile başvuran ve alt konkanın submuköz hipertrofisi tespit edilen 60 erişkin hasta dahil edilmiştir. Çalışmaya katılan 60 hastanın hepsi erişkin yaş grubunda olup steroid enjeksiyonu grubundaki 30 hastanın 16 (%53,3)'sı kadın 14 (%46,7)'ü erkekti. RFTA grubundaki 30 hastanın 13 (%43,3)'ü kadın 17 (%56,7)'si erkekti. Steroid enjeksiyonu grubuna 40 mg/1 ml metilprednizolon asetat alt konkanın anterior kısmına submukozal bül oluşturulacak şekilde dental enjektör yardımıyla uygulandı. RFTA grubuna konkalara üç noktaya 350'şer joule enerji verilerek, hedef sıcaklık 75 oC,12W ve toplam 1050 joule enerji verildi. Konkaların objektif değerlendirilmesi preoperatif dönem ve postoperatif 1. ve 3. aylarda çekilen koronal plan paranazal sinüs bilgisayarlı tomografileri (BT) karşılaştırılarak yapıldı. Ayrıca başka bir hekim konka boyutlarını VAS ile değerlendirdi. Hastalar tarafından, nazal obstrüksiyonun VAS ve her iki uygulama esnasındaki ağrı değerlendirmesi ve karşılaştırılması yapıldı. Bulgular: Hastaların yaşları steroid enjeksiyonu grubunda 19 ile 75 yıl (ort. 32,40±14,330), RFTA grubunda 18 ile 66 yıl (ort.31,30±12,075) arasında değişmekteydi. Hastaların her iki grupta preoperatif ve postoperatif 1. ve 3. aylarda sağ ve sol konka boyutları; anterior, orta ve posterior kesimde, koronal paranazal sinüs BT ile değerlendirildi. RFTA grubunda postoperatif 1. ayda konka boyutlarının ortalama %23 küçüldüğü tespit edildi. Buna karşın Steroid enjeksiyonu grubunda postoperatif 1. ayda konka boyutlarının ortalama %7,1915 daha fazla küçülerek toplamda %30,2813 küçüldüğü saptandı. Postoperatif 3. ayda ise steroid enjeksiyonunun etkisinin devam ettiği, ancak azalarak küçülme oranının %16,5'e gerilediği saptandı. Buna karşın RFTA grubunda konka boyutlarındaki küçülme oranının %31,5 kadar arttığı saptandı. Her iki grup için farklı hekim tarafından preoperatif ve postoperatif birinci ayda kaydedilen VAS'da hem sağ, hem de sol konkada istatistiksel olarak anlamlı derecede konka küçülmesi saptandı. Her iki gruptaki hastalarda postoperatif 1. ayda memnuniyetin yüksek oranda olduğu görüldü. Postoperatif 1. ayda steroid enjeksiyonu grubundaki 28 hastada hiçbir şikayet yok iken, 1 hastada geçmeyen burun tıkanıklığı, 1 hastada hafif burun akıntısı şikayeti mevcuttu. RFTA grubundaki 23 hastada hiçbir şikayet yok iken 6 hasta burunda oluşan kabuklanmadan, 1 hasta ise geçmeyen tıkanıklıktan şikayet ediyordu. Her iki gruptaki hastaların hiçbirinde postoperatif dönemde meydana gelen enfeksiyon izlenmemiş olup, hiçbir hastaya antibiyoterapi başlanmamıştır. Ayrıca her iki grubun postoperatif 1. ve 3. aylarda yapılan kontrollerinde hastaların hiçbirinde steroid enjeksiyonu veya RFTA tedavisi ile ilgili komplikasyon izlenmemiştir. Sonuç: Alt konka hipertrofilerine bağlı olarak gelişen nazal obstrüksiyonun tedavisinde, intranazal steroid enjeksiyonu ve RFTA tedavisi etkin, kolay uygulanabilen, ciddi komplikasyonlara yol açmayan, maliyeti düşük, hasta memnuniyetinin yüksek olduğu, çok ağrılı olmayan güvenli bir yöntemdir. Bununla birlikte, ayaktan vakalara bile kolaylıkla uygulanabilmesi, ön hazırlık gerektirmemesi, ağrılı olmayan, düşük maliyetli, ciddi komplikasyonlara yol açmayan, hasta memnuniyetinin yüksek, güvenli ve uygulanabilme kolaylığı açısından intranazal steroid enjeksiyonu, RFTA tedavisine göre daha tercih edilebilir bulunmuştur.

Anahtar Kelimeler: Nazal obstrüksiyon, steroidler; nazal konka; hipertrofi
ABSTRACT
Objective: The aim of the study is to evaluate the effectiveness of steroid injection and radiofrequency thermal ablation (RFTA) method in the cases that chronic obstruction depends on isolated submucous inferior turbinate hypertrophy using computerized tomography (CT), visual analogue scale (VAS) and to evaluate after compare both methods for pain during application and patient satisfaction. Material and Methods: 60 patients applying to the Otolaryngology Department of Meram Medical School of Selcuk University between June 2009 and September 2010 for chronic nasal obstruction and diagnosed isolated inferior turbinate hypertrophy included this study. All the patients were adults. There were 30 patient at steroid injection group, 16 (53.3%) were women and 14 (46.7%) men. There were 30 patient at RFTA group 13 (43.3%) were women and 17 (56.7%) men. At the steroid injection group 40 mg/1 ml methylprednisolone acetate was administrated to anterior part of the inferior turbinate with denthal injector to form a submucosal bule. Radiofrequency thermal ablation group totally 1050 joul energy, target heat 75 oC, 12W, each 350 joule energy onto three points, was administered. Objective evaluation of the turbinate was carried out by comparing coronal plan paranasal sinus CT scores performed preoperatively and within 1 and 3 month postoperatively. VAS evaluation of nasal obstruction and pain during application were implemented by all patients. Results: Age rates of the patients were ranging from 19 to 75 years (mean age rate 32.40±14.330) at steroid injection group, from 18 to 66 years (mean age rate 31.30±12.075) at the RFTA group. At both two group of patients preoperatively and first and third months postoperatively in bilaterally concha sizes at anterior, middle and posterior aspect were evaluated with coronal paranasal sinus CT. At RFTA group it has been detected that concha sizes decreased approximately 23%, in first month. However it has been detected at steroid injection group postoperatively first months concha sizes were decreased 7% more than RFTA group (30.281% decrease). It has been seen that steroid injection effect continued at postoperatively 3. month but concha size reduction rate decreased to 16.5%. However at RFTA group concha size reduction rate increased to 31.5%. For both group according to VAS, which obtained preoperative and postoperatively first month there was significant reduction for bilaterally inferior turbinates. Postoperatively first month for both group there was high patient satisfaction. In the postoperatively first month at steroid injection group 28 patient had no complaint one patient had nasal obstruction, one patient had mild rhinore. At RFTA group 23 patient had no complaint but six patient had incrustration at nasal cavity one patient had nasal obstruction. There has been seen no infection for both group postoperatively and no antibiotic used. For both group's patients there was no complication detected, related with RFTA and steroid injection therapy. Conclusion: Intranasal steroid injection theraphy and RFTA have no serious complication and pain during application. They are effective, easy applicable, patient satisfying, cost effective and safe methods for inferior turbinate hyperthropy based nasal obstruction treatment. In the out patient cases injection method can be applied without preparation. In terms of they are applicable easly, cost effectiveness, low complication rates, effectiveness, safeness and patient satisfaction it appears steroid injection theraphy is more preferable than RFTA therapy.

Keywords: Nasal obstruction; steroids; nasal concha; hypertrophy

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