Comparison of long term results after Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates.
OBJECTIVE
Various laser systems have been used to reduce the volume of hyperplastic inferior nasal turbinates during the last 25 years. Although there are many studies reporting the clinical results immediately after laser treatment, there are only a few describing long-term results. Therefore, a clinical study was performed to assess and to compare the long-term outcome of both endonasal Ho:YAG and endonasal diode laser-assisted turbinate surgery.


METHODS
In the first treatment group, a total of 80 patients (allergic rhinitis (46%) and vasomotor rhinitis (54%)) suffering from nasal obstruction due to hyperplastic inferior nasal turbinates were treated by a pulsed Ho:YAG laser emitting light at a wavelength of lambda = 2,100 nm (pulse energy: 0.8-1.2 J/pulse, repetition rate: 4-8 Hz) under local anesthesia. In the second group, an additional 113 patients (allergic rhinitis (52%) and vasomotor rhinitis (48%)) were treated by means of a continuous wave GaAlAs-diode laser emitting light at a wavelength of lambda = 940 nm (power: 8-10 W). The treatment time was 3-10 minutes per turbinate and the nasal cavities were left unpacked following the procedure. The study concerning long-term effects was conducted using a standardized questionnaire, allergy test, and rhinomanometry within a follow-up period of 6 month and after 3 years. All patients were refractory to conservative medical treatment prior to laser treatment.


RESULTS
Three years after laser treatment, a subjective improvement of nasal airflow had been described by the patients in 67.5% after Ho:YAG- and in 74.4% after diode laser treatment. Rhinomanometry revealed a significant improvement of the nasal airflow at both 6 months and 3 years after the laser treatment as compared to the preoperative data. Side effects like nasal dryness and pain were rare (<5%) and occurred only during the first weeks after the intervention. After diode laser treatment, patients showed nasal obstruction due to postoperative edema and nasal crusting during the first 3-4 weeks, whereas patients from the Ho:YAG laser group described these symptoms only for a period of 1-2 weeks.


CONCLUSIONS
Both Ho:YAG- and diode laser treatment, which are performed as an outpatient procedure under local anesthesia, show promising long-term results. It has therefore, developed to become a time and cost-effective treatment modality in endonasal laser surgery at our institution. While short-term differences concerning the healing process after Ho:YAG- compared to diode-laser treatment could be ascertained according to the subjective and objective evaluation, no significant long-term differences between the two investigated groups could be observed.
Sroka
Ronald
R
Laser-Research Laboratory at the LIFE-Center, Ludwig-Maximilians University, 81377 Munich, Germany. ronald.sroka@med.uni-muenchen.de
Janda
Philip
P
Killian
Tina
T
Vaz
Francis
F
Betz
Christian S
CS
Leunig
Andreas
A
D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D053685:Laser Therapy / Q000379:methods*; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000601:surgery; D012223:Rhinitis, Vasomotor / Q000601:surgery; D025363:Rhinomanometry; D014420:Turbinates / Q000473:pathology* / Q000601:surgery*