Rhinitis medicamentosa: therapeutic effect of diode laser inferior turbinate reduction on nasal obstruction and decongestant abuse.
BACKGROUND
The purpose of this study was to evaluate long-term outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in therapy-refractory rhinitis medicamentosa (RM).


METHODS
In a prospective clinical investigation, 42 consecutive RM patients underwent videoendoscopic ITR with a diode laser after topical anesthetic preparation. Intra- and perioperative details were recorded including the occurrence of bleeding, crusting, pain, or discomfort. Treatment efficiency was assessed by follow-ups 1 and 6 weeks as well as 6 and 12 months after surgery. Subjective pre- and posttherapeutic nasal airflow (NA) and patient satisfaction were rated on visual analog scales (VASs). Assessment of the long-term objective clinical effectiveness was based on rhinomanometry, IT photodocumentation, and the recurrent need for decongestants.


RESULTS
Preoperative addiction to decongestants lasted 5 +/- 2 years (mean +/- SD). There was no major bleeding requiring nasal packing, and there were no other perioperative complications. Postoperative edema disappeared within the 1st week and crusting within 6 weeks after surgery. VAS was characterized by very low values for intraoperative pain and discomfort and high postoperative patient satisfaction. After 6 months, NA data revealed a significant improvement of subjective VAS and objective rhinomanometry (250.4-413.9 cm3/s inspiration at 150 Pa). A total of 88% of patients managed to successfully stop decongestant abuse after 6 months (74% after 1 year).


CONCLUSIONS
In therapy-refractory RM, outpatient diode laser ITR of hyperplastic IT represents a highly effective, safe, and well-tolerated treatment option that provides long-lasting recovery by markedly improving NA and stopping addiction to nasal decongestants.
Caffier
Philipp P
PP
Department of Otorhinolaryngology, Head and Neck Surgery; Charité-University Medicine Berlin, Berlin, Germany. philipp.caffier@charite.de
Frieler
Katja
K
Scherer
Hans
H
Sedlmaier
Benedikt
B
Göktas
Onder
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D014663:Nasal Decongestants / Q000009:adverse effects*; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012220:Rhinitis / Q000139:chemically induced* / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome; D014420:Turbinates / Q000601:surgery*
D014663:Nasal Decongestants