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Pediatric Turbinate Hypertrophy PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Pediatric Turbinate Hypertrophy" by Nina L. Shapiro, MD.

This medical PowerPoint presentation is about pediatric turbinate hypertrophy, the enlargement of the turbinates, which are structures located inside the nose that help to warm, humidify, and filter the air we breathe. In children, this condition can lead to nasal obstruction, difficulty breathing through the nose, snoring, and sleep apnea.

There are several factors that can contribute to pediatric turbinate hypertrophy, including allergies, infections, and anatomical factors. Allergies are a common cause of turbinate hypertrophy, as they can cause inflammation of the nasal tissues. Infections, such as the common cold, can also cause nasal inflammation and swelling. Anatomical factors, such as the shape and size of the nasal passages, can also play a role.

Treatment for pediatric turbinate hypertrophy may include medications, such as nasal steroids and antihistamines, to reduce inflammation and swelling. In cases where medication is not effective, surgery may be recommended to remove or reduce the size of the enlarged turbinates. It is important to consult with a pediatrician or an otolaryngologist (ear, nose, and throat specialist) for proper evaluation and treatment.

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Published on : Jun 23, 2023 | Views : 699 | Downloads : 0

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Slide 1-

Pediatric Turbinate HypertrophyNina L. Shapiro, MDAssociate ProfessorPediatric OtolaryngologyUCLA School of Medicine
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Introduction: Turbinate Hypertrophy Chronic rhinitis leading to turbinate hypertrophy common in both children and adults 20 million people in U.S $2 billion annually Infectious or non-infectious Allergic or non-allergic
Slide 3-

Turbinate hypertrophy: Children Smaller intranasal anatomy Obstruction due to turbinate hypertrophy plays larger role in pediatric patients relative to adults
Slide 4-

Turbinate Anatomy
Slide 5-

Introduction Children with adenotonsillar obstruction Adenoidectomy or Adenotonsillectomy alleviates obstruction in presence of enlarged turbinates Surgical intervention to reduce turbinate hypertrophy may be additional option
Slide 6-

Adenotonsillar Hypertrophy
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Medical Management Antihistamines Decongestants Topical nasal steroids/nasal saline/sinus rinses Antibiotics if sinusitis Immunotherapy if allergic
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Surgical Options Cold-steel turbinectomy/turbinoplasty Lateralization/outfracture of inferior turbinate Diathermy (electrocautery) Laser Cryosurgery Powered Microdebrider Radiofrequency Ablation Coblation
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What Is Coblation? Bipolar configuration RF current through conductive solution 100-300 V, 100-500 kHz Plasma field by RF current In NaCl, orange glow Not heat-driven Molecular dissociation Minimal thermal penetration Cell death (<125 mm)
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Coblation Low frequency Decreased tissue penetration Minimal collateral tissue damage Surface temperatures 40° to 70° C Shorter current path Control of energy delivery Volumetric tissue removal Monopolar spark between electrode and tissue Localized tissue heating 450° to 600° C Tissue desiccation and vaporization Electrocautery
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ReFlex Ultra™ 45 Plasma Wand Coblation® Turbinate Wand Needle-tip wand with contact markers Coblation foot pedal control Saline gel application for each turbinate entry Varying durations/contacts/entries
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Coblation Turbinate Reduction Coblation shrinks submucosal tissue Preserves mucosal and glandular architecture Immediate reduction in nasal obstruction, with greater reduction over time Thermal lesion remains after tissue vaporization Soft tissue attenuation/contracture progresses
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Coblation Turbinate Reduction Operating room or in-office procedure Topical/Local anesthetic <25% require post-operative narcotic analgesic Fast, minimally invasive procedure 20-30 seconds per side
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Coblation Turbinate Reduction:Experience in Adults Fast In-office Restores normal breathing immediately Improvement progresses over time Minimal side effects
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Coblation Turbinate Reduction:Experience in Adults 50% reduction in nasal blockage at 1 week, 3, 6, and 12 months Easy to perform in OR or office Minimal pain; low incidence of post-op crusting Each lesion created in 10 seconds Minimal damage to surrounding tissue Bäck LJ, Hytönen ML, Malmberg HO, Ylikoski JS. Laryngoscope. 2002;112:1806–1812. Bhattacharyya N, Kepnes LJ. Otolaryngol Head Neck Surg. 2003;129:365–371
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Clinical Effectiveness of Coblation Inferior Turbinate Reduction OBJECTIVE Determine safety and clinical efficacy of Coblation inferior turbinate reduction DESIGN 26 patients with inferior turbinate hypertrophy treated in-office with Coblation Bhattacharyya N, Kepnes LJ. Otolaryngol Head Neck Surg. 2003;129:365-371.
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Clinical Effectiveness of Coblation Inferior Turbinate Reduction Bhattacharyya N, Kepnes LJ. Otolaryngol Head Neck Surg. 2003;129:365-371.
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CONCLUSIONS Inferior turbinate reduction by Coblation is effective for inferior turbinate hypertrophy Clinical benefit persists for at least 6 months Clinical Effectiveness of Coblation Inferior Turbinate Reduction Bhattacharyya N, Kepnes LJ. Otolaryngol Head Neck Surg. 2003;129:365-371.
Slide 19-

Coblation vs. Microdebrider 60 patients randomized/not blinded 30 coblation/30 microdebrider 3,6, 12 month follow-up Improvement at all time points in both groups Nasal obstruction Postnasal drip
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Coblation vs. Microdebrider Symptoms of nasal obstruction and nasal cavity better in microdebrider group at 12 months HOWEVER, only one coblation needle pass, unknown contact duration anteriorly Lee JY, Lee JD. Laryngoscope 116:729-734, 2006.
Slide 21-

Radiofrequency vs. Submucous resection 75 patients 25 submucous resection/25 radiofrequency/ 25 controls (medical management) Followed 1 week, 1 month, 3 months Both techniques equally effective in short-term follow period Nasal obstructive symptoms, rhinomamometry
Slide 22-

Radiofrequency vs. submucous resection: RF benefits Local anesthesia Preserves nasal epithelium No increased secretions or crusting No nasal packing Sooner return to work/activities; minimal pain; in-office May outweigh increased cost of RF wand Cavaliere M, Mottola G, Iemma M. Otolaryngol Head Neck Surg 133(6): 972-978, 2005.
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Radiofrequency vs. placebo 32 adult patients In-office/local anesthesia RF probe with or without energy delivery Results: Treatment group improved over placebo group at 8 wks/ 6mo follow-up Frequency/severity of nasal obstruction Ability to breathe through nose Nease CJ, Krempl GA. Otolaryngol Head Neck Surg 2004; 130:291-299.
Slide 24-

Radiofrequency vs. Placebo RF group at 2 years follow-up Same improvement in symptoms Frequency/severity of nasal obstruction Ability to breathe through nose Statistically significant at 8 weeks and 2 years follow-up (p<0.05) compared with pre-op with sustained benefit. Porter MW, Hales NW, Nease CJ, Krempl GA. Laryngoscope 116:554-557, 2006.
Slide 25-

Pediatric Patient Selection Children with nasal obstruction alone History of allergic/non-allergic rhinitis with non-response or non-compliance to medical therapy Children with turbinate hypertrophy secondary to other problems Turbinate reduction in conjunction with other procedures such as sinus surgery or T&A Pediatric OSA? Previous/concurrent adenoidectomy?
Slide 26-

Pediatric Patient Selection Typically treat children >6 years that have failed trial of medical therapy Most children <3 years not yet truly diagnosed with allergies Young children have other sources of airway obstruction such as adenoid hypertrophy
Slide 27-

Pre- op Evaluation History/physical Nasal endoscopy Acoustic rhinometry Sinus CT Scan to rule out concomitant anatomic abnormalities/sinus disease/polyps Prior medical management: poor outcome/compliance
Slide 28-

Pediatric Coblation Turbinate Reduction: Surgical Technique 0-degree endoscope Turbinate injection with 1% lidocaine or saline 2-3 cc per side Turbinate wand channeling Topical cottonoids with oxymetazoline
Slide 29-

Coblation Pediatric Turbinate Reduction Technique Create two anterior lesions within the bulk of the turbinate One superior, one inferior 10 seconds per lesion Coblation setting of 6
Slide 30-

Inferior Turbinate Channeling Before each insertion, apply saline gel or other conductive media to ensure formation of plasma field Activate controller foot pedal as advance wand tip into the inferior turbinate (power setting 4-6 coblate based on user preference)
Slide 31-

Inferior turbinate channeling Stop insertion at appropriate visualization marker and continue to hold coblation pedal for 10 seconds to create lesion First marker for anterior turbinate Last marker for posterior turbinate Withdraw inactivated wand to additional markers and repeat ablation When last ablation complete, remove inactivated wand Repeat steps to create additional channels No need to use coagulation pedal
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Post-op Evaluation Follow-up at 3-6 weeks, 6 months, 12 months Physical exam/symptom improvement/reduction in medical therapy Acoustic rhinometry Allergy follow-up as needed
Slide 37-

Adult vs. Pediatric Techniques Similar settings (4-6 coblate) Similar duration of contact (10 seconds) Consider fewer passes/fewer contact points in children No data on pediatric outcomes
Slide 38-

Surgical Reduction of Inferior Turbinates with Coblation in Children: Multi-center Trial Prospective/Controlled Study (CHSD/MEEI/UCLA) Assess nasal obstructive symptom reduction in children following Coblation turbinate reduction (12 month follow-up)
Slide 39-

Pediatric turbinate reduction: CHSD/MEEI/UCLA Pediatric turbinate reduction patients Selection criteria Allergic/Non-allergic rhinitis Prior medical therapy failure Nasal endoscopy/photos Acoustic rhinometry CT Scan Absence of adenotonsillar hypertrophy Surgical intervention Follow-up at 4 weeks, 6 months, 12 months
Slide 40-

Pediatric turbinate reduction: CHSD/MEEI/UCLA Medical management Topical nasal steroids, oral antihistamines, immunotherapy, environmental controls where possible Surgical intervention Coblation turbinate reduction (without concomitant procedure) Follow-up examination, endoscopic photos, questionnaire, acoustic rhinometry
Slide 41-

Pediatric turbinate reduction: CHSD/MEEI/UCLA Clinical outcomes assessment Does coblation turbinate reduction improve nasal obstruction in children with allergic and non-allergic rhinitis? Does coblation turbinate reduction obviate need for medical therapy? Are the benefits long-lasting?
Slide 42-

Coblation Turbinate Reduction Stand-alone procedure Normal tonsils/adenoids Poor response to medical therapy Combined procedure T&A with significant turbinate hypertrophy Endoscopic sinus surgery
Slide 43-

Coblation Use When is it indicated to combine T&A or Adenoidectomy with turbinate reduction? Allergic patients with ATH Severe turbinate hypertrophy with ATH Severe OSA One anesthetic– get it all done!
Slide 44-

Coblation Use Indications to perform separately Turbinates alone– non-invasive, minimal recovery, small tonsils/adenoids Especially if surgeon does not coblate tonsils/adenoids T&A, Adenoid alone– younger child, small turbinates
Slide 45-

Otolaryngologist Objections Cost Minimal morbidity and long-term benefits outweigh wand cost
Slide 46-

Otolaryngologist Objections Reluctance to change technique Submucosal reduction Ease of performance Patient satisfaction Surgeon satisfaction Ancillary staff satisfaction
Slide 47-

Otolaryngologist Objections Reluctance to perform in children Safety/efficacy/minimize medical therapy Just as OSD under-recognized, Turbinate hypertrophy under-recognized
Slide 48-

Conclusions Nasal obstruction due to turbinate hypertrophy is common in adults and children Coblation turbinate reduction is safe, effective, and long-lasting in adults Clinical experience is promising in children Prospective data is forthcoming
Slide 49-

Studies Pang YT, Willatt DJ. Laser reduction of inferior turbinates in children. Singapore Med J 1995; 36(5):514-516. Weider DJ, Sulzner SE. Inferior turbinate reduction surgery in children. Ear Nose Throat J 1998; 77(4):304-2, 314. Hol MK, Huizing EH. Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology 2000; 38(4):157-166. Coste A, Yona L, Blumen M et al. Radiofrequency is a safe and effective treatment of turbinate hypertrophy. Laryngoscope 2001; 111(5):894-899. Bäck LJ, Hytonen ML, Malmberg HO et al. Submucosal bipolar radiofrequency thermal ablation of inferior turbinates: a long-term follow-up with subjective and objective assessment. Laryngoscope 2002; 112(10):1806-1812. Segal S, Eviatar E, Berenholz L et al. Inferior turbinectomy in children. Am J Rhinol 2003; 17(2):69-73. Bhattacharyya N, Kepnes LJ. Clinical effectiveness of coblation inferior turbinate reduction. Otolaryngol Head Neck Surg 2003; 129(4):365-371. Chang CW, Ries WR. Surgical treatment of the inferior turbinate: new techniques. Curr Opin Otolaryngol Head Neck Surg 2004; 12(1):53-57. Rejali SD, Upile T, McLellan D et al. Inferior turbinate reduction in children using Holmium YAG laser-a clinical and histological study. Lasers Surg Med 2004; 34(4):310-314.