Another Option for Allergic Rhinitis?: Study examines long-term safety, efficacy of RF turbinoplasty

In a written comment to ENT Today, Richard Rosenfeld, MD, professor and chairman of otolaryngology at the State University of New York Downstate Medical Center in Brooklyn, N.Y., criticized the design and conduct of the study. He said the data suggested a placebo effect because there was a strong improvement at six months that was reduced substantially at five years. In addition, three of the symptoms that showed significant improvements, sneezing, itchy eyes and itchy nose, would not be influenced by the procedure.

“Turbinoplasty would only be expected to reduce nasal obstruction and, possibly, rhinorrhea,” he noted. Furthermore, “only 57 percent of those who responded to the satisfaction survey said they would have the surgery again (knowing what they know now), which would be expected to be much higher if, indeed, the data in the table reflected improvements.”

Matthew Ryan, MD, assistant professor of otolaryngology at the University of Texas Southwestern Medical Center at Dallas, said the study does not show that RF reduction of the turbinate is now proven to be an effective treatment for allergic rhinitis. And, because the study was uncontrolled, “it is difficult to determine if the clinical improvement noted in the study subjects was due to the RF intervention, other medications and treatments administered through the years, the passage of time or other unknown factors,” he added.

“Turbinoplasty would only be expected to reduce nasal obstruction and, possibly, rhinorrhea.”

—Richard Rosenfeld, MD

Dr. Ryan noted that he isn’t using RF turbinoplasty in his practice, and “I think more people are using different techniques. Compared to other techniques, RF turbinoplasty is not as effective for long-term relief of nasal obstruction.”

Dr. Rosenfeld said that “for allergic rhinitis, in general, this study does not convince me of a benefit. Therefore, I would be more likely to recommend interventions of proven benefit to patients with chronic allergy symptoms [who have been] unresponsive to conventional therapy, such as injection immunotherapy or sublingual immunotherapy, both of which have been shown effective in randomized controlled trials and Cochrane reviews.” Dr. Rosenfeld said he would consider turbinoplasty for patients with allergic rhinitis whose primary complaint is nasal airway obstruction confirmed by nasal endoscopy.

Michael Friedman, MD, professor of otolaryngology-head and neck surgery at Rush University Medical Center and medical director at the Advanced Center for Specialty Care in Chicago, had a different take. “I think the take-home message of the study is that radiofrequency reduction is an option for long-term control of patients who are not responsive to medical therapy,” he said. One of the paper’s authors, Dr. Friedman noted that the study’s purpose was not to compare RF turbinoplasty with other treatments but to determine if RF turbinoplasty has good long-term results. “We as otolaryngologists and physicians treating our patients should have an open mind to multiple options,” he said.