Dr. Sillers emphasized that using the device in an otolaryngology office is simple, requiring little equipment beyond the “small plug-and-play console and stylus,” and that several of his patients opted to undergo the Vivaer treatment during their initial consultation visit itself due to its simplicity and convenience.
Explore This IssueSeptember 2018
As a new technology, the device’s one drawback is the lack of a reimbursement code; therefore, patients are required to pay for it out of pocket. Dr. Sillers suggested that patients are willing to pay for effective procedures such as this one, however.
“In our practice, like most everyone’s, we realized that patients increasingly pay large amounts out of pocket due to the rapidly changing insurance landscape,” he said. “Patients are more open to paying out of pocket for the benefits of an effective and convenient treatment.”
Cryotherapy for Excessive Rhinorrhea
For patients with excessive rhinorrhea, a novel device that uses cryotherapy to ablate the posterior nasal nerves (PNN) is showing beneficial results. Called Clarifix (Arrinex, Redwood City, Calif.), the device is the first of its kind to apply cryotherapy to the nose.
“This device is based on a well-known technology of cryoablation placed on a platform that allows for endoscopic visualization and specific placement where the posterior nasal nerves enter the nasal cavity,” said Amber Luong, MD, PhD, associate professor and director of research in the department of otorhinolaryngology–head and neck surgery and the Center of Immunology and Autoimmune Disease at the Institute of Molecular Medicine in Houston.
Results of the first series of patients treated with this approach showed that the device decreased rhinitis symptom scores for at least six months, and was safe and well-tolerated (Int Forum Allergy Rhinol. 2017;7:952–956).
Published in 2017, the study included 27 patients with chronic rhinorrhea and/or nasal congestion for more than three months. Patients were excluded from the study if they had self-reported history of chronic rhinosinusitis, severe septal deviation that prohibited visualization of the middle meatus, polyps or purulence in the middle meatus, septal perforation, or prior sinus or nasal surgery that significantly altered the posterior nasal cavity anatomy.
All patients underwent cryosurgical ablation of the PNN region. In the procedure, which was performed under local anesthesia, an otolaryngologist applied the cryotherapy device endoscopically to the posterior middle meatus to freeze the PNN region bilaterally.