Allergic Rhinitis Treatment

Researches » Allergic Rhinitis Treatment

 
 
 

  

Minimally Invasive KTP Laser Treatment

of Perennial Allergic Rhinitis:

A Preliminary Report

 

Allergic rhinitis is a common disease in otolaryngologic practice for which the symptoms are often annoying, and/or disturbing. Though the most effective means to halt the effect of the the condition is to avoid the causative allergens, this is just not as practical as causative agents can go from the common dust to changes in weather condition, and other environmental factors. Antihistamines and decongestants may also offer symptomatic relief but is not the direct treatment for the procedure, and more often than not, these medications have sedative effects.

Immunotherapy had also been an effective option to improve but not totally cure allergic rhinitis. Since immunotherapy also takes into factor patient compliance due to its long treatment span, the practicality is often questionable.

With this, the researchers sought of a more immediate and effective approach to treat allergic rhinitis. The study was carried out at the Otolaryngology Department, Ramathibodi Hospital, Mahidol University, in Bangkok, Thailand. 58 patients, 35 of which were women, and 23 are men, were included as subjects to the study. The age range of the subjects was 28-70 years old with a mean of 38 years.

The criteria for inclusion in the study were (1) perennial allergic rhinitis refractory to medical treatment, (2) absence of severe nasal septum deviation, (3) absence of sinusitis, (4) absence of nasal polyps, (5) absence of systemic disease, (6) nonpregnant, (7) consent to undergo treatment.

For the subjects involved in the study, the diagnosis of allergy was based primarily on a positive history for allergy and a positive intradermal allergic skin test. Meticulous anterior and posterior rhinoscopy and paranasal sinuses plain film scans were done in every patient to confirm the absence of polyp, septal deviation, or sinusitis.

The laser system that was used for the study was the KTP, which emits a green light at a wave length of 532nm. The optical fiber was applied directly into the nose. The optical fiber is inserted into a laser channel of an angulated hand piece with built in suction channel to allow simultaneous laser delivery and smoke evacuation.

Only one side of the nose was treated with laser while the other side was left untreated to serve as a control. The side that was treated was chosen randomly if the symptoms are equal on both sides, if the symptoms somehow differ, the side with the more prominent symptoms was treated.

The treatment started with the KTP Laser set at 12 watts in  a continuous noncontact mode, spot size of about 2mm. The anterior ¼ of the inferior turbinate, 1-1.5cm in length from the anterior tip backwards including the superior attachment to the inferior-free margin on one side was irradiated by laser. The endpoint of the treatment was reached when the treated area had already turned white homogeneously, without any bleeding point as this signifies ever superficial distribution of laser energy. No nasal packing was used for the any of the patients.

Prior to treatment, the range serum IgE was between 40.2 to 2284.2 IU/mL with a mean of 125.8, and the absolute eosinophil count was 80 to 1050 cells/mL with a mean of 327.5. During the first few days after the laser irradiation, majority of the patients experienced serous discharge and symptoms of ipsilateral partial nasal obstruction. Subjective improvements were mostly reported by the patients 2 weeks after the treatment.

Five patients were lost to follow-up while 53 patients were available for subjective clinical evaluation. The patients reported 100% improvement of the obstructing symptom on the side that was treated with the laser while it’s 0% on the untreated side. The average degree of improvement of the nasal discharge was 90% on the treated side and 20% on the untreated site; the itching symptoms improved at an average of 85% on the treated site while only 30% on the untreated side. The patients also reported an overall reduction of sneezing by 70%. Overall, 81.2% of the patients subjectively rate their results as excellent, 16.6% rate it as fair, while the remaining 1.8% rate the result as poor. None of the subjects reported worsening of the symptoms or no improvement at all.

As the result of the treatment shows, the study concluded that KTP Laser Photocoagulation is an effective alternative treatment to control all four subjective symptoms of perennial allergic rhinitis. The most advantageous benefit from this option is that it is simple and it is a one-time procedure that can be done in the doctor’s office under topical anesthesia.

 

See paper abstract here.

 

 

 

 

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