Sarah Goodwin

Kathi Ovnic
Holly Korschun
June 1, 1998

Emory University ENT physicians are using a quick, new outpatient procedure to relieve stuffy noses in people suffering from enlarged turbinates the mucous membrane-covered bony structures that protrude into the nasal airway and help cleanse and humidify air. Emory surgeons John DelGaudio, M.D., and Todd Kingdom, M.D., using a new technology called somnoplasty, reduce the enlarged tissue in a stuffed-up nose using a small electrode that emits very low levels of radiofrequency energy to heat and reduce tissue.

Although everyone has turbinates, they become enlarged in people with chronic rhinitis inflamed mucous membranes caused by allergies or chronic infections resulting in swollen blood vessels that blocks the nasal passages, making it difficult to breathe in the daytime and at night. Rhinitis can be caused by allergies, changes in temperature and humidity, a reaction to irritants such as cigarette smoke, chemicals, dust, or odors, or excessive use of nasal sprays or drops. In extreme cases, enlarged turbinates turn even normal activities like speaking, eating and drinking into annoying and sometimes painful experiences. A chronic stuffy nose can cause headaches, snoring, and sleep apnea. Once turbinate enlargement becomes chronic, it is impossible to reverse it without some type of surgery.

In the somnoplasty procedure, a technology licensed by Somnus Medical Technologies and approved by the Food and Drug Administration, a topical or local anesthetic is given within the nose and a tiny electrode is inserted into the swollen turbinate. The electrode is connected to a radiofrequency generator that emits low-level energy to reduce the amount of tissue. The procedure also destroys small blood vessels responsible for the enlargement of the turbinate so that they cannot swell.

Some patients experience minor discomfort during the administration of local anesthesia and a slight feeling of heat during the procedure. Since the delicate mucous layer of the turbinate is preserved, however, there is very little crusting, bleeding, or swelling and no pain relievers are required afterwards. Patients can return immediately to their daily activities. The tissue heals completely in about three to four weeks.

Until now, the standard medical treatments for a stuffy nose included avoiding exposure to the factors that cause rhinitis and taking antihistamines, decongestants and corticosteroids. These medications provide only temporary relief of symptoms and sometimes drowsiness, rebound nasal cognition and burning. Surgery is recommended for enlarged turbinates that became chronic.

"There are as many surgical techniques for treating enlarged turbinates as there are ENT doctors," says Dr. Kingdom, "They can be removed by cauterization (burning), lasers, trimming, crushing or delivering an electrical current. All these are more painful, and all usually require a trip to the operating room, more post-operative care and a longer recovery period than somnoplasty," he points out. Many times these procedures result in swelling and crusting within the nose that lasts three weeks or longer.

"Somnoplasty requires only two-minutes for each turbinate," explains Dr. Kingdom. "We use local anesthesia in our clinic offices and send the patients back to their normal activities after 30 minutes." He expects that since traditional turbinate surgery is covered by insurance, somnoplasty for turbinates is likely to be covered also.

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