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Gilead Berger, MD; Dov Ophir, MD; Koby Pitaro, MD; Roee Landsberg, MD

Arch Otolaryngol Head Neck Surg. 2008;134(8):819-823.

Objective  To assess the medium- to long-term histopathological changes after coblation (cold ablation) inferior turbinate (IT) reduction (CITR) surgery for refractory IT hypertrophy.

Design  Two-center, prospective, nonrandomized, controlled histological study.

Setting  University-affiliated hospitals.

Patients  The coblation-treated group included 22 samples from 16 men with IT hypertrophy in whom CITR had failed and who underwent endoscopically guided mucotomy. The control group included 18 samples from 14 men who had nasal obstruction due to refractory IT hypertrophy and who had undergone inferior turbinectomy.

Main Outcome Measures  After processing the samples of both groups, we assessed the general histopathological features, the area fraction of various soft-tissue constituents, and the epithelial integrity.

Results  Qualitative analysis showed marked fibrosis and depletion of submucosal glands and venous sinusoids in the lamina propria after CITR. Compared with the control group, the coblation-treated group showed a significantly increased area fraction of connective tissue and a significantly decreased area fraction of submucosal glands and venous sinusoids (P < .001 for all 3 comparisons). A significantly decreased relative proportion of intact epithelium and a significantly increased relative proportion of partial epithelial shedding were also found in the coblation-treated group (P = .03 and P = .04, respectively).

Conclusions  The long-term histological effects of CITR were significant fibrosis, glandular and venous sinusoid depletion, and partial epithelial shedding. The latter probably resulted from vascular damage, causing a reduction in epithelial perfusion. Questions remain concerning the long-term implications of the histopathological changes of CITR on nasal physiology.

Author Affiliations: Ear, Nose, and Throat Histopathologic Research Laboratory (Drs Berger and Pitaro), Department of Otolaryngology–Head and Neck Surgery (Drs Berger and Ophir), Meir Medical Center, Kfar Saba, Israel; and Departments of Otolaryngology–Head and Neck Surgery, Tel Aviv Sourasky Medical Center (Dr Landsberg), and Sackler Faculty of Medicine (Drs Berger, Ophir, and Landsberg), Tel Aviv University, Tel Aviv, Israel. Dr Pitaro is now with the Department of Otolaryngology–Head and Neck Surgery, Assaf Harofeh Medical Center, Zeriffin, Israel.

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