underwent ST at Fukui Red Cross Hospital (Fukui, Japan) between
992 and 1994, and at Fukui Medical University (Fukui, Japan)
per second has been evaluated at the pressure of 50 or 100 Pa in the
1–3,7
1
previous report
from Japan. We also evaluated the nasal airflow
between 1994 and 1996. All patients were completely followed up
after surgery. Thirty of 45 patients (66.7%) passed the time point of
more than 5 years after ST, and the other patients (15 cases [33.3%
of patients]) were followed up for at least 3 years. None of the
patients has been lost to follow-up after the surgery.
value at the pressure of 100 Pa in the current study.
Nasal Challenge Test
A nasal challenge test was performed using a disk that
contained HDM (Torii, Tokyo, Japan) on the mucosa of the ante-
All patients with perennial allergic rhinitis had a high titer
of anti-Dermatophagoides pteronyssinus–specific immunoglobu-
lin E (IgE) antibodies. Thirteen of 45 patients also had a high titer
of Japanese cedar pollen (Cryptomeria japonica)–specific IgE an-
tibodies. They also had positive reactions on skin tests and posi-
tive reactions on provocation tests using HDM. They had a his-
tory of perennial nasal allergic symptoms that were resistant to
various antihistamines and to intranasal spray of topical cortico-
steroids. We excluded the patients who had sinusitis, nasal pol-
yps, or aspirin intolerance. We also excluded patients who were
treated with tranquilizers. None had a history of HDM-specific
immunotherapy before or after ST. Informed consent was ob-
tained from all patients before surgery.
1,13
rior site of the inferior turbinate
by a physician who had not
participated the nasal surgery. When nasal challenge tests were
performed after the surgery, the challenged site was apart from
the incision scar. The grades for nasal challenge test results were
as follows: 0, no allergic symptom or one of three allergic symp-
toms (local edema of the mucosa, sneezing, and rhinorrhea) oc-
curred within 15 min after challenge; 1, two allergic symptoms; 2,
all three allergic symptoms; and 3 (all three allergic symptoms
with more than six sneezes).
Investigation of Quality of Life With Card
Questionnaire
1
Procedures of ST were previously described in detail.
For 30 patients who were observed for at least 5 years
(average period, 5.6 y) after the surgery, we investigated their
QOL, as well as their nasal symptom scores, using an anonymous
mail questionnaire. The daily grade of nasal congestion and the
frequency of both sneezing and nasal blowing were recorded for 2
weeks in the same manner. In addition, two questions and select-
able answers were as follows:
Briefly, incision of the nasal mucosa was performed along the
edge of the apertura piriformis with the patient under local an-
esthesia by injection with 0.5% lidocaine and 1:10,000 adrenaline,
and the turbinate bone was isolated and removed.
Periods for Evaluation
All patients were referred to our clinic at 1 year and more than
1
) What do you think about your nasal allergic symptoms
now in comparison with those before the operation? a)
Excellent, b) Good, c) Not changed, d) Worse.
3
years (average period, 3.6 y) after surgery. In four cases, we could
not estimate the nasal condition at the 1-year period after ST with
their busy life. However, all four patients came to our clinic 3 years
after ST. The daily grade of nasal congestion and the frequency of
both sneezing and nasal blowing were recorded for 2 weeks just
before their coming to us. We called the patients 1 month before
their visiting us. Patients were free of postoperative medications for
allergies, in principle. We permitted the patients to use an intrana-
sal inhalation of beclomethasone dipropionate occasionally, when
the symptoms of nasal allergy occurred within a year of ST. A year
after ST, oral antihistamine was administrated to patients on ap-
propriate days. In patients treated with an antihistamine or topical
corticosteroid, or both, the medications were stopped at least 2
weeks before their visiting us. For the patients with a high titer of
Japanese cedar pollen, we avoided the pollen season (March and
April) when evaluating their nasal conditions.
2
) Have you needed postoperative treatments with your nasal
allergy? a) No, b) Take medicine occasionally when some
symptoms occurred without consultation of an otorhinolar-
yngology clinic, c) Sometimes consult (one or two times per
a few months) an otorhinolaryngology clinic, d) Now receiv-
ing treatment from an otorhinolaryngology clinic (more
than one time per month).
Statistical Analysis
All data were analyzed with the Mann-Whitney U test.
Macintosh computers (Statview software, Abacus Concepts, Inc.,
Berkeley, CA) were used for all statistical analyses.
RESULTS
Evaluation of Sneezing, Rhinorrhea, Subjective
Nasal Congestion Score, and Total Nasal
Symptom Score
Rhinoscopic Findings
Intranasal findings before and 5 years after ST are
shown in Fig. 1A and B. The reduction of the volume of the
inferior turbinate continued, and constriction at the sur-
gical scar in the turbinate mucosa was also detected.
Mean values for the daily frequency of sneezing and nasal
blowing and a subjective grade for nasal congestion were evaluated
1,13
using a numerical scoring system
and nasal blowing, grades were 0 (none), 1 (1–4 times per day), 2
5–9 times per day), and 3 (more than 10 times per day); and for
nasal congestion, grades were 0 (none), 1 (mild), 2 (moderate) and 3
severe). Total nasal symptom score was expressed as the sum of the
as follows: for both sneezing
(
Subjective Symptom Scores
The mean (Ϯ SD) total nasal symptom score was 7.5
Ϯ 1.6 before ST, and this score was significantly reduced
to low levels 1 year after ST. At 3 years and 5 years after
ST, although the score gradually increased, the mean
score was still lower than before ST (Table I). The rates of
patients without nasal symptoms (score 0) at the periods
of 1 and more than 3 years after ST were 36.6% (15
patients) and 20.0% (9 patients), respectively. After 5
years, no patients were free of symptoms, but a low-level
score (a score less than 3) was maintained in 70.0% (21 of
30 patients). In regard to individual symptoms, we found
that the scores of all items increased gradually; however,
(
three scores. The maximum possible score was 9.
Evaluation of Nasal Airflow Value
Total nasal airflow was measured using a rhinomanometer
(model MPR-2100, Nihon Koden, Tokyo, Japan) by the anterior
method with the patient in a sitting position. The International
Committee of Standardization of nasal functionary examination
suggested that nasal expiratory flow should be evaluated at a pres-
sure of 150 Pa. However, our Japanese physique is smaller than that
of Westerners. The pressure at the nasopharynx in Japanese indi-
viduals cannot often exceed 150 Pa. Thus, the value of expirations
Laryngoscope 112: May 2002
Mori et al.: Effect of Submucous Turbinectomy
8
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