Chronic Hypertrophic Rhinitis Resistant to Conservative Therapy – Comparison of Various Surgical Techniques of Mucotomy/Turbinoplasty (Including Economic Analysis)
Authors:
J. Kastner 1,2; M. Kuchař 1
; M. Zábrodský 1; Z. Balatková 1
; J. Hroboňová; J. Plzák 1; J. Lisý 3; J. Betka 1
Authors‘ workplace:
Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha
1; Ušní, nosní, krční ambulance Kastner, s. r. o., Beroun a Plzeň
2; Klinika zobrazovacích metod 2. LF UK a FN v Motole, Praha
3
Published in:
Otorinolaryngol Foniatr, 61, 2012, No. 3, pp. 162-171.
Category:
Original Article
Overview
In our setting of equipment of personnel of the clinical workplace we intended to prove rationality in performed surgical interventions on the inferior concha in hypertrophic chronic rhinitis which was resistant to conservative therapy and, at the same time, to compare so far used commonly introduced surgery (classical surgical partial mucotomy/turbinoplasty and outpatient laser or radiofrequency turbinoplasty. It has become obvious that the apparently more expensive modern surgical procedures performed in outpatient wards significantly improve quality of life of the patients, but they can simultaneously decrease financial cost for the public health system and in this way a higher social-economic effect for the society (lower demands for the public health system shorter working disability, etc.). The study demonstrated a comparatively effective favorable resulting medical effect of all above mentioned techniques of mucotomy/turbinoplasty. The outpatient interventions dominate the better quality of life of the patients in the early postoperative period. The economic analysis demonstrated viability of one of them (laser turbinoplasty) even in conditions of the public health system of the Czech Republic, which has been so far unable to differentiate between standard and above-standard interventions within the framework of legal (statutory) health insurance. Moreover, the presently public health insurance – preferred interventions (limiting mucotomy/turbinoplasty to intervention under hospitalization) rather clearly and simultaneously not understandably load the public health system by cost, which could be limited. This observation, however, was not the aim of the study, but it can serve as an example of the lack of economy of the present system of health care.
The data following from the conclusions of the economic analysis, nevertheless, may in the future at least theoretically contribute to the support of this goal, specifically a complex reform of public health including differentiation of the standard and above-standard interventions within the framework of health insurance, or introduction of private additional insurance, which is functioning so well in socially developed countries such as Germany or Austria and which represent a benefit for the patient as well as for the public health system. In contrast to for example the N.H.S. system in Great Britain with two antipoles, where one of them represents a completely socialist public health (where everybody has the right for everything, but also after one or two years in the system of planned operation interventions) and the other fully private medical institutions. This is, however, a topic for another paper.
Key words:
chronic hypertrophic rhinitis, mucotomy/turbinoplasty, standard and above-standard interventions, health insurance.
Sources
1. Beck, J. C.: Pathology and intramural electrocoagulation of theinferior turbinate. Ann. Otol. Rhinol. Laryngol., 39, 1930, s. 349-363.
2. Bhattacharyya, N., Lepneš, L. J.: Clinical effectiveness of oblation nferior urbinate eduction. Otolaryngol. Head Neck Surg., 129, 2003, s. 365-371.
3. Blackwell, D. L., Collins, J. G., Coles, R.: Summary health statistics for U.S. adults: National Health Interview Survey, 1997. Vital Health Stat., 10, 2002, s. 1-109.
4. Buyuklu, F., akmak, O., izal, E., onmez, F. Y.: Outfracture of the nferior urbinate: A computed tomography study. Plast. Reconstr. Surg., 009, 23, [elektronická verze].
5. Egeli, E., emirci, L., azycy, B., arputluoglu, U.: Evaluation of the nferior urbinate n patients with deviated nasal septum by using computed tomography. Laryngoscope, 14, 2004, s. 113-117.
6. Fokkens, W., Lund, V., Mullol, J. et al.: European position paper on rhinosinusitis and nasal olyps group. European position paper on rhinosinusitis and nasal polyps. Rhinology, Suppl., 20, 2007, s. 1-136.
7. Fokkens, W., Lund, V., Mullol, J. et al.: The European position paper on rhinosinusitis and nasal polyps. Rhinology, 23, 2012, Suppl. s. 1-299.
8. Freer, O. T.: The inferior turbinate: Its longitudinal resection for chronic intumescence. Laryngoskope, 21, 1911, s. 1136-1144.
9. Hartus, H. I.: Improved technique for submucous resection. Ann. Otol. Rhinol. and Laryngol., 45, 1936, s. 481-484.
10. Hol, M. K., Huizing, E. H.: Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology, 38, 2000, 157-166.
11. Janda, P., Sroka, R., Baumgartner, R., Revers, G., Leunig, A.: Laser treatment of hyperplastic inferior nasal turbinates: a review. Lasers Surg. Med., 28, 2001, s. 404-413.
12. Narcis, W. M. C.: Removal of hypertrophied turbinated tissue by écrasement with the cold wire. Arch. Laryngol., 1882, 3, s. 105-111.
13. Jun, B. C., im, S. W, im, S. W., ho, J. H., ark, Y. J., oon, H. R.: Is urbinate urgery necessary when performing a septoplasty? Eur. Arch. Otorhinolaryngol., 66, 2009, s. 975-980.
14. Kim, D. H., ark, H. Y., im, H. S., ang, S. O., ark, J. S., an, N. S., im, H. J.: Effect of septoplasty on nferior urbinate ypertrophy. Arch. Otolaryngol. Head Neck Surg., 34, 2008, s. 419-423.
15. Lenders, H., irsig, .: How can hyperreflexia rhinopathy be modified surgically? Literature review. Laryngorhinootologie, 69, 1990, s. 246-254.
16. Lenders, H., irsig, .: How can hyperreactive rhinopathy be modified surgically? II: Acoustic rhinometry and anterior urbinoplasty. Laryngorhinootologie, 69, 1990, s. 291-297.
17. Li, K. K., Powell, N. B., Riley, R. W., Troll, R. J., Guilleminault, C.: Radiofrequency olumetric tissue reduction for treatment of urbinate ypertrophy: a pilot study. Otolaryngol. Head Neck Surg., 119, 1998, s. 569-573.
18. Linhart, C. P.: A submucous operation for the reduction of hypertrophied turbinals. Laryngoskope, 18, 1908, s. 128-134.
19. Low, S.: Eine neue operation - submucöse turbinektomie. J. Clin. Research, 1906, s. 320.
20. Mabry R. L.: Medical management of the stuffy nose. South Med. J., 74, 1981, s. 984-988.
21. Mabry, R. L.: Surgery of the inferior turbinates: How much and when? Otolaryngol. Head Neck Surg., 92, 1984, s. 571-576.
22. Mabry, R. L.: “How I do it” – plastic surgery. Practical suggestions on facial plastic surgery. Inferior turbinoplasty. Laryngoskope, 92, 1982, s. 459-461.
23. Mabry, R. L.: Inferior turbinoplasty: Patient selection, technique, and long term consequences. Otolaryngol. Head Neck Surg., 98, 1988, s. 60-66.
24. Medical Expenditure Panel Survey (MEPS). Dostupné na www.meps.ahrq.gov.
25. Michel, M., Jakob, S., Roger, G., Pelosse, B., Laurier, D., Le Pointe, H. D., Bernier, M. O.: Eye lens radiation exposure and repeated head CT scans: A problem to keep in mind. Eur. J. Radiol., 2011, [elektonická verze].
26. National Center for Health Statistics. Dostupné na www.cdc.gov/nchs.
27. Rice, D. H., Kern, E. B., Marple, B. F., Mabry, R. L., Friedman, W. H.: The turbinates in nasal and sinus surgery: A consensus statement. Ear Nose Throat J., 82, 2003, s. 82-84.
28. Stuck, B. A., Kauter, A., Hermann, K., Verse, T., Maurer, J. T.: Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial. Slep, 28, 2005, s. 847-850.
29. Vogt, K., Jalowayski, A. A., Althaus, W., Caom C, Han, D., Hasse, W., Hoffrichter, H., Mösqes, R., Pallanch, J., Shah-Hosseini, K., Wernecke, K. D., Zhang, L., Zaproshenko, P.: 4-Phase-Rhinomanometry – basics and practice. Rhinology, 2010, Suppl. 21, s. 1-50.
30. Willatt, D.: The evidence for reducing inferior turbinates. Rhinology, 47, 2009, s. 227-236.
31. Würdemann, H. V.: Submucous turbinectomy. Laryngoskope, 18, 1908, s. 284-285.
Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
2012 Issue 3
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