Use of radiofrequency waves to reduce nasal mucosa swelling: (RFVTR- IT: Radiofrequency volumetric tissue reduction Inferior Turbinate)

Chronic rhinitis (allergic rhinitis) occurs when the nasal mucosa is abnormally sensitive to stimuli such as strong odors, dust, and smoke, causing symptoms like itching, sneezing, nasal congestion, runny nose, and postnasal drip. Most patients can relieve symptoms by avoiding allergens combined with medication and nasal sprays. However, some patients do not improve despite avoiding allergens and using medication fully. Some cannot avoid triggers, or in cases where patients do not want to use medication, radiofrequency treatment is another option that can improve symptoms.

Radiofrequency Treatment Method
Radiofrequency treatment for chronic rhinitis or nasal mucosal swelling is a popular minor surgery nowadays because it effectively reduces nasal congestion, allergic reactions, sneezing, itching, and runny nose. It is especially useful for chronic rhinitis cases unresponsive to medication or for patients who prefer not to use drugs, such as those wanting to avoid side effects like drowsiness, palpitations, dry mouth, and dry throat. The treatment involves inserting a special needle into the nasal mucosa to deliver high-frequency radio waves (Radiofrequency) that convert into heat energy to the surrounding tissue. This causes partial submucosal tissue loss and subsequent fibrosis, leading to contraction and volume reduction of the nasal mucosa blocking the nasal cavity, thus opening the nasal passages. Additionally, the high-frequency waves destroy mucus-producing gland nerves, reducing itching, sneezing, runny nose, and postnasal drip. Studies on radiofrequency effects in patients with chronic nasal congestion show significant symptom reduction lasting about 3-5 years.

Another advantage of this treatment is that it can be done under local anesthesia, so patients do not need to be hospitalized. The procedure takes about 10-15 minutes. The reduction in itching, sneezing, runny nose, and postnasal drip becomes noticeable within 4-6 weeks. International research shows radiofrequency can reduce nasal congestion by about 80%, and the procedure can be repeated if results are unsatisfactory.

This surgery is performed endoscopically through the nasal cavity, so there are no visible external wounds. The lower turbinate bone is laterally fractured (Lateralization outfracture) until a cracking sound is heard. This method moderately improves nasal congestion with few side effects, but the effect may be temporary as the lower turbinate may rebound. The limitation is that the lower turbinate size is not actually reduced, nor is any tissue removed.

Preparation Before Radiofrequency Surgery
Patients should maintain good health and get enough rest before surgery to prevent colds or respiratory infections that may delay the procedure. Patients taking certain medications, such as blood thinners, must stop them several days before surgery after consulting their doctor. The doctor will assess the patient’s readiness, which may include blood tests, chest X-rays, or electrocardiograms as needed. If all tests are normal, patients can come to the hospital on the scheduled surgery day.

Postoperative Care

1. Patients will have wounds on the nasal mucosa and hemostatic materials inside the nasal cavity. Mild nasal pain from the small surgical wounds and slight blood-tinged mucus or saliva may occur.
2. In the first 1-2 days after surgery, nasal mucosa swelling may increase, causing more nasal congestion and possibly mouth breathing. Patients should sleep with their head elevated using pillows or an adjustable bed and frequently apply ice packs to the forehead or neck within the first 24-48 hours to reduce bleeding at the surgical site.
3. Patients may experience fever, swelling, a feeling of blockage or tightness as if something foreign is in the nasal cavity, or voice changes. These symptoms usually resolve within one week.
4. Patients will receive anti-inflammatory drugs, pain relievers, decongestants, and medications to reduce runny nose.
5. Avoid forceful nose blowing, nose picking, trauma to the nose, strenuous activities, intense sports, or heavy lifting within 24-48 hours after surgery, as these may cause bleeding from the nasal mucosa wound. If bleeding occurs, rest with the head elevated, use prescribed hemostatic nasal drops (3-4 drops in each nostril), and apply ice or cold packs to the forehead. If bleeding is excessive or does not stop, seek immediate medical attention.
6. Within 48-72 hours after surgery, clean the nose and surgical wound with warm saline to prevent crust formation caused by mucus sticking to the nasal mucosa wound, which can delay healing. Clean at least twice daily.
7. Normally, the nasal mucosa wound heals within about 3-4 weeks. The nasal mucosa will reduce in size, and symptoms of congestion, itching, sneezing, runny nose, and postnasal drip improve within 4-6 weeks after surgery. If symptoms do not clearly improve within this period, repeat treatment may be necessary until symptoms improve.

Possible Complications
Postoperative complications may include bleeding from the surgical wound, which if severe requires hemostasis in the operating room. Patients may experience breathing difficulties, nasal congestion from swelling of tissues around the surgical site, or surgical wound infection, though these are rare. Usually, patients can go home after surgery without hospitalization, except in cases where the doctor deems it necessary for observation.

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Dr. Uthai Prapamonthon
Specialist in Head, Neck, Bronchus, and Larynx Surgery
For more information, please contact
Ear, Nose, and Throat Center, Phyathai 3 Hospital, 4th Floor
Tel. 02-467-1111 ext. 4416, 4417