Friday, September 30, 2011

Recent management concepts in the management of Atrophic rhinitis and empty nose syndrome


The presence of normal sized nasal turbinates covered by normal moist mucosa is vital for the normal function of the nose.  It should also be remembered that the receptors for initiating nasobronchial / nasal cardiac reflexes are found embedded in the mucosal lining of the nasal turbinates.  Surgical augmentation of atrophied turbinates and nasal mucosa will help in the restoration of nasal function and regeneration of nasal mucosa.  Usually various types of implant materials are considered for this purpose.

Commonly used implant materials:

1. Bone
2. Cartilage
3. skin
4. Fat
5. Plastic
6. Calcium hydroxyapatite

Role of Hyaluronic acid as an implant:

Hyaluronic acid is a naturally found polysaccharide consisting of a linear chain of fragments of D-glucoronic acid and N-acetlyglucosamine that alternate in the structure.  In its pure form it is not an allerge and does not stimulate immunogenic rejection process.  In view of its negative struture it absorbs large quantities of water.  On absorption of water hyaluronic acid forms a gel like structure.  It is extensively being used in plastic and reconstructive surgical procedures.  Its important unique property is that it maintains its liquid form when it is under pressure, the moment the pressure reduces it solidifies.  Hence it can be injected through a small needle.    It has another important property i.e. Isovolumetric degradation, which indicates single molecules of this substance undergoes periodic degradation while the remaining molecules absorb large amounts of water thereby enabling it to maintain its volume.  The overall volume of the gel maintains a constancy.

Hyaluronic acid can be injected submucosally thereby enlarging the size of the turbinates.  It can also be injected under the septal mucosa.  This not only cause narrowing of the nasal cavity but also promotes regeneration of nasal mucosal lining.  If a cannula is used to inject hyaluronic acid instead of needle it causes less mucosal trauma thereby minimizing the risk of accidental intravascular injection.  It would be better if the quantity of hyaluronic acid injected is the same on both sides.  Studies conducted by Marek Modrzynski, M.D.
 showed promising results.


Brett said...

I believe I suffer from ENS-type after I had an unnecessary coblation done on my left turbinate (I should have only had it done to the right, which now has the correct shape and appearance and does not give me problems..)

From what I've read, this Hyaluronic method seems like it would be a promising solution to my problem, especially since I don't have full-blown empty nose, but rather an overly-reduced turbinate that affects my 'nasobronchial / nasal cardiac' processes, thereby causing a constant sense of discomfort and anxiety -- Do you know of any other doctors who are performing this method? It seems to be rather straightforward and simple, especially compared to having surgery w/ implants, etc.


Raging Rouge said...

Hello there, Dr. Balu! I have a similar problem to Brett. About 6 weeks ago my inferior turbinate was reduced using submucosal resection via microdebrider. The reduction must have been too significant, as I also am suffering with ENS symptoms that increase as time passes. My first round of injections are scheduled for Friday, and my doctor plans to focus only on the portion of the inferior turbinates near the nasal opening at first. Is it important to increase the volume of the turbinate all the way back into the nasal cavity? My doctor also might reshape my turbinate bone, so it fills my nasal cavity more.

zahid said...

Hi dr. Tbalu. I am from bangladesh. Suffering from atrophic rhhinitis for last 14 years. Did you personally performed this operation with hyaluronic. It sounds promising. I like to come to you for my treatment. Can i get your mail address. My email address is Pl respond. Thanks.