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Clinical and Experimental Otorhinolaryngology > Accepted Articles
doi: https://doi.org/10.21053/ceo.2020.02383    [Accepted]
Development of HIGH-INTENSITY FOCUSED ULTRASOUND(HIFU) Therapy in Inferior Turbinate Hypertrophy
Joon Kon Kim1 , Sung-Woo Cho1 , Hyojin Kim3 , Sung Chan Jo4 , Hyung Gu Kim5 , Tae-Bin Won1 , Jeong-Whun Kim1 , Jae Hyun Lim6 , Chae-Seo Rhee1,2
1Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
2Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
3Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
4KORUST Company Limited, Anyang, Korea
5Department of Otorhinolaryngology- Head and Neck Surgery, Hanyang National University Guri Hospital, Guri, Korea
6Department of Otorhinolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, Korea
Correspondence  Chae-Seo Rhee ,Tel: +82220723991, Fax: +8227662447, Email: csrhee@snu.ac.kr
Received: November 29, 2020; Revised: March 1, 2021   Accepted: March 9, 2021.  Published online: March 30, 2021.
Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy.
First, computed tomography (CT) images of patients without any evidence of sinonasal disease were evaluated to measure and compared the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on human anatomical studies. The experimental study was performed in five pigs; the cross-sectional areas of the nasal cavity airway and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and control.
The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial IT spaces was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm. HIFU showed no postoperative complications including bleeding or scar formation. After HIFU treatment, the cross-sectional area of the nasal airway increased by 196.62(7.8%) mm3 and 193.74(8.3%) mm3 at 1 week and 4 weeks, compared with the increase of 87.20(3.1%) mm3 and 213.81(9.0%) mm3, respectively, after radiofrequency therapy. Qualitative histologic analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis along with decreased glandular structure at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis, and decreased glandular structure.
The efficacy and safety of HIFU turbinoplasty had been observed in an animal study. Our results warrant the need for further human clinical trials.
Keywords: High-intensity focused ultrasound ablation; Turbinates; Postoperative complications; Radiofrequency therapy
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