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You're not the only one…According to H. Dugan’s “Bedlam in the Boudour” (1947): “Twenty of thirty-two Presidents of the Unitied States are proved or believed on a thick web of circumstances to have been nocturnal nuisances in the White House” and “President Theodore Roosevelt once snored so loudly in a hospital that complaints were filed by almost every patient in the wing where he was recuperating”
Home Surgical Procedures Coblation Coblation Turbinate Reduction
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Coblation Turbinate Reduction
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Many people with nasal blockage or congestion are due to enlargement of the turbinates. These are located in the nose along the sides of the nasal cavity. They are responsible for the suffy nose when you are sick, cause your nose to block off on the side you are sleeping on, or cause the alternating nasal congestion in many of my patients. They swell in response to allergies, chemical exposure, smoking, and for many other reasons.  Although treating nasal obstruction rarely results in complete snoring relief, it is an important part of ensuring long term relief from other procedures and in relieving many other symptoms from nasal obstruction. This includes improvement in nasal congestion, morning post-nasal drip, mouth breathing, and dry mouth and throat in the morning.

The goal of turbinate surgery is to increase nasal airflow while preserving the normal function. The turbinates have a major role in adding humidity to the air we inspire and in filtering the air. The lining of the turbinates contains cilia, which are small hairs that beat to move the mucous (which has trapped debris) in our nose. Venous sinusoids are blood vessels which lie under the surface of the turbinates to add moisture to the air we breathe in. This makes sure the air is clean and moist – just perfect for our lungs.

The key to ensuring normal function is mucosal preservation – which means keeping the lining of the nose intact. Traditionally, we have used electrocautery techniques placed below the surface of the nose.

Cautery Device
Electrocautery reaches high temperature to cause destruction of tissue by boiling and coagulation. It results in unpredictable collateral damage, pain, and recovery time. The swelling or inflammation can be prolonged, the cilia and glands may be destroyed leading to nasal crusting, and the underlying bone has occasionally died (Willimas et al. J Laryngol Otol, 1991). New techniques to reduce the turbinates have involved keeping the temperature low to create more precise surgical techniques which limit collateral damage. There is therefore less pain, quicker recovery, less time off work, and less complications.

Coblation is a surgical device which allows shrinkage of tissue under the lowest of temperatures compared to other radiofrequency techniques.

Coblation Device
Studies show that the energy delivered is much more predictable and the surface lining of the turbinates (cilia) remains normal and functioning 1 year after treatement (Elwany, Am J Rhinol, 1999). Healing is also twice as fast (7 days versus 14) when complared to cautery (Chinpairoj et al, Laryngoscope, 2001).

How happy are patients with coblation? The evidence for this is variable but overall, 89% of patients are satisfied and would have the procedure again (Atef et al, Am J Rhinol, 2000; Back et al. Am J Rhinol 2006 ; Bhattacharyya et al, Otolaryngol Head and Neck Surg, 2003). Complication rates for coblation can be extrapolated (an educated guess) from studies on this and other radiofrequency techniques. About ¼ of patients have some discomfort during the procedure, especially if the back part of the turbinates are done. About 1/3 will have some blood tinged mucous on Kleenex when they blow their nose. About 1/20 patients (5%) have more rapid bleeding which requires packing to be placed in the nose.

What to expect?
The nose is first frozen topically. To do this, cotton balls are stretched out and soaked in a topical freezing than place in your nose. After about 20 minutes, the nose is injected with freezing. After another 5 to 10 minutes the procedure is begun.

The Reflex Ultra 45 Wand (the probe) is inserted into the turbinate to the desired depth. Either one or two sites are chosen based on your anatomy and level of obstruction.

Coblation Turbinate Reduction
You will not feel any discomfort when the probe is inserted but I always give a quick check to ensure there is enough freezing before starting the coblation. Each site is treated for about 10 seconds. Usually 2 to 4 sites on each side of the nose is used.

After the procedure, you are given a prescription for pain medication, antibiotics, and are asked to rinse your nose out regularly with a salt water spray. You can expect some discomfort for the first day or two. As a general rule, ¼ people don’t use pain medications at all, 2/4 people use Tylenol, and ¼ people need a prescription pain medication. There can be some crusting for the first week and some blood on the Kleenex if you blow your nose for the first 4 days. If there is any significant bleeding or increasing pain after the first day you should contact me at the office or through the Dartmouth General Hospital.

I will see you back 3 weeks after the procedure to make sure things are healing properly and 6 weeks after to see if any more work needs to be done. About half of my patients will chose to have 2 or more sessions.

What does the procedure cost?
If the procedure is medically necessary, the cost of the procedure is covered by MSI. The coblation needles unfortunately are not. Currently the cost of the needles and any disposables used for the procedure is covered by the patient. There is no profit made off the sale of these devices. The procedure is offered as cutting edge technology to improve satisfaction and there are alternative options available at no cost. For an estimate, please contact my office under contact information. There are lower cost alternatives which are offered to everyone.

Before starting the procedure I recommend that you take a pain medication which I will provide. This can make people a little drowsy after the procedure so you will need a ride home. I will than apply a gel to the roof of your mouth which contains a topical anesthetic to freeze the palate. If you have a strong gag reflex, I will also get you to rinse your mouth with an anesthetic. Finally, you will gargle with Peridex Solution which reduces any bacteria in your mouth.

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