Critical Appraisal Topics Outline Critical Appraisal Topics Outline Title Microdebrider assisted by nikeborome

VIEWS: 35 PAGES: 4

									                        Critical Appraisal Topics Outline
Title:
Microdebrider-assisted inferior turbinoplasty with lateralization (MAITL) is equally effective as
submucosal resection(SR) in patients with perennial allergic rhinitis who have substantial nasal
obstruction.


Clinical bottom line:
Microdebrider-assisted inferior turbinoplasty with lateralization appears to be as effective as
submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and
saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have
had substantial nasal obstruction.


Citation/s:
Laryngoscope, 118:1270–1274, 2008
Long-Term Efficacy of Microdebrider-Assisted Inferior Turbinoplasty With Lateralization for
Hypertrophic Inferior Turbinates in Patients With Perennial Allergic Rhinitis


Lead author's name and fax:
Send correspondence to Dr. Hung-Meng Huang, Department of Otorhinolaryngology,
Taipei City Hospital, Taipei Medical University, 12 Fu Chou Street, Taipei, Taiwan.
E-mail: hmengh@yahoo.com.tw


Three-part Clinical Question:
P: allergic rhinitis with hypertrophic turbinate
I: microdebrider-assisted inferior turbinoplasty
C: traditional submucosal resection
O: relief nasal symptoms
Type of Question: Therapy


Search Terms & Strategy:
Database: Pubmed
#3 Search #1 or #2                                                                         23:41:27 11
#1 Search (turbinate hypertrophy and turbinoplasty) AND                                    23:39:08 11
   ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH
   Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR
   random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])
#2 Search (turbinate hypertrophy and turbinoplasty) AND systematic[sb]                     23:38:39 1
The Study: Individual Randomized Controlled Trial, Level of Evidence: 1b
1. From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis
   and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering
   from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR
   group, each comprised of 80 patients.
2. For the submucosal resection group, patients underwent submucosal resection of the inferior
   turbinate, whereas patients in the MAITL group underwent microdebrider-assisted inferior
   turbinoplasty with lateralization.
3. Assessments (visual analogue scale, anterior hinomanometry, and saccharin test) were
   conducted prior to the surgery and 1, 2, and 3 years after completion of surgery.


The Evidence:
1. Compared to preoperative values, subjective complaints including nasal obstruction, sneezing,
rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in
both groups (P < 0.05 for all) No significant differences were noted between the MAITL and SR
groups at each postoperative visit (P > 0.05 for all).




2. Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years
postoperatively in both groups (P < 0.05 for all). No significant differences were noted between the
MAITL and SR groups at each of the three postoperative visits (P > 0.05 for all).
3. Saccharin transit time was significantly decreased (P < 0.05 for all) compared to preoperative
values 1, 2, and 3 years after surgery in both groups. No differ significantly between the MAITL
and SR groups (P >0.05 for all)




Comments:
1. 搜尋共有 11 篇與此次主題相關的文獻,本篇所引用的文獻為其中最新亦是 case number
   較多的一篇,作為此次的主要引用文獻。
2. 以外科手術方式治療 allergic rhinitis 所引起的 inferior turbinate hypertrophy,在過去的 130
   年間發展出六種以上的手術方式,Reference 1.指出:Submucosal resection resulted in optimal long-term
    normalization of nasal patency and in restoration of mucociliary clearance and local secretory IgA production to a
    physiological level with few postoperative complications (p < .001). The addition of lateral displacement of the inferior
    turbinate improved the long-term results. We recommend, in spite of the greater surgical skill required, submucosal
    resection(SR) combined with lateral displacement as the first-choice technique for the treatment of nasal obstruction due
    to hypertrophy of the inferior turbinates.
3. 近年來為創顯微手術盛行,在下鼻甲肥厚治療上更發展出 Microdebrider-assisted inferior
   turbinoplasty with lateralization (MAITL),與較為傳統的 submucosal resection(SR)做比較,
   在鼻部症狀(鼻塞,流鼻水,打噴嚏,打鼾等…)的改善上效果並無顯著差異。
4. MAITL 與 SR 在鼻阻力檢查結果顯示兩者術後均較術前改善,但在兩者間並無顯著差異。
                                             ,
5. 在 nasal mucociliary transport time(NMTT) MAITL 與 SR 在效果比較上與 2.3.的結果一樣,
   兩者效果無顯著差異。
6. 在下鼻甲肥厚的手術裡,除術後鼻止血棉為自費項目外,使用 microdebrider 來做下鼻甲
   的整型術 microdebrider 本身是屬於自費項目,而傳統 submucosal resection 並無其他自費
   器械,根據本篇的結論,以 long term 的觀點而言,MAITL 與 SR 術後減少鼻部症狀效果
   的比較是並無顯著差異的。於耳鼻喉科醫師的手術經驗裡,術中使用 microdebrider 可以有
   效減少術後鼻部疼痛感、術後出血以及減少住院天數,這些在本篇文獻未提及的
   microdebrider 優點,則需更多其他文獻來佐證。
7. 本篇作者於另一篇著作文獻 Reference 2 指出:針對 120 個下鼻甲肥厚的孩童以手術分式
   將之分成兩個 group(60 個 MAITL 與 60 個 SR),MAITL 與 SR 術後減少鼻部症狀效果的
   是差不多的,此結論與本篇的結論是相同的。




Reference:
1. Treatment of inferior turbinate hypertrophy: A randomized clinical trial. Desiderio Passali; Francesco
Maria Passali; Giulio Cesare Passali; Valerio Da...The Annals of Otology, Rhinology & Laryngology; Aug 2003; 112, 8;
ProQuest Nursing & Allied Health Source pg. 683


2. Chen YL, Liu CM, Huang HM. Comparison of microdbriderassisted inferior turbinoplasty with
submucosal resection in children with hypertrophic inferior turbinates. Int J Pediatr
Otorhinolaryngol 2007;71:921–927.




Appraised by: 吳思緯 醫師                                 Date: 5/24/2009          Email:128097@cch.org.tw

Kill or Update By:             5/23/2010

								
To top