The Effect of Early Radiofrequency Turbinate Reduction, Intranasal Steroid, and Antihistamine H-1 on Persistent Allergic Rhinitis: a Randomized Clinical Trial.

Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed toevaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention groupand 13 patients in control group. At week 4, clinical response improved significantly in theintervention group compared to control group (Chi-Square test, p < 0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (MannWhitney test, p > 0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher inintervention group (unpaired t-test, p < 0,05). Meanwhile, increase in HSP-70 in the interventiongroup was slightly lower than in control group, but the difference with control group was notsignificant (Mann Whitney test, p > 0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given topersistent moderate-severe AR patients give more improvement only in early clinical symptomsand reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapiesfor the management of moderate-severe persistent AR. However, further investigation with alarger sample size and longer follow-up period is needed. Level of evidence: 1B. (c) 2022 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Publishedby Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).