Cauterization of the nasal mucosa for the treatment of vasomotor rhinitis

Laser coagulation of nasal vessels is a surgical intervention involving cauterization of vessels located on the nasal septum using laser radiation. Our clinic has everything necessary for successful laser vasotomy in Krasnodar. During the procedure, in order to evaporate pathological cells, the specialist directs the rays precisely to the affected area. According to our statistics, the operation helps to heal and restore the normal functioning of the mucous membrane of the nasal passages in 98% of cases of the total number of interventions performed.

What is nosebleed and why is it dangerous?

Nosebleeds are defined as the flow of blood from the nose. It is caused by vascular damage. This pathology occurs in patients of any age and gender. This condition is a clear indicator of trouble in the body. They also appear due to injuries. If they appear, you should immediately contact an ENT doctor.

The causes of nosebleeds are as follows:

Trauma is a common cause of nasopharyngeal bleeding. They occur during operations on the mucous membrane, diagnostic procedures, and foreign bodies. Pathologies with congestion of the mucous membrane (sinusitis, rhinitis). Dystrophy of the mucous membrane accompanies a deviated nasal septum, as well as atrophic rhinitis. Tumors are benign and malignant.

If this is neglected, repeated episodes occur and the course of the disease, which became the cause of the pathological process, worsens. Nosebleeds have become a major factor in seeking emergency medical care.

The danger of constant nosebleeds is the appearance of iron deficiency anemia. Heavy, repeated bleeding causes a sharp drop in blood pressure. If the lesion involves large vessels, the risk of large blood loss increases. They pose a threat to the patient's life.

Who needs to have the procedure?

The main indications for laser coagulation of nasal vessels are pathological conditions of the capillaries of the nasal passages, which are accompanied by frequent bleeding:

• chronic inflammatory processes of the nasal passages with thinning of the mucous membrane, sinuses, nasopharynx (chronic rhinitis, sinusitis);
• congenital and acquired curvature of the nasal septum;
• individual features of the structure of the capillary network in the nose;
• regular exposure to adverse environmental factors, as well as inhalation of dust and toxic substances at work;
• hypertonic disease;
• hormonal imbalance, chronic fatigue, stressful situations;
• hypovitaminosis conditions;
• long-term use of blood thinning medications.

A serious reason for surgery is frequent relapses of bleeding from the nasal cavity, which as a result can provoke the development of anemia, persistent arterial hypotension and even a state of shock.

Methods for coagulation of nasal vessels

Cauterization of blood vessels is considered an effective and low-traumatic method of surgical intervention. It quickly relieves discomfort and restores breathing. Patients easily tolerate this manipulation, quickly recover from surgery and return to normal life.

Instrumental cauterization is carried out using the following methods:

Laser coagulation. It is considered an effective but expensive technique. The laser beam affects the affected vessels, healthy nearby tissues are not affected. Blood flow in a specific vessel stops. Then it is sealed. Coagulation by radio waves. The vessels are sealed under the influence of current. The electrode is inserted into the nasal passage and the bleeding capillaries are coagulated. The bleeding stops, and a scab forms on the surface of the mucous membrane. Cryodestruction. Here the lesion is treated with liquid nitrogen. It destroys blood vessels, causing blood clots to form in them. Blood circulation stops. Radio knife. This is a thin rod. It doesn't heat up. It cuts tissue and simultaneously cauterizes the edges of the wound. The liquid in the vessels boils and then evaporates. Radio waves. The device produces high frequency radio waves. They quickly evaporate moisture, and then the vessels coagulate.

Mechanical techniques are now rarely used due to their high invasiveness and low effectiveness.

Are there any contraindications?

Like any other operation, the procedure for laser coagulation of nasal vessels (laser vasotomy) has a number of limitations, including:

• acute inflammatory processes in the body, regardless of their location and degree of complexity (surgery for respiratory and viral infections is postponed until the patient’s general health condition is normalized);
• diseases that are accompanied by blood clotting disorders;
• the presence of menstrual flow in the woman at the time of the manipulation.

Before the procedure, the patient must be examined by the attending physician, who not only assesses the degree of abnormalities in the nose, but also excludes the presence of contraindications in the patient.

Progress of the operation

The intervention is performed under local anesthesia. The patient is operated on in a supine position or seated in a chair.

Cauterization of capillaries is performed as follows:

Adrenaline is instilled into the nose to constrict blood vessels; a local one is carried out - turundas with a special solution are introduced into the nasal passages and held for a couple of minutes; the surface is disinfected with alcohol; cauterization of vessels is carried out using endoscopic devices; after the intervention, turundas pre-moistened in a hemostatic solution are inserted into the nasal passages.

The procedure lasts up to half an hour and is easily tolerated by patients.

Preparing for surgery

Despite the low-impact nature of laser coagulation, doctors at our clinic approach its preparation with the utmost seriousness. First, the patient is scheduled for a consultative visit to a specialist, where he determines the indications for correction, explains to the patient the essence of the future intervention and warns about the likely consequences.

Before surgery, each patient at the clinic must pass the prescribed tests and, if necessary, undergo a diagnostic examination. After all this, the specialist conducts a second consultation and sets a date and time for the procedure.

In the process of preparing for surgery, the patient is prohibited from:

• drink alcohol;
• take medications to thin your blood.

It is very important to listen to all doctor's recommendations. Otherwise, the risk of complications increases several times.

Recovery process

The rehabilitation process, as a rule, does not exceed 2 weeks. To accelerate the regeneration of mucosal tissues, it is recommended to use special ointments. You should also carefully remove the crusts that form during the healing process.

To prevent infection of the operated mucosa, the patient should use antiseptic rinsing solutions. Warming the nose, intense physical activity and strong nose blowing are prohibited.

Compliance with medical recommendations will reduce the duration of rehabilitation and minimize the discomfort that accompanies healing.

Rehabilitation

After a vasotomy, the patient does not have to stay in the hospital, but can go home straight away. On average, the post-rehabilitation period takes from 7 to 10 days. During this period it is prohibited:

• engage in physical activity (lift heavy objects, run);
• visit a sauna, bathhouse, swimming pool;
• drinking alcohol.

It is necessary to clean the nasal cavity yourself: remove dry crusts, rinse the nose with saline solutions, apply antibacterial and anti-inflammatory compounds to the nasal mucosa.

The cost of the operation is from 18,000 rubles.

Cauterization methods

Cauterization of vessels in the nose occurs using the following basic techniques:

• thermocoagulation;
• radio wave coagulation;
• laser conchotomy;
• chemical cauterization;
• cryodestruction;
• ultrasonic disintegration.

More information about cauterization methods:

1. Thermocoagulation, which can also be called electrocoagulation, is performed using an electric current. A heated electrode is inserted into the mucosal tissue, burning out excess tissue. Subsequently, the treated mucosa heals, and the volume of the shell decreases.
2. Radio wave coagulation - the name of the method speaks for itself. Cauterization here is performed using a probe that transmits a radio wave. The wire itself does not heat up, but the current carried through it heats the cells, which leads to their destruction. As a result, the volume of excess tissue and the shell are reduced in volume. This method is characterized by good tolerability, since the effect of the current is not accompanied by a painful effect, and after the procedure, swelling and inflammation are minimal.
3. Laser cauterization of vessels in the nose or conchotomy involves exposing the tissue to a beam of light with a certain power. The laser acts in a targeted manner, so the surrounding tissue around the damaged area is not affected. The laser removes hypertrophied mucosal tissue and forms a coagulation film. The latter eliminates infection and further bleeding. Pain and swelling are also reduced.
4. Chemical cauterization is usually called, in a simplified formulation, cauterization with silver, since this procedure uses a solution of silver nitrate in a concentration of about 50%. This is a more gentle procedure, which is performed by applying cotton swabs soaked in a special solution to the mucous membrane. The bactericidal effect of silver nitrate is due to a significant change in the properties of the protein (denaturation). The result is the formation of a crust in the nasal cavity, which goes away on its own over the next few days. The use of silver nitrate must be done extremely carefully so that the solution does not come into contact with the patient’s skin.
5. Cryodestruction - this cauterization method involves exposure to low temperatures that are transmitted through a cryoprobe. Here, bleeding and thrombosis occur, and the hypertrophied mucosal tissue is destroyed. As a result, the volume of the nasal concha decreases. Sometimes a scheduled repetition of the procedure is required. A few days after cryodestruction, a mucous secretion emanates from the cavity as a spontaneous cleansing.
6. Ultrasonic disintegration is done using an ultrasonic waveguide to restore blood supply in the pathologically enlarged tissues of the nasal mucosa. It is characterized as a gentle procedure. The consequence of this effect is reduction of the mucous membrane and normalization of breathing.

Based on the existing symptoms, as well as the age of the patient (the procedure can be performed even on a child), the appropriate technique is selected. During these procedures, safety precautions must be observed. The patient is prohibited from moving his head and talking without the doctor's permission.

Cauterization of the nasal mucosa cost

The cost of the operation to cauterize the nasal mucosa is 17,000 rubles. Please note that this price is for both nasal turbinates. The cost of a disposable sterile electrode for the Celon device, which fully guarantees your protection from all infections, is 15,000 rubles. The cost of local anesthesia is 500 rubles.

Examinations by an ENT doctor once a week for a month after cauterization of the nasal mucosa are free of charge (4 examinations).

Treatment of vasomotor rhinitis was carried out by ENT doctor, Ph.D. A.V. Arkhandeev, assistant to ENT doctor E. Shilova.

Recovery Features

Rehabilitation after the procedure includes several rules:

1. Avoid physical activity: running, exercise, swimming.
2. Avoid muscle tension in the nasal cavity, such as blowing your nose.
3. Avoid mechanical impact, including friction and attempts to remove crusts yourself. Their removal risks further bleeding and an increase in the recovery period.
4. Use prescribed agents that promote the restoration of mucous membranes: petroleum jelly, sea buckthorn oil, saline solutions (Aquamaris, Aqualor).
5. Visit an otolaryngologist in a timely manner for examination.
6. For a period determined by the doctor, do not visit baths and saunas, and also do not drink alcoholic beverages.

In Moscow, specialists from medical institutions use all of the above methods. The variability of prices for various types of procedures depends on the chosen treatment method. In addition, services included in the same category may cost differently depending on the level of the organization and the brand of equipment used. Thus, each patient can choose a procedure that suits their cost.

Indications for the operation

Despite the fact that cauterization of blood vessels is considered a simple and safe intervention, it is prescribed only if conservative treatment is ineffective. In most cases, the procedure is performed to stop nosebleeds. They occur if small blood vessels are located close to the surface of the mucous membrane, and their walls are not strong enough. At the slightest impact or increase in pressure, they are injured, so treatment with medications does not bring results.

Other indications for cauterization of blood vessels may be:

• chronic rhinitis, constant inflammation of the nasal mucosa;
• atrophic changes in the mucosa;
• constant difficulty breathing, nasal congestion;
• inflammation of blood vessels and expansion of their lumen.

REFERENCE! If one or more indications appear, surgery is definitely recommended for adults. It is simple and can be done without complications or side effects. However, weakness of the vascular walls in children can be temporary and goes away with age.

Ways to treat spider veins

Sclerotherapy

It is the process of introducing a special drug into the vessels - sclerosant, the active substance of which glues the vessels together. After administering the sclerosant, the affected area must be bandaged and compression garments placed on it. Sclerosant is mainly used for lesions of the veins of the lower extremities. The number of necessary procedures directly depends on the extent of the disease. The disadvantage of this method is the fact that the sclerosant does not remove capillaries on the body. The advantage of administering sclerosant is that the operation is less traumatic and easily tolerated, according to reviews.

Electrocoagulation

Involves the effect of electric current on the capillaries. Experts do not recommend removing spider veins on the face using electrocoagulation, since healthy vessels can be affected along with the affected capillaries, and subsequently scars and scars appear on the face. The advantage of the electric shock procedure is the fact that the entire procedure is necessary to treat the vascular network.

Radio wave surgery

A special device “Surgitron” is used. The drug uses high-frequency radio waves in treatment, which, without contacting directly with the skin, remove the vascular network. The advantage of using this technique is that it is low-traumatic and does not cause swelling or the appearance of scar tissue. The disadvantages include the fact that high-frequency waves cannot remove a large number of affected capillaries, according to reviews.

Laser or photocoagulation

The method is often used for cosmetic purposes to remove mesh on the face and décolleté. The technique involves removing the affected vessels with a laser, whereby the capillaries absorb the laser energy and are sealed. The obvious advantages include the fact that photocoagulation is an excellent method that does not require direct contact with the skin. Disadvantages include the fact that laser therapy covers a small area of ​​action, often no more than 3 mm, and also that the use of laser in treatment is not suitable for people with dark or tanned skin. Due to this, laser photocoagulation is used on small areas of skin that have been affected by the vascular network.

Ozone therapy

It is based on the use of an ozone-oxygen mixture in treatment, which in turn stimulates oxidative processes in blood vessels and their walls are destroyed. The use of an ozone mixture is often done to remove spider veins on the legs.

Contraindications

Contraindications for removing vascular network include the following factors:

• allergic reaction or complete intolerance to the drug sclerosant;
• renal failure;
• diabetes;
• not recommended for use by nursing mothers and women during pregnancy;
• for inflammatory processes on the skin;
• heart disease;
• with the development of peripheral arthropathy.

The result of cauterization of the nasal mucosa

After surgical treatment of vasomotor rhinitis, the patient's nasal congestion was completely eliminated, her runny nose, night snoring went away, and her dependence on vasoconstrictor drops was removed.

An examination by an ENT specialist is carried out the day after the operation, and it is also recommended to visit an otolaryngologist once a week for 4 weeks.

During a repeat endoscopic examination a month after cauterization of the nasal mucosa with the Celon Elite device, the ENT specialist noted a significant expansion of the nasal passages (shown by arrows in the photo) and a satisfactory condition of the mucous membrane (swelling was eliminated, normal color was restored).

Nasal breathing has been restored on both sides.

The patient noted that after eliminating nasal congestion and, accordingly, stopping the use of vasoconstrictor drops, blood pressure normalized. The quality of sleep has improved due to the absence of snoring. In the morning she feels much more alert. The nose breathes constantly!

Advantages of endoscopic vasotomy and turbinate conchotomy

• Operations are performed with minimal tissue trauma.
• The use of general anesthesia with controlled hypotension allows us to minimize the risk of intra- and postoperative bleeding and perform surgical intervention as quickly and accurately as possible to prevent relapses of rhinitis.
• The use of endoscopic technology makes it possible to eliminate hypertrophy of even individual areas of the nasal concha with maximum preservation of the concha and mucous membrane.
• The development of various pathological conditions in other organs and systems is prevented.
• The procedures are painless and comfortable for the patient with a minimal rehabilitation period.

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Vasomotor rhinitis treatment

The ENT specialist proposed surgical treatment of vasomotor rhinitis - cauterization of the nasal mucosa using the latest device for bipolar radiofrequency-induced thermotherapy Celon Elite ESG 200 Olympus (Japan).

Cauterization of the nasal mucosa helps eliminate nasal congestion for a long time, and not temporarily, like vasoconstrictor drops (the effect after surgery lasts for years). The device for cauterization of the nasal mucosa Celon Elite ESG 200, which is used in the Dial-Dent clinic, is one of the best today, as it ensures an effective and safe procedure thanks to automatic control of tissue heating, the use of a disposable electrode and point exposure (details read about the Celon Elite device here).

One procedure of cauterization of the nose is enough for the “stuffy nose for years” condition to go away and the feeling of a full life, full of smells and tastes, to return.

How does the procedure work?

Before the operation, the patient undergoes a full examination and receives recommendations from the attending physician for preparation and subsequent rehabilitation. The procedure itself does not take much time and is performed on an outpatient or inpatient basis, using local or general anesthesia.

To carry out radio wave coagulation, special electrodes are used, which are applied inside the enlarged nasal turbinates. When using a laser, a thin beam acts as an electrode. It is generated by a laser installation of a certain power.

Under the influence of laser radiation or radio waves, the tissues of the pathological mucosa heat up and evaporate. At the same time, blood vessels are coagulated, the affected area is disinfected, and pathogenic bacteria and viruses are destroyed. Effective, gentle techniques eliminate the risk of infection.

Lasers and radio wave instruments

For example, the German diode laser CERALAS50, based on the semiconductor material gallium arsenide, generates radiation with a wavelength of 980 nm. An important parameter of such a laser is the laser radiation wavelength of 980 nm. The specificity of otorhinolaryngological operations is work on tissues with abundant blood supply. Laser radiation with a wavelength of 980 nm is maximally absorbed by blood hemoglobin, which is the main component of human soft tissues, so the radiation is absorbed in the surface layers, reducing the risk of damage to underlying organs, providing a good hemostatic effect.

The same pronounced hemostatic effect is ensured by the use of a radio wave instrument. The electromagnetic field generated by the COBLATOR-2 device coagulates edematous vascular tissue with minimal blood loss during surgery.

To carry out the procedure, local superficial anesthesia is sufficient, which completely eliminates possible discomfort during the intervention. Postoperative tamponade is usually not required, and the risk of scar formation is minimal. The procedure is well tolerated and can be operated on an outpatient basis. The advantages of laser and radio wave operations, such as low trauma, bloodlessness, and accuracy, are gaining increasing recognition among specialists and patients.