The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract 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 to evaluate 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 group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention 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 (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

Age, duration of work, noise and vibration in inducing hearing and balance impairments.

Noisy and vibrating bajaj, a public transportation in Jakarta, is a potential risk in inducing hearing and balance problems. Bajaj drivers in the Jakarta area were chosen by consecutive sampling and examined medically in the Neurotological Subdivision of the ENT Department of the Cipto Mangunkusumo Hospital, Jakarta. Hearing and balance impairments were then diagnosed from audiometric and posturographic tests. The study was carried out from March 2000 until October 2001. A number of 350 bajaj drivers participated in this study. There were 97 subjects without hearing and balance impairments, and 96 subjects suffered from hearing and balance impairments. Compared to drivers aged less than 40 years, those aged 41 years or more had a four-fold increased risk of developing hearing and balance impairments [adjusted odds ratio (OR) = 3.90; 95% confidence interval (CI) = 1.67-9.01. Drivers working 9 hours or more a day had an increased risk 2.3 times of developing hearing and balance impairments compared those working less than 9 hours a day (adjusted OR = 2.32; 95% CI=I.22-4.41). Furthermore, when compared to those who had been working for 1-5 years, those who had been working for 5 years had an increased tendency of developing hearing and balance impairments. Those who had been working 21-30 years had a seven-fold increased risk of developing hearing and balance impairments (adjusted OR = 7.11; 95% CI = 1.88-26.92). To minimize hearing and balance impairments bajaj drivers are recommended to work less than 8 hours a day.