Nelson B Powell, MD; Robert W Riley, MD, DDS; Adriane I Zonato, MD (presenter); Kasey K Li, MD, DDS; Robert J Troell, MD; Palo Alto CA; Palo Alto CA; Sao Paulo, Brazil; Palo Alto, CA; Palo Alto CA

Objective: To investigate the use of radio frequency (RF) treatment to improve the use of nasal CPAP in subjects complaining of nasal congestion refractory to medical management of diagnosed turbinate hypertrophy. Methods: A prospective randomized double-blind placebo controlled study in which 22 subjects underwent pretreatment (2 weeks) and posttreatment (4 weeks) rhinoscopy and visual analog scales (VAS) of nasal obstruction and CPAP tolerance, with metered (objective) compliance of CPAP use time. RF turbinate ablation was via a Somnus instrument for a single outpatient treatment session. Randomized placebos (n = 5) received blinded treatment without energy delivery. Reevaluation (n =22) was at 1 day, 2 to 3 days, 1 week, 4 weeks following treatment. Results: Twenty-two patients (12 women, mean age 54.3 years, BMI 29.3 kg/m^{2}, and RDI 33.5) started and finished the protocol. A mean of 413 J of RF energy was given to each turbinate. Investigators (before and after treatment) found an overall mean clinical change of 27.0% (right and left turbinates) compared with patients’ (n = 17) subjective (VAS) change in nasal obstruction, which was 48.0%. The placebo (n = 5) change by investigators was 27.0% and by patients 28.7%, respectively. Tolerance (n = 17) to CPAP improved 28.9% (VAS, 4.92 – 6.34) versus placebo (n = 5) decrease of 10.4% (VAS, 4.36 – 3.32). Computer-metered CPAP compliance in treated was pretreatment 5.6 hours/days to post treatment 5.8 hour/day verse the placebo of 4.11 hours/day to 3.75 hours/day. Conclusion: Tolerance of CPAP was subjectively improved 28.9% in patients after treatment. This finding paralleled our anatomic clinical nasal findings and those of patients’ VAS scores for nasal turbinate obstruction, suggesting increased airway size may improve ease of CPAP use. This positive outcome was even in light of the fact that objective CPAP compliance in this group was not significantly changed with RF treatment. The outcomes of the placebo controls were further evidence to support our conclusions and strengthen the need to continue usage of randomized placebo-controlled studies for such treatment outcomes.