Surgical Reduction of the Inferior Turbinates for Nasal Obstruction

Chronic rhinitis, or inflammation of the nasal mucosa, is one of the most common causes of
nasal obstruction in the pediatric population. Chronic rhinitis may result in mucous gland
hypertrophy, engorgement of the vascular system and deposition of collagen in the nasal
mucosa. These changes occur most prominently in the inferior turbinate, causing enlargement
and nasal obstruction. In children, inferior turbinate hypertrophy is associated with a
greater degree of nasal obstruction relative to adults because of their small nasal anatomy.

Cases that do not respond to conservative treatments may be considered for one of many
surgical procedures, including turbinate excision, submucosal resection, submucosal cautery,
laser treatment, cryosurgery, powered microdebridement, or radiofrequency-based ablation.
Clinical studies have shown that bipolar radiofrequency-based plasma (Coblation®) devices
are capable of creating focal submucosal lesions with minimal or no damage to structures
adjacent to the treated area. At present, however, this technique has not been formally
evaluated in children. This study will investigate whether surgical turbinate reduction
performed using a Coblation device is associated with reduced nasal obstruction symptoms
that has failed to improve with other treatment methodologies.

Inclusion Criteria:

1. Patient is >=6 and <=17 years old.

2. Patient has had symptoms of nasal obstruction for >=6 months.

3. Patient has nasal obstruction symptoms unresponsive to at least 8 weeks of documented
maximum medical management (as described in Section 4.1).

4. Patient has bilateral hypertrophied inferior turbinates without other abnormalities
contributing to nasal obstruction (by nasal evaluation and examination).

5. Patient and parent /guardian agree to participate in the clinical study and to
complete all required visits and evaluations.

6. Patient (or guardian) must sign IRB approved informed consent form.

Exclusion Criteria:

1. Patient has clinically significant identifiable structural deformities other than
turbinate hypertrophy that may contribute to nasal or upper airway obstruction
including:

1. Septal deviation

2. Concha bullosa

3. Enlarged adenoids or tonsils (lingual, palatine, or sphenoid)

4. Nasal polyps

5. Nasal valve collapse.

2. Patient has been diagnosed with obstructive sleep apnea not originating from the
turbinates.

3. Patient has active or chronic upper airway infection that may contribute to nasal
obstruction (not including chronic rhinosinusitis).

4. Patient has active coagulation disorder or patient is receiving anti-coagulants,
which cannot be safely stopped for 14 days (7 days prior to surgery and 7 days
post-surgery).

5. Patient has systemic disease affecting the nasal passage(e.g. Wegener's
granulomatosis).

6. Patient is receiving or has received immunotherapy (any type) within 12 months of
enrollment.

7. Patient has a nasal septal perforation.

8. Patient has had any previous turbinate surgery.

9. Patient has had any previous nasal surgery.

10. Patient has had any sinus surgery within 6 months of enrollment.

11. Patient has had an adenoidectomy within 3 months of enrollment.

12. Patient is pregnant or potentially pregnant.

13. Patient or caregiver is incapable of understanding or responding to the study
questionnaires.

14. Patient is participating in another clinical study during the 12 month enrollment
period.