Dr. Jose Barrera, MD, a Clinical Professor of the Uniform Services University in Washington DC and a Clinical Associate Professor at the University of Texas Health Sciences Center talks about the LATERA implant.
Interview conducted by Ivanhoe Broadcast News in January 2018.
Why did you get on this LATERA as opposed to a surgical procedure that might do the same thing or reasonably the same thing?
Dr. Barrera: I’m glad you asked. The LATERA implant is one option for patients with nasal airway obstruction, due to nasal valve collapse. There are many options for nasal airway obstruction. If the major cause of obstruction is due to weak sidewalls – when you breathe in and your sidewalls collapse – LATERA may be an option, but so can reconstructive rhinoplasty (an operation which opens up the skin of the nose and restructures the cartilages to support collapsibility; we often use rhinoplasty for aesthetic purposes). LATERA is an implant made out of polylactic acid, it’s absorbable and is a bio active stimulator collagen. LATERA will support the weak sidewalls and then once it absorbs, it will dissolve over two years and leaves behind a little collagen track which supports the sidewall. So consider it like an internal Breath Right strip.
It dissolves after a couple of years; it builds up the sidewalls. Are you talking about the sides of the nose and not the middle portion or is that included as well?
Dr. Barrera: Correct. The sidewall of the nose, which is anything from the nasal bones down to the tip. Any collapsibility when you breathe in, LATERA will help to alleviate.
I assume that most people who have this disorder realize that they have it but I’ve read if you take your fingers and do that, breathe like that you can breathe better?
Dr. Barrera: Correct. That’s called the Cottle maneuver, taking your fingers and simply pulling your cheek to hold your nostril to the side while taking a breath in, you’ll probably breathe better if you do that. But many folks, millions, hundreds of millions of Americans every year use Breathe Right Strips. So, if a Breath Right Strip helps you breathe, a LATERA implant may also help you breathe, except a LATERA implant is something that is a onetime procedure. You don’t have to keep purchasing Breathe Right Strips to breathe.
And glue them on at night as well.
Dr. Barrera: Exactly. Many patients complain about just that. They have a sore nose, or it peels the skin. But if a Breath Right Strip works for you – by all means, it may be an alternative. So what you’re really talking about are non-surgical alternatives to treating nasal airway obstruction. The LATERA implant is a minimally invasive alternative. More invasive surgical alternatives would be fixing a deviated septum or reducing the lining of the nose (turbinates), which can swell up from allergies. Additionally, for folks that can’t use a CPAP machine at night, because they have too much nasal obstruction, alleviating this nasal obstruction may be a benefit.
So with the CPAP which is forcing air, forcing room air in to your mouth and nose if they’re obstructed nasally then, unless they open their mouth, it’s not going to do the job right?
Dr. Barrera: Correct, the most common cause of CPAP intolerance or the inability to use CPAP at night is nasal obstruction. There is also claustrophobia and early arousal or frequent arousals due to the foreign body sensation. Lastly, your spouse may not like the hissing sound of the CPAP machine. But, if you can’t tolerate the CPAP machine and you want to try it, you want to use it, and make every effort to have your nose evaluated to see if we can improve things. We know that if we improve nasal airway breathing we can drop the pressure of the CPAP at least by three points, by three M bars. If you’re at a CP pressure twelve, you can drop it to nine, just simply by having nasal surgery.
Common sense tells me that going back to this, anybody who does that and opens up their nasal passage is going to be able to breathe better. How does one tell if they really are in need of this?
Dr. Barrera: If you feel during the daytime that you have nasal obstruction – you feel congested, you feel blocked, you feel like you can’t breathe out of one side compared to the other, then it’s time for an evaluation. If you’re on maximal medical therapy, meaning, you’re using saline sprays, using nasal steroid like Flonase or Nasonex, Nasacort and you’re still not better and feeling congested, it’s time to come in and get evaluated.
So there must be a lot of people out there who are trying that methodology and they’re not getting any better and are wondering? I don’t think it would dawn on me that it could be something that could be surgically corrected. So address that if you will number one. Number two, if they are doing that is there kind of a reverse attack method where you over use it and it swells the passages?
Dr. Barrera: Yes a lot of folks go out and they use Afrin for example. They buy Afrin over the counter and it provides some relief, but what ends up happening is that the lining of the nose gets conditioned to the Afrin. The Afrin works to decrease the swelling of the internal lining of the nose. But guess what? When you stop using Afrin you have a rebound effect. You get into this cycle of needing to use Afrin all the time. So we advise as otolaryngologists, only to use Afrin for no more than three days, if necessary. For the most part it’s not necessary; we want you off of Afrin and want you on a nasal steroid. We want you to do your allergy testing and see what’s causing the swelling to the internal lining of the nose. But other people have blockage, they have a deviated septum, they’ve had trauma or they’ve had a previous rhinoplasty that did not support the nose. This means they have collapsibility, they have obstruction because the rhinoplasty did not support the external structure of the nose. We’re speaking about doing a revision rhinoplasty, especially if the aesthetic quality o