Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy

Karataş, Abdullah

doi:10.5152/tao.2017.2443

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…The involvement of the QRI in the NAIROS was also cited by staff as having a positive influence on recruitment rates. As in previous studies, 148,149 research nurses in particular were highlighted by surgeons as being essential to the implementation of the trial at their sites. However, participants also described several challenges in relation to implementation.…”

Section: Collective Action: People's Ability To Take On the Work Need...mentioning

confidence: 62%

Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT

Carrie,

Fouweather,

Homer

et al. 2024

Health Technol Assess

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Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes – Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements – peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were −20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval −23.6 to −16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.

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Section: Collective Action: People's Ability To Take On the Work Need...mentioning

confidence: 62%

Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT

Carrie,

Fouweather,

Homer

et al. 2024

Health Technol Assess

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“…On the other hand, the rigid endoscope-based turbinoplasty is highly preferred in the ITH reduction techniques. [11][12][13][14][15]…”

Section: Resultsmentioning

confidence: 99%

Postoperative complications of partial inferior turbinectomy vs powered endoscopic turbinoplasty

Jwad

Albualih²,

Mahdi³

2021

JPTCP

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Background and Aim: Nasal obstruction can be induced by various causes; however, inferior turbinate hypertrophy is considered the most frequent cause of this anatomical malfunctioning condition. The current surgical interventional study was focused on comparing the final outcomes of partial inferior turbinectomy (PIT) and powered endoscopic turbinoplasty (PET). Subjects and Methods: The criterion followed for deciding the successfulness of each surgical method was the rate of occurrence of postoperative complications such as bleeding, crustation, and atrophic rhinitis. Fifty patients who suffered from nasal obstruction were randomly divided into two groups: PIT group, with 25 patients, of which 15 (52%) were males and 10 were (48%) females, at an average age of 27.40 ± 7.7 years, and PET group, with 25 patients, out of which 14 (48%) were males and 11 (62%) were females, at an average age of 26.68 ± 6.82 years. The surgical operations were performed at the

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“…The use of topical long-term intranasal steroids is another method of treating lower turbinate hypertrophy [16][17][18]. While some studies suggest its effectiveness, the long-term use of this treatment may lead to adverse effects such as nosebleeds, nasal dryness, crusting, and septal perforation [19].…”

Section: Discussionmentioning

confidence: 99%

Treating Chronic Rhinitis and Turbinate Hypertrophy Without Surgery: The Effectiveness of Silver Nitrate Cauterization

Guvenmez¹,

Zhanbaeva²,

Keskin³

et al. 2023

Cureus

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Introduction: Chronic rhinitis and chronic turbinate hypertrophy are conditions that affect the quality of life of individuals. The conchas, or the three half-crescent-shaped structures in the nasal cavity, play a crucial role in the respiratory system by filtering and humidifying the air we breathe. The growth of the conchas outside of normal physiological conditions can lead to conditions such as hyperplasia of the inferior turbinate and hypertrophy of the inferior turbinate.Methods: The study was conducted between June 2020 and December 2022 and aimed to evaluate the effect of silver nitrate cauterization on patients with chronic rhinitis and chronic turbinate hypertrophy. A total of 638 patients and 520 controls with nasal obstruction were included in the study and underwent silver nitrate cauterization without the need for surgical intervention. The treatment was performed under local anesthesia and involved the application of silver nitrate on the anterior one-centimeter part of the medial surface of both inferior turbinates. Patients were instructed to use an isotonic solution nasal spray and take an antihistamine pill for seven days.Results: A significant improvement was observed in the overall inspiratory function without the need for nasal decongestant sprays or surgery in all patients after one and three months. There was also a significant improvement noted three months after the silver nitrate cauterization in the Nasal Obstruction Symptom Evaluation (NOSE) scores, which measure the level of nasal obstruction. Conclusion: Silver nitrate cauterization showed to be an effective treatment for patients with turbinate hypertrophy, leading to an improvement in overall inspiratory function and reducing the severity of nasal obstruction. This treatment can serve as an alternative to surgical intervention for these conditions.

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Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy

Cited by 5 publications

References 25 publications

Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT

Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT

Postoperative complications of partial inferior turbinectomy vs powered endoscopic turbinoplasty

Treating Chronic Rhinitis and Turbinate Hypertrophy Without Surgery: The Effectiveness of Silver Nitrate Cauterization

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