Systematic Review of Surgical Interventions for Inferior Turbinate Hypertrophy

Abstract

Background Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique. Objective This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques. Methods PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT). Results A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery. All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3–6 months follow-up. Conclusions All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year.

Long‐Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review

“…A meta‐analysis by Bin Lajdam et al found no significant difference in outcomes between turbinectomy, radiofrequency ablation, and “conventional turbinoplasty” techniques 63 . A systematic review by Zhang et al found that radiofrequency ablation, electrocautery, laser ablation, and submucosal resection are all effective in treating inferior turbinate hypertrophy, but did not quantitatively compare them 65 …”

“…63 A systematic review by Zhang et al found that radiofrequency ablation, electrocautery, laser ablation, and submucosal resection are all effective in treating inferior turbinate hypertrophy, but did not quantitatively compare them. 65 Finally, poor psychiatric health, specifically anxiety, depression, and low self-esteem, may be associated with poorer self-perception of nasal function after surgery. [66][67][68][69] This is worrisome given that the prevalence of anxiety and mood disorders is significantly higher in patients with nasal obstruction.…”

Diagnosis and Management of Common Presentations of Posttraumatic Nasal Deformity: A Narrative Review

“…51 Other evidence-based inferior turbinate reduction techniques include coblation of the inferior turbinate, 52 radiofrequency ablation, 53 and use of ultrasound. 54 In a recent systematic review, 55 Zhang et al reviewed various surgical interventions for inferior turbinate hypertrophy including turbinectomy, submucosal resection, radiofrequency ablation, microdebrider-assisted turbinoplasty, laser, and electrocautery. They reported improvement in NAO in all the above techniques using a visual analog scale for nasal obstruction.…”

Nasal Patency Measurement: State of the Art of Acoustic Rhinometry

“…AR can be used to measure reduced nasal patency in patients with anatomical problems, 36 such as septal deviation, 37 rhinitis, 6 and inferior turbinate hypertrophia. 38 It is possible to measure the treatment effects and also the effect of nasal challenges 39,40 (with allergen, aspirin, etc.). Guidelines for their use exist.…”