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Review

American Journal of Rhinology & Allergy 2023, Vol. 37(1) 110 – 122

Systematic Review of Surgical Interventions for Inferior Turbinate Hypertrophy

© The Author(s) 2022 Article reuse guidelines:

sagepub.com/journals-permissions DOI: 10.1177/19458924221134555 journals.sagepub.com/home/ajr

Kathy Zhang, MD 1 , Royal M. Pipaliya, BS 1 Shaun A. Nguyen, MD 1 , and Rodney J. Schlosser, MD 1

, Amar Miglani, MD 1

,

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 identi fi ed with 62 meeting inclusion criteria. Reported techniques included turbinec tomy, submucosal resection, RFA, MAIT, laser, or electrocautery. All techniques demonstrated signi fi cant improvements in nasal obstruction using the visual analog scale. Further compre hensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in sig ni fi cant improvements in nasal resistance, nasal cavity volume, and nasal air fl ow. 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 bene fi t 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 air fl ow outcomes and while bene fi ts are sustained long-term, the peak bene fi t for both techniques appears to be achieved within the fi rst year.

Keywords allergic rhinitis, non-allergic rhinitis, visual analog scale, inferior turbinate reduction, inferior turbinate hypertrophy, radiofrequency ablation, laser, microdebrider-assisted turbinoplasty, submucosal resection, turbinectomy

turbinate tissue while preserving the nasal mucosa and its physiologic functions that include warming and humidi fi ca tion of inspired air. 6 Various techniques for ITR exist, including radiofrequency ablation (RFA), microdebrider assisted inferior turbinoplasty (MAIT), electrocautery, and laser-assisted turbinoplasty, submucosal resection (SMR), and partial or total turbinectomy. Given the numerous

Introduction Inferior turbinate hypertrophy (ITH) is among the most common causes of nasal airway obstruction, most fre quently due to allergic or non-allergic rhinitis. 1,2 In allergic rhinitis (AR), the mucosal epithelium is the principal site of immunoglobulin (Ig)E-mediated allergic reactions and chronic in fl ammation, resulting in mucosal swelling and hypertrophic changes, 3 whereas in non-allergic rhinitis (NAR), mucosal in fl ammation and tissue swelling occurs as a result of non-allergic triggers, such as parasympathetic imbalance in vasomotor rhinitis. 4,5 First-line treatment for nasal congestion secondary to ITH includes antihistamines, corticosteroids sprays, or immunotherapy. Cases refractory to medical therapy are deemed candidates for inferior turbi nate reduction (ITR) to reduce the volume of inferior

1 Department of Otolaryngology

– Head and Neck Surgery, Medical

University of South Carolina, Charleston, SC, USA

Corresponding Author: Royal Pipaliya, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, MSC 550, Charleston, SC 29425, USA. Email: pipaliya@musc.edu