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Efficacy of inferior turbinate reduction in pediatric patients: a prospective analysis
Rachel L Whelan1, Amber D Shaffer1, Amanda L Stapleton1
1Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Insights
Inferior turbinate reduction (ITR) significantly improves nasal congestion and reduces medication use in children. However, children with allergic rhinitis (AR) still experience more symptoms post-surgery, highlighting the need for combined treatments.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Allergy & Immunology
Background:
- Chronic nasal congestion is a prevalent issue in pediatric patients.
- Inferior turbinate reduction (ITR) serves as a potential surgical option for cases unresponsive to medical therapy and adenoidectomy.
Purpose of the Study:
- To prospectively assess nasal congestion symptoms and daily medication requirements in children following ITR.
- To compare outcomes between children with and without allergic rhinitis (AR).
Main Methods:
- A prospective study involving 96 pediatric patients undergoing ITR.
- Nasal Obstruction Symptom Evaluation (NOSE) scores and daily medication use were recorded preoperatively and at 3, 6, and 12 months postoperatively.
- Statistical analyses included Wilcoxon signed-rank, McNemar's, and Wilcoxon rank-sum tests to compare outcomes and patient groups.
Main Results:
- ITR significantly improved NOSE scores from a median of 65 to 20 at 12 months (p < 0.001).
- Median daily medication use decreased significantly from 1 to 0 (p = 0.017).
- Patients with AR (58.3%) used more medications pre- and post-surgery and had higher NOSE scores at 12 months compared to those without AR.
Conclusions:
- ITR is an effective adjuvant surgical approach for improving chronic nasal congestion in children.
- Children with allergic rhinitis (AR) represent a distinct subgroup requiring tailored management strategies.
- A multimodal treatment approach is essential for managing chronic nasal congestion, especially in pediatric patients with AR.
Background:
Chronic nasal congestion is a common presentation in the pediatric setting. For patients who fail to respond to maximal medical therapy and adenoidectomy, inferior turbinate reduction (ITR) may be a reasonable adjuvant surgical approach. Our objective was to prospectively evaluate nasal congestion symptoms and daily medication use in the year following ITR in children with and without allergic rhinitis (AR).
Methods:
Patients younger than 18 years undergoing ITR alone or in combination with nonsinonasal procedures were enrolled. Scores from the Nasal Obstruction Symptom Evaluation (NOSE) survey were collected preoperatively and at 3, 6, and 12 months postoperatively from 96 patients. Number and type of pertinent daily medications utilized were also analyzed using Wilcoxon signed-rank and McNemar's tests. Patients with and without comorbid AR were then compared using Wilcoxon rank-sum tests.
Results:
Median (range) NOSE sum scores significantly improved from preoperative median of 65 out of 100 points (0-100) to 20 (0-100), (z = 7.12, p < 0.001) at 12 months postoperatively. The median number of daily medications was significantly reduced from 1 (range, 0-4) preoperatively to 0 (range, 0-5) postoperatively (z = 2.38, p = 0.017). Fifty-six (58.3%) patients had AR. AR patients received more medications preoperatively and postoperatively compared with those without AR (z = -2.96, p = 0.003; z = -2.23, p = 0.024). At 12 months, NOSE scores remained significantly greater in patients with AR compared with those without AR (β = 11.6; 95% confidence interval [CI], 0.676-22.5; p = 0.038).
Conclusion:
Our data highlight the need for a multimodal approach to chronic nasal congestion, particularly in children with AR.
