Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement
Antonino Maniaci1,2, Christian Calvo-Henriquez1,3, Giovanni Cammaroto1,4
1Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France.
Insights
Pediatric inferior turbinate hypertrophy (PedTH) is a common cause of nasal obstruction in children. This consensus statement offers a diagnostic and management framework, emphasizing clinical examination and less invasive treatments for improved breathing.
Area of Science:
- Otolaryngology
- Pediatric Respiratory Medicine
- Rhinology
Background:
- Pediatric inferior turbinate hypertrophy (PedTH) is a frequent, often overlooked cause of nasal breathing difficulties in children.
- Existing guidelines for PedTH diagnosis and management are lacking, leading to clinical controversies.
- A multidisciplinary approach is needed to address this condition effectively.
Purpose of the Study:
- To establish a clinical consensus statement (CCS) for the diagnosis and management of PedTH.
- To provide a multidisciplinary reference framework based on shared clinical experience and evidence.
- To address existing controversies and guide clinical practice in the absence of specific guidelines.
Main Methods:
- A panel of 20 international contributors developed the CCS using the modified Delphi method.
- A systematic literature review adhering to PRISMA criteria was conducted.
- Seven high-evidence articles were selected, and a 34-statement survey was used to reach consensus.
Main Results:
- Two items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus after three voting rounds.
- The CCS provides a framework for managing PedTH, acknowledging its frequent association with other nasal or craniofacial disorders.
- Clinical examination and endoscopy are key diagnostic tools; rhinomanometry, cytology, and questionnaires have limited roles.
Conclusions:
- The CCS serves as a valuable reference for PedTH management until further prospective data become available.
- PedTH should be recognized as a distinct nasal obstructive disease in children, not merely an adult condition.
- Treatment should prioritize less invasive procedures, considering specific indications and features of available options.
Objective:
Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies.
Methods:
A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available.
Results:
A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus.
Conclusions:
Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures.
Level Of Evidence:
5 Laryngoscope, 134:1437-1444, 2024.
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