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Inferior Turbinate Reduction Using Bipolar Cautery: Technique and Outcomes in Pediatric Patients
Ahmed Hashim Ali1, Cynthia Riley1, German Paul Digoy2
1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Insights
Bipolar-cautery inferior turbinate reduction (ITR) shows high short-term success in children, but effectiveness decreases over 3 years, especially for ITR-only procedures. Concurrent surgeries may offer more stable results.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinology
Background:
- Inferior turbinate hypertrophy is a common cause of nasal obstruction in children.
- Inferior turbinate reduction (ITR) aims to improve nasal airflow.
- Bipolar-cautery is a widely used technique for ITR.
Purpose of the Study:
- To evaluate the long-term (up to 6 years) outcomes of bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort.
- To assess the durability of symptom improvement following ITR.
- To compare outcomes of ITR alone versus ITR with concurrent procedures.
Main Methods:
- Retrospective case series of 326 children undergoing 12-W bipolar-cautery ITR.
- Parent-reported nasal breathing improvement assessed up to 6 years post-procedure.
- Statistical analysis using Cochran's Q tests and generalized estimating equations (GEE).
Main Results:
- High initial improvement rates (>90% at 1 year) declined over time, with 78.7% improvement at 3 years in the full cohort.
- The ITR-only subgroup showed a more pronounced decline in efficacy compared to those with concurrent surgeries.
- Complication rates were low, including minor bleeding (4.6%) and major bleeding (1.2%).
Conclusions:
- Bipolar-cautery ITR offers safe and effective short-term relief for pediatric nasal obstruction.
- Long-term efficacy of ITR diminishes over time, particularly when performed alone.
- Concurrent airway surgeries may lead to more sustained improvements, highlighting the importance of patient selection and long-term follow-up.
Objectives:
To evaluate extended outcomes up to 6 years following bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort.
Methods:
Retrospective case series of 326 children (mean age 9.0 ± 4.1 years) who underwent 12-W bipolar-cautery ITR between December 2017 and May 2024 at a single-surgeon tertiary practice. Concurrent procedures were performed in 82% of patients; 59 underwent ITR alone. Parent-reported nasal breathing improvement was assessed at regular intervals up to 6 years. Statistical analyses included Cochran's Q tests and generalized estimating equations (GEE).
Results:
In the full cohort, nasal breathing improvement rates were: 95.4% at 3 months, 91.7% at 6 months, 90.2% at 1 year, 88.1% at 2 years, and 78.7% at 3 years. Sample sizes decreased beyond 3 years due to follow-up attrition. Cochran's Q test showed significant changes over time through 3 years (Q = 60.101, P < .001). The ITR-only subgroup showed more marked decline: 98% improvement at 3 months to 69.0% at 3 years (P = .002), compared to more stable rates with concurrent surgery. GEE analysis confirmed significant time effects (P < .001). Compared to ITR alone, concurrent septoplasty (OR 0.39, P = .002) and sinus surgery (OR 0.34, P = .020) were each associated with significantly lower odds of reporting persistent symptoms (i.e., a greater likelihood of improvement). Complications remained low: minor bleeding (4.6%), major bleeding requiring intervention (1.2%), MRSA infection (0.3%), and synechiae (1.5%).
Conclusions:
Bipolar-cautery ITR provides safe, effective symptom improvement with excellent short-term results (>90% at 1 year). However, efficacy declines over time, particularly in ITR-only patients (78.7% overall at 3 years). Concurrent airway procedures may provide more stable outcomes. These findings emphasize the need for long-term follow-up and appropriate patient selection.
