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Turbinate Surgery in Children With Sleep-Disordered Breathing: A Randomized Prospective Study
Suhas Bharadwaj1, Turaj Vazifedan2, Cristina M Baldassari1,2
1Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia, USA.
Insights
Submucosal ablation of turbinates (SAT) combined with adenotonsillectomy (AT) improved nasal obstruction symptoms in children. However, this study found no significant additional benefit of SAT over AT alone for nasal symptoms.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Nasal obstruction is a common symptom in children with sleep-disordered breathing (SDB).
- Turbinate hypertrophy frequently contributes to nasal obstruction in this population.
- Adenotonsillectomy (AT) is a standard treatment for SDB, but its effect on nasal obstruction can be variable.
Purpose of the Study:
- To evaluate the efficacy of submucosal ablation of turbinates (SAT) when performed concurrently with AT for improving nasal obstruction in children.
- To compare the outcomes of AT with SAT versus AT alone in reducing nasal obstruction symptoms.
Main Methods:
- A randomized, single-blinded study involving 51 children (ages 3-17) with SDB and nasal obstruction.
- Participants underwent either AT alone (control) or AT with SAT.
- Outcomes were assessed using the Sinus and Nasal Quality of Life Survey (SN-5) and Visual Analog Scale (VAS) at 3 and 12 months post-operatively.
Main Results:
- Both groups showed improvement in SN-5 scores post-surgery.
- No statistically significant difference was observed in the reduction of total SN-5 scores between the AT with SAT group and the AT alone group at 3 months (51% vs 50.1%) and 12 months (52.1% vs 43.6%).
- The SAT group had higher preoperative SN-5 scores, indicating more severe baseline nasal symptoms.
Conclusions:
- While SAT combined with AT improves nasal symptoms in children, it does not appear to offer additional benefits over AT alone for nasal obstruction.
- Further research is needed to assess the impact on SDB symptom burden to clarify the role of turbinate surgery in pediatric SDB.
Objective:
To assess whether submucosal ablation of turbinates (SAT) at the time of adenotonsillectomy (AT) confers benefit in the reduction of nasal obstruction compared to AT alone.
Study Design:
A randomized, single-blinded study between 2014 and 2017. Children between 3 and 17 years with sleep-disordered breathing (SDB) and nasal obstruction were eligible. Patients had turbinate hypertrophy at baseline and were scheduled to undergo AT for SDB. The sinus and nasal quality of life survey (SN-5) and the visual analog scale (VAS) were measured.
Setting:
Tertiary Children's Hospital.
Methods:
Children were randomized to AT (control group) or AT with SAT. The study was powered to assess for changes in the SN-5 at 3 and 12 months.
Results:
In total, 51 patients were randomly assigned: 18 in the control group and 33 in the AT with SAT group. The SAT group had higher preoperative SN-5 scores compared to the control group. Both groups experienced improvement in SN-5 scores at 3 and 12 months. There was no statistically significant difference in the reduction of the total SN-5 score at 3 months (51% vs 50.1%, P = .707) and 12 months (52.1% vs 43.6%, P = .225) between the AT with SAT group and the AT alone group.
Conclusion:
Children with nasal obstruction that undergo AT and SAT experience improvement in SN-5 scores. It remains uncertain whether SAT performed at the time of AT confers additional improvement in nasal symptoms compared to AT alone. Future research should include an assessment of SDB symptom burden to allow for a definitive determination of the role of turbinate surgery in children with SDB.
