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Impact of Combined Holmium:YAG Laser-Assisted Inferior Turbinate Reduction and Adenoidectomy on Pediatric Nasal
Elvin Alaskarov1, Aytaj Allahverdiyeva2
1Department of Otorhinolaryngology, İstanbul Medipol University Health Care Practice and Research Center, Esenler Hospital, İstanbul, Türkiye; Azerbaijan Medical University, Baku, Azerbaijan.
Insights
Adding laser-assisted inferior turbinate reduction to adenoidectomy significantly improved nasal airflow and quality of life in children with persistent nasal obstruction. This combined approach offers sustained clinical benefits for pediatric patients.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinology
Background:
- Pediatric nasal obstruction is often caused by adenoid hypertrophy.
- Inferior turbinate hypertrophy can worsen nasal obstruction and reduce adenoidectomy effectiveness.
Purpose of the Study:
- To evaluate the added clinical value of Holmium:YAG (Ho:YAG) laser-assisted inferior turbinate reduction combined with adenoidectomy in children.
- To compare outcomes of combined surgery versus adenoidectomy alone.
Main Methods:
- Prospective comparative study of 52 children (aged 6-12) divided into two groups: adenoidectomy plus Ho:YAG turbinate reduction (Group 1) and adenoidectomy alone (Group 2).
- Measurements included acoustic rhinometry and OSA-18 quality-of-life scores preoperatively and at 3 months post-surgery.
- Long-term follow-up ranged from 15-24 months.
Main Results:
- Group 1 demonstrated significantly greater improvements in minimal cross-sectional area and nasal volume compared to Group 2 (p < 0.001).
- Both groups showed OSA-18 score improvements, but Group 1 had significantly better outcomes.
- Preoperative TNSS ≥9.5 and MCA ≤0.29 cm² were identified as potential indicators for turbinate surgery.
Conclusions:
- Concurrent Ho:YAG laser-assisted inferior turbinate reduction with adenoidectomy provides significant additional benefits for nasal airflow and quality of life in selected pediatric patients.
- The combined procedure has a favorable safety profile and offers sustained clinical improvement.
- Addressing turbinate hypertrophy alongside adenoidectomy is recommended for persistent pediatric nasal obstruction.
Abstract:
Pediatric nasal obstruction is most commonly caused by adenoid hypertrophy; however, inferior turbinate hypertrophy may contribute significantly to persistent nasal obstruction and may limit the effectiveness of adenoidectomy alone. This prospective comparative study evaluated the additional clinical value of Holmium:YAG (Ho:YAG) laser-assisted inferior turbinate reduction performed concurrently with adenoidectomy in children with nasal obstruction. Fifty-two children aged 6-12 years were enrolled between 2023 and 2025. Group 1 underwent adenoidectomy plus Ho:YAG turbinate reduction (n = 24), whereas Group 2 underwent adenoidectomy alone (n = 28). Acoustic rhinometry and OSA-18 quality-of-life scores were measured before surgery and at postoperative 3 months. Long-term follow-up was conducted for 15-24 months. Group 1 showed significantly greater improvements in minimal cross-sectional area and nasal volume compared with Group 2 (p < 0.001). OSA-18 total and subdomain scores improved in both groups but were significantly better in Group 1. Exploratory ROC analysis suggested that preoperative TNSS ≥9.5 and MCA ≤ 0.29 cm2 were associated with clinician-based decision-making regarding inferior turbinate surgery. The combined procedure demonstrated a favorable safety profile with sustained clinical improvement. These findings suggest that, in selected pediatric patients with persistent nasal obstruction, addressing turbinate hypertrophy may provide additional benefit in terms of nasal airflow and quality of life.
