Inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment

 

Abstract

Background

Allergic rhinitis is a highly prevalent disease that results from an IgE-mediated hypersensitivity reaction of the nasal mucosa to inhaled allergens. It is primarily treated by allergen avoidance and medical treatment, but when these measures fail to control symptoms then surgery to the inferior turbinates of nose is often performed. It is unclear whether these procedures are beneficial in the long term or indeed whether the risks outweigh the benefits.

Objectives

To assess the effectiveness of inferior turbinate surgery on unrelieved or partially relieved nasal obstruction in patients after maximal medical treatment of proven allergic rhinitis, to compare the results using different surgical techniques and to measure short and long-term results.

Search methods

We searched the following databases from their inception for published, unpublished and ongoing trials: the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2); PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; CNKI; mRCT (Current Controlled Trials); ClinicalTrials.gov; ISRCTN; ICTRP (International Clinical Trials Registry Platform); Cambridge Scientific Abstracts; Google and additional sources for published and unpublished trials. We modelled subject strategies for databases on the search strategy designed for CENTRAL. The date of the most recent search was 6 July 2010.

Selection criteria

Randomised controlled trials of inferior turbinate surgery versus continued medical treatment for proven allergic rhinitis, or comparisons between one technique of inferior turbinate surgery versus another technique, after maximal medical treatment.

Data collection and analysis

Both authors independently screened the search results and assessed the full text of potentially relevant studies. We attempted to contact trial authors for additional information.

Main results

There were no studies that fulfilled the inclusion criteria of the review.

Authors' conclusions

This review highlights the need for randomised controlled trials to evaluate the role of inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment. Future trials needs to be rigorous in design and delivery, separate adults from paediatric patients, not combine allergic with non-allergic patients and last long enough to determine long-term results and complications.

 

Plain language summary

Surgery to the inferior turbinate (lining of the nose) in order to relieve nose block in allergic rhinitis after failed medical treatment

Inferior turbinate (lining of nose) surgery is a commonly performed procedure in ENT as shrinking the lining may reduce some of the symptoms of allergic rhinitis, particularly nose blockage. This procedure is carried out using a multitude of techniques including cautery, laser and plasma knife. Although unusual, there is the potential for complications such as excessive bleeding and dry nose from these procedures.

We set out to identify randomised controlled trials (RCTs) of inferior turbinate surgery compared to continued medical treatment in allergic rhinitis patients in whom medical treatment had failed to relieve symptoms. We also looked for RCTs comparing one technique of turbinate surgery with another. Although our search was extensive, we were not able to find any RCTs which met our inclusion criteria.

Research, in the form of properly conducted trials comparing various techniques and assessing long-term results and complications, has not yet been done in this field. We therefore conclude that the evidence in the literature is not robust enough about the usefulness of surgery using any technique for this condition.

 

Resumen

Antecedentes

Cirugía de los cornetes inferiores para la obstrucción nasal de la rinitis alérgica después del fracaso del tratamiento médico

La rinitis alérgica es una enfermedad de gran prevalencia que resulta de una reacción de hipersensibilidad de la mucosa nasal a los alergenos inhalados en la que interviene la IgE. Principalmente se trata evitando los alergenos y mediante tratamiento médico, pero cuando estas medidas no logran controlar los síntomas a menudo se realiza una cirugía de los cornetes nasales inferiores. No está claro si estos procedimientos son beneficiosos a largo plazo o si los riesgos superan los beneficios.

Objetivos

Evaluar la efectividad de la cirugía de los cornetes inferiores para la obstrucción nasal no resuelta o parcialmente resuelta en pacientes que han recibido el tratamiento médico máximo de rinitis alérgica comprobada, comparar los resultados del uso de diferentes técnicas quirúrgicas y cuantificar los resultados a corto y a largo plazo.

Estrategia de búsqueda

Se hicieron búsquedas de ensayos publicados, no publicados y en curso en las siguientes bases de datos desde su inicio: Registro Especializado de Ensayos del Grupo Cochrane de Enfermedades de Oído, Nariz y Garganta (Cochrane Ear, Nose and Throat Disorders Group); Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL) (The Cochrane Library 2010, número 2); PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; CNKI; mRCT (Current Controlled Trials); ClinicalTrials.gov; ISRCTN; ICTRP (International Clinical Trials Registry Platform); Cambridge Scientific Abstracts; Google y fuentes adicionales de ensayos publicados y no publicados. Las estrategias de temas para las bases de datos se modelaron a partir de la estrategia de búsqueda diseñada para CENTRAL. La fecha de la búsqueda más reciente fue el 6 julio 2010.

Criterios de selección

Ensayos controlados aleatorios de cirugía de los cornetes inferiores versus tratamiento médico continuo para la rinitis alérgica comprobada, o comparaciones entre una técnica de cirugía de los cornetes inferiores versus otra técnica, después del tratamiento médico máximo.

Obtención y análisis de los datos

Dos autores de forma independiente examinaron los resultados de la búsqueda y evaluaron los textos completos de los estudios potencialmente pertinentes. Se intentó establecer contacto con los autores de ensayos para obtener información adicional.

Resultados principales

No había estudios que cumplieran los criterios de inclusión de la revisión.

Conclusiones de los autores

Esta revisión destaca la necesidad de realizar ensayos controlados aleatorios que evalúen la función de la cirugía de cornetes inferiores para la obstrucción nasal de la rinitis alérgica después del fracaso del tratamiento médico. Los ensayos futuros deben ser rigurosos en el diseño y el informe, separar los pacientes adultos de los pediátricos, no combinar pacientes alérgicos con pacientes no alérgicos y ser lo suficientemente prolongados como para determinar las complicaciones y los resultados a largo plazo.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano