Surgical management of adult inferior turbinate hypertrophy

A Systematic Review of the Evidence

Authors

  • Pete S. Batra MD,

    Corresponding author
    1. Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
    • Section of Nasal & Sinus Disorders, Head & Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A71, Cleveland, Ohio 44195
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  • Allen M. Seiden MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio, U.S.A.
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  • Timothy L. Smith MD

    1. Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • This work was supported by a research grant to Dr. Batra from Xoran Technologies. Dr. Batra is a consultant for Medtronic. Dr. Smith is a consultant for Sinexus.

Abstract

Objectives/Hypothesis:

The evidence-based medicine (EBM) schema advocates critical appraisal of the scientific literature for treatment of diseases. The objective of this review was to analyze the role of surgery for symptomatic adult inferior turbinate hypertrophy (ITH) by focusing on the following question: In adults with nasal airway obstruction (NAO) from documented ITH having failed medical therapy, does inferior turbinate surgery improve disease-specific quality of life, symptoms, and/or objective parameters with minimum 6-month follow-up?.

Study Design:

Evidence-based review.

Methods:

Articles for inclusion were identified by query of appropriate search terms in the PubMed database. The articles were reviewed independently by two authors and assigned an evidence level based on standard EBM guidelines.

Results:

The search yielded 514 abstracts for review, retrieved 143 abstracts for full review, and included 96 articles in the report. The majority of the articles were assigned level 4 (75) or level 5 (18) evidence. One report was assigned level 1 and two reports were assigned level 2. Median number of patients reported was 50 (range, 1–533). Subjective assessment parameters were reported in 80 studies. Objective parameters were evaluated in 36 studies, including acoustic rhinometry or rhinomanometry (26) and mucociliary function (8). Overwhelming data supported efficacy of surgery for NAO from ITH with positive results reported in 93 studies.

Conclusions:

The literature provides considerable level 4 and 5 evidence for efficacy of surgery for adult symptomatic ITH. Given the paucity of level 1 and 2 data, future studies should focus on prospective studies with matched control groups for comparison.

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