Utility of Inferior Turbinoplasty for the Treatment of Nasal Obstruction in Children: A 10-Year Review

Abstract

Importance: Inferior turbinoplasty (IT) in pediatric patients is a common procedure used to treat childhood nasal obstruction. Most of the published IT studies in this population did not control for concurrent airway procedures.

Objective: To assess postoperative outcomes in pediatric patients undergoing isolated IT.

Design, setting, and participants: Ten-year retrospective review of the medical records of 1770 children (aged <18 years) undergoing an IT procedure at Children’s Hospital Colorado from August 1, 2003, through August 1, 2013. Patients with simultaneous procedures involving the upper airway were excluded. The review identified demographic and clinical information, operative technique, and postprocedural follow-up data. The last follow-up was completed on April 21, 2014. A telephone questionnaire was administered to parents to obtain long-term outcome data. Data were analyzed from March 10 to July 23, 2014.

Main outcomes and measures: Demographics, complications, postoperative outcomes, the need for revision surgery and continued use of medication, and overall parent satisfaction with the procedure. Outcomes were assessed with a 5-point Likert scale of parental perception of their child’s ability to breathe through the nose (nasal patency) preoperatively and currently (1 indicates extremely poor; 5, extremely well) and their overall satisfaction rating for the procedure (1 indicates extremely dissatisfied; 5, extremely satisfied).

Results: Of the 1770 children, 107 underwent isolated IT. The mean age of the cohort was 10.5 (range, 1.2-17.9) years. The IT procedures included radiofrequency ablation (72 [67.3%]), microdebridement (19 [17.8%]), and partial turbinate resection (21 [19.6%]). No major complications were observed. Eight revision ITs for persistent nasal symptoms were performed independently of the initial surgical procedure, including 4 of 72 radiofrequency ablations (5.6%), 1 of 19 microdebridements (5.3%), and 3 of 21 partial turbinate resections (14.3%), with no difference among the 3 techniques (P = .10). The parents of 63 patients completed the telephone questionnaire with a mean follow-up of 4.55 (range, 0.63-10.68) years. The combined parental satisfaction on a 5-point Likert scale for the extremely satisfied and satisfied categories was 44 (69.8%), and the nasal patency score improved significantly from 2.0 to 3.4 (95% CI, 1.03-1.65; P < .001), independently of surgical techniques. Thirty-four patients (54.0%) continued to require medical management owing to persistent nasal symptoms. Patients with a history of allergic rhinitis had a greater improvement of nasal patency (2.1 to 3.9; P = .02) and a higher postoperative use of medical therapy (13 of 34 patients [38.2%] vs 21 of 73 [28.8%]; P = .01).

Conclusions and relevance: Inferior turbinoplasty showed overall utility and was safe and effective in the treatment of nasal obstruction in children for whom medical management had failed. No differences between surgical techniques were found in patient satisfaction, improvement of nasal patency, and recurrence, likely related to sample size. More than half of the patients continued to use medical therapy postoperatively, suggesting that inferior turbinate hypertrophy should not be considered solely as a surgical disease. Allergic rhinitis was identified as a significant comorbidity.