Citation Information :
Wong DK, Saim L, Saim A. No Difference in Clinical Outcome between Middle Turbinate Resection vs Inferior Turbinoplasty in Patients with Rhinitis. Int J Otorhinolaryngol Clin 2019; 11 (1):1-4.
Introduction: To date, there is no optimal surgical management for rhinitis. Current techniques include inferior turbinate resection or turbinoplasty (ITP), septoplasty, and submucosal resection. Middle turbinate resection (MTR) at present is used as part of endoscopic sinus surgery to prevent adhesions and recurrent disease. In this study, the outcomes of MTR and ITP were compared via peak nasal inspiratory flow (PNIF), sinonasal outcome test-22 (SNOT-22), and visual analog scale (VAS) in patients with rhinitis. Materials and methods: In a prospective study, 22 consented patients with rhinitis from the otolaryngology head and neck surgery outpatient clinic were selected and underwent surgery. Twelve patients had MTR and 10 patients had ITP with a 6-month follow-up. Patients were evaluated pre- and postoperatively via PNIF, SNOT-22, VAS, and endoscopic examination. Results: Both treatment groups showed statistically significant improvements (p < 0.01) in PNIF, SNOT-22, and VAS scores postoperatively in early and late follow-up when compared preoperatively. There was a median increase of 57–58% in PNIF, a decrease in SNOT-22 scores by 53–80%, and a decrease in 64–78% VAS scores at the 6-month follow-up. There were no significant differences between scores when comparing the MTR and ITP groups. ITP group had more early postoperative bleeding compared to the MTR group (p < 0.05) and a few patients from the ITP group complained of intermittent long-term epistaxis. Conclusion: Middle turbinate resection was observed to be as effective as ITP to reduce the signs and symptoms of rhinitis and has a lower morbidity of postoperative bleeding.
Bonini S, Bonini M, Bousquet J, et al. Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN. Allergy. 2006;61(6):681–692. DOI: 10.1111/j.1398-9995.2006.01080.x.
Tan G, Ma Y, Li H, et al. Long-term results of bilateral endoscopic vidian neurectomy in the management of moderate to severe persistent allergic rhinitis. Arch Otolaryngol Head Neck Surg 2012;138(5):492–497. DOI: 10.1001/archoto.2012.284.
Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg 2015;152(1 Suppl):S1–S43. DOI: 10.1177/0194599814561600.
Allergies in America. A telephone survey conducted in 2500 adults with allergic rhinitis. Healthstar Communications, Inc in partnership with Shulman, Ronca and Bucuvalas, Inc Allergies in America: A landmark survey on nasal allergy sufferers Executive summary Florham Park NJ: Altana Pharma US, Inc. 2006.
Barham HP, Thornton MA, Knisely A, et al. Long-term outcomes in medial flap inferior turbinoplasty are superior to submucosal electrocautery and submucosal powered turbinate reduction. Int Forum Allergy Rhinol 2015.
Prokopakis EP, Koudounarakis EI, Velegrakis GA. Efficacy of inferior turbinoplasty with the use of CO(2) laser, radiofrequency, and electrocautery. Am J Rhinol Allergy 2014;28(3):269–272. DOI: 10.2500/ajra.2014.28.4044.
Yankauer S. The Complete Sphenoethmoid Operation. The Laryngoscope. 1921;31(11):831–841. DOI: 10.1288/00005537-192111000-00002.
Choby GW, Hobson CE, Lee S, et al. Clinical effects of middle turbinate resection after endoscopic sinus surgery: a systematic review. Am J Rhinol Allergy 2014;28(6):502–507. DOI: 10.2500/ajra.2014.28.4097.
Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: a literature review. Int Forum Allergy Rhinol 2014;4(10):834–838. DOI: 10.1002/alr.21368.
Noruddin NA, Saim AB, Chua KH, et al. Human nasal turbinates as a viable source of respiratory epithelial cells using co-culture system versus dispase-dissociation technique. Laryngoscope 2007;117(12):2139–2145. DOI: 10.1097/MLG.0b013e3181453a1e.
Ruszymah BH, Izham BA, Heikal MY, et al. Human respiratory epithelial cells from nasal turbinate expressed stem cell genes even after serial passaging. Med J Malaysia 2011;66(5):440–442.
Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology 1993;31(4):183–184.
Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy. 2016;71(2):162–174. DOI: 10.1111/all.12778.
Starling-Schwanz R, Peake HL, Salome CM, et al. Repeatability of peak nasal inspiratory flow measurements and utility for assessing the severity of rhinitis. Allergy 2005;60(6):795–800. DOI: 10.1111/j.1398-9995.2005.00779.x.
Ottaviano G, Lund VJ, Nardello E, et al. Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses. Rhinology 2014;52(1):25–30. DOI: 10.4193/Rhin13.037.
Morgenstein KM, Krieger MK. Experiences in middle turbinectomy. Laryngoscope 1980;90(10 Pt 1):1596–1603. DOI: 10.1288/00005537-198010000-00002.
Giacchi RJ, Lebowitz RA, Jacobs JB. Middle turbinate resection: issues and controversies. Am J Rhinol 2000;14(3):193–197. DOI: 10.2500/105065800782102726.
Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63(Suppl 86):8–160. DOI: 10.1111/j.1398-9995.2007.01620.x.
Demoly P, Calderon MA, Casale T, et al. Assessment of disease control in allergic rhinitis. Clin Transl Allergy 2013;3(1):7. DOI: 10.1186/2045-7022-3-7.
Lange B, Thilsing T, Baelum J, et al. The Sinonasal Outcome Test 22 score in persons without chronic rhinosinusitis. Clin Otolaryngol. 2016;41(2):127–130. DOI: 10.1111/coa.12481.
Gillett S, Hopkins C, Slack R, et al. A pilot study of the SNOT 22 score in adults with no sinonasal disease. Clin Otolaryngol 2009;34(5):467–469. DOI: 10.1111/j.1749-4486.2009.01975.x.
Bousquet PJ, Combescure C, Neukirch F, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy 2007;62(4):367–372. DOI: 10.1111/j.1398-9995.2006.01276.x.
Farhood Z, Schlosser RJ, Pearse ME, et al. Twenty-two-item sino-nasal outcome test in a control population: a cross-sectional study and systematic review. Int Forum Allergy Rhinol 2015.
Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Ann Otol Rhinol Laryngol 2000;109(7):634–640. DOI: 10.1177/000348940010900704.
Lundberg JM, Alving K, Lacroix JS, et al. Local and central reflex mechanisms in the neural control of airway microcirculation. Eur Respir J Suppl 1990;12:624s–628s.
Lacroix JS, Kurt AM, Pochon N, et al. Neutral endopeptidase activity and concentration of sensory neuropeptide in the human nasal mucosa. Eur Arch Otorhinolaryngol 1995;252(8):465–468. DOI: 10.1007/BF02114752.
Heppt W, Dinh QT, Cryer A, et al. Phenotypic alteration of neuropeptide-containing nerve fibres in seasonal intermittent allergic rhinitis. Clin Exp Allergy 2004;34(7):1105–1110. DOI: 10.1111/j.1365-2222.2004.01990.x.
White LC, Weinberger P, Coulson H, et al. Why sinonasal disease spares the inferior turbinate: An immunohistochemical analysis. Laryngoscope 2015.
Marchioni D, Alicandri-Ciufelli M, Mattioli F, et al. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol 2008;128(9):1019–1026. DOI: 10.1080/00016480701827541.
Soler ZM, Hwang PH, Mace J, et al. Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope 2010;120(4):832–837. DOI: 10.1002/lary.20812.