Inferior Turbinate Reduction during Rhinoplasty: Is There Any Effect on Rhinitis Symptoms?

João Pedro T Garcia, Bianca H de Moura, Vinícius H Rodrigues, Manoela A Vivan, Simone M de Azevedo, José Eduardo L Dolci, Raphaella Migliavacca, Michelle Lavinsky-Wolff, João Pedro T Garcia, Bianca H de Moura, Vinícius H Rodrigues, Manoela A Vivan, Simone M de Azevedo, José Eduardo L Dolci, Raphaella Migliavacca, Michelle Lavinsky-Wolff

Abstract

Introduction Inferior turbinate surgery is often performed concomitantly with rhinoseptoplasty. As inferior turbinates play a major role in allergic rhinitis, it seems reasonable to suggest that inferior turbinate surgery reduces allergy. Objective To assess the impact of nasal turbinate surgery on non-obstructive allergic symptoms (nasal discharge, sneezing, pruritus, and allergic conjunctivitis) and on the use of allergic medication in patients with allergic rhinitis undergoing rhinoseptoplasty. Methods Secondary analysis of aggregated data from two randomized controlled trials. Participants with allergic rhinitis aged ≥ 16 years were recruited. Data from two groups were analyzed: patients with rhinoseptoplasty and concomitant turbinate reduction (intervention group) and patients with rhinoseptoplasty only (control group). The 90-day postoperative frequency of non-obstructive allergic symptoms and of nasal steroid and oral antihistamine use were analyzed. Results A total of 100 patients were studied. The groups were similar in terms of allergic symptom intensity and mean age. The frequency of non-obstructive allergic symptoms decreased 90 days postoperative in both groups ( p < 0.01). There was no difference between the groups in the frequency of non-obstructive allergic symptoms at 90 days ( p = 0.835). Topical nasal steroid and oral histamine antagonist use decreased in the intervention group at 90 days ( p < 0.05). Conclusions Ninety days after the surgery, turbinate reduction performed in association with rhinoseptoplasty did not reduce the frequency of non-obstructive allergic symptoms more than rhinoplasty alone. However, the observed decrease in nasal steroid and oral antihistamine use suggests an impact of turbinate reduction on medication use in patients with allergic rhinitis undergoing rhinoseptoplasty. Trial Registration ClinicalTrials.gov database (NCT01457638 and NCT02231216).

Keywords: allergic; randomized controlled trial; rhinitis; rhinoplasty; steroids; turbinates.

Conflict of interest statement

Conflict of Interests The authors declare that there is no conflict of interests.

Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Figures

Fig. 1
Fig. 1
Study protocol.
Fig. 2
Fig. 2
Forest plot showing risk of symptoms and medication use 90 days after nasal turbinate reduction.

References

    1. Leong S C, Eccles R. Inferior turbinate surgery and nasal airflow: evidence-based management. Curr Opin Otolaryngol Head Neck Surg. 2010;18(01):54–59. doi: 10.1097/MOO.0b013e328334db14.
    1. Veit J A, Nordmann M, Dietz B. Three different turbinoplasty techniques combined with septoplasty: Prospective randomized trial. Laryngoscope. 2017;127(02):303–308. doi: 10.1002/lary.26264.
    1. Passàli D, Lauriello M, Anselmi M, Bellussi L. Treatment of hypertrophy of the inferior turbinate: long-term results in 382 patients randomly assigned to therapy. Ann Otol Rhinol Laryngol. 1999;108(06):569–575. doi: 10.1177/000348949910800608.
    1. Brożek J L, Bousquet J, Agache I. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(04):950–958. doi: 10.1016/j.jaci.2017.03.050.
    1. Passàli D, Passàli F M, Damiani V, Passàli G C, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol. 2003;112(08):683–688. doi: 10.1177/000348940311200806.
    1. Kim D H, Park H Y, Kim H S. Effect of septoplasty on inferior turbinate hypertrophy. Arch Otolaryngol Head Neck Surg. 2008;134(04):419–423. doi: 10.1001/archotol.134.4.419.
    1. Downs B W. The inferior turbinate in rhinoplasty. Facial Plast Surg Clin North Am. 2017;25(02):171–177. doi: 10.1016/j.fsc.2016.12.003.
    1. Grymer L F.Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry Laryngoscope 1995105(4 Pt 1):429–431.10.1288/00005537-199504000-00017
    1. Lavinsky-Wolff M, Camargo H L, Jr, Barone C R. Effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes: a randomized clinical trial. Laryngoscope. 2013;123(01):82–89. doi: 10.1002/lary.23628.
    1. de Moura B H, Migliavacca R O, Lima R K. Partial inferior turbinectomy in rhinoseptoplasty has no effect in quality-of-life outcomes: A randomized clinical trial. Laryngoscope. 2018;128(01):57–63. doi: 10.1002/lary.26831.
    1. Grymer L F, Gregers-Petersen C, Baymler Pedersen H. Influence of lateral osteotomies in the dimensions of the nasal cavity. Laryngoscope. 1999;109(06):936–938. doi: 10.1097/00005537-199906000-00018.
    1. Grymer L F, Hilberg O, Pedersen O F, Rasmussen T R. Acoustic rhinometry: values from adults with subjective normal nasal patency. Rhinology. 1991;29(01):35–47.
    1. Lukka V K, Jacob T M, Jeyaseelan V, Rupa V. Do turbinate reduction procedures restore epithelial integrity in patients with turbinate hypertrophy secondary to allergic rhinitis? A histopathological study. Eur Arch Otorhinolaryngol. 2018;275(06):1457–1467. doi: 10.1007/s00405-018-4955-y.
    1. Global Allergy and Asthma European Network ; Grading of Recommendations Assessment, Development and Evaluation Working Group . Brozek J L, Bousquet J, Baena-Cagnani C E. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(03):466–476. doi: 10.1016/j.jaci.2010.06.047.
    1. World Health Organization ; GA(2)LEN ; AllerGen . Bousquet J, Khaltaev N, Cruz A A. 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 86:8–160. doi: 10.1111/j.1398-9995.2007.01620.x.
    1. Mori S, Fujieda S, Igarashi M, Fan G K, Saito H. Submucous turbinectomy decreases not only nasal stiffness but also sneezing and rhinorrhea in patients with perennial allergic rhinitis. Clin Exp Allergy. 1999;29(11):1542–1548. doi: 10.1046/j.1365-2222.1999.00645.x.
    1. Chhabra N, Houser S M. The surgical management of allergic rhinitis. Otolaryngol Clin North Am. 2011;44(03):779–795, xi. doi: 10.1016/j.otc.2011.03.007.
    1. Stewart M G, Witsell D L, Smith T L, Weaver E M, Yueh B, Hannley M T. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130(02):157–163. doi: 10.1016/j.otohns.2003.09.016.
    1. Chen Y L, Tan C T, Huang H M. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008;118(07):1270–1274. doi: 10.1097/MLG.0b013e31816d728e.
    1. Bakshi S S, Shankar Manoharan K, Gopalakrishnan S. Comparison of the long term efficacy of radiofrequency ablation and surgical turbinoplasty in inferior turbinate hypertrophy: a randomized clinical study. Acta Otolaryngol. 2017;137(08):856–861. doi: 10.1080/00016489.2017.1294764.
    1. Huang T W, Cheng P W. Changes in nasal resistance and quality of life after endoscopic microdebrider-assisted inferior turbinoplasty in patients with perennial allergic rhinitis. Arch Otolaryngol Head Neck Surg. 2006;132(09):990–993. doi: 10.1001/archotol.132.9.990.
    1. Di Rienzo Businco L, Di Rienzo Businco A, Ventura L, Laurino S, Lauriello M. Turbinoplasty with quantic molecular resonance in the treatment of persistent moderate-severe allergic rhinitis: Comparative analysis of efficacy. Am J Rhinol Allergy. 2014;28(02):164–168. doi: 10.2500/ajra.2014.28.3990.
    1. Coste A, Dessi P, Serrano E. Empty nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129(02):93–97. doi: 10.1016/j.anorl.2012.02.001.
    1. Mori S, Fujieda S, Yamada T, Kimura Y, Takahashi N, Saito H. Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis. Laryngoscope. 2002;112(05):865–869. doi: 10.1097/00005537-200205000-00016.
    1. Caffier P P, Scherer H, Neumann K, Lück S, Enzmann H, Haisch A. Diode laser treatment in therapy-resistant allergic rhinitis: impact on nasal obstruction and associated symptoms. Lasers Med Sci. 2011;26(01):57–67. doi: 10.1007/s10103-010-0813-x.
    1. Hamerschmidt R, Hamerschmidt R, Moreira A T, Tenório S B, Timi J RR. Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis. Rev Bras Otorrinolaringol (Engl Ed) 2016;82(02):131–139. doi: 10.1016/j.bjorl.2015.10.010.
    1. Kim Y H, Kim B J, Bang K H, Hwang Y, Jang T Y. Septoplasty improves life quality related to allergy in patients with septal deviation and allergic rhinitis. Otolaryngol Head Neck Surg. 2011;145(06):910–914. doi: 10.1177/0194599811424119.
    1. Baiardini I, Pasquali M, Giardini A. Rhinasthma: a new specific QoL questionnaire for patients with rhinitis and asthma. Allergy. 2003;58(04):289–294. doi: 10.1034/j.1398-9995.2003.00079.x.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅