Query, Concerning Mechanism of Inferior Turbinate Enlargement

Abstract

In the June 2006 issue of the Archives, Berger et al1 discuss the histopathologic changes associated with hypertrophy of the inferior turbinate and compare the findings of histologic evaluation in 17 patients with refractory inferior turbinate hypertrophy with those in 12 subjects with normal inferior turbinates. This is an interesting area for research as there is little information on the topic in the literature apart from some articles by this research group. When I first read the abstract, I was concerned that there could be an ethical problem in removing the inferior turbinate from normal volunteers, but as I read the main text my concern was about the validity of the study. The authors claim that the turbinate tissue in the control group was normal, yet in the “Methods” section they describe the control group as patients with anatomically narrow nasal passages who underwent septoplasy and turbinectomy. I cannot see how a group of patients who have nasal obstruction severe enough to need nasal surgery with septoplasty and turbinectomy can be classified as having normal nasal turbinates. Changes in the anatomy of the nasal passages and changes in airflow are known to cause changes in the size and structure of the nasal turbinates, and this is the main thesis that the authors are pursuing, so it is to be expected that the control group cannot be a proper control for this type of study. I am unaware of any purely anatomical problem of the nasal passages apart from a nasal septal deviation that can cause nasal obstruction, and it would be useful if the authors could provide more information about this unusual group of patients. For example, was the anatomical problem an acquired condition due to trauma or was it related to some congenital problem with the development of the nasal passages? Presumably, this anatomical abnormality had been present for some time; otherwise, the patients would not have been referred to a surgeon for treatment. I have doubts about the validity of the study and especially about the comparisons between the 2 groups. If the subjects in the control group were “normal,” why were they undergoing nasal surgery? I also have reservations about the term turbinate hypertrophy, which is in common use, but I am sure that Berger and colleagues do not use it in its correct histologic sense of meaning enlarged cells. A better term for these conditions would be turbinate enlargement, which could be caused by vascular engorgement of venous sinuses, tissue hyperplasia, or tissue hypertrophy.