Inferior Turbinate Enlargement Research Articles

Exploring the Relationships Between Clinical Examination Findings, Subjective Reported Symptoms and Objective Nasal Patency Measures in Nasal Obstruction: A Baseline NAIROS Sub-Study Analysis.

The role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined. To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction. This is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB-arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, [NPR] and PNIF) were measured using PNIF and rhinospirometry. The mean NPR for left-sided, both-sided and right-sided septal deviation was -0.35, -0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and -0.29, respectively (p < 0.001). This study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.

Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients

The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Normal anatomic variants of paranasal sinus region studied by computed tomography

Background and objective: Variation in paranasal sinus anatomy, as shown on computed tomographic scans, is of potential significance as it may pose risks during surgery or predispose to certain pathologic conditions. This study aimed to investigate the frequency of anatomic variants of the nasal cavity and paranasal sinuses in our population and determine their relationship with gender and find out the association of these variants with mucosal abnormalities. Methods: This was a cross-sectional study conducted at the College of Medicine, Hawler Medical University from October 2017 to January 2019. A review of computed tomography scans of the paranasal sinuses of 300 patients was done; special attention was directed toward identifying bony anatomic variants and mucosal abnormalities. Results: Frequent variants were: Agger nasi cells (72%), nasal septal deviation (71.7%), Haller cells (70.7%), concha bullosa (61%), elongation of uncinate process (69.7%) and different variants of the sphenoidal sinus (78.8%). The frequency of variants did not differ significantly with respect to gender, except for sphenoidal variants along with Keros types and asymmetry of the ethmoidal roof. A significant association was found between middle concha variants and inferior turbinate enlargement (P <0.001). Conclusion: Anatomic variants of the paranasal sinus region were common in our population; the most frequent ones were those involving the nasal septum, ethmoid air cells, sphenoid sinuses, and middle turbinates. The study of these variants is important for the management of paranasal sinus region disease.

Clinical outcome following septoplasty with or without inferior turbinate reduction

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deviation of nasal septum towards one side is often associated with over growth of inferior turbinate, which occupies expansive space of contralateral nasal cavity. The enlargement of inferior turbinate can be due to mucosal elements or bony expansion. Many surgeons are of the belief if septoplasty is done, compensatory hypertrophy regresses on its own. There are others who argue that these changes are not spontaneously reversible and should be corrected in conjunction with nasal septal surgery. Otherwise surgery may relieve the obstruction on one side of nose but leave other side of obstructed because of relocation of septum towards hypertrophied turbinate.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective interventional randomized comparative study is carried out from 1&lt;sup&gt;st&lt;/sup&gt; November 2017 to 31&lt;sup&gt;th&lt;/sup&gt; March 2019, with a sample size of 40 patients. Patients were divided in two surgical groups; group A, with conventional septoplasty done and group B, with reduction of inferior turbinate along with conventional septoplasty done. Post operatively patients’ symptoms will be evaluated using nasal obstructions evaluation scale (NOSE) and nasal airway with nasal endoscopy at 1, 3 and 6 months, and compared with preoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Data is analyzed using percentage graph and tables. The comparisons of NOSE score at 1, 3- and 6-months interval showed the p value of 0.001 which was significant. Also comparison of two groups with NOSE score showed significant improvement in group B.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study shows that hypertrophied turbinate need reduction along with septoplasty in cases of long standing nasal obstruction.&lt;/p&gt;

A randomised trial comparing the subjective outcomes following septoplasty with or without inferior turbinoplasty

AimsThe surgical management of contralateral inferior turbinate hypertrophy in patients with deviated nasal septum is controversial. In this randomised clinical trial, we aimed to investigate the subjective improvement of nasal symptoms postoperatively in patients undergoing septoplasty with or without inferior turbinoplasty. Material and methodsOne hundred and thirty-seven patients with nasal obstruction, who had unilateral septal deviation and compensatory contralateral inferior turbinate enlargement, were randomised into either septoplasty alone arm (n=66) or septoplasty combined with turbinoplasty arm (n=71). Preoperative symptom scores and the subjective perception of the nasal obstruction were compared between two groups of the study using Nasal Obstruction Symptom Evaluation Scale (NOSE) and Visual analog scale (VAS) respectively. The measurements were repeated 6 months after surgery as well as at 1, 2, and 4 years postoperatively. ResultsWith regard to the findings obtained from both scales, both interventions successfully relieved the patients’ complaints of nasal obstruction at almost all postoperative visits when compared with the baseline measurements (P˂0.005 for most comparisons). However, the relief of nasal obstruction was more pronounced in patients undergoing combined intervention at all postoperative visits, except at the 1st follow-up session (P˂0.005). Nasal symptoms of septoplasty alone group began to deteriorate over the period between month 24 and month 48. In contrast, patients undergoing the combined surgery steadily showed symptomatic improvement over the whole period of study. ConclusionsA turbinate reduction surgery should be conducted along with septoplasty to achieve better results in cases suffering from deviated nasal septum with concomitant hypertrophied inferior turbinate.

A prospective, randomized, placebo-controlled study of inferior turbinate surgery.

The purpose of this study was to compare radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty techniques in the treatment of chronic nasal obstruction caused by inferior turbinate enlargement, and to compare these techniques with a placebo procedure. Prospective, randomized, single-blinded, placebo-controlled study. A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into a placebo, radiofrequency ablation, diode laser, and microdebrider-assisted inferior turbinoplasty groups in a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. The severity of nasal obstruction measured by visual analog scale score decreased statistically significantly in all the groups, including placebo. Radiofrequency ablation (P = .03), diode laser (P = .02), and microdebrider-assisted inferior turbinoplasty (P = .04) all decreased the symptom score of the severity of nasal obstruction statistically significantly more compared to the placebo procedure. The placebo effect had a large role in the overall improvement of the severity of nasal obstruction after the inferior turbinate surgery. However, all three techniques provided a statistically significant additional reduction of the severity of nasal obstruction compared to the placebo procedure. 1b. Laryngoscope, 128:1997-2003, 2018.

Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement

The aim of this study was to evaluate the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and Eustachian tube dysfunction-related symptoms using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) as an assessment method. A total of 80 adults were enrolled. Group 1 comprised consecutive patients with enlarged inferior turbinates and group 2 comprised healthy controls. The ETDQ-7 scores and tympanometry results of both groups were analyzed and compared. The median total scores of the ETDQ-7 in groups 1 and 2 were 1.9 (interquartile range, 1.4-2.8) and 1.1 (interquartile range, 1.0-1.7), respectively ( P < .001). There was no significant difference in the abnormal tympanometry results between the groups. There was no significant difference in the ETDQ-7 total score between the patients with allergic sensitization and other patients in group 1. Patients with inferior turbinate enlargement have more symptoms related to Eustachian tube dysfunction than healthy controls. Most patients with Eustachian tube dysfunction had normal tympanometry and normal otoscopy, which indicates a baro-challenge-induced Eustachian tube dysfunction. Whether the patient has allergic sensitization or not does not seem to cause a difference in symptoms related to Eustachian tube dysfunction.

Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study).

Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). In a prospective, real-life study, 130 paediatric PER patients (13.1±2.8years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). After 2months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.

Surgery for nasal obstruction in inferior turbinate hypertrophy

Abstract In the international literature, there is no consensus on patient selection for turbinate surgery. Surgery is usually indicated to the patients on the basis of subjective complaint of nasal obstruction and surgeon´s clinical examination. Although most surgical techniques demonstrate a subjective and objective improvement in postoperative nasal airflow and subjective scores, it is hard to say which technique is best suited for treating inferior turbinate enlargement. Inferior turbinate reduction for nasal obstructive symptoms caused by enlarged turbinates is a useful procedure and is reserved for patients who are not responding to medical treatment or in whom the medical management is contraindicated.

Inferior turbinate reduction

The inferior turbinate is an important structure serving a vital role in nasal physiology. However, inferior turbinate enlargement can lead to decreased nasal airflow and a sensation of nasal obstruction. Chronic nasal obstruction can substantially affect quality of life, productivity, and finances, and when medical therapies fail, surgical management is often recommended. Many techniques for inferior turbinate reduction exist, including outfracturing, submucosal soft tissue reduction (ie, electrocautery, radiofrequency coblation, and powered microdebrider), submucosal bone removal, argon plasma coagulation, laser reduction, partial turbinectomy, and total turbinectomy. These techniques have demonstrated varied long-term results, and there remains a lack of consensus as to the optimal surgical technique. However, given the important role the inferior turbinates play in nasal physiology, many contemporary surgeons aim to strike a balance between adequate tissue resection for symptom improvement and preservation of functional turbinate tissue and its contribution to normal nasal physiology.

Tuberculosis of the Nasolacrimal Duct

Nasolacrimal tuberculosis is rare. The authors present a young Peruvian-born female with subacute onset of right eye epiphora, isolated right inferior turbinate enlargement, and ipsilateral cervical lymphadenopathy. Turbinate and neck mass incisional biopsies demonstrated histopathological findings consistent with tuberculosis. QuantiFERON-TB Gold-In-Tube testing was positive. Complete resolution of symptoms occurred after dacryocystorhinostomy and 9 months of standard 4-drug antituberculosis therapy. Tuberculosis of the nasolacrimal duct is highly unusual but should be considered in patients with tuberculosis risk factors who present with nasolacrimal obstruction from an inferior turbinate mass.

Aerodynamic effects of inferior turbinate surgery on nasal airflow--a computational fluid dynamics model

Turbinate reduction surgery may be indicated for inferior turbinate enlargement when conservative treatment fails. The aim of this study was to evaluate the effects of inferior turbinate surgery on nasal aerodynamics using computational fluid dynamics (CFD) simulations. CFD simulations were performed for the normal nose, enlarged inferior turbinate and following three surgical procedures: (1) resection of the lower third free edge of the inferior turbinate, (2) excision of the head of the inferior turbinate and (3) radical inferior turbinate resection. The models were constructed from MRI scans of a healthy human subject and a turbulent flow model was used for the numerical simulation. The consequences of the three turbinate surgeries were compared with originally healthy nasal model as well as the one with severe nasal obstruction. In the normal nose, the bulk of streamlines traversed the common meatus adjacent to the inferior and middle turbinate in a relatively vortex free flow. When the inferior turbinate was enlarged, the streamlines were directed superiorly at higher velocity and increased wall shear stress in the nasopharynx. Of the three surgical techniques simulated, wall shear stress and intranasal pressures achieved near-normal levels after resection of the lower third. In addition, airflow streamlines and turbulence improved although it did not return to normal conditions. As expected, radical turbinate resection resulted in intra-nasal aerodynamics of atrophic rhinitis demonstrated in previous CFD studies. There is little evidence that inspired air is appropriately conditioned following radical turbinate surgery. Partial reduction of the hypertropic turbinate results in improved nasal aerodynamics, which was most evident following resection of the lower third. The results were based on a single individual and cannot be generalised without similar studies in other subjects.

Correlation Between Eosinophilia and Nasal Features in Allergic Rhinosinusitis

A characteristic feature of nasal allergy is local accumulation of inflammatory cells, particularly mast cells and eosinophils, and their mediators, which have been implicated to be responsible for symptoms and signs of allergies. This prospective study tested the hypothesis that severity of nasal symptoms at presentation was related to the presence of nasal eosinophilia, using consecutive patients with allergic rhinitis attending the outpatient Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria, between March and December 2008. Excluded were those who had commenced antihistamine and similar antiallergy drugs. Nasal eosinophilia, skin sensitivity, sinus radiograph, and clinical features were graded using standard classification. The study was composed of 49 subjects (28 males and 21 females). The subjects’ age ranged from 7 to 53 years (mean ± SD: 28 ± 4 years). Nasal eosinophilia and abnormal skin sensitivity response were seen in 41 (83.8%) and 37 (75.5%) subjects, respectively. Rhinorrhea, sneezing, and nasal obstruction constituted 42 (85.7%), 31 (63.3%), and 21 (42.9%), respectively, while inferior turbinate enlargement and radiological involvement were seen in 29 (59.2%) and 36 (73.5%) patients. The Spearman correlation test revealed a significant association between nasal smear eosinophilia and rhinorrhea (P = .008) and sneezing (P = .04), although there was no significant association with other variables. The authors conclude that the degree of nasal eosinophilia may be useful in predicting the severity of rhinorrhea and sneezing among the clinical features of nasal allergy.

Restoration of Nasal Cytology after Endoscopic Turbinoplasty versus Laser-Assisted Turbinoplasty

Insult from surgical trauma leads to a degeneration of the nasal epithelium, resulting in morphological-volumetric changes involving the entire cell or a specific cell component. Alterations in normal nasal mucosa were assessed by nasal cytology and other functional tests after either endoscopic turbinoplasty or laser-assisted turbinoplasty for reducing inferior turbinate enlargement. A total of 150 patients with chronic nasal obstruction due to inferior turbinate hypertrophy were randomly assigned to undergo laser-assisted turbinoplasty or endoscopic turbinoplasty. Preoperative and postoperative assessment at 1 and 3 months follow-up included active anterior rhinomanometry, measurement of mucociliary transport time (MCTt), and nasal cytology to determine whether improved nasal breathing was accompanied by a restoration of preoperative nasal cytology and MCTt. One year after the operation, nasal cytology was repeated to definitively evaluate the presence of surgery-related cytological damage. At both postoperative visits, nasal resistance had decreased similarly in both treatment groups; mean MCTt was significantly shorter in the endoscopic turbinoplasty-treated group (p < 0.05); at both visits, the number of altered ciliated cells had increased in the laser-assisted turbinoplasty-treated group but decreased in the endoscopic turbinoplasty-treated group, which, unlike the laser-assisted turbinoplasty-treated group, was also noted to have progressed toward a significant improvement in the goblet-to-ciliated cell ratio (p < 0.01). When compared with laser-assisted turbinoplasty, endoscopic turbinoplasty is a conservative technique for inferior turbinate reduction that allows better restoration of preoperative nasal cytology and shorter MCTt.

Inferior turbinate surgery and nasal airflow: evidence-based management

This review will discuss the evidence-based management of enlarged inferior turbinate by considering methods of assessing nasal airflow, controversies surrounding patient selection and surgical outcomes. There is currently no consensus on patient selection for turbinate surgery. Patients are empirically offered surgery on the basis of subjective complaint of nasal obstruction and surgeon's clinical examination. Few authors have utilized objective measurements of nasal airflow such as rhinomanometry to select suitable patients for surgery. There is a small body of evidence suggesting that more robust criteria of selecting patients, using a nasal decongestant test and rhinomanometry, may have some influence on the surgical outcome. Although most surgical techniques demonstrate improvement in postoperative nasal airflow and subjective scores, it is impossible to draw conclusions as to which technique is best suited for treating inferior turbinate enlargement. The heterogeneous study cohorts, differing patient selection criteria and outcome measures used do not allow meta-analysis of outcomes and comparison between surgical techniques. Inferior turbinate surgery is an evolving operative concept and the evidence supporting the efficacy of the various techniques remains undecided. More prospective controlled studies are needed with both objective and subjective outcome measures.

Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation

Conclusion: Inferior turbinate enlargement (ITE), nasal valve collapse (NVC) and concha bullosa (CB) are nasal anatomic problems that may accompany septal deviation (SD). Establishment of a causal relationship between these variations and SD is doubtful. In patients complaining of nasal obstruction, all nasal structures that may contribute to the symptom must be separately and carefully assessed for setting an appropriate treatment plan and thereby minimizing the failure rate of surgery. Objective: To investigate if the convexity of SD is associated with the occurences of ITE, CB and NVC. Patients and methods: This retrospective study was performed on 109 patients who had been operated due to anterior C-shaped SDs. ITE, CB and NVC were encountered in 65 (59.6%), 27 (24.8%) and 55 (50.5%) patients, respectively. Patients with other forms of SD, allergic rhinitis, non-allergic rhinitis with eosinophilia, acute and chronic sinusitis, nasal polyposis, antrochoanal polyps, those who had recently used systemic or topical decongestants and patients with a history of previous nasal surgery were excluded from the study group. Assessment of the patients was based on data derived from the history, physical examination findings and paranasal sinus CT imaging records. Results: No significant correlation was found between the convexity of the SD and occurrence of ITE, CB and NVC (p = 0.098, 0.717 and 0.171, respectively).

Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation

Association of inferior turbinate enlargement, concha bullosa and nasal valve collapse with the convexity of septal deviation

Inferior Turbinate Surgery: Is There an Increase of Frequency?

Background: Nasal obstruction is a very common symptom in the general population and may be attributed to septal deviation and inferior turbinate enlargement, often a manifestation of allergic rhinitis. Allergic rhinitis has become more frequent in recent years, or at least diagnosis has become more common.

Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

Anterior Trimming vs Outer Displacement of Inferior Turbinate: A Comparative Study at a Tertiary Care Hospital

Background: Obstruction of nose due to enlargement of inferior turbinate is a very common problem faced by ENT surgeon.In thisstudy a usefultechnique for treatment of inferior turbinate hypertrophy is described.Objective:To determine the surgical outcome and complications ofthe two surgicalprocedures.Material and Methods: This non-randomized comparative study was performed in the Department of ENT, HNS, MTI/LRH,Peshawar, Pakistan, from June 01, 2017 to May 31, 2018. After ethical approval, sample size of 112 was calculated and patientsincluded of both genders fulfilling inclusion criteria. After taking consent patients were equally divided into two groups with nonrandom number table method. Both subjective and objective assessment was carried out and observations were recorded on apredesignedproforma.Data were analyzed using SPSS 20.Results: Total patients were 112,in age range from 16 to 50 years. There were 56(50%) patients in each group.Maleswere 71 andfemale 41withmale to female ratio of 1.7:1 and mean age was 32.92+S.D 10.29 years.Relief from nasal obstruction obtained was94.64% and 92.86% in Group A and B respectively. Headachewas relived 83.34 % and 88.38% in Group A and B respectively. Thecomplications experienced were post operative bleeding, adhesion formation and crusting 2.6%, 3.5% and 1.78% respectively.Statistics showed no significant difference between the two operations (p &gt;0.05).Conclusion: Both trimming and outer displacement of hypertrophied inferior turbinate are effective procedures for relief of nasalobstruction but there was no significant difference betweenthe two techniques interm of outcome and complications.Keywords:Inferiorturbinate, Hypertrophy, Trimming, Outer displacement. Nasal obstruction