Inferior Turbinate Hypertrophy: A Review of the Evolution of Management in Children

Abstract

Background Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment. Objective To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time. Methods In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts. Results Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction. Conclusion This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.

Inferior turbinate hypertrophy presenting as bilateral nasal masses in a paediatric patient

“…[1][2][3] More generally, paediatric nasal masses can be divided into congenital, inflammatory and neoplastic aetiologies. Occasionally, inferior turbinate hypertrophy can be so severe that it leads to reactive sinus disease, [2][3][4] as was seen here. Nasal masses noted in the perinatal period are generally limited to the congenital type, but differential diagnosis broadens with increasing age and…”

Comparative Study Between Conventional Inferior Turbinectomy and Endoscopic Inferior Turbinoplasty for Treatment of Inferior Turbinate Hypertrophy

“…The procedures practised include total turbinectomy, turbinoplasty, partial inferior turbinectomy, sub mucosal resection, cryosurgery, laser assisted turbinoplasty, and electrocautery with monopolar or bipolar techniques. [7][8][9][10][11][12][13][14] Partial inferior turbinectomy is performed with an aim to remove nasal obstruction trying to preserve some portion of turbinate to maintain physiological function of turbinates. 15,16 In our study, we compared conventional inferior turbinectomy and endoscopic inferior turbinoplasty.…”

Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies

“…With the available newer technologies such as microdebrider or radiofrequency performed as an intraturbinoplasty technique, such procedures can be performed as mucosalsparing methods with greater efficacy and minimal postoperative complications [50]. Remarkably, the mucosal-sparing approach has been shown to be safe and efficacious when performed concurrently with other procedures such as adenotonsillectomy [51].…”