Making a successful transition to office-based inferior turbinate hypertrophy (ITH) surgery depends on proper coding and other financial concerns. But a more basic question first needs to be considered before breaking out the calculator: What is the optimal technique for performing the surgery?
Explore this issue:November 2013
As with so many chronic, common conditions, there are myriad options. Indeed, according to one of the first widely cited comprehensive reviews of the ITH literature, by Hol and Huizing (Rhinology. 2000;38:157-166), there have been at least 13 different techniques developed for the condition, ranging from the very aggressive, mucosal-damaging thermal coagulation and electrocautery methods that dominated the early days of ITH surgery to later, more precise mucosal-sparing approaches such as radiofrequency (RF) ablation. Based on the horrific side effects of the earlier interventions, including mucosal atrophy, tissue necrosis and crusting that essentially obliterated the functional structures of the nose, the authors concluded that the best surgical approach is the one that “achieves optimal [turbinate] volume reduction with preservation of function.”
Unfortunately, that criterion still leaves multiple surgical techniques currently in use, which is one of the reasons why a leading otolaryngologist decided to conduct a more up-to-date literature review. The study, by Pete S. Batra, MD, co-director of the Comprehensive Skull Base Program in the department of otolaryngology-head and neck surgery at the University of Texas Southwestern Medical Center in Dallas, employed evidence-based medicine to assess the evidence (Laryngoscope. 2009;119:1819-1827). Why take that approach? “It’s our fiduciary responsibility to scrutinize all of the relevant literature; you don’t want to look at just one uncontrolled study and use that as the basis for how you manage patients,” Dr. Batra told ENTtoday. In the case of ITH, that is especially important, he noted, because new technology tends to drive the ITH literature, where the latest device is evaluated in an uncontrolled, often short-term study, and in some cases touted as practice changing.
One of the most ground-breaking studies included in his EBM review was by Passali and colleagues, Dr. Batra noted, and he gave it high marks because it was randomized, it included a large number of patients (382), and it compared the most commonly used ITH surgical techniques (turbinectomy, laser cautery, electrocautery, cryotherapy, submucosal resection and submucosal resection with outfracture.) “The study also followed the patients for six years,” Dr. Batra noted. “That type of long-term follow-up is critical for assessing the utility of these surgical interventions.”