Inferior Turbinate Surgery No Better than Placebo in Treating ETD

What are the effects of various inferior turbinate surgery techniques on Eustachian tube dysfunction (ETD)-related symptoms?

Bottom line: ETD-related symptom improvement due to surgery of the anterior half of the inferior turbinate was found to be equal to placebo. The findings do not support the use of this surgery as a sole procedure intended to treat ETDQ-7-assessed ear symptoms.

Background: ETD is a common condition with symptoms including fullness or clogging of the ears, pain or discomfort, hearing loss, tinnitus, dizziness, and an inability to rapidly equilibrate middle ear pressure. However, the relationship between chronic nasal obstruction caused by inferior turbinate enlargement and ETD and the effect of turbinate surgery on ETD have not been evaluated previously in the literature.

Study design: Placebo-controlled, non-blinded study of 72 patients who underwent surgery for enlarged inferior turbinates due to persistent year-round rhinitis between February 2014 and November 2016.

Setting: Tampere University Hospital, Tampere, Finland.

Synopsis: Patients were consecutively randomized into active treatment groups (radiofrequency ablation (RFA) (n=20); diode laser (n=18); microdebrider-assisted inferior turbinoplasty (MAIT) (n=23)) and a sham surgery group (n=11). On a preoperative Eustachian Tube Dysfunction Questionnaire (ETDQ-7), 45% of the patients had a total score of 1.0 to 1.9; 33% had a score of 2.0 to 2.9; and 22% had a score of 3.0 or more. There were no significant changes in preoperative and postoperative tympanometric peak pressure values among either actively treated or sham surgery patients. In all patients, RFA, MAIT, and sham surgery procedures decreased the total ETDQ-7 score significantly. In patients with a preoperative score of 2.0 or more, all active treatment procedures decreased the total score significantly. There were no significant differences in covariance with sex, allergy status, and age with any combination of procedure group and/or sham group. A limitation of the study was that less than 10% of the patients enrolled had an abnormal tympanogram confirming ETD diagnosis, meaning the study results cannot be generalized to ETD.

Citation: Harju T, Kivekäs I, Numminen J, Rautiainen M. The effect of inferior turbinate surgery on ear symptoms. Laryngoscope. 2018;128:568–572.