Surgical Indications for Pediatric Turbinate Reduction: Arguments For and Against

Although little prospective data exist evaluating surgical turbinate reduction for chronic pediatric sinusitis and rhinitis, some otolaryngologists do perform the procedure on patients for whom medical therapy has been aggressively tried but clinical symptoms persist. This article presents a point-and-counterpoint discussion of the benefits and risks of surgical intervention in this patient population.

Pediatric sinusitis and rhinitis are extremely common. Children average six to eight upper respiratory infections per year, with 0.5% to 5% of these progressing to acute sinusitis. The actual number of cases that progress to chronic sinusitis is not known.1,2

Chronic sinusitis has been defined as an episode of inflammation of the paranasal sinuses lasting for more than 90 days.2 Symptoms may include nasal congestion and discharge (possibly with purulent secretions), cough, postnasal drip, maxillofacial pressure/pain, and occasionally fever and/or headache.3

Potential etiologies of rhinosinusitis include viral or bacterial infection, allergy, environmental irritants, adenoiditis, immunodeficiency, cystic fibrosis (CF), or gastroesophageal reflux disease (GERD).2,3 Anatomic abnormality with fixed anatomic obstruction is relatively uncommon in children.3

References

1. Lusk R. Pediatric chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2006;14:393-6.

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2. Clinical practice guideline: management of sinusitis. Pediatrics 2001;108:798-808.

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3. Manning S. Surgical intervention for sinusitis in children. Curr Allergy Asthma Rep 2001;1:289-96.

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4. Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children: a prospective analysis. Arch Otolaryngol Head Neck Surg 2000;126:831-6.
5. Bothwell MR, Parsons DS, Talbot A, Barbero GJ, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngol Head Neck Surg 1999;121:255-62.
6. Segal S, Eviatar E, Berenholz L, Kessler A, Shlamkovitch N. Inferior turbinectomy in children. Am J Rhinol 2003;17:69-73; discussion 69.
7. Fradis M, Malatskey S, Magamsa I, Golz A. Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement. Am J Otolaryngol 2002;23:332-6.
8. Passali D, Passali FM, Damiani V, Passali GC, Bellussi L. Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol 2003;112:683-8.
9. Ferri E, Garcia Purrinos FJ, Ianniello F, Armato E, Cavaleri S, Capuzzo P. [Surgical treatment of inferior turbinate hypertrophy with argon plasma: a long-term follow-up in 157 patients]. Acta Otorrinolaringol Esp 2004;55:277-81.
10. Harsten G. How we do it: radiofrequency-turbinectomy for nasal obstruction symptoms. Clin Otolaryngol 2005;30:64-6.
11. Lieser JD, Derkay CS. Pediatric sinusitis: when do we operate? Curr Opin Otolaryngol Head Neck Surg 2005;13:60-6.
12. Cotter CS, Stringer S, Rust KR, Mancuso A. The role of computed tomography scans in evaluating sinus disease in pediatric patients. Int J Pediatr Otorhinolaryngol 1999;50:63-8.

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