The study showed that submucosal resection (SMR) plus outfracture (also known as lateral displacement [LD]) achieved the best balance between long-term symptom relief “and an acceptable risk profile,” Dr. Batra said. Specifically, at year six, SMR + LD patients achieved an average symptom score of 10 (range, 5 to 30). Although that may seem modest compared with the higher scores of other procedures such as electrocautery, which had a 26 score at the six-year follow-up, the rate of side effects (e.g., crusting, bleeding and mucosal atrophy) were telling: electrocautery patients had a complication score of 39 (range, 0 to 50), versus a score of 10 for the SMR + LD group.
Explore This IssueNovember 2013
Based on those findings, the authors of the Passali study concluded that SMR + SD should be considered “the first-choice technique for the treatment of nasal obstruction due to hypertrophy of the inferior turbinates.”
Dr. Batra said SMR +LD is his own treatment of choice for managing patients with turbinate hypertrophy. “This is what the data tell us, so I have incorporated these findings into my practice—provided there is evidence that patients have not responded to an adequate course of medical therapy,” he said.
Several additional studies published shortly after the accrual date for Dr. Batra’s evidence-based review also concluded that SMR offers the best outcomes for patients with ITH, he said. In one, by Liu and colleagues, 120 patients were treated with either a coblation or microdebrider procedure (Laryngoscope; 2009;119:414-418). After approximately one year of follow-up, both techniques were equally effective in relieving symptoms based on visual analog scores, acoustic rhinometry tests and other measures of sinus function, Dr. Batra noted. Between one and three years of follow-up, however, “the microdebrider group had significantly better outcomes,” he noted.
Interestingly, despite relatively poor support in the literature, some surgeons are still performing invasive procedures for ITH such as a partial or even complete resection of the inferior turbinates, Dr. Batra noted. He explained that this aggressive approach “fundamentally alters the nasal environment” by destroying the turbinates’ ability to filter out potentially harmful organisms. “This may result in colonization with opportunistic gram-negative bacteria and could set up patients with long-term chronic infections, crusting and bleeding,” he said. “So the only time I really do this in my practice is for patients who have a benign tumor or a malignancy involving the inferior turbinate.”
On the flip side, overly light-handed approaches such as thermal-only techniques, “where you just do surface cautery or even submucosal cautery, and frankly lasers,” are not optimal. “Yes, the risk for side effects may be lower, but long-term, the clinical benefits are just not there, as the literature details.”