Inferior turbinate reduction may result in greater improvement in sinonasal symptoms, nasal obstruction, and sleep-related quality of life compared with continued medical therapy among pediatric patients with refractory allergic rhinitis, with higher rates of endoscopic disease regression at 1 and 3 months.
In a prospective cohort pilot study, researchers evaluated 34 patients aged 5 to 17 years with allergic rhinitis who remained symptomatic despite at least 3 months of intranasal corticosteroids and oral antihistamines. The patients were allocated to inferior turbinate reduction or continued medical therapy based on parental choice, with 17 patients in each group. The outcomes were assessed using the Sinus and Nasal Quality of Life Survey (SN-5), the Obstructive Sleep Apnea–18 (OSA-18) questionnaire, and the Nasal Obstruction Symptom Evaluation (NOSE) scale at baseline, 1 month, and 3 months.
At 1 month, the patients who underwent surgery had greater mean reductions in symptom scores compared with those receiving medical therapy. Mean decreases in SN-5 scores were 9.9 ± 5.8 vs 6.8 ± 3.9, while OSA-18 scores decreased by 23.2 ± 9.8 vs 17.3 ± 7.1, and NOSE scores by 8.2 ± 3.8 vs 4.6 ± 2.8.
Endoscopic findings supported these patient-reported outcomes. At 1 month, complete disease regression was observed in about 88% of the patients who underwent surgery compared with 29% of those receiving medical therapy. No perioperative or postoperative complications were reported within 30 days.
At 3 months, reductions in the SN-5, OSA-18, and NOSE scores remained greater in the surgical group. Mean reductions in SN-5 scores were 16.6 ± 6.1 vs 9.3 ± 4.3, OSA-18 scores decreased by 40 ± 1.31 vs 25.5 ± 11.3, and NOSE scores by 14.8 ± 3.2 vs 7 ± 4.1. The patients who underwent surgery also reported reduced dependence on intranasal corticosteroids and oral antihistamines during follow-up.
Baseline characteristics, including age, sex distribution, smoke exposure, and family history of atopy were comparable between groups. Many patients were sensitized to dust mites (32%) or animal dander (26%), with 20% reacting to multiple allergens.
The study had several limitations. The sample size was small, and follow-up at 3 months included only 20 of the 34 total patients. Group allocation wasn't randomized, introducing potential selection bias. The outcomes relied on patient-reported questionnaires without objective measures such as rhinomanometry or polysomnography.
“[I]nferior turbinate reduction resulted in significantly greater improvement in sinonasal symptoms, nasal obstruction, and sleep-related quality of life compared with continued medical therapy in children with refractory allergic rhinitis,” wrote lead study author Jad Hosri, of the Department of Otolaryngology–Head and Neck Surgery at the American University of Beirut Medical Center in Lebanon, and colleagues.
The study authors reported no conflicts of interest.
