Clinical outcome following septoplasty with or without inferior turbinate reduction
Keywords:Nasal septum, Turbinate hypertrophy, NOSE Score, Nasal endoscopy
Background: Deviation of nasal septum towards one side is often associated with over growth of inferior turbinate, which occupies expansive space of contralateral nasal cavity. The enlargement of inferior turbinate can be due to mucosal elements or bony expansion. Many surgeons are of the belief if septoplasty is done, compensatory hypertrophy regresses on its own. There are others who argue that these changes are not spontaneously reversible and should be corrected in conjunction with nasal septal surgery. Otherwise surgery may relieve the obstruction on one side of nose but leave other side of obstructed because of relocation of septum towards hypertrophied turbinate.
Methods: A prospective interventional randomized comparative study is carried out from 1st November 2017 to 31th March 2019, with a sample size of 40 patients. Patients were divided in two surgical groups; group A, with conventional septoplasty done and group B, with reduction of inferior turbinate along with conventional septoplasty done. Post operatively patients’ symptoms will be evaluated using nasal obstructions evaluation scale (NOSE) and nasal airway with nasal endoscopy at 1, 3 and 6 months, and compared with preoperative findings.
Results: Data is analyzed using percentage graph and tables. The comparisons of NOSE score at 1, 3- and 6-months interval showed the p value of 0.001 which was significant. Also comparison of two groups with NOSE score showed significant improvement in group B.
Conclusions: The study shows that hypertrophied turbinate need reduction along with septoplasty in cases of long standing nasal obstruction.
Hildebrandt T, Heppt WJ, Kertzscher U, Goubergrits L. The concept of rhinorespiratory homeostasis - a new approach to nasal breathing. Facial Plast Surg. 2013;29(2):85-92.
Hildebrandt T. Das Konzept der Rhinorespiratorischen Homöostaseeinneuertheo-retischer Ansatzfür die Diskussionphy-siologischer undphysikalischer Zusammenhängebei der Nasenat-mung. Freiburg imBreisgau, Germany; Albert-Ludwigs-Universität. 2011.
Chiesa EC, Rivera ST, Ossa ECC, Betances RFA, Osorio VA, Santidrian HC. Compensatory hypertrophy of the contralateral inferior turbinate in patients with unilateral nasal septal deviation. A computed tomography study. Otolaryngol Pol. 2015;69(2):14-20.
Jun BC, Kim SW, Cho JH, Park YJ. Is turbinate surgery necessary when performing a septoplasty. Eur Arch Otorhinolaryngol. 2009;266(7):975-80.
Gaur K, Kasliwal N, Bhandari AB, Gupta AVP, and Gupta R. Changing trends in otorhinolaryngological diseases at a non-government clinic in Jaipur. Indian J Otolaryngol Head Neck Surg. 2009;61(3):173-8.
Mathai J. Inferior turbinectomy for nasal obstruction review of 75 cases. Indian Journal of otolaryngology and Head and Neck surgery. 2004;56(1):23-6.
De Corso E, Bastanza G, Di Donfrancesco V, Guidi ML, MorelliSbarra G, Passali GC, et al. Radiofrequency volumetric inferior turbinate reduction: long-term clinical results. Acta Otorhinolaryngol Ital. 2016;36(3):199-205.
Bhattacharya N, Kepnes LJ. Clinical effectiveness of coblation inferior turbinate reduction. Otolaryngology- Head and Neck Surgery. 2003;129(4):365-71.
Moore M, Eccles R. Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. ClinOtolaryngol. 2011;36(2):106-13.
Kahveci OK, Miman MC, Yucel A, Yucedag F, Okur E, Altuntas A. The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation. AurisNasus Larynx. 2012;39(3):275-9.
Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, et al. Outcome after nasal septoplasty: Results from the nasal obstruction septoplasty effectiveness (Nose) study. Otolaryngology and Head and Neck surgery. 2004;130(3):283-90.
Devseren NO, Ecevit MC, Erdag TK, Ceryan K. A randomized clinical study: outcome of submucous resection of compensatory inferior turbinate during septoplasty. Rhinology. 2011;49(1):53-7.
Rajendran DK, Rajashekar M. Comparative study of improvement of nasal symptoms following septoplasty with partial inferior turbinectomy versus septoplasty alone in adults by NOSE scale: A Prospective Study. Indian J Otolaryngol Head Neck Surg. 2016;68(3):275-84.