Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease

Drew H Smith; Benjamin S Daines; Juliana Cazzaniga; Naveen D Bhandarkar

doi:10.7759/cureus.34280

Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease

Cureus. 2023 Jan 27;15(1):e34280. doi: 10.7759/cureus.34280. eCollection 2023 Jan.

Authors

Drew H Smith¹, Benjamin S Daines¹, Juliana Cazzaniga², Naveen D Bhandarkar³

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.
² Department of Otolaryngology - Head and Neck Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
³ Department of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, USA.

Abstract

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Keywords: aerosols; hypertrophy; nasal obstruction; nasal surgery; sars-cov-2; turbinoplasty.

Publication types

Review