S C Leong1, H Kubba, P S White. 1. Common Cold Centre, Cardiff School of Biosciences, Cardiff CF10 2AX, Wales, United Kingdom.
Abstract
BACKGROUND: The surgical management of enlarged inferior turbinates in children is controversial. The evidence base for turbinate surgery is weak and surgeons empirically offer surgery where the predominant symptom was nasal obstruction. OBJECTIVE: To evaluate the evidence for inferior turbinate surgery in children suffering with chronic nasal congestion. METHODS: A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the MeSH terms: nasal obstruction, turbinates, surgery and children. Only articles focusing on turbinate surgery with an exclusively paediatric cohort were included. RESULTS: Eleven studies fulfilled the inclusion criteria. The ages of the children ranged from 1 to 17 years at the time of surgery and were followed-up for a period of 3 months to 14 years. Surgical indication for all studies was chronic nasal congestion, resistant to a trial of medical treatment for 2-3 months preceding surgery. Of the 730 cases reviewed, 79.1% had turbinate surgery as the standalone procedure. The remaining 21.9% had other concurrent procedures performed, the most common being adeno-tonsillectomy. Although all studies generally supported the effectiveness of turbinate reduction surgery for inferior turbinate hypertrophy, the outcome measures used were varied and did not allow comparison across studies. CONCLUSIONS: There is currently little evidence to support turbinate reduction surgery in children. The role of surgery, if any, has not been properly examined. Furthermore, the long-term effects on nasal airflow dynamics, nasal physiology and long-term complications remain to be studied. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.
BACKGROUND: The surgical management of enlarged inferior turbinates in children is controversial. The evidence base for turbinate surgery is weak and surgeons empirically offer surgery where the predominant symptom was nasal obstruction. OBJECTIVE: To evaluate the evidence for inferior turbinate surgery in children suffering with chronic nasal congestion. METHODS: A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the MeSH terms: nasal obstruction, turbinates, surgery and children. Only articles focusing on turbinate surgery with an exclusively paediatric cohort were included. RESULTS: Eleven studies fulfilled the inclusion criteria. The ages of the children ranged from 1 to 17 years at the time of surgery and were followed-up for a period of 3 months to 14 years. Surgical indication for all studies was chronic nasal congestion, resistant to a trial of medical treatment for 2-3 months preceding surgery. Of the 730 cases reviewed, 79.1% had turbinate surgery as the standalone procedure. The remaining 21.9% had other concurrent procedures performed, the most common being adeno-tonsillectomy. Although all studies generally supported the effectiveness of turbinate reduction surgery for inferior turbinate hypertrophy, the outcome measures used were varied and did not allow comparison across studies. CONCLUSIONS: There is currently little evidence to support turbinate reduction surgery in children. The role of surgery, if any, has not been properly examined. Furthermore, the long-term effects on nasal airflow dynamics, nasal physiology and long-term complications remain to be studied. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.