Inferior Turbinate Hypertrophy: A Review of the Evolution of Management in Children

Background Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment. Objective To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time. Methods In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts. Results Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction. Conclusion This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.

Radiological airway changes following bipolar radiofrequency volumetric tissue reduction

Objective:To characterise the appearance of lesions of the tongue base and soft palate induced by bipolar radiofrequency volumetric tissue reduction, using magnetic resonance imaging up to six weeks post-procedure.Methods:Five men with sleep-disordered breathing were treated with one session of bipolar radiofrequency volumetric tissue reduction to a number of sites, including the tongue base and soft palate. Magnetic resonance imaging was performed pre-operatively and one week and six weeks after surgery.Results:Lesions were visible from day one. T1 (spine lattice relaxation Time)-weighted images demonstrated areas of central hyperintensity, reflecting haemorrhagic, coagulative necrosis, surrounded by hypointensity, representing oedema; corresponding short tau inversion recovery (STIR) sequences showed central hypointensity with surrounding high signal. The lesions expanded up to day three and then gradually diminished, but were still evident at week six on short tau inversion recovery images.Conclusion:The characterisation of lesions induced by bipolar radiofrequency volumetric tissue reduction enables us to elucidate the pathophysiology of this procedure, to optimise treatment benefits and clinical outcomes, and to explain patient symptoms.