-
American Journal of Otolaryngology 2018The inferior turbinate has well-recognized respiratory and immune functions to provide the airway with appropriate warmth, humidification, and filtration of the inspired... (Review)
Review
The inferior turbinate has well-recognized respiratory and immune functions to provide the airway with appropriate warmth, humidification, and filtration of the inspired air while sampling the environment for pathogens. Normal functioning of the inferior turbinate relies on an intact autonomic system to maintain homeostasis within the nasal cavity. The autonomic nervous system innervates the submucosal glands and the vasculature within the inferior turbinate, resulting in control of major turbinate functions: nasal secretions, nasal patency, warmth, and humidification. This review will summarize the autonomic innervations of the turbinates, both the normal and abnormal autonomic processes that contribute to the turbinate functions, and the clinical considerations regarding optimal functioning of the turbinate autonomic system.
Topics: Autonomic Nervous System; Humans; Turbinates
PubMed: 30193745
DOI: 10.1016/j.amjoto.2018.08.009 -
Facial Plastic Surgery Clinics of North... May 2017There is controversy regarding optimum treatment of the hypertrophied inferior turbinate. Patients undergoing rhinoplasty will likely need treatment of bony hypertrophy... (Review)
Review
There is controversy regarding optimum treatment of the hypertrophied inferior turbinate. Patients undergoing rhinoplasty will likely need treatment of bony hypertrophy as well as possibly soft tissue hypertrophy. Although inferior turbinate hypertrophy is a heterogeneous entity, future studies should standardize outcome measures and compare treatment methods with rigorous clinical trials.
Topics: Humans; Hypertrophy; Nasal Obstruction; Nasal Septum; Rhinoplasty; Treatment Outcome; Turbinates
PubMed: 28340648
DOI: 10.1016/j.fsc.2016.12.003 -
Otolaryngologic Clinics of North America Oct 2018Inferior turbinate reduction is a common technique used to improve nasal breathing in patients with inferior turbinate hypertrophy. Subjective nasal breathing improves... (Review)
Review
Inferior turbinate reduction is a common technique used to improve nasal breathing in patients with inferior turbinate hypertrophy. Subjective nasal breathing improves for the majority of patients with most surgical techniques, but effectiveness often diminishes over time. Inferior turbinate reduction techniques typically have low complication rates. Empty nose syndrome is a rare complication associated most classically with total or subtotal inferior turbinate reduction. Most techniques attempt to preserve the turbinate mucosa for the purposes of preserving normal mucociliary clearance and sensation. Clinical trials comparing inferior turbinate reduction techniques as well as studies on long-term effectiveness, value, and cost are needed.
Topics: Disease Management; Humans; Hypertrophy; Mucociliary Clearance; Nasal Obstruction; Nasal Surgical Procedures; Physical Therapy Modalities; Prosthesis Implantation; Randomized Controlled Trials as Topic; Treatment Outcome; Turbinates
PubMed: 30029923
DOI: 10.1016/j.otc.2018.05.008 -
The Journal of Craniofacial Surgery Jun 2021In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and...
OBJECTIVE
In what follows, it is extremely rare for the inferior turbinate to occur with a mucocele. The authors aim to evaluate the characteristics, clinical features, and treatment outcome of the inferior turbinate mucocele in our hospital.
PATIENTS AND METHODS
Five patients with radiologically confirmed inferior turbinate mucocele between January 2006 and December 2017 were enrolled in this study.
RESULTS
Out of the 5 patients with inferior turbinate mucocele reviewed, 2 out of the 5 patients had symptoms of nasal obstruction and headache respectively, whereas the other 3 remaining patients were found incidentally by radiological examinations without any nasal symptoms. Four patients were performed the surgery by the transnasal endoscopic marsupialization. One patient had a very small size of an inferior turbinate mucocele and had no symptoms, and in that case the authors decided to do a periodic observation without a surgical intervention. There were no major complications resulting from this surgical intervention, and no recurrence of the inferior turbinate mucocele.
CONCLUSIONS
The inferior turbinate mucocele is an extremely rare disease and can be diagnosed accurately by the use of radiologic examinations. The prevailing discipline is that endoscopic marsupialization is the best treatment for the inferior turbinate mucocele, which is known for showing very good results without recurrence of the condition.
Topics: Endoscopy; Humans; Mucocele; Nasal Obstruction; Neoplasm Recurrence, Local; Turbinates
PubMed: 33852517
DOI: 10.1097/SCS.0000000000007583 -
American Journal of Rhinology & Allergy Mar 2019Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy,... (Review)
Review
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.
Topics: Disease Management; Humans; Hypertrophy; Nasal Obstruction; Otorhinolaryngologic Surgical Procedures; Turbinates
PubMed: 30554518
DOI: 10.1177/1945892418815351 -
Plastic and Reconstructive Surgery Sep 2016Inferior turbinate hypertrophy is often encountered by plastic surgeons who perform rhinoplasty. Many treatment options are available to treat the inferior turbinate.... (Comparative Study)
Comparative Study Review
BACKGROUND
Inferior turbinate hypertrophy is often encountered by plastic surgeons who perform rhinoplasty. Many treatment options are available to treat the inferior turbinate. The objective of this study was to systematically review outcomes of available techniques and provide guidance to surgical turbinate management.
METHODS
A MEDLINE search was performed for means of treating inferior turbinate hypertrophy. Studies selected focused on treatment of the inferior turbinate in isolation and excluding patients with refractory allergic rhinitis, vasomotor rhinitis, or hypertrophic rhinitis.
RESULTS
Fifty-eight articles were identified, collectively including the following surgical treatments of inferior turbinate hypertrophy: total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryotherapy, electrocautery, radiofrequency ablation, and turbinate outfracture. Outcomes and complications were collected from all studies. Procedures such as turbinectomy (partial/total) and submucosal resection showed crusting and epistaxis at comparatively higher rates, whereas more conservative treatments such as cryotherapy and submucous diathermy failed to provide long-term results. Submucosal resection and radiofrequency ablation were shown to decrease nasal resistance and preserve mucosal function. No literature exists to support the belief that turbinate outfracture alone is an effective treatment for turbinate hypertrophy.
CONCLUSIONS
Treatment of inferior turbinate hypertrophy is best accomplished with modalities that provide long-lasting results, preservation of turbinate function, and low complication rates. Submucosal resection and radiofrequency ablation appear to best fulfill these criteria. Turbinate outfracture should only be considered in combination with tissue-reduction procedures.
Topics: Catheter Ablation; Cryotherapy; Humans; Hypertrophy; Outcome and Process Assessment, Health Care; Rhinoplasty; Turbinates
PubMed: 27556616
DOI: 10.1097/PRS.0000000000002433 -
The Journal of Laryngology and Otology Feb 2022Neonatal nasal obstruction may result in respiratory distress, feeding difficulties, sleep apnoea and failure to thrive; hence, it requires thorough evaluation and... (Review)
Review
BACKGROUND
Neonatal nasal obstruction may result in respiratory distress, feeding difficulties, sleep apnoea and failure to thrive; hence, it requires thorough evaluation and prompt intervention. Congenital inferior turbinate hypertrophy is relatively uncommon, and its presentation can mimic other congenital nasal anomalies.
RELEVANCE
This paper reports two cases of congenital inferior turbinate hypertrophy in neonates that resulted in significant respiratory distress, feeding difficulties and sleep disturbance. Both patients were successfully treated surgically by endoscopic nasal dilatation and stenting. A literature search was performed to identify articles on congenital inferior turbinate hypertrophy in neonates and its management.
CONCLUSION
Albeit rare, congenital inferior turbinate hypertrophy should be considered a differential diagnosis in newborns presenting with respiratory distress at birth.
Topics: Acrocephalosyndactylia; Dilatation; Female; Humans; Hypertrophy; Infant; Infant, Newborn; Nasal Obstruction; Nasal Surgical Procedures; Stents; Turbinates
PubMed: 34649637
DOI: 10.1017/S0022215121002905 -
Archives of Otolaryngology--head & Neck... Jan 1998
Review
Topics: Humans; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Turbinates
PubMed: 9440790
DOI: 10.1001/archotol.124.1.104 -
Acta Otorrinolaringologica Espanola 2024Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the... (Meta-Analysis)
Meta-Analysis Review
Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.
Topics: Humans; Mucociliary Clearance; Turbinates; Nasal Mucosa; Nasal Obstruction; Hypertrophy
PubMed: 37722657
DOI: 10.1016/j.otoeng.2023.09.002 -
American Journal of Rhinology & Allergy Mar 2019Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in... (Comparative Study)
Comparative Study
BACKGROUND
Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in asymptomatic patients and those with rhinitis.
OBJECTIVE
The aim of this study was to assess the diagnostic characteristics of inferior turbinate tissue biopsy sIgE in asymptomatic and rhinitic patients.
METHODS
A diagnostic cross-sectional study was undertaken, involving patients who underwent inferior turbinate surgery with or without other surgical interventions. Inferior turbinate tissue biopsy was performed during surgery and was assessed for allergen sIgE (dust mite, grass [temperate or subtropical], and animal epithelium) using an automated immunoassay. Tissue sIgE was assessed among asymptomatic patients and those with nasal symptoms. Data were presented as median (interquartile range). A receiver operating curve was used to predict the diagnostic utility of turbinate tissue sIgE in determining allergic rhinitis.
RESULTS
A total of 160 patients (41.89 ± 14.65 years, 36.9% females) were included. The median tissue sIgE concentration among the asymptomatic nonatopic group of patients was 0.09 (0.08-0.10) kUA/L and tissue sIgE > 0.10 kUA/L was determined as a positive threshold. Inferior turbinate tissue sIgE was shown to be a predictive test for allergic rhinitis (area under curve: 0.87, 95% confidence interval: 0.84-0.90) with 90% sensitivity and 89% negative predictive value.
CONCLUSION
Inferior turbinate tissue biopsy sIgE is a sensitive tool to predict allergic rhinitis. The threshold value of 0.1 kUA/L corresponded well with the asymptomatic nonatopic group of patients. This method detects sIgE in the nasal mucosa and may be a useful test for allergic rhinitis in future research.
Topics: Adult; Allergens; Cross-Sectional Studies; Female; Humans; Immunoglobulin E; Male; Middle Aged; Nasal Mucosa; ROC Curve; Rhinitis; Rhinitis, Allergic; Skin Tests; Turbinates
PubMed: 30656948
DOI: 10.1177/1945892418825224