Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion | Allergy and Clinical Immunology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
May 2017

Sinonasal Quality of Life in Children After Outfracture of Inferior Turbinates and Submucous Inferior Turbinoplasty for Chronic Nasal Congestion

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Central Florida College of Medicine, Orlando
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Kansas School of Medicine, Kansas City
  • 3Division of Otolaryngology, Department of Surgery, Nemours Children’s Hospital, Orlando, Florida
JAMA Otolaryngol Head Neck Surg. 2017;143(5):452-457. doi:10.1001/jamaoto.2016.3889
Key Points

Question  What is the effect on quality of life in children with chronic nasal congestion who undergo outfracture and submucous microdebrider inferior turbinectomy?

Findings  This case series of 43 children with chronic nasal congestion found that, at long-term and short-term follow-up, patients who underwent outfracture and submucous microdebrider inferior turbinectomy reported a decrease in symptoms, demonstrated by scores on the Sinus and Nasal Quality of Life Survey, decreased use of medication, and improvement in quality of life.

Meaning  Concomitant outfracture and submucous microdebrider inferior turbinectomy improves quality of life in children with chronic nasal congestion and can reduce use of daily medication.

Abstract

Importance  Chronic nasal congestion often persists in children despite empirical treatment using intranasal corticosteroids, systemic antihistamines, and/or leukotriene receptor antagonists. Symptoms are often reported even with negative results of skin or blood allergy testing. Inferior turbinoplasty has been effective in adults and children, but outfracture of inferior turbinates in children is rarely reported, as is use of validated quality-of-life measures to quantify improvements after intervention. Effective use of these 2 procedures for treating chronic nasal congestion may reduce the need for medication and improve sinonasal quality of life.

Objective  To quantify changes in sinonasal quality of life for children after outfracture of inferior turbinates and concomitant submucous microdebrider inferior turbinoplasty for chronic nasal congestion.

Design, Setting, and Participants  A case series with planned data collection was conducted in an ambulatory pediatric otolaryngology clinic among 43 patients with chronic nasal congestion who underwent surgical intervention between January 1, 2014, and May 31, 2015.

Exposures  Microdebrider submucous inferior turbinoplasty (without bony resection) and outfracture of inferior turbinates.

Main Outcomes and Measures  Demographics and medication use before and after the procedure were reviewed. Scores on the Sinus and Nasal Quality of Life Survey (SN-5) and quality-of-life scores were collected at baseline, 4 to 6 weeks after the procedure, and more than 6 months after the procedure.

Results  Among the 43 patients (14 girls and 29 boys; mean age, 11.2 years [range, 4.8-17.6 years]), every domain showed significant improvements in scores on the Sinus and Nasal Quality of Life Survey and quality-of-life scores 1 to 2 months after the proecdure: sinus infection (–2.55; 95% CI, 1.85-3.26), nasal obstruction (–3.51; 95% CI, 2.88-4.14), allergy symptoms (–2.14; 95% CI, 1.43-2.86), emotional distress (–2.37; 95% CI, 1.68-3.06), activity limitation (–1.70; 95% CI, 1.14-2.25), and overall quality of life (3.72; 95% CI, 2.95-4.48). At long-term follow-up, improvement was maintained in all categories. Significant improvements in SN-5 and quality-of-life scores correlated with proportional decreased reporting of snoring after the procedure (33 [77%] vs 1 [2%]; absolute reduction, 75%; 95% CI, 62%-88%), as well as nasal congestion (41 [95%] vs 1 [2%]; absolute reduction, 93% ; 95% CI, 85%-100%), and rhinorrhea (44 [41%] vs 1 [2%]; absolute reduction, 42%; 95% CI, 27%-57%). The proportion reporting use of intranasal corticosteroids (25 [58%] vs 2 [5%]; absolute reduction, 50%; 95% CI, 39%-71%), antihistamines (27 [63%] vs 1 [2%]; absolute reduction, 61%; 95% CI, 46%-75%), and leukotriene receptor antagonists (13 [30%] vs 0; absolute reduction, 30%; 95% CI, 16%-44%) also decreased.

Conclusions and Relevance  Concomitant outfracture and submucous microdebrider inferior turbinoplasty improves quality of life in children with chronic nasal congestion and can reduce use of daily medication.

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