Turbinate Reduction Outcomes in Children with Sleep Disordered Breathing Undergoing Adenotonsillectomy
Abstract
Introduction: Inferior Turbinate Hypertrophy is linked to chronic nasal congestion and is associated with sleep-disordered breathing (SDB) in pediatric patients. While adenotonsillectomy is the standard surgical intervention for children, rates of persistent obstruction are high. Currently, there is insufficient data to determine whether turbinate surgery performed at the time of adenotonsillectomy improves pediatric Obstructive Sleep Apnea (OSA) outcomes.
Methods: A prospective randomized clinical trial was designed to assess children ages 3-12 years (n = 86) with turbinate hypertrophy and at least 3 months of chronic nasal congestion with or without mouth breathing who were undergoing adenotonsillectomy for the treatment of SDB. Participants were randomized to adenotonsillectomy alone or adenotonsillectomy plus turbinate reduction and outfracturing. Standardized, validated questionnaires, including the OSA-18, Nasal obstruction symptom evaluation (NOSE), and the Sleep Related Breathing Disorder (SRBD) section of the Pediatric Sleep Questionnaire (PSQ), were assessed at baseline and 3-month follow-up. Physiological measurements of nasal obstruction were done using acoustic rhinometry and rhinomanometry at baseline and 3-month follow-up.
Results: The recruitment of children is ongoing. Preliminary data is being managed in REDcap, and protocols for the standardized performance of both acoustic rhinometry and rhinomanometry have been developed.
Conclusion: Turbinate reduction is a rapidly evolving surgical method for managing chronic nasal obstruction in pediatrics. Further research using randomized control trials in pediatric patients with enlarged turbinates is needed to fully evaluate the effects of turbinate reduction on symptom burden and QOL in children presenting with chronic nasal obstruction in SDB.