Does inferior turbinate reduction improve outcomes following adenotonsillectomy in pediatric OSA and allergic rhinitis patients?

OBJECTIVE

To evaluate persistent obstructive and allergic rhinitis (AR) symptoms in pediatric patients with concurrent sleep disordered breathing (SDB) and AR, comparing adenotonsillectomy (T&A) alone to T&A and inferior turbinate reduction (ITR).

STUDY

DESIGN

This retrospective cohort study examined patients ages 5-18 years who underwent T&A±ITR from 2007 to 2017. Exclusions were no AR (n = 1771), no SDB (n = 170), no otolaryngology clinic note (n = 60), tonsillectomy or adenoidectomy only (n = 53), no follow-up (n = 142), age <5 years (n = 5), syndrome (n = 9), concomitant airway surgery (n = 3), and ITR before T&A (n = 1).

SETTING

UPMC Children's Hospital of Pittsburgh.

METHODS

Chi-squared, Fisher's exact, Wilcoxon rank-sum, Wilcoxon signed-rank, McNemar's, and Spearman correlation tests were used (α = 0.05).

RESULTS

Of the 269 patients, 42 had T&A with ITR, and 227 had T&A only (median age: 12 years, range 5-18 years). Pre-T&A±ITR, common medications were oral antihistamines (112/269, 41.6 %) and nasal corticosteroids (104/269, 38.7 %). In the T&A only group, fewer patients used oral antihistamines post-operatively compared with pre-operatively (χ2 (1) = 30.6, p < 0.001). In both the T&A only (χ2 (1) = 9.28, p = 0.002) and T&A with ITR (χ2 (1) = 14.2, p < 0.001) groups, fewer patients used nasal corticosteroids post-operatively. No significant differences in complications or post-op AR symptoms or sleep abnormalities were observed between groups. Seven T&A-only patients underwent ITR in the following 5 years.

CONCLUSIONS

Both T&A with ITR and T&A alone resulted in reduced AR symptoms and improved AHI post-operatively. While no significant differences were observed in complications, post-op AR symptoms, or AHI between the groups, T&A with ITR significantly reduced post-operative nasal corticosteroid use. This study highlights the benefits of appropriate patient selection for T&A vs T&A with ITR in managing patients with SDB and AR.