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

Abstract

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.