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

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-09-27 DOI:10.1016/j.ijporl.2025.112578

Pooja D. Reddy , Sarah Ung , Jiage Qian , Brian Ocasio-Nieves , Amber D. Shaffer , Marina V. Rushchak , Amanda L. Stapleton

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引用次数: 0

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.

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下鼻甲复位是否能改善儿童OSA和变应性鼻炎患者腺扁桃体切除术后的预后？

目的：评价伴有睡眠呼吸障碍（SDB）和AR的儿童患者的持续性阻塞性和变应性鼻炎（AR）症状，并比较单纯腺扁桃体切除术（T&A）与T&A +下鼻甲复位（ITR）。研究设计：本回顾性队列研究调查了2007年至2017年接受T&A±ITR的5-18岁患者。排除病例为：无AR (n = 1771)，无SDB (n = 170)，无耳鼻喉科门诊记录（n = 60），仅扁桃体切除术或腺样体切除术（n = 53），无随访（n = 142），年龄：匹兹堡UPMC儿童医院。方法：采用卡方检验、Fisher精确检验、Wilcoxon秩和检验、Wilcoxon符号秩检验、McNemar相关检验和Spearman相关检验（α = 0.05）。结果：269例患者中，42例T&A合并ITR， 227例仅T&A（中位年龄：12岁，范围5-18岁）。t&a±ITR前常用药物为口服抗组胺药（112/269,41.6%）和鼻用糖皮质激素（104/269,38.7%）。与术前相比，单纯T&A组术后口服抗组胺药患者较少(χ2 (1) = 30.6, χ2 (1) = 9.28, p = 0.002)， T&A联合ITR组术后患者较少（χ2 (1) = 14.2, p）。结论：T&A联合ITR组和单纯T&A组术后均可减轻AR症状，改善AHI。虽然两组之间在并发症、术后AR症状或AHI方面没有观察到显著差异，但T&A合并ITR显著减少了术后鼻腔皮质类固醇的使用。本研究强调了适当的T&A患者选择与T&A合并ITR在管理SDB和AR患者方面的益处。

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.