Reviews
Published: 2022-11-23
download
PDF

Microdebrider-assisted inferior turbinoplasty versus other surgical techniques

Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
https://orcid.org/0000-0001-9138-9215
turbinoplasty microdebrider radiofrequency submucosal resection laser

Abstract

This meta-analysis was conducted to evaluate the effects of microdebrider-assisted inferior turbinoplasty (MAIT) versus other techniques in treating inferior turbinate hypertrophy.  The protocol was registered in PROSPERO (CRD 42019126157). Cochrane Register of Controlled Trials CENTRAL, which includes MEDLINE was searched from inception until September 2021. One hundred twenty-four records were retrieved from the search of the electronic database and other sources. Ten articles were selected and analyzed quantitatively. There was significant reduction of nasal obstruction in microdebrider compared to radiofrequency by visual analogue scale but not by objective evaluations. Microdebrider has similar effect in reducing nasal obstruction to submucosal resection and laser. There was a higher incidence of postoperative bleeding in microdebrider compared to radiofrequency but shorter operative time and lesser intraoperative blood loss compared to submucosal resection.  In conclusion, the effect of MAIT is comparable to submucosal resection, laser and radiofrequency in reducing nasal obstruction. Whilst microdebrider has a shorter operative time and less intraoperative blood loss than submucosal resection, postoperative bleeding is greater than radiofrequency.

 

Introduction

Chronic and refractory nasal obstruction is one of the most challenging conditions to treat 1. Although nasal obstruction is not life-threatening, it may significantly impact the quality of life of patients 2. The anterior end of the inferior turbinate is the narrowest part of the nasal airway where hypertrophied inferior turbinate may cause significant nasal obstruction 3. Turbinate hypertrophy may lead to nasal obstruction, mouth breathing, snoring and retention of secretion 4. First-line treatment of this disorder is pharmacological. When standard pharmacological treatment using steroids, topical decongestants and antihistamines are inadequate, surgical treatment to address the inferior turbinate hypertrophy is necessary 1. Several surgical interventions are available, which include using microdebrider, laser argon, carbon dioxide laser, radiofrequency, cryocoagulation and submucosal ablation by electrocautery 3.

The goal of turbinate surgery is to reduce the erectile submucosal tissue volume and the bony turbinate 5. With volume reduction, surgery on submucosal tissue also creates scarring, which helps prevent the engorgement of the inferior turbinate 5. It is imperative not to cause excessive damage to the turbinate mucosa, which is associated with a higher risk of throat dryness, nasal crusting, nasal bleeding, synechia formation, osteitis, atrophic rhinitis and inadequate volume reduction 6. Preservation of the mucosa avoids disruption of normal nasal physiology, including maintaining the equilibrium of temperature, humidity and filtration of inhaled air. Turbinoplasty has emerged as a preferred choice to achieve volume reduction while minimising complications associated with such intervention. Microdebrider-assisted inferior turbinoplasty (MAIT) is one of the surgical techniques to address the hypertrophic turbinates 1. We aimed to evaluate the outcomes of MAIT versus other turbinoplasty procedures in treating patients with inferior turbinate hypertrophy. The primary outcome of this meta-analysis was the reduction of nasal obstruction, while the secondary outcome was complications of the procedure.

Materials and methods

The systematic review was conducted according to a protocol published in PROSPERO with identification serial number as CRD 42019126157. The methods and reporting were based on the Cochrane Collaboration and the preferred reporting items for systematic reviews and meta-analyses statement 7. The evaluation was done according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines 8.

Eligibility criteria

We included all randomised controlled trials (RCTs) comparing MAIT with other surgical techniques for inferior turbinoplasty. We included only articles published in English. The inclusion criteria were patients of all age groups who presented with obstructive nasal symptom due to inferior turbinate hypertrophy. Exclusion criteria were nasal obstruction unrelated to inferior turbinate hypertrophy and patients who underwent other nasal or sinus surgery. Studies must have extractable data and a follow-up period of at least postoperative one-month to be included.

Search strategy

We searched the Cochrane Register of Controlled Trials CENTRAL, which includes MEDLINE from inception until December 2021. Search words used were ‘turbinoplasty’, ‘turbinate reduction’, ‘microdebrider’ in combination with ‘AND’ and ‘OR’. We applied the Cochrane Highly Sensitive Search. We checked the reference list of identified RCTs and reviewed articles to find unpublished trials or trials not identified by electronic searches. Ongoing trials were searched by using other databases when necessary.

Study selection

Two review authors (NK, NMN) screened the titles and abstracts from the searches and obtained full-text articles when they appeared to meet the eligibility criteria or insufficient information to assess the eligibility. We assessed the eligibility of the trials independently and documented the reasons for exclusion. We resolved any disagreement between the review authors by discussion.

Data extraction

Data were extracted using data collection forms. The reviewers independently extracted study settings, participant characteristics, methodology and duration of the follow-up. The method of assessment of nasal obstruction together with the reported complications of these procedures were also extracted.

Risk of bias assessment

We assessed the risk of bias 7. All trials were classified as low risk, unclear risk, or high risk depending on random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, completeness of outcome data, the selectivity of outcome reporting and other bias. We resolved any disagreements by discussion.

Grading quality of evidence

We assessed the quality of evidence for primary and secondary outcomes according to the GRADE methodology for risk of bias, inconsistency, indirectness, imprecision and publication bias that was classified as very low, low, moderate and high 8.

Statistical analysis

We undertook a meta-analysis using Review Manager 5.3.5 software (RevMan 2014) and used the random-effects model to pool data. The heterogeneity was interpreted as follows: 0 to 40% might not be important; 30 to 60% may represent moderate heterogeneity; 50 to 90% may represent substantial heterogeneity, and 75 to 100% would be considerable heterogeneity 7. We measured the treatment effect for dichotomous outcomes using risk ratio (RR), and for continuous outcomes, we used mean difference (MD) and standardised mean difference (SMD) with 95% confidence interval (CI).

Results

Study selection

We retrieved 126 records from search of the electronic databases and one record from other sources (Fig. 1). Following removal of the duplicates, 126 records were left. After screening, 98 records were excluded. We identified 28 articles as possibly meeting the review inclusion criteria. Fifteen articles were excluded, of which 11 were non-randomised trials, three articles did not report the outcomes of interes, and one article was not available in English. Thirteen articles were included in this review, all of which were analysed quantitatively.

Participants

Table I shows the characteristics of the included trials. Eleven of the 13 trials were single-centre trials 3,9-18 and two were multicentre trials 19,20. All the trials were in adults except for one 20, which was in children with a mean age of 11.6 years.

Intervention

Nine trials 3,9,12-18 compared MAIT with radiofrequency, and three trials 10,11,20 compared it with submucosal resection. Three trials 17-19 compared MAIT to diode laser. MAIT was performed under local anaesthesia in 9 trials 3,9,10,12-15,17,18 and under general anaesthesia in 3 trials 16,19,20. One trial11 did not state the type of anaesthesia used. All procedures were done as an endoscopic technique. The procedure of MAIT was performed by inserting a microdebrider submucosally, medial to the conchal bone from the anterior head of the inferior turbinate along its entire length until the posterior end 3,9-12,14-20. In addition to MAIT, one trial 10 out-fractured the inferior turbinate and lateralised it. Another trial 13 performed MAIT by using a microdebrider to trim the redundant and hypertrophied mucosa of the anterior head and the inferomedial side of the inferior turbinate.

Similarly, radiofrequency was performed by applying a radiofrequency probe submucously at the anterior, medial and inferior portions of the inferior turbinate in an anterior to posterior direction 3,9,12-18. A submucosal resection was performed by making an initial mucosal incision on the head of the inferior turbinate 10,11,20. The submucosal tissue was dissected using an elevator from the medial surface and inferior edge of the concha bone along the length of inferior turbinate and subsequently removed. A laser turbinoplasty technique was performed by creating an incision at the anterior aspect of the inferior turbinate 17-19. A bare optical fibre was inserted submucosally, and laser pulses were delivered to the turbinate via the optical fibre along its entire length.

Outcomes

Relief of nasal obstruction was measured subjectively via a visual analogue score (VAS) and subjective nasal obstruction scale (SNOS), and objectively via acoustic rhinometry and mucociliary transport time. Visual analogue score evaluated the subjective feeling of nasal obstruction based on a scale ranging from 0 (no obstruction) to 10 (complete obstruction). Subjective nasal obstruction scale quantified the severity of nasal obstruction by a 4-scale measurement where 0 is no obstruction, 1 is mild obstruction, 2 is moderate obstruction, 3 is severe obstruction and 4 is complete obstruction. All 9 trials comparing microdebrider and radiofrequency reported relief of nasal obstruction. Six trials 9,13,14,16-18 measured nasal obstruction using VAS; one trial15 measured using SNOS and one trial 12 did not report it. Four trials 9,12,14,18 evaluated mucociliary transport time and 4 trials 13,15,17,18 evaluated via acoustic rhinometry. All trials 10,11,20 comparing microdebrider with submucosal resection used VAS to measure the relief of nasal obstruction. Additionally, 2 trials 11,20 evaluated it by mean total nasal resistance. Three trials 17-19 comparing microdebrider with laser, measured relief in nasal obstruction by VAS and acoustic rhinometry.

Seven of the 9 trials 3,9,12,13,16-18 comparing microdebrider with radiofrequency reported the complications related to the procedures. Three trials 3,13,16,17 stated the operative time difference, and 2 trials 3,12 reported the incidence of recurrent nasal obstruction between microdebrider and radiofrequency. All trials 10,11,20 comparing microdebrider with submucosal resection reported on complications related to the procedures. One trial 11 stated the operative time difference between microdebrider and submucosal resection. Two trials 17,18 comparing microdebrider with diode laser reported crusting post-operation. One trial 19 evaluated the operative time difference and amount of blood loss, but did not report the values.

Risk of bias in included studies and quality of evidence

Four trials 9,17-19 described the randomisation method that was assessed as low risk of bias. Three trials 10,12,17 did not elaborate on the randomisation method, which was assessed as high risk, and it was not reported in the other five trials 3,11,13-16, which was assessed as unclear risk. Allocation concealment was mentioned in one of the trials 19, assessed as low risk, but was unclear in 12 trials 3,9-18,20 and assessed as unclear risk. All 13 trials measured the primary outcome and were included in the meta-analysis. Eleven trials 3,9,11-13,15-20 measured the primary outcome at 2 to 12 months with no patient lost during follow-up. Two other trials 10,14 measured outcomes for up to 3 years with less than 20% of patients lost to follow-up. All the trial protocols were not provided, but all trials reported the outcomes specified in their respective methodology. We detected no other potential sources of bias.

Comparisons and effects of interventions

Primary outcomes

MICRODEBRIDER VERSUS RADIOFREQUENCY

All trials 3,9,12-18 comparing microdebrider with radiofrequency reported the relief of nasal obstruction. Seven trials 9,13-18 measured reduction of nasal obstruction subjectively using continuous data. A significant reduction of nasal obstruction was achieved with microdebrider compared to radiofrequency (Fig. 2, Tab. II). Four trials 9,12,14,18 evaluated the mucociliary transport time. There was no significant difference in mucociliary transport time between microdebrider and radiofrequency (Supplementary Fig. 1, Tab. II). Four trials 13,15,17,18 reported evaluation by acoustic rhinometry. There was no significant difference between microdebrider and radiofrequency by acoustic rhinometry (Fig. 3, Tab. II).

MICRODEBRIDER VERSUS SUBMUCOSAL RESECTION

All trials 10,11,20 comparing microdebrider with submucosal resection reported relief of nasal obstruction using VAS. Two of the trials 10,20 were continuous data. There was no significant difference between microdebrider with submucosal resection (Fig. 2, Tab. III). Another trial 11 using dichotomous data showed no significant difference between microdebrider and the submucosal resection (Tab. III).

MICRODEBRIDER VERSUS DIODE LASER

Two trials 17,18 reported that the relief of nasal obstruction using VAS as continuous outcomes demonstrated no significant difference between groups (Fig. 2, Tab. IV). One trial 19 reported using dichotomous data showed no significant difference between groups by VAS (Tab. IV). There was no significant difference between microdebrider and diode laser by acoustic rhinometry (Fig. 3, Tab. IV).

Secondary outcomes

Microdebrider had a higher incidence of postoperative bleeding compared to radiofrequency 12,13,17 (Fig. 4, Tab. II). Three trials 16-18 comparing microdebrider with radiofrequency reported no difference in the incidence of crusting (Fig. 5, Tab. II). Similarly, no different was found in the incidence of crusting between microdebrider and submucosal resection 10,11 (Fig. 5, Tab. III). Postoperative pain was identical between microdebrider and submucosal resection 11 (Tab. III).

The incidence of recurrent nasal obstruction was equivalent between microdebrider and radiofrequency 3,12 (Supplementary Fig. 2, Tab. II). Likewise, there was no difference in the operative time between microdebrider and radiofrequency 3,13,16,17 (Fig. 6, Tab. II). A shorter operative time was observed in microdebrider compared to submucosal resection 11 in addition to less intraoperative blood loss 11 (Tab. III). No significant difference was seen in the incidence of crusting between microdebrider and diode laser 17,18 (Fig. 5, Tab. IV).

Discussion

Summary of main results

This meta-analysis concluded that MAIT is a promising surgical intervention for inferior turbinate hypertrophy with a favourable effect. There was a significant reduction of nasal obstruction with a microdebrider compared to radiofrequency by VAS and SNOS measurements. However, there was no difference in the two techniques based on objective evaluations using rhinometry and mucociliary transit time. In addition, the effect of microdebrider on the reduction of nasal obstruction commensurate with those of submucosal resection and diode laser. In terms of complications, microdebrider has a higher incidence of postoperative bleeding compared to radiofrequency but a smaller amount of intraoperative blood loss and shorter operative time compared to submucosal resection. The microdebrider demonstrated no difference in recurrent nasal obstruction, operative time, or crusting compared to radiofrequency and a similar effect to submucosal resection in the incidence of crusting and postoperative pain.

Quality of evidence

Using GRADE, the level of evidence that contributed to this review was assessed as low to moderate quality. The quality of evidence for the primary outcome was low to moderate in the comparison of microdebrider versus radiofrequency, low for microdebrider versus submucosal resection and low to moderate for microdebrider versus diode laser. For the secondary outcomes, comparisons of microdebrider with radiofrequency, submucosal resection and diode laser ranged from low to moderate quality of evidence. Overall, most of the trials have a small number of patients and high heterogeneity, which could be attributed to surgeons with varying levels of expertise performing the surgical procedure. The high heterogeneity could also be contributed to the different techniques being performed with a microdebrider, such as submucosal tunnelling and extraturbinal resection coupled with lateralisation of the inferior turbinate.

In general, all studies had low to unclear risk of bias in all domains except in blinding of participants and personnel. There was no evidence of selective reporting bias in all reported trials. Loss during follow-up was less than 20% in all included trials, and all the trials performed intention-to-treat analysis. Due to the low to moderate quality of evidence, the results should be interpreted cautiously. Further randomised controlled trials with a greater number of participants and robust objective evaluation might provide a better quality of evidence. Additionally, trials with extended follow-up period could evaluate the long-standing outcomes of the technique.

Potential biases in the review process

We eliminated publication bias by checking the reference lists of all related trials for further references and searching multiple databases without language restriction. We could not construct a funnel plot to detect bias or heterogeneity due to an insufficient number of trials contributing to each outcome.

Agreements and disagreements with other reviews

A review by Acevedo et al. 21 comparing microdebrider and radiofrequency showed that the two methods are equally effective in reducing nasal obstruction. In contrast, a more recent meta-analysis by Mirza et al. 22 reported that a microdebrider has better outcomes compared to to radiofrequency in reducing nasal obstruction, but has a higher rate of postoperative bleeding. Although the present meta-analysis found a microdebrider is superior to radiofrequency in reducing nasal obstruction subjectively, this effect was not supported by objective evaluations. Though two previous meta-analyses 21,22 have evaluated the effects of microdebrider compared to radiofrequency, to the best of our knowledge there is no meta-analysis assessing the effects of microdebrider compared to submucosal resection and laser. Thus, the present meta-analysis contributes to the existing literature by providing a comprehensive overview of the overall effects and complications of MAIT in comparison with other surgical techniques.

Conclusions

Microdebrider-assisted inferior turbinoplasty is an effective surgical technique with an effect comparable to radiofrequency, submucosal resection and laser in reducing nasal obstruction in patients with inferior turbinate hypertrophy. While MAIT provides greater reduction of subjective nasal obstruction, the effect is not demonstrable by objective evaluation, and has a higher incidence of postoperative bleeding compared to radiofrequency. Among its advantages in comparison to submucosal resection are shorter operative time and less intraoperative blood loss.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

NK, NMN and BA made a substantial contribution to the conception and design of the article, to the acquisition, analysis and interpretation of data. SSAH critically revised the article and gave the final approval of the version to be published.

Ethical consideration

The systematic review and meta-analysis design of this article does not require ethical approval from our institution.

This article does not involve generation of new data from human or animal and no consent is necessary.

Figures and tables

Figure 1.Flow diagram of study selection.

Figure 2.Relief of nasal obstruction based on the visual analogue scale: (A) microdebrider versus radiofrequency; (B) microdebrider versus submucosal resection; (C) microdebrider versus diode laser.

Figure 3.The acoustic rhinometry assessment between: (A) microdebrider and radiofrequency; (B) between microdebrider and diode laser.

Figure 4.The incidence of post-operative bleeding between microdebrider and radiofrequency.

Figure 5.The incidence of crusting between: (A) microdebrider and radiofrequency; (B) microdebrider and submucosal resection; (C) microdebrider and diode laser.

Figure 6.The operative time between microdebrider and radiofrequency.

Supplementary Figure 1.The mucociliary transport time between microdebrider and radiofrequency.

Supplementary Figure 2.The incidence of recurrent nasal obstruction between microdebrider and radiofrequency.

First author, year Country Number of pts/trial sites* Inclusion period Comparison Study period Outcome measures Patient selection
Akagun, 2016 9 Turkey 40/ 1 Sept 2007 -June 2008 Radiofrequency 3 months Nasal obstruction;Complication Allergic and non-allergic rhinitis
Kizilkaya, 2008 12 Turkey 30/1 August 2004 - September 2005 Radiofrequency 6 months Nasal obstruction; Complication Non-allergic rhinitis
Lee, 2006 13 South Korea 60/1 March 2003 - September 2004 Radiofrequency 12 months Nasal obstruction; Operative time Non-allergic rhinitis
Liu, 2009 14 Taiwan 120/1 January 2001 - December 2006 Radiofrequency 3 years Nasal obstruction Allergic rhinitis
Pelen, 2016 15 Turkey 40/1 January 2009 - March 2010 Radiofrequency 2 months Nasal obstruction; Complication Allergic and non-allergic rhinitis
Chen, 2007 20 Taiwan 120/2 January 2002 - December 2005 Submucosal resection 3 months Nasal obstruction; Complication Allergic and non-allergic rhinitis
Kumar, 2014 3 India 30/1 November 2009 - April 2011 Radiofrequency 6 months Nasal obstruction; Complication; Operative time Non-allergic rhinitis
Chen, 2008 10 Taiwan 160/1 January 2002 - December 2006 Submucosal resection 3 years Nasal obstruction; Complication Allergic rhinitis
El Henawi, 2011 11 Egypt 46/1 N/A Submucosal resection 6 months Nasal obstruction; Complication; Operative time Allergic and non-allergic rhinitis
Kassab, 2012 19 Egypt 40/2 N/A Diode laser 6 months Nasal obstruction; Complication; Operative time Allergic and non-allergic rhinitis
Harju, 2018 17 Finland 98/1 February 2014 - September 2017 Radiofrequency, Diode laser 3 months Nasal obstruction; Complication; Operative time Allergic and non-allergic rhinitis
Hegazy, 2014 16 Saudi Arabia 70/1 December 2010 - May 2012 Radiofrequency 6 months Nasal obstruction; Complication Chronic rhinitis
Harju, 2021 18 Finland 77/1 February 2014 - September 2017 Radiofrequency, Diode laser 12 months Nasal obstruction Allergic and non-allergic rhinitis
Table I.Characteristics of included studies.
Microdebrider compared to radiofrequency for turbinate hypertrophy
Patient or population: Turbinate hypertrophy
Intervention: Microdebrider
Comparison: Radiofrequency
Outcomes No. of participants (studies) Certainty of the evidence (GRADE) Relative effect (95% CI) Anticipated absolute effects
Risk with Radiofrequency Risk difference with Microdebrider
Reduction of nasal obstruction by subjective assessments (VAS and SNOS) 436 (7 RCTs) ⊕⊕⊕⃝ Moderatea - - SMD 1.22 lower (2.12 lower to 0.33 lower)
Mucociliary transport time 270 (4 RCTs) ⊕⊕⊕⃝ Moderateb - The mean mucociliary transport time was 0 MD 0.42 lower (1.21 lower to 0.37 higher)
Incidence of post-operative bleeding 296 (3 RCTs) ⊕⊕⊕⃝ Moderateb RR 4.58 (1.35 to 15.57) 14 per 1,000 50 more per 1,000 (5 more to 200 more)
Incidence of crusting 176 (3 RCTs) ⊕⊕⊕⃝ Moderatea - The mean incidence of crusting was 0 MD 0.03 higher (0.31 lower to 0.36 higher)
Recurrent nasal obstruction 120 (2 RCTs) ⊕⊕⊕⃝ Moderateb RR 0.37 (0.09 to 1.54) 117 per 1,000 74 fewer per 1,000 (106 fewer to 63 more)
Operative time 246 (4 RCTs) ⊕⊕⃝⃝ Lowa,b - The mean operative time was 0 MD 5.37 higher (3.91 lower to 14.65 higher)
Reduction of nasal obstruction (acoustic rhinometry) 206 (4 RCTs) ⊕⊕⃝⃝ Lowa,b - The mean reduction of nasal congestion (acoustic rhinometry) was 0 MD 0.37 lower (1.35 lower to 0.61 higher)
Table II.Summary of findings for microdebrider versus radiofrequency.
Microdebrider compared to submucosal resection for turbinate hypertrophy
Patient or population: Turbinate hypertrophy
Intervention: Microdebrider
Comparison: Submucosal resection
Outcomes No. of participants (studies) Certainty of the evidence (GRADE) Relative effect (95% CI) Anticipated absolute effects
Risk with Radiofrequency Risk difference with Microdebrider
Reduction of nasal obstruction by VAS 280 (2 RCTs) ⊕⊕⃝⃝ LOW a,b - The mean nasal obstruction was 0 MD 0.1 lower (0.36 lower to 0.15 higher)
Reduction of nasal obstruction by VAS 46 (1 RCT) ⊕⊕⃝⃝ LOW a,b RR 1.00 (0.84 to 1.20) 913 per 1,000 43 fewer per 1,000 (146 fewer to 183 more)
Incidence of crusting 206 (2 RCTs) ⊕⊕⃝⃝ LOW a,b RR 0.25 (0.02 to 2.78) 146 per 1,000 109 fewer per 1,000 (143 fewer to 259 more)
Incidence of pain 46 (1 RCT) ⊕⊕⃝⃝ LOW a,b - The mean pain score was 0 MD 0.9 lower (2.17 lower to 0.37 higher)
Operative time 46 (1 RCT) ⊕⊕⃝⃝ LOW a,b - The mean duration of operation was 0 MD 18.29 lower (20.33 lower to 16.25 lower)
Intraoperative blood loss 46 (1 RCT) ⊕⊕⃝⃝ LOW a,b - The mean intraoperative blood loss was 0 MD 10.7 lower (15.62 lower to 5.78 lower)
Table III.Summary of findings for microdebrider versus submucosal resection.
Microdebrider compared to diode laser for turbinate hypertrophy
Patient or population: Turbinate hypertrophy
Intervention: Microdebrider
Comparison: Diode Laser
Outcomes No. of participants (studies) Certainty of the evidence (GRADE) Relative effect (95% CI) Anticipated absolute effects
Risk with Radiofrequency Risk difference with Microdebrider
Reduction of nasal obstruction (acoustic rhinometry) 148 (3 RCTs) ⊕⊕⊕⃝ Moderatea - The mean reduction of nasal obstruction (acoustic rhinometry) was 0 MD 0.06 higher (0.3 lower to 0.42 higher)
Reduction of nasal obstruction (VAS) 108 (2 RCTs) ⊕⊕⊕⃝ Moderatea - - MD 0.04 lower (0.81 lower to 0.73 higher)
Reduction of nasal obstruction (VAS) 40 (1 RCT) ⊕⊕⃝⃝ LOW a RR 1.13 (0.83 to 1.55) 902 per 1,000 40 fewer per 1,000 (140 fewer to 183 more)
Incidence of crusting 108 (2 RCTs) ⊕⊕⊕⃝ Moderatea - The mean incidence of crusting was 0 MD 0.28 higher (1.27 lower to 1.83 higher)
Table IV.Summary of findings for microdebrider versus diode laser.

References

  1. Larrabee YC, Kacker A. Which inferior turbinate reduction technique best decreases nasal obstruction?. Laryngoscope. 2014; 124:814-815. DOI
  2. Yamasaki A, Levesque PA, Bleier BS. Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery. Laryngoscope. 2019; 129:1554-1560. DOI
  3. Vijay Kumar K, Kumar S, Garg S. A comparative study of radiofrequency assisted versus microdebrider assisted turbinoplasty in cases of inferior turbinate hypertrophy. Indian J Otolaryngol Head Neck Surg. 2014; 66:35-39. DOI
  4. Bandos RD, Rodrigues de Mello V, Ferreira MD. Clinical and ultrastructural study after partial inferior turbinectomy. Braz J Otorhinolaryngol. 2006; 72:609-616. DOI
  5. Abdullah B, Singh S. Surgical interventions for inferior turbinate hypertrophy: a comprehensive review of current techniques and technologies. Int J Environ Res Public Health. 2021; 18:3441. DOI
  6. Lee CF, Chen TA. Power microdebrider-assisted modification of endoscopic inferior turbinoplasty: a preliminary report. Chang Gung Med J. 2004; 27:359-365.
  7. Higgins JP, Thomas J, Chandler J. Cochrane handbook for systematic reviews of interventions. Version 6.0. Cochrane. 2019. Publisher Full Text
  8. Guyatt GH, Oxman AD, Kunz R. What is “quality of evidence” and why is it important to clinicians?. BMJ. 2008; 336:995-998. DOI
  9. Akagun F, Imamoggu M, Cobanoglu HB. Comparison of radiofrequency thermal ablation and microdebrider-assisted turbinoplasty in inferior turbinate hypertrophy: a prospective, randomized, and clinical study. Turk Arch Otorhinolaryngol. 2016; 54:118-123. DOI
  10. Chen YL, Tan CT, Huang HM. Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope. 2008; 118:1270-1274. DOI
  11. El Henawi Del D, Ahmed MR, Madian YT. Comparison between power-assisted turbinoplasty and submucosal resection in the treatment of inferior turbinate hypertrophy. ORL J Otorhinolaryngol Relat Spec. 2011; 73:151-155. DOI
  12. Kizilkaya Z, Ceylan K, Emir H. Comparison of radiofrequency tissue volume reduction and submucosal resection with microdebrider in inferior turbinate hypertrophy. Otolaryngol Head Neck Surg. 2008; 138:176-181. DOI
  13. Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty. Laryngoscope. 2006; 116:729-734. DOI
  14. Liu CM, Tan CD, Lee FP. Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty. Laryngoscope. 2009; 119:414-418. DOI
  15. Pelen A, Tekin M, Ozbilen Acar G. Comparison of the effects of radiofrequency ablation and microdebrider reduction on nasal physiology in lower turbinate surgery. Kulak Burun Bogaz Ihtis Derg. 2016; 26:325-332. DOI
  16. Hegazy HM, ElBadawey MR, Behery A. Inferior turbinate reduction; coblation versus microdebrider – a prospective, randomised study. Rhinology. 2014; 52:306-314. DOI
  17. Harju T, Numminen J, Kivekas I. A prospective, randomized, placebo-controlled study of inferior turbinate surgery. Laryngoscope. 2018; 128:1997-2003. DOI
  18. Harju T, Numminen J. The effect of inferior turbinate surgery on nasal symptoms and inferior turbinate contractility. Am J Otolaryngol. 2021; 42:102778. DOI
  19. Kassab AN, Rifaat M, Madian Y. Comparative study of management of inferior turbinate hypertrophy using turbinoplasty assisted by microdebrider or 980 nm diode laser. J Laryngol Otol. 2012; 126:1231-1237. DOI
  20. Chen YL, Liu CM, Huang HM. Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates. Int J Pediatr Otorhinolaryngol. 2007; 71:921-927. DOI
  21. Acevedo JL, Camacho M, Brietzke SE. Radiofrequency ablation turbinoplasty versus microdebrider-assisted turbinoplasty: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015; 153:951-956. DOI
  22. Mirza AA, Alandejani TA, Shawli HY. Outcomes of microdebrider-assisted versus radiofrequency-assisted inferior turbinate reduction surgery: a systematic review and meta-analysis of interventional randomised studies. Rhinology. 2020; 58:530-537. DOI

Affiliations

Nithya Kanesan

Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Mohd Noor Norhayati

Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Suzina Sheikh Abdul Hamid

Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Baharudin Abdullah

Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2022

  • Abstract viewed - 221 times
  • PDF downloaded - 79 times