Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2023
Improvement in congestion lasted at least one year.
For many patients with allergic rhinitis, congestion is the most troublesome symptom, and it is not always relieved with allergen avoidance, pharmacotherapy or immunotherapy. Turbinate reduction therapy is an option (especially with newer turbinate surgery methods), but older total inferior turbinate resections sometimes led to loss of normal mucosal physiological function or ‘empty nose syndrome.’
Researchers performed a meta-analysis of 18 case series and randomised trials that involved 1411 patients with allergic rhinitis and persistent nasal congestion. These included studies in which mucosal saving techniques were used: radiofrequency ablation (radiofrequency energy is delivered submucosally to the inferior turbinate via needle) or microdebridement (a rotary tool is placed into a small incision in the inferior turbinate to resect mucosal tissue). The meta-analysis revealed significant improvement in nasal congestion, as well as rhinorrhoea, sneezing and itching, that persisted at least one year after turbinate surgery. Side effects were mild and consisted of bleeding, crusting and nasal dryness.
Comment: For patients with allergic rhinitis, a combination of nasal corticosteroids and nasal antihistamines is the most effective pharmacotherapy. Oral antihistamines and montelukast offer little relief of congestion and are not additive to nasal sprays. Short courses of oral and topical decongestants can be helpful, but side effects, such as rebound congestion with oxymetazoline and insomnia and possibly increased blood pressure with pseudoephedrine (phenylephrine is no better than placebo), limit use. For patients with symptoms that are inadequately controlled with medical therapies, turbinate reduction surgery is a good option that offers sustained relief for at least one year with minimal complications.
David J. Amrol, MD
Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.
Park SC, et al. Long-term outcomes of turbinate surgery in patients with allergic rhinitis. JAMA Otolaryngol Head Neck Surg 2023; 149: 15-23.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine