Endoscopic Submucosal Resection Versus Endoscopic Submucosal Diathermy for Inferior Turbinate Hypertrophy

  • Vijay Kumar Lukka
  • Regi KurienEmail author
  • Lalee Varghese
  • Vedantam Rupa
Original Article


Endoscopic submucous resection and endoscopic submucous diathermy of the inferior turbinate are two different surgical methods of reducing size in turbinate hypertrophy. We aimed to compare the efficacy of both methods in reducing the nasal symptoms and improving nasal airway. This is a prospective randomized controlled trial conducted in a tertiary hospital, involving fifty patients with inferior turbinate hypertrophy not relieved by medications. After preoperative airway grading using a subjective symptom score, objective airway score and endoscopic score, patients were randomized to undergo either endoscopic submucous diathermy or endoscopic submucous resection. The primary outcome was postoperative improvement of airway and reduction of nasal symptoms. Secondary outcomes were postoperative bleeding and pain. All 24 patients who underwent endoscopic submucous diathermy and 26 who underwent endoscopic submucous resection showed statistically significant reduction in nasal symptoms both in the immediate and late postoperative periods. Patients who underwent endoscopic submucous resection showed greater improvement of airway at 1 week than those who had endoscopic submucous diathermy (p = 0.001). This difference however equalized at the 3–6 months postoperative period. Postoperative bleeding (p = 0.02) and pain (p = 0.04) were significantly more in patients who underwent endoscopic submucous resection. Both endoscopic submucous diathermy and endoscopic submucous resection are equally effective in improving airway in inferior turbinate hypertrophy with a slight advantage of endoscopic submucous resection in the early postoperative period. Reduced postoperative bleeding and pain may make endoscopic submucous diathermy a more attractive option overall.


Inferior turbinate hypertrophy Endoscopic submucous resection Endoscopic submucous diathermy 



We would like to acknowledge the contribution of Ms. VisalakshiJeyaseelan, MSc. (Biostatistics), Biostatician, Christian Medical College, Vellore, towards statistical analysis.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Gupta A, Mercurio E, Bielamowicz S (2001) Endoscopic inferior turbinate reduction: an outcomes analysis. Laryngoscope 111:1957–1959CrossRefGoogle Scholar
  2. 2.
    Fradis M, Malatskey S, Magamsa I, Golz A (2002) Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement. Am J Otolaryngol 23:332–336CrossRefGoogle Scholar
  3. 3.
    Gindros G, Kantas I, Balatsouras DG, Kaidoglou A, Kandiloros D (2010) Comparison of ultrasound turbinate reduction, radiofrequency tissue ablation and submucosal cauterization in inferior turbinate hypertrophy. Eur Arch Oto-Rhino-Laryngol 267:1727–1733CrossRefGoogle Scholar
  4. 4.
    Seeger J, Zenev E, Gundlach P, Stein T, Müller G (2003) Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months’ follow-up. Laryngoscope 113:130–135CrossRefGoogle Scholar
  5. 5.
    Elwany S, Harrison R (1990) Inferior turbinectomy: comparison of four techniques. J Laryngol Otol 104:206–209CrossRefGoogle Scholar
  6. 6.
    Hol MK, Huizing EH (2000) Treatment of inferior turbinate pathology: a review and critical evaluation of the different techniques. Rhinology 38:157–166PubMedGoogle Scholar
  7. 7.
    Fradis M, Golz A, Danino J, Gershinski M, Goldsher M, Gaitini L et al (2000) Inferior turbinectomy versus submucosal diathermy for inferior turbinate hypertrophy. Ann Otol Rhinol Laryngol 109:1040–1045CrossRefGoogle Scholar
  8. 8.
    Passàli D, Passàli FM, Damiani V, Passàli GC, Bellussi L (2003) Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol 112:683–688CrossRefGoogle Scholar
  9. 9.
    Ishida H, Yoshida T, Hasegawa T, Mohri M, Amatsu M (2003) Submucous electrocautery following submucous resection of turbinate bone—a rationale of surgical treatment for allergic rhinitis. Auris Nasus Larynx 30:147–152CrossRefGoogle Scholar
  10. 10.
    Joniau S, Wong I, Rajapaksa S, Carney SA, Wormald P-J (2006) Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates. Laryngoscope 116:1612–1616CrossRefGoogle Scholar
  11. 11.
    Friedman M, Tanyeri H, Lim J, Landsberg R, Caldarelli D (1999) A safe, alternative technique for inferior turbinate reduction. Laryngoscope 109:1834–1837CrossRefGoogle Scholar
  12. 12.
    Mori S, Fujieda S, Yamada T, Kimura Y, Takahashi N, Saito H (2002) Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis. Laryngoscope 112:865–869CrossRefGoogle Scholar
  13. 13.
    Rakover Y, Rosen G (1996) A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates. J Laryngol Otol 110:732–735CrossRefGoogle Scholar
  14. 14.
    Lin H-C, Lin P-W, Friedman M, Chang H-W, Su Y-Y, Chen Y-J et al (2010) Long-term results of radiofrequency turbinoplasty for allergic rhinitis refractory to medical therapy. Arch Otolaryngol Head Neck Surg 136:892–895CrossRefGoogle Scholar
  15. 15.
    Deenadayal DS, Kumar MN, Sudhakshin P, Hameed S (2014) Radiofrequency reduction of inferior turbinates in allergic and non allergic rhinitis. Indian J Otolaryngol Head Neck Surg 66(Suppl 1):231–236CrossRefGoogle Scholar
  16. 16.
    Shah AN, Brewster D, Mitzen K, Mullin D (2015) Radiofrequency coblation versus intramural bipolar cautery for the treatment of inferior turbinate hypertrophy. Ann Otol Rhinol Laryngol 124:691–697CrossRefGoogle Scholar
  17. 17.
    Greywoode JD, Van Abel K, Pribitkin EA (2010) Ultrasonic bone aspirator turbinoplasty: a novel approach for management of inferior turbinate hypertrophy. Laryngoscope 120(Suppl 4):S239CrossRefGoogle Scholar
  18. 18.
    Larrabee YC, Kacker A (2014) Which inferior turbinate reduction technique best decreases nasal obstruction? Laryngoscope 124:814–815CrossRefGoogle Scholar
  19. 19.
    Leong SC, Eccles R (2010) Inferior turbinate surgery and nasal airflow: evidence-based management. Curr Opin Otolaryngol Head Neck Surg 18:54–59CrossRefGoogle Scholar
  20. 20.
    Jose J, Coatesworth AP (2010) Inferior turbinate surgery for nasal obstruction in allergic rhinitis after failed medical treatment. Cochrane Database Syst Rev 12:CD005235Google Scholar
  21. 21.
    Ye T, Zhou B (2015) Update on surgical management of adult inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg 23:29–33PubMedGoogle Scholar
  22. 22.
    Hegazy HM, ElBadawey MR, Behery A (2014) Inferior turbinate reduction; coblation versus microdebrider—a prospective, randomised study. Rhinology 52:306–314CrossRefGoogle Scholar
  23. 23.
    Lee D-H, Kim EH (2010) Microdebrider-assisted versus laser-assisted turbinate reduction: comparison of improvement in nasal airway according to type of turbinate hypertrophy. Ear Nose Throat J 89:541–545PubMedGoogle Scholar
  24. 24.
    Garzaro M, Landolfo V, Pezzoli M, Defilippi S, Campisi P, Giordano C et al (2012) Radiofrequency volume turbinate reduction versus partial turbinectomy: clinical and histological features. Am J Rhinol Allergy 26:321–325CrossRefGoogle Scholar
  25. 25.
    Barbosa ADA, Caldas N, Morais AXD, Campos AJDC, Caldas S, Lessa F (2005) Assessment of pre and postoperative symptomatology in patients undergoing inferior turbinectomy. Braz J Otorhinolaryngol 71:468–471CrossRefGoogle Scholar
  26. 26.
    Gertner R, Podoshin L, Fradis M (1984) A simple method of measuring the nasal airway in clinical work. J Laryngol Otol 98:351–355CrossRefGoogle Scholar
  27. 27.
    Boezaart AP, van der Merwe J, Coetzee A (1995) Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth J Can Anesth 42:373–376CrossRefGoogle Scholar
  28. 28.
    Chen Y-L, Tan C-T, Huang H-M (2008) Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis. Laryngoscope 118:1270–1274CrossRefGoogle Scholar
  29. 29.
    Talaat M, El-Sabawy E, Baky FA, Raheem AA (1987) Submucous diathermy of the inferior turbinates in chronic hypertrophic rhinitis. J Laryngol Otol 101:452–460CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyChristian Medical CollegeVelloreIndia

Personalised recommendations