Turbinate Cauterization in Children With Sleep-Disordered Breathing: A Randomized Prospective Study

Introduction: Indications for pediatric turbinate surgery are evolving. Our objective was to assess whether turbinate surgery at time of adenotonsillectomy confers additional benefit in reduction of nasal obstruction compared to AT alone.

Methods: We conducted a randomized, single-blinded study at a children’s hospital between 2014-2020. Children between 3 and 17 years with sleep disordered breathing (SDB) and nasal obstruction despite medical management were eligible. Patients had evidence of turbinate hypertrophy at baseline and were scheduled to undergo adenotonsillectomy (AT) for SDB. Children were randomized to AT with nasal endoscopy (control group) or AT with inferior turbinate cautery (ITC). The study was powered to assess for changes in the SN-5, a validated survey assessing nasal symptoms, between baseline, 3, and 12-month follow-up.

Results: In total, 51 patients were randomized: 19 in control group and 32 in adenotonsillectomy (AT) with inferior turbinate cautery (ITC) group. Both groups experienced improvement in SN-5 scores 3 months following surgery and improvements were maintained at 12 months. There was no statistically significant difference in percentage reduction of SN-5 Score at three months (51% vs 50.1%, p = 0.707) and 12 months (52.1% vs 43.6%, p = 0.225) between the AT with ITC group and the AT alone group. AT with ITC group had a minor complication rate of 2% which was comparable to AT alone group

Conclusions: Inferior turbinate cautery performed at the time of adenotonsillectomy in children with sleep disordered breathing is safe and improves nasal symptoms. However, inferior turbinate cautery may not confer additional benefit in obstruction compared to AT alone. Future research is needed to assess the impact of ITC on SDB outcomes.