Comparative analysis of inferior turbinoplasty and inferior turbinate electrocauterization in the treatment of inferior turbinate hypertrophy using quality of life scales

Introduction: Nasal obstruction, a hindrance to comfortable breathing through the nose, significantly impacts patients' quality of life. The most common form of nasal obstruction is mechanical blockage, with septum deviation and inferior turbinate hypertrophy being the primary causes. Turbinate hypertrophy can arise from various etiologies, such as allergic rhinitis, vasomotor rhinitis, infectious rhinitis, and compensatory mechanisms. Numerous medical and surgical interventions are employed in the treatment of inferior turbinate hypertrophy, especially when medical treatment proves ineffective. The ideal outcome of surgery for inferior turbinate hypertrophy is to alleviate symptoms and obstructions without complications while preserving the nose's natural physiology. Objective: This study aims to compare the outcomes of the classical inferior turbinoplasty surgical technique and inferior turbinate electrocauterization method in treating inferior turbinate hypertrophy. This comparison utilizes specific nasal obstruction symptom evaluation forms (NOSE form and Sino-Nasal Outcome Test-22 (SNOT-22)) and the general quality of life visual analog scale (Eq-5d-3l-VAS), statistically analyzing the results. Materials and Methods: Patients aged 17-65 presenting with nasal obstruction and difficulty breathing at the Otolaryngology Department of İnönü University Faculty of Medicine underwent anterior rhinoscopic examination and endoscopic evaluation. Patients diagnosed with septum deviation and inferior turbinate hypertrophy were included in the study. Exclusion criteria encompassed patients under 17 or over 65 years, those with nasal polyps, sinonasal malignancies, comorbid diseases, and those requiring revision surgery. 59 patients with inferior turbinate hypertrophy and nasal septum deviation were treated with either septoplasty combined with classical inferior turbinoplasty (28 patients) or septoplasty combined with inferior turbinate electrocauterization (31 patients), ensuring homogeneity in age and gender. All patients were evaluated before and after treatment at 1 and 3 months using the NOSE form, SNOT-22, and Eq-5d-3l-VAS scale and forms. Data analysis was performed using SPSS (Statistical Program for Social Sciences) version 25. Findings: The study included 59 patients, 28 in the septoplasty with classical inferior turbinoplasty group (10 females, 18 males; average age 31.39 ± 10.97) and 31 in the septoplasty with inferior turbinate electrocauterization group (5 females, 26 males; average age 27.65 ± 8.38). No significant statistical difference was found between the groups in terms of age and gender (p>0.05). No significant difference was observed between the groups (turbinoplasty and electrocauterization) in the NOSE form evaluations preoperatively, postoperatively, and at first and second follow-ups (p>0.05). Both groups showed statistically significant improvements in NOSE form scores during the treatment process (p<0.05). The turbinoplasty group's preoperative NOSE score decreased from 17.32 ± 3.19 to 2.61 ± 3.36 at 3 months postoperatively, and the electrocauterization group's score decreased from 16.23 ± 3.45 to 2.87 ± 3.85. Both methods benefited patients, as evidenced by improved NOSE questionnaire results, with no superiority of one method over the other. Similar findings were observed with the SNOT-22 form. A significant difference was noted preoperatively, but no significant difference in effectiveness was observed postoperatively between the two methods. The turbinoplasty group showed a decrease in SNOT score from 57.04 ± 6.43 preoperatively to 16.36 ± 7.04 postoperatively at 3 months, while the electrocauterization group showed a decrease from 51.48 ± 7.74 to 21.06 ± 10.55. The SNOT-22 questionnaire results indicated improvement in both methods without one being superior to the other. Regarding the EQ-5D-3L VAS scale, no significant difference was found between the groups preoperatively and at the first and second postoperative controls (p>0.05). However, a statistically significant change was observed in both groups over the treatment process. The turbinoplasty group showed an increase in the EQ-5D-3L VAS score from 39.29 ± 13.31 preoperatively to 86.07 ± 13.15 at 3 months postoperatively, while the electrocauterization group increased from 40.65 ± 15.9 to 81.94 ± 16.21. The EQ-5D-3L VAS questionnaire results indicated that patients benefited from both methods, as reflected in increased scores, indicating improved postoperative well-being. No superiority was observed in either method. In the EQ-5D-3L scale evaluation, a significant difference was observed between the groups preoperatively and at the first and second postoperative controls (p<0.05). A decrease in the frequency of patients reporting problems in EQ5D domains such as anxiety/depression, mobility, pain/discomfort, and usual activities was observed in both groups. A more significant reduction in the number of patients reporting pain/discomfort issues was observed in the turbinoplasty group. The treatment methods applied for inferior turbinate hypertrophy and nasal septum deviation improved patients' quality of life in EQ5D domains. Conclusion: This study, which compared classical inferior turbinoplasty and inferior turbinate electrocauterization methods for treating inferior turbinate hypertrophy, found no significant difference between the two in terms of NOSE, SNOT-22, and EQ-5D-3L VAS values. There was no superiority of one group over the other. Significant improvements were observed in both groups in terms of NOSE, SNOT-22, and EQ-5D-3L VAS values over the course of treatment. Both methods were found to be effective in treating inferior turbinate hypertrophy. Additionally, the NOSE, SNOT-22, and EQ-5D-3L VAS scales were found to be effective in evaluating the treatment of the condition. Keywords: Nasal obstruction, turbinoplasty, inferior turbinate cauterization, SNOT-22, NOSE form, general quality of life scale (Eq-5d-3l-VAS)