Brian Manzi MS-4 University of Central Florida College of Medicine Sinonasal Quality of Life in Children After Outfracture Inferior Turbinates & Submucous Inferior Turbinoplasty For Nasal Congestion Julie Wei, MD Division of Otolaryngology Nemours Children’s Hospital Orlando, Florida

Chronic Nasal Congestion Frequent in children of all ages Usually presumed to be allergic rhinitis Persistent despite daily and long-term use of:  Intranasal steroid  Oral and/or intranasal antihistamine  Leukotriene receptor antagonist Present even when allergy testing is negative Decreases quality of life  Mouth breathing  Sleep disordered breathing/OSA  May reduce attention span/daytime performance 2

Background Objective: To quantify changes in the sinonasal quality of life after concomitant outfracture and inferior turbinoplasty 3

Inferior Turbinates Anterior portions of IT influence cross sectional area of nasal airway Nasal resistance IT Hypertrophy impedes the normal nasal cycle Nasal “stuffiness” 4

Study Design Retrospective summary from Jan May patients Sinonasal quality of life (SN-5)survey completed by parents Baseline and 4-6 week post op Medication use pre and post op Allergy history Procedures Outpatient (15-20 minutes) Outfracture inferior turbinates using long nasal speculum Submucous IT Medtronic 2mm pediatric inferior turbinoplasty blade 5

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Patient Demographics 9 Gender29 male 14 female Age (years)11.2 +/- 1.0 Median Age (years)10.8 Age Range (years)4.8 – 17.6 Height (m)1.45+/-0.05 Weight (kg)45.4 +/ BMI (kg/m 2 )20.7 +/- 1.8 Follow-up (weeks)5.7 +/- 1.0 Patient Demographics

Baseline Symptoms and Medication Use 10 No. of Patients Preop ProportionNo. of Patients Postop ProportionAbsolute Reduction P Value Nasal Congestion 4195%12%93%<0.01 Rhinorrhea1944%12%41%<0.01 Snoring3377%12%74%<0.01 Use of INS2560%25%55%<0.01 Antihistamine2763%12%60%<0.01 LTRA1330%00%31%<0.01

History of Allergy Testing 10 OverallSkin Prick Test Allergen-Specific Immunoglobulin E Total20 [47%]12 [60%]4 [20%] +Dust Mites4 [20%]1 [8%]2 [50%] +Grass/Pollen10 [50%]6 [50%]3 [75%] +Mold2 [10%]2 [17%]0 [0%] +Food6 [30%]3 [25%]1 [25%] +Animal6 [30%]4 [33%]1 [25%] Negative6 [30%]4 [33%]1 [25%]

Results 11 DomainBaseline Mean, CI Post-op Mean, CI ChangeP Value Sinus Infection4.55 [3.95,5.15]2.00 [1.61, 2.39]2.55<0.01 Nasal Obstruction5.72 [5.31,6.13]2.21 [1.73, 2.69]3.51<0.01 Allergy Symptoms4.59 [4.03, 5.15]2.45 [1.99, 2.91]2.14<0.01 Emotional Distress4.16 [3.58, 4.74]1.79 [1.42, 2.16]2.37<0.01 Activity Limitation2.88 [2.35, 3.41]1.18 [1.01, 1.35]1.70<0.01 Overall QoL5.21 [4.57, 5.85]8.93 [8.5, 9.36]3.72<0.01 Paired two sample for mean t-test compared between SN-5 data pre- and post- procedures Summary Statistics for Sinonasal Quality-of-Life Survey

Conclusions Concomitant outfracture and submucous inferior turbinoplasty improves sinonasal QoL and is an effective treatment for chronic nasal congestion in children  Decreased nasal congestion, snoring, rhinorrhea  Decreased medication use (INS by 55%, antihistamine by 60%, singulair by 31%)  Minimally invasive, no adverse events, outpatient procedure Effective treatment option  Reduce daily medication use  Reduce cost  Reduce possible side effects of INS, antihistamine, LTRA  Improve nasal airway, reduce SDB/OSA, QoL 13

Discussion Nasal dysfunction – why?  Persistent inferior turbinate hypertrophy even without proven allergies to environmental allergens Long-term follow up needed to determine if symptom resolution is maintained Unclear if either procedure alone, would achieve equivalent or better outcome 14

References Arganbright, JM. "Utility of Inferior Turbinoplasty for the Treatment of Nasal Obstruction in Children: A 10-Year Review." JAMA Otolaryngol Head Neck Surg (2015): Lanqille, M., and H. El-Hakim. "Pediatric Inferior Turbinoplasty with or without Adenoidectomy: Preliminary Report on Improvement of Quality of Life, Symptom Control, and Safety." J Otolaryngol Head Neck Surg40.5 (2011): Coatesworth, Jose J. "Inferior Turbinate Surgery for Nasal Obstruction in Allergic Rhinitis after Failed Medical Treatment (Review)." The Cochrane Collaboratoin (2010): n. pag. John Wiley & Sons, Ltd. Hol, Myrthe. "Treatment of Inferior Turbinate Pathology: A Review and Critical Evaluation of the Different Techniques." Rhinology 3B (2000): Department of Otorhinolaryngology, University of Medical Centre Utrechte, the Netherlands. Jiang, Zi Yang, Kevin D. Pereira, et al. "Inferior Turbinate Surgery in Children: A Survey of Practice Patterns." Laryngoscope (2012): Kay, D. "Quality of Life for Children with Persistent Sinonasal Symptoms.“ Otolaryngol Head Neck Surg (2003): Tan, Bruce, MD, and Rakesh Chandra, MD. "Inferior Turbinoplasty, Procedure." Encyclopedia of Otolaryngology, Head and Neck Surgery (2013): Arganbright JM, Jensen EL, Mattingly J, et al. Utility of inferior turbinoplasty for the treatment of nasal obstructionin children: a 10-year review. JAMA Otolaryngol Head Neck Surg 2015 Sep 3:1-4. Langille M, El-Hakim. Pediatric inferior turbinoplasty with or without adenoidectomy: preliminary report on quality of life, symptom control, and safety. J Otolaryngol Head Neck Surg 2011 Oct;40(5):