1 Department of Otolaryngology-Head and Neck Surgery, Boston University, School of Medicine, Boston, Massachusetts.
2 Department of Surgery, VA Medical Center, Boston, Massachusetts.
Am J Rhinol Allergy. 2019 Mar;33(2):212-219. doi: 10.1177/1945892418815351. Epub 2018 Dec 17.
Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment.
To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time.
In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1-17 years). Exclusion criteria included reviews and abstracts.
Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction.
This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.
在过去，儿童下鼻甲肥大（ITH）的治疗方法存在不确定性。虽然治疗通常从药物治疗开始，但对于耐药病例，手术治疗的决策越来越普遍。在儿科人群中，鼻甲缩小术可通过鼻甲切除术、电灼术、激光、黏膜下微切除术和射频容积组织减少术（RVTR）来实现。然而，对于首选治疗方法，仍然缺乏共识。
比较不同手术方法的疗效、持续时间和并发症如何随时间的推移改变了儿童下鼻甲肥大的治疗方法。
2018 年 3 月，在 PubMed 上对所有与儿童下鼻甲肥大管理相关的研究进行了全面的文献检索。纳入标准包括儿童（年龄 1-17 岁）。排除标准包括综述和摘要。
在过去的 30 年中，每种技术都在与当时可用的技术相关的同时经历了一个流行期，并且在成人研究中也有证据支持。儿童 ITH 管理的文献在很大程度上遵循了这些趋势，研究质量的提高反映了手术实践的总体增加。在目前使用的所有方法中，RVTR 和黏膜下微切除术提供了最微创和最有效的缓解鼻塞的方法。
本综述概述了儿童 ITH 管理的演变，并根据历史和当前的证据，提出了以下分级治疗建议：（1）药物治疗 3 个月的试验，（2）评估腺样体肥大，考虑同期腺样体切除术，（3）作为一线手术方法的 RVTR 或黏膜下微切除术。
