Comparative Efficacy and Safety of Turbinate Surgery for Chronic Rhinitis: A Systematic Review and Network Meta-Analysis.

Objectives

To evaluate the treatment outcomes of various turbinate surgeries in patients with chronic rhinitis.

Design and setting

A systematic review and meta-analysis.

Main outcome measures

A systematic search was conducted using six databases. Treatment conditions included six surgical interventions-coblator-assisted turbinoplasty (CAT), laser ablation, microdebrider-assisted turbinoplasty (MAT), radiofrequency tissue volume reduction (RFVTR), submucosal diathermy (SMD) and partial inferior turbinectomy (PIT)-and a reference intervention (submucosal resection). Outcomes included symptom scores, turbinate size, operative time and surgery-related adverse effects such as atrophic changes, crusting, nasal dryness, mucosal tearing, revision rate and postoperative bleeding. Both pairwise and network meta-analyses were performed.

Results

MAT was associated with better outcomes across most parameters but showed a higher risk of mucosal tearing. SMD was associated with lower effectiveness in alleviating nasal obstruction at 6-12 months and laser ablation was associated with reduced effectiveness in decreasing turbinate size. RFVTR exhibited the shortest operative time and was associated with advantages in minimising nasal dryness and preserving the mucosa. Regarding adverse effects, laser ablation was associated with an increased risk of atrophic rhinitis, PIT with a higher incidence of crusting and dryness and SMD with a greater likelihood of requiring revision surgery.

Conclusion

MAT was associated with relatively favourable outcomes across most parameters; however, it also showed a higher risk of mucosal tearing. RFVTR was associated with advantages in minimising nasal dryness and preserving mucosal integrity. Both SMD and laser ablation were associated with comparatively limited efficacy and relatively higher rates of adverse effects.