From the Guidelines
Before considering inferior turbinate reduction, patients should be tried on intranasal corticosteroids, such as fluticasone, mometasone, or budesonide, for at least 4-6 weeks, as well as oral second-generation antihistamines, like loratadine, cetirizine, or fexofenadine, for at least 2-4 weeks, as recommended by the clinical practice guideline for allergic rhinitis 1. The initial approach to managing nasal congestion and turbinate hypertrophy should focus on reducing inflammation and shrinking the turbinate tissue.
- Intranasal corticosteroids are recommended for patients with allergic rhinitis whose symptoms affect their quality of life, as stated in the guideline 1.
- Oral second-generation antihistamines are recommended for patients with allergic rhinitis and primary complaints of sneezing and itching, as stated in the guideline 1.
- Nasal saline irrigation using devices like a neti pot or saline sprays should be used regularly to clear mucus and irritants.
- Decongestants such as pseudoephedrine or oxymetazoline nasal spray may be used short-term (3-5 days maximum for sprays to avoid rebound congestion) to assess potential benefit.
- Leukotriene modifiers like montelukast might be considered for patients with concurrent allergies or asthma, although the guideline recommends against oral leukotriene receptor antagonists as primary therapy for patients with allergic rhinitis 1. A comprehensive trial of these medications for at least 3-6 months under medical supervision is typically recommended before considering surgical intervention, such as inferior turbinate reduction, which may be offered to patients with nasal airway obstruction and enlarged inferior turbinates who have failed medical management 1.
From the Research
Medications to be Tried Before Inferior Turbinate Reduction
- Nasal steroids, as their use decreased in patients who underwent turbinate reduction in association with rhinoseptoplasty 2
- Oral antihistamines, as their use also decreased in patients who underwent turbinate reduction in association with rhinoseptoplasty 2
- Immunotherapy, as it is considered when patients fail pharmacologic management, and inferior turbinate reduction can be considered before immunotherapy 3
- Oxymetazoline, as it relieves nasal obstructive symptoms via vasoconstriction, and can be used to change nasal aerodynamics and symptomatology in patients with turbinate hypertrophy 4
Treatment Approach
- A multimodal approach to chronic nasal congestion, particularly in children with allergic rhinitis, may be necessary 5
- Inferior turbinate reduction can be considered as a cost-effective treatment option for patients who fail initial pharmacotherapy 3
- Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate can be an effective treatment for nasal obstruction, rhinorrhea, and nasal pruritus 6