Inferior Turbinate Reduction Using Bipolar Cautery: Technique and Outcomes in Pediatric Patients

Abstract

Objectives:

To evaluate extended outcomes up to 6 years following bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort.

Methods:

Retrospective case series of 326 children (mean age 9.0 ± 4.1 years) who underwent 12-W bipolar-cautery ITR between December 2017 and May 2024 at a single-surgeon tertiary practice. Concurrent procedures were performed in 82% of patients; 59 underwent ITR alone. Parent-reported nasal breathing improvement was assessed at regular intervals up to 6 years. Statistical analyses included Cochran’s Q tests and generalized estimating equations (GEE).

Results:

In the full cohort, nasal breathing improvement rates were: 95.4% at 3 months, 91.7% at 6 months, 90.2% at 1 year, 88.1% at 2 years, and 78.7% at 3 years. Sample sizes decreased beyond 3 years due to follow-up attrition. Cochran’s Q test showed significant changes over time through 3 years (Q = 60.101, P < .001). The ITR-only subgroup showed more marked decline: 98% improvement at 3 months to 69.0% at 3 years (P = .002), compared to more stable rates with concurrent surgery. GEE analysis confirmed significant time effects (P < .001). Compared to ITR alone, concurrent septoplasty (OR 0.39, P = .002) and sinus surgery (OR 0.34, P = .020) were each associated with significantly lower odds of reporting persistent symptoms (i.e., a greater likelihood of improvement). Complications remained low: minor bleeding (4.6%), major bleeding requiring intervention (1.2%), MRSA infection (0.3%), and synechiae (1.5%).

Conclusions:

Bipolar-cautery ITR provides safe, effective symptom improvement with excellent short-term results (>90% at 1 year). However, efficacy declines over time, particularly in ITR-only patients (78.7% overall at 3 years). Concurrent airway procedures may provide more stable outcomes. These findings emphasize the need for long-term follow-up and appropriate patient selection.