The Role of Inferior Turbinoplasty in Endoscopic Sinus Surgery: A Systematic Review

The Role of Inferior Turbinoplasty in Endoscopic Sinus Surgery: A Systematic Review | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 15 July 2025 V1 Latest version Share on The Role of Inferior Turbinoplasty in Endoscopic Sinus Surgery: A Systematic Review Authors : Suliman Ali 0000-0001-5111-6781 [email protected] , Avenie Mavadia , Alf Cuddeford , Zahra Mubaarak , Yadsan Devabalan 0000-0001-6389-8397 , Chuanyu Gao , Remo Accorona , and Haissan Iftikhar Authors Info & Affiliations https://doi.org/10.22541/au.175255756.60439733/v1 Published Cureus Version of record Peer review timeline 339 views 244 downloads Contents Abstract TITLE PAGE CONFLICT OF INTEREST FUNDING INTRODUCTION MATERIALS AND METHODS DISCUSSION CONCLUSION References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Functional endoscopic sinus surgery (FESS) is widely used to treat chronic rhinosinusitis (CRS) and related sinonasal diseases, often performed alongside inferior turbinoplasty to improve symptoms. However, the added value of concurrent turbinoplasty remains unclear. This systematic review evaluates outcomes of FESS with and without inferior turbinoplasty. Methods: A systematic search of MEDLINE, Embase, and Cochrane databases was conducted following PRISMA guidelines. After screening, five studies comprising 4,619 patients met the inclusion criteria. Results: Four studies assessed quality of life (QoL), all demonstrating postoperative improvement with both FESS alone and FESS plus inferior turbinoplasty. Only one study showed a significant QoL benefit with turbinoplasty; the others found no meaningful difference. One study evaluated olfaction and reported no significant impact from additional turbinoplasty. Revision surgery rates were not reported in any study. A paediatric study found no increased 30-day readmission risk associated with turbinoplasty. Conclusions: Concurrent inferior turbinoplasty with FESS appears safe and may offer benefit in select patient subgroups, such as those with nasal polyps. However, routine addition does not consistently improve overall QoL or olfactory outcomes. Further randomized controlled trials are required to clarify its clinical value. TITLE PAGE The Role of Inferior Turbinoplasty in Endoscopic Sinus Surgery: A Systematic Review Running title: Role of Inferior Turbinoplasty in FESS CONFLICT OF INTEREST The authors declare that they have no conflicts of interest relevant to this work. FUNDING This research received no specific grant from any funding agency. KEY WORDS Functional Endoscopic Sinus Surgery; Inferior Turbinoplasty; Chronic Rhinosinusitis; Olfaction; Quality of Life ABSTRACT Background : Functional endoscopic sinus surgery (FESS) is widely used to treat chronic rhinosinusitis (CRS) and related sinonasal diseases, often performed alongside inferior turbinoplasty to improve symptoms. However, the added value of concurrent turbinoplasty remains unclear. This systematic review evaluates outcomes of FESS with and without inferior turbinoplasty. Methods : A systematic search of MEDLINE, Embase, and Cochrane databases was conducted following PRISMA guidelines. After screening, five studies comprising 4,619 patients met the inclusion criteria. Results : Four studies assessed quality of life (QoL), all demonstrating postoperative improvement with both FESS alone and FESS plus inferior turbinoplasty. Only one study showed a significant QoL benefit with turbinoplasty; the others found no meaningful difference. One study evaluated olfaction and reported no significant impact from additional turbinoplasty. Revision surgery rates were not reported in any study. A paediatric study found no increased 30-day readmission risk associated with turbinoplasty. Conclusions : Concurrent inferior turbinoplasty with FESS appears safe and may offer benefit in select patient subgroups, such as those with nasal polyps. However, routine addition does not consistently improve overall QoL or olfactory outcomes. Further randomized controlled trials are required to clarify its clinical value. KEY POINTS Unclear Added Benefit : While both FESS alone and FESS with inferior turbinoplasty improve quality of life (QoL), only one of five studies showed a statistically significant advantage with the addition of turbinoplasty—suggesting its routine inclusion may not provide consistent added benefit. Selective Utility in Nasal Polyps : Subgroup analysis indicated that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may experience greater nasal obstruction relief with turbinoplasty, though benefits were not evident in non-polyp patients (CRSsNP). Olfactory Outcomes Are Unchanged : Only one study assessed smell function and found no significant improvement from adding inferior turbinoplasty, raising questions about its impact on olfaction. Safe in Paediatric Use : A large retrospective paediatric study found no increased 30-day readmission rates following FESS with turbinoplasty, supporting its short-term safety in children. Evidence Quality and Limitations : Most included studies were observational and varied in technique, outcomes, and follow-up duration, limiting definitive conclusions; further high-quality randomized controlled trials are necessary to clarify turbinoplasty’s role. INTRODUCTION Inferior turbinate hypertrophy often coexists with sinonasal disease (1) . It is most commonly caused by allergic rhinitis, vasomotor rhinitis and compensatory hypertrophy secondary to septal deviation (2-3) . Conditions causing chronic inflammation cause deposits of collagen under the basement membrane of the sinonasal mucosa which results in mucous gland hyperplasia and resultant hypersecretion (4) . The inferior turbinates regulate nasal airflow, humidification, and filtration in the nose by increasing the surface area of the nose to aid pulmonary alveolar gas exchange (5) . When hypertrophied, they can obstruct nasal breathing, either due to mucosal inflammation causing hypertrophy of the lamina propria, bony enlargement, or both (6) . This is more likely to cause nasal obstruction than septal deviation, pharyngeal tonsil hypertrophy and nasal polyps (7) . This has led some surgeons to combine FESS with inferior turbinoplasty to optimise nasal airflow. Turbinoplasty is an umbrella term for surgical modification of turbinates: it is designed to reduce turbinate size by bone and meatal surface removal with greater mucosal preservation, causing a reduction of turbinate volume whilst maintaining physiological function and increased nasal airflow (8) . Various methods include submucous diathermy (SMD), radiofrequency ablation, outfracturing the turbinates and turbinectomy (total, subtotal or partial) (9) . However, the role of concurrent inferior turbinoplasty during FESS remains a debate within the otolaryngology community, particularly on their impact on objective outcomes such as olfactory function, the need for revision surgery, and subjective patient-reported quality of life (6) . Long-term surgical success measured by the need for revision surgery is another crucial consideration. Revision surgery is needed if disease recurs or persists but it remains unclear with limited data addressing whether concurrent turbinate reduction affects the long-term success and durability of FESS (10) . Despite the widespread addition of turbinoplasty in FESS by surgeons, there remains no consensus regarding its added clinical benefit or the optimal surgical method (11) . Given the heterogeneity of existing studies, with differences in surgical techniques, patient populations, and outcome measures, a systematic review is warranted to elucidate the impact of adding turbinoplasty to FESS. MATERIALS AND METHODS The systematic review was developed and performed with accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement to ensure methodological rigor and transparency whilst enabling reproducibility and reducing bias (12) . Search strategy A comprehensive literature search was conducted across MEDLINE, Embase and Cochrane, to identify relevant studies in March 2025. The review was registered on PROSPERO (ID: 1006186).A combination of Medical Subject Headings (MeSH) terms and free-text keywords were used to ensure comprehensive coverage of relevant studies. Initial search terms were developed with input from a medical librarian and refined through a preliminary PubMed search before being adapted for each database. The search focused on intervention (I) and comparison (C) elements. The full search strategy for each database is detailed in Appendix. Additionally, the reference lists of included studies were manually screened for further eligible articles and to exclude grey literature. Study selection process The study selection process followed PRISMA guidelines. All records retrieved from database searches were imported into Covidence for deduplication. Two independent reviewers (SA and AM) screened the titles and abstracts, followed by full-text screening of potentially eligible studies against a predefined inclusion and exclusion criteria for suitability. Disagreements were resolved through discussion or consultation with a third reviewer. Inclusion and exclusion criteria Studies were deemed eligible if they met the following criteria: Included an comparison group of FESS +/- inferior turbinectomy, studies in English language, no age restriction. Exclusion criteria included: Case reports, letters to the editor, conference abstracts, studies lacking relevant outcome measures, studies reporting on the superior or middle turbinates and qualitative studies without comparison groups. Data extraction Key study characteristics, including study design, population, outcomes, and year of publication were extracted using a standardised data extraction form formulated on Microsoft word. The form was piloted on two studies and revised accordingly. Two independent reviewers extracted data from each eligible study, resolving discrepancies through discussion with a third and fourth reviewer. Final data categories included QoL symptom scoring and olfactory assessment. Outcomes The following predefined outcomes were evaluated: QoL, olfaction function, and the need for revision surgery. The assessed outcomes are detailed in Table 1. Risk of bias Each study was evaluated for biases related to selection, performance, attrition and reporting. Two independent reviewers conducted the risk of bias assessment and discrepancies were resolved through discussion. Study Selection A total of 652 studies were identified through database searches (Embase: X, Scopus: Y). After removing 214 duplicates (213 via Covidence and 1 manually), 438 unique articles remained for screening. Title and abstract screening excluded 373 studies that did not meet the predefined eligibility criteria. This yielded 65 full-text articles for detailed evaluation. Of these, 60 were excluded—primarily due to the absence of a direct comparison between functional endoscopic sinus surgery (FESS) with and without turbinoplasty. Five studies fulfilled the eligibility criteria and were included in this systematic review. The PRISMA flow diagram (Figure 1) outlines the study selection process. Study Characteristics The five included studies are summarized in Table 1. They consisted of a randomised control trial and prospective or retrospective observational cohort studies published between 2012 and 2023. Sample sizes ranged from 80 to 2,205 patients, collectively evaluating over 4,000 participants undergoing FESS with or without turbinoplasty. Two studies (13-14) included adult patients with chronic rhinosinusitis (CRS), while one study (16) also included patients with recurrent acute sinusitis and nasal polyposis and another with inferior turbinate hypertrophy and CRS (5) . The fifth study (15) focused on paediatric patients (<18 years) who underwent endoscopic sinus surgery for CRS and were readmitted within 30 days postoperatively. Follow-up periods ranged from 1 month to 4 years, allowing for the assessment of both short- and long-term outcomes. Regarding surgical techniques, two (5,14) studies utilised submucosal diathermy (SMD) for inferior turbinate reduction. One study (13) left the choice of turbinoplasty to the surgeon’s discretion, while two (15-16) did not specify the technique. Only one study randomised patients to either FESS with or without turbinoplasty, while in two studies, the decision to perform turbinoplasty was based on the surgeon’s evaluation of patient symptoms, endoscopic findings, and radiologic results. Two studies did not report the selection criteria. Outcomes and Findings None of the included studies reported on the need for revision surgery. Four studies evaluated Quality of Life (QoL) using various patient-reported outcome measures. Two used validated instruments - SNOT-22 and the Chronic Sinusitis Survey (CSS), whilst another employed a modified seven-item version of SNOT, and one utilised a 10-point visual analogue scale (VAS) (Table 2). Other QOL scoring systems used also included Rhinosinusitis Disability Index (RSDI) - a standardized 30-item survey, EuroQol 5 Dimension (EQ-5D ), Short Form 6-Dimension Health Utility Survey (SF-6D HUS) and the 36-Item Short Form Health Survey (SF-36). Olfactory function was evaluated in one study using the B-SIT (brief smell identification test) and SIT, a 12 and 40 item Smell Identification Test, respectively. Other additional outcomes, the final studies assessed included the Lund and Kenny Score, number of complications and percentage of readmissions. The results are summarized in Table 2 and Table 3 Quality of Life (QoL) All four studies (5,13-14,16) evaluating QoL demonstrated significant postoperative improvement in both FESS-only and FESS+BITR (bilateral inferior turbinate reduction) groups. However, only of these studies (5) , showed the group with FESS + BITR to have superior QoL outcomes than the group without BITR. One study (14) , again found significant improvement in CSS, SNOT-22, and RSDI scores when either a FESS was performed with or without BITR. However, in the BITR group, the improvement in CSS, SNOT-22 and RSDI was not clinically meaningful as it did not exceed the minimum clinically important difference (MCID). Also, when examining specifically at the nasal blockage/congestion item of SNOT-22, although nasal blockage symptoms improved more in the BITR group, the difference was not statistically significant. In a subgroup analysis, patients with chronic rhinosinusitis with nasal polyps (CRSwNP) showed significantly greater improvement in nasal obstruction with BITR (−3.67 ± 1.86 vs. −2.32 ± 1.78, p = 0.006). However, this difference was not significant in the CRSsNP subgroup (2.24[±1.60] vs 1.6[±1.50], p=0.076). Another study (13) reported significant improvements in SNOT-22, CSS, and EQ-5D scores over a 4-year follow-up in both groups, with no significant difference between FESS alone and FESS+BITR. Multivariate analysis confirmed that BITR was not an independent predictor of superior QoL improvement. The third study (16) , comparing FESS alone versus FESS+SMD, found no statistically significant difference in symptom scores at 12 months (mean improvement: 3.9 points greater with FESS+SMD, p = 0.321). One study (5) reported that FESS+BITR resulted in significantly greater improvement in NES, modified SNOT, and modified Lund-Kennedy scores at the 3-month follow-up compared to FESS alone. However, the short follow-up period (3 months) limited the generalizability of these findings. Olfaction The study assessing olfaction using the SIT found that BITR was not independently associated with significant improvement in full SIT scores, as defined by an increase of at least one MCID value (14) . Paediatric Readmission Rates The final study, which examined 30-day readmission rates in paediatric patients, found no increased risk associated with adjunctive turbinoplasty (15) . Among the 426 patients who underwent concurrent turbinectomy, none required readmission. Quality Assessment The RCT included in this study was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool whilst the cohort studies included were assessed using the Newcastle Ottawa Scale (NOS) (Tables 4a,4b). Overall the studies included were of high quality with low risk of bias. DISCUSSION Patient-reported outcome measures, such as the validated 22-item Sino-Nasal Outcome Test (SNOT-22), are increasingly recognized as a key measure of surgical success. This evaluates symptom burden, quality of life and post-operative well-being from the patient’s perspective in the form of a validated questionnaire. Although FESS alone has demonstrated significant improvements in SNOT-22 scores, the additive effect of turbinoplasty on these outcomes remains controversial (17) . Some studies report enhanced symptom relief when turbinoplasty is performed alongside FESS, whereas others suggest that the effect is minimal or transient (13) . This systematic review found that while both FESS alone and FESS with IT result in significant postoperative improvement, the added benefit of IT remains debatable. Notable improvements in QoL were seen in all the studies regardless of the addition of IT. Although only one reported a significant improvement in QoL outcomes with the inclusion of IT (5) . This study however has the shortest follow up period of three months, limiting its reliability. The other studies found no statistically significant difference with the combination of IT and FESS compared to FESS alone. Soudry et al (14) found a significant difference between pre- and post-operative outcomes for both FESS and FESS with ITR. However, statistical tests were not employed to assess the significance of difference between both interventions, which gives us limited information about the effectiveness of including ITR. Further subgroup analyses in one of the papers suggested CRS patients with nasal polyps (CRSwNP) may derive greater benefit from IT surgery. However, this effect was not observed in those without nasal polyps, demonstrating that there might be disease phenotype/endotype-specific benefits of IT despite no overall benefit. This warrants further investigation greater clarification for the subset of CRS patients who would benefit maximally from the addition of IT with FESS. Olfactory function is a critical but unfortunately often overlooked aspect of turbinate surgery. The nasal turbinates play a crucial role in airflow dynamics, in directing odorants toward the olfactory cleft. Thus, surgical modification could theoretically either improve or impair the sense of smell, with some studies suggesting improvement of olfactory function by improving airflow dynamics, whilst others indicating concerns about disruption to the olfactory pathway and causing empty nose syndrome (10) . Additionally, postoperative inflammation, crusting and mucosal healing may influence olfactory recovery (3) . Another study looking at olfactory function on patients undergoing septoplasty with partial inferior turbinectomy, found that although most patients experienced post-operative olfactory improvement, approximately 20% exhibited a moderate decrease in olfactory function, suggesting that IT can adversely affect the sense of smell in a subset of individuals (18) . Furthermore, the study evaluating paediatric readmission rates found no increased risk associated with additional IT at 30 days (15) . This suggests that, at least in paediatric populations, the addition of inferior turbinectomy does not increase morbidity in the short term post-operatively. This addresses a common concern amongst surgeons regarding potential complications and the safety and feasibility in this population, although larger paediatric studies are needed to confirm this finding. The results of this review are congruous with existing literature, which report mixed outcomes. Some studies highlight combining IT with FESS, can cause an improvement in nasal congestion and airflow. For example, one study demonstrated a significant post-operative improvement in mucociliary clearance, when assessing mucociliary function in patients undergoing nasal surgeries, including FESS+IT (19) . On the other hand, other studies have shown a negative outcome. For example, research has suggested an inferior turbinectomy can predispose patients to sinus infections, possibly because of alterations in nasal physiology and mucociliary clearance, causing patients to develop chronic sinusitis postoperatively (20) . Furthermore, in a randomised controlled trial looking at QoL outcomes between patients with endoscopic partial inferior turbinectomy (EPIT) combined with primary rhinoseptoplasty versus rhinoseptoplasty on their own, no significant difference was found in the two groups (21) . This suggested the addition of EPIT increases surgical time and potential general anaesthesia-associated morbidity without any significant improvement in postoperative outcomes. For instance, a 20% overall complication rate was found in a retrospective study evaluating early complications in patients undergoing inferior turbinectomy (22) . 9% of cases also had significant haemorrhage and other complications included adhesions, crusting, infection, and septal perforation. Another study on patients undergoing the surgery, reported complications such as synechiae (15%), atrophic rhinitis (15%), persistent obstruction (12%), and abnormal nasal sensation (9%) (23) . These complications demonstrate the potential complications of the surgery and how it can negate the intended benefits. A retrospective study on the surgical outcomes of inferior turbinectomy in mucormycosis patients highlighted a high recurrence of 21%, demonstrating the problem of relying solely on the surgery without tackling systemic factors such as glycaemic control and emphasises the routine addition of inferior turbinectomy should be reserved for specific patient profiles rather than applied universally (24) . Strengths and Limitations This systematic literature review supplies a thorough integration of the current evidence on FESS with and without inferior turbinate surgery. The inclusion of both adult and paediatric populations and with the inclusion of multiple outcomes, including QoL and olfaction, enhances the generalisability of the results. However, several limitations must be acknowledged. Firstly, there is heterogeneity between the papers. This includes heterogeneity in the surgical technique (e.g., submucosal diathermy, radiofrequency ablation), population, outcomes (as well as the tools used to assess these outcomes) and the follow-up period which overall limits the ability to draw definitive conclusions. Secondly, only one study incorporated randomisation, while the remaining studies were observational cohorts, adding risk of selection bias. Thirdly, some studies had a short follow up period of 3 months which could underestimate long-term benefits. Finally, there was exclusion of non-English studies and grey literature in this literature review which may have introduced publication bias, potentially skewing the results toward studies with significant findings. CONCLUSION The routine addition of IT surgery to FESS may not be universally beneficial. While it showed surgery did offer additional symptom relief in select patient subgroups, such as those with CRSwNP, its overall effect on QoL and olfactory outcomes appears limited thus the results be interpreted with caution. There is evidence for a patient selection criteria to be applied for this surgery, potentially limiting the use of IT surgery to patients with significant inferior turbinate hypertrophy or with nasal polyps. TABLES Table 1 . Study characteristics Author Country Year Study design Population Sample size Intervention Control Outcome measured F/u Manimaran et al (5) India 2023 RCT Adults CRS 80 FESS + SMD FESS NES, modified SNOT, Modified Lund Kennedy Endoscopic Scoring 1,2,3 months Scangas et a (13) US 2019 Cohort study Adults CRS 901 FESS + BITR FESS EQ-5D, SNOT-22, CSS 3, 12, 24, 36, 48 months Soudry et al (14) US 2019 Cohort study Adults CRS 571 FESS + BITR FESS SNOT 22, RSDI, CSS, SF-36, Lund-Mackay CT score, SIT score 6, 12, 18 months McKeon et al (15) US 2019 Retrospective cohort study Paediatric 2986 FESS + turbinoplasty FESS Readmission no. (%) 30 days Murthy et al (16) UK 2013 Cohort study > 16 years CRS 93 FESS + TR FESS Symptom score 4, 12 months Table 1. Summary of the characteristics of the five studies included in the systematic review. The table presents key details of each study, including author(s) and year of publication, study design, sample size, surgical intervention, outcome measures, and follow up period Study designs vary across the included studies, and sample sizes range from 80 to 2986 participants. Outcome measures differ between studies, reflecting the heterogeneity of the included research. Table 2 and Table 3. Summary of results of papers included in the systematic review. Table 2. Quality of life outcomes Study SNOT-22 (+ modified) CSS NES RSDI total EQ5-D Symptom score SF-6D HUS SF36 general health FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR Manimaran et al (5) 9.00 ± 3.08 6.00 ± 1.81 - - 4.05 ± 1.66 2.38 ± 0.89 - - - - - - - - - Scangas et a (13) −21.0 −28.2 23.41 34.29 - - - - 0.077 0.083 0.12 - - - - - Soudry et al (14) -24.3 -27.8 21.2 35.6 - - -19.7 -25.3 - - - - 0.09 0.08 4.5 10.6 McKeon et al (15) - - - - - - - - - - - - - - - - Murthy et al (16) - - - - - - - - - - - 3.9 (-3.9 to 11.6) - - - - \ Table 3: Clinical Outcomes Study Lund and Kennedy (+ modified) Complications SIT B-SIT Readmission % FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR FESS FESS + BITR Total FESS FESS + BITR Manimaran et al (5) 3.35 ± 1.46 2.50 ± 0.84 - - - - - - - - Scangas et a (13) - - 4/788 1/113 - - - - - - Soudry et al (14) -3.1 -1.9 - - 2.2 0 0.1 0.7 - - McKeon et al (15) - - - - - - - - 4% 3.90% Murthy et al (16) Table 2 and 3. Quality of life outcomes include the Sinonasal Outcome Test (SNOT-22), Chronic Sinusitis Survey (CSS), Nasal endoscopy score (NES), Rhinosinusitis Disability Index (RSDI), EuroQol 5 Dimension (EQ5-D), symptom score, Short Form 6-Dimension health utility survey (SF-6D HUS), Short-for health survey (SF36 general health). Clinical outcomes included Lund and Kennedy score, number of complications, Brief Smell Identification Test (SIT and B-SIT) and percentage of readmissions. Manimaran et al utilised a modified SNOT scoring system using only 7 parameters, and modified Lund Kennedy endoscopic scoring system using 4 parameters. Results were described as the mean + standard deviation (SD) at the 3 month period. Results by Scangas et al. and Soudry et al. were recorded as a change in the mean outcome measure over time at the end of the study. Scangas et al. noted 5 cases of epistaxis requiring admission following surgery, where 1 of those cases underwent BITR. McKeon et al. recorded the number of readmissions in FESS with turbinectomy, which showed no significant difference compared to FESS. Murthy et al assessed Symptoms Scores at 12 months using linear regression analysis. Results were noted as: Effect (95% CI). Table 4a,4b. Quality assessment and risk of bias Study Representativeness of the exposed cohort Selection of the non-exposed cohort Ascertainment of exposure Outcome not present at start Comparability of cohorts (design or analysis) Assessment of outcome Was follow-up long enough for outcomes to occur? Adequacy of follow-up of cohorts Total Scangas et al (13) ☆ ☆ ☆ ☆ ☆☆ ☆ ☆ x 8/9 Soudry et al (14) ☆ ☆ ☆ ☆ ☆☆ ☆ ☆ x 8/9 McKeon et al (15) ☆ x ☆ ☆ ☆☆ ☆ ☆ ☆ 8/9 Murthy et al (16) ☆ x ☆ ☆ ☆☆ ☆ ☆ x 7/9 Table 4a. Newcastle Ottowa Scale (NOS) for assessing the quality of cohort studies included in this systematic review. Scangas et al demonstrated strong selection and comparability components, and robust outcome measurement. However, high dropout rates especially in later years could introduce potential attrition bias (down to 31% by year 4). Soudry et al also produced a high quality study scoring 8/9 due to moderate loss to follow-up (~35%). McKeon et al scored 8/9 stars due as it lacked a comparison to a non-surgical control group. Murthy et al scored 9/7 for lack of a non-exposed cohort and limited information on follow-up completeness. Table 4b. Quality assessment using the Cochrane Risk of Bias 2.0 (RoB 2) tool for Randomised Controlled Trials. References 1. 1. Van Delden MR, Cook PR, Davis WE. Endoscopic partial inferior turbinoplasty. Otolaryngol Head Neck Surg. 1999;121(4):406-409. 2. Karamatzanis I, Kosmidou P, Ntarladima V, et al. Inferior turbinate hypertrophy: a comparison of surgical techniques. Cureus. 2022;14(12):e32579. 3. Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg. 1999;103(1):300-312. 4. Cook PR. 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Am J Rhinol. 1998;12(4):257-261. 21. De Moura BH, Migliavacca RO, Lima RK, et al. Partial inferior turbinectomy in rhinoseptoplasty has no effect on quality-of-life outcomes: a randomized clinical trial. Laryngoscope. 2018;128(1):57-63. 22. Dawes PJ. The early complications of inferior turbinectomy. J Laryngol Otol. 1987;101(11):1136-1139. 23. Oburra HO. Complications following bilateral turbinectomy. East Afr Med J. 1995;72(2):101-102. 24. Rajagopal A, Yashveer JK, Gondane B, Ambulker M. Post-COVID-19 mucormycosis: a retrospective study to analyze risk factors and surgical outcomes. Int J Pharmacol Clin Res. 2023;15(11):871-874. Google Scholar Information & Authors Information Version history V1 Version 1 15 July 2025 Peer review timeline Published Cureus Version of Record 16 Nov 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords endoscopic sinus surgery general quality of life rhinitis rhinology smell Authors Affiliations Suliman Ali 0000-0001-5111-6781 [email protected] Northampton General Hospital Richmond Library View all articles by this author Avenie Mavadia Northampton General Hospital Richmond Library View all articles by this author Alf Cuddeford Northampton General Hospital Richmond Library View all articles by this author Zahra Mubaarak Northampton General Hospital Richmond Library View all articles by this author Yadsan Devabalan 0000-0001-6389-8397 Northampton General Hospital Richmond Library View all articles by this author Chuanyu Gao Northampton General Hospital Richmond Library View all articles by this author Remo Accorona Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda View all articles by this author Haissan Iftikhar Northampton General Hospital Richmond Library View all articles by this author Metrics & Citations Metrics Article Usage 339 views 244 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Suliman Ali, Avenie Mavadia, Alf Cuddeford, et al. The Role of Inferior Turbinoplasty in Endoscopic Sinus Surgery: A Systematic Review. Authorea . 15 July 2025. DOI: https://doi.org/10.22541/au.175255756.60439733/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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