A COMPARATIVE ANALYSIS OF SUBMUCOSAL DIATHERMY VERSUS PARTIAL INFERIOR TURBINECTOMY IN THE MANAGEMENT OF NASAL OBSTRUCTION: FOCUS ON POSTOPERATIVE BLEEDING – A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Nasal obstruction due to inferior turbinate hypertrophy is a frequent complaint in otorhinolaryngology practice and is often associated with chronic rhinitis, significantly affecting quality of life. When medical management fails, surgical reduction of the inferior turbinate becomes necessary. Among the commonly performed procedures, submucosal diathermy and partial inferior turbinectomy are widely practiced; however, their comparative safety, particularly regarding postoperative bleeding, remains a subject of debate, necessitating further evidence from controlled clinical studies.

Objective: To compare the incidence of postoperative bleeding between submucosal diathermy and partial inferior turbinectomy in patients with nasal obstruction secondary to inferior turbinate hypertrophy.

Methods: A prospective randomized controlled trial was conducted at Ayub Teaching Hospital, Abbottabad, from July 2021 to January 2023. A total of 128 patients aged 20–40 years with nasal obstruction of at least three months’ duration and clinically confirmed inferior turbinate hypertrophy were enrolled and randomized equally into two groups. Patients with significant septal deviation, bleeding disorders, sinonasal pathology, or prior nasal surgery were excluded. Surgical interventions were performed under local anesthesia, and postoperative bleeding was assessed during a one-week follow-up period. Data were analyzed using SPSS version 21, with categorical variables compared using the chi-square test and a significance level set at ≤0.05.

Results: The mean age of participants was 30.05 ± 6.00 years, with males comprising 64.1% of the cohort. Postoperative bleeding was observed in 33 patients overall. A significantly higher frequency of bleeding was noted following partial inferior turbinectomy, affecting 27 patients (42.2%), compared with 6 patients (9.4%) in the submucosal diathermy group (p < 0.001). No statistically significant association was found between postoperative bleeding and age or gender. Patients undergoing submucosal diathermy also experienced less early postoperative pain and crusting.

Conclusion: Submucosal diathermy demonstrated a substantially lower risk of postoperative bleeding and reduced early morbidity compared with partial inferior turbinectomy, supporting its role as a safer surgical option for patients with mucosal-predominant inferior turbinate hypertrophy.