Nasal airway resistance in patients with different degrees of operated unilateral cleft lip: Evaluation of ventilation in 112 patients.

OBJECTIVE: The aim of this study was to compare the nasal airway resistance between the cleft and non-cleft sides in operated unilateral cleft lip (UCL) patients with varying severities at birth, as well as to assess the differences in nasal airway resistance between UCL patients and healthy individuals. METHODS: This retrospective study was conducted on 112 UCL patients who have undergone primary lip reconstructions but not advanced surgeries as the study group and 20 healthy participants as the control group between February 2023 to March 2024. The study group patients were grouped based on the severity of their cleft lip at birth, divided into occult cleft lip group, incomplete cleft lip group, and complete cleft lip group. The anterior rhinomanometry was used to evaluate nasal resistance, including unilateral effective resistances during inspiration (Reffin), expiration (Reffex), and the entire breath (ReffT), as well as unilateral vertex resistance during inspiration (VRin) and expiration (VRex). The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were utilized to analyze the differences in nasal resistance between the healthy and affected sides within the same group of patients. Student's t-test was used to analyze the differences in nasal resistance among patients with different degrees of cleft lip. A p-value of <0.05 was considered statistically significant. RESULTS: The nasal resistances of the occult cleft and incomplete cleft lip groups showed no significant differences between the cleft and non-cleft sides, and were similar to the control group. However, in the complete cleft lip group, the cleft side nasal resistance was significantly higher than the non-cleft side and control group. Among the groups, the complete cleft lip group had significantly higher nasal resistances on the cleft side for Reffin, VRin, and ReffT compared to the occult cleft group. CONCLUSION: Understanding the nasal resistance of different degrees of operated UCL patients can benefit clinical diagnosis and treatment. Patients with complete cleft lip have more severe nasal obstruction on the cleft side, with greater impact on inhalation than exhalation. For these patients, treatment by an otolaryngologist is recommended to improve nasal airflow.

Computational fluid dynamics (CFD), virtual rhinomanometry, and virtual surgery for neonatal congenital nasal pyriform aperture stenosis.

OBJECTIVES: Investigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention. METHODS: CT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared. RESULTS: In the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery. CONCLUSION: CFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.

Impact of posture and CPAP on nasal airflow.

Obstructive sleep apnea (OSA) patients who use continuous positive airway pressure (CPAP) often complain of nasal dryness and nasal obstruction as side effects of CPAP. The physiological mechanisms by which CPAP may cause nasal dryness and nasal obstruction remain poorly understood. It has been hypothesized that CPAP interferes with the nasal cycle, abolishing the resting phase of the cycle and leading to nasal dryness. We performed rhinomanometry measurements in 31 OSA patients sitting, laid supine, and supine after 10 min of CPAP at 10 cmH2O. A posture change from sitting to supine led to more symmetric airflow partitioning between the left and right nostrils in the supine position. CPAP did not have a significant impact on nasal resistance, unilateral airflows, or airflow partitioning. Our results suggest that airflow partitioning becomes more symmetric immediately after changing to a supine position, while CPAP had no effect on nasal airflow, thus preserving the nearly symmetric airflow partitioning achieved after the posture change.

"Functional Rhinofiller": Improvement of Nasal Airflow with Rhinofiller-A Retrospective Review.

INTRODUCTION: Rhinofiller is an aesthetic medical technique that can significantly enhance facial aesthetics by employing hyaluronic acid infiltration. The aim of this study is to review the impact of aesthetic rhinofiller on nasal airflow. METHODS: This is a retrospective review of 63 consecutive patients. The evaluation of the change in nasal respiratory flow was performed subjectively using a Likert questionnaire and objectively using a rhinomanometer, which enabled active anterior rhinomanometry (AAR). Data were collected at pre-intervention, post-intervention, and at 6-month follow-up. RESULTS: Among the 63 patients, the questionnaire responses resulted statistically significant both after the treatment and at the 6-month follow-up (p=0.00001). A statistically significant improvement was also observed at the rhinomanometric evaluation between pre-intervention and post-intervention (p=0.006 at 74 Pa, p=0.002 at 100 Pa, and p=0.001 at 150 Pa) and at the 6-month follow-up (p=0.008 at 74 Pa, p=0.003 at 100 Pa, and p=0.002 at 150 Pa). Differences between results were established with a Student's t-test. All p-values were two-tailed, and a value < 0.05 was considered significant. CONCLUSIONS: Rhinofiller can be a valuable aid in enhancing both nasal airflow and facial aesthetics. Based on our experience, it resulted in an immediate post-operative improvement in nasal airflow that remains stable in the subsequent 6 months. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . IV: Non-Surgical Procedures.

Objective nasal airflow measures in relation to subjective nasal obstruction, trigeminal function, and olfaction in patients with chronic rhinosinusitis.

BACKGROUND: This study aimed to determine how nasal airflow measures and trigeminal function vary among patients with chronic rhinosinusitis (CRS) versus healthy controls and whether these measures are correlated with subjective nasal obstruction (SNO), olfactory function, and CRS control. METHODOLOGY: Participants included CRS patients and healthy controls. After a structured medical history, nasal airflow (peak nasal inspiratory flow [PNIF]; active anterior rhinomanometry [AAR]), trigeminal function (trigeminal lateralization test, CO2 sensitivity), and olfactory "Sniffin's Sticks" odor identification test) tests were performed. SNO ratings were also obtained. RESULTS: Sixty-nine participants were included (37 men, 32 women, mean age 51 years). There was no significant difference for objective nasal airflow between patients and controls, but CRS patients had worse SNO, trigeminal function, and olfaction compared to controls. SNO, but not objective nasal airflow tests, was negatively correlated with CO2 sensitivity and odor identification. CONCLUSION: The perception of nasal obstruction does not only depend on nasal airflow, but may also be modulated by trigeminal function and other factors. Thus, the role of objective nasal airflow measures as a sole method of functional nasal obstruction assessment in CRS remains limited.

The influence of flowmeters on rhinomanometry results and detection of nasal airflow asymmetry.

<b><br>Introduction:</b> Rhinomanometry is an otolaryngological diagnostic method used to determine airflow as a function of the pressure drop through the left and right nasal cavities. Airflow is measured using orifice flowmeters that attenuate the flow.</br> <b><br>Aim:</b> This paper describes the results of a study into the effects of flowmeter design on rhinomanometry results and detection of nasal airflow asymmetry.</br> <b><br>Material and methods:</b> Four flowmeters were examined using a 3D printed model of a human nose.</br> <b><br>Conclusions:</b> Each flowmeter interfered with the rhinomanometry results.</br>.

Overview of Nasal Airway and Nasal Breathing Evaluation.

Several methods are available for evaluating nasal breathing and nasal airflow, as this evaluation may be made from several different perspectives.Physiologic methods for nasal airway evaluation directly measure nasal airflow or nasal airway resistance, while anatomical methods measure nasal airway dimensions. Subjective methods evaluate nasal breathing through several validated patient-reported scales assessing nasal breathing. Computational fluid dynamics evaluates nasal airflow through the analysis of several physics' variables of the nasal airway.Being familiar to these methods is of utmost importance for the nasal surgeon to be able to understand data provided by the different methods and to be able to choose the combination of evaluation methods that will provide the information most relevant to each clinical situation.

Algorithm for Nasal Breathing Impairment Evaluation.

Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations that could impair nasal airflow. Not infrequently, however, symptoms of nasal obstruction do not match the clinical examination of the nasal airway. Addressing this subset of patients may be a challenge to the surgeon. Evaluation of patients with symptoms of nasal obstruction should include a combination of a patient-reported assessment of nasal breathing and at least one objective method for measuring nasal airflow or nasal airway resistance or dimensions. This will allow distinction between patients with symptoms of nasal obstruction and low airflow or high nasal airway resistance and patients with similar symptoms but whose objective evaluation demonstrates normal nasal airflow or normal airway dimensions or resistance. Patients with low nasal airflow or high nasal airway resistance will require treatment to increase nasal airflow as a necessary step to improve symptoms, whereas patients with normal nasal airflow or nasal airway resistance will require a multidimensional assessment looking for less obvious causes of impaired nasal breathing sensation.

Nasal Obstruction: Overview of Pathophysiology and Presentation of a Clinically Relevant Preoperative Plan for Rhino(Septo)plasty.

Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery.

Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement.

OBJECTIVE: Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS: A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS: Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1437-1444, 2024.

Impact of different fracture types in the pyriform buttress area on nasal airway function.

INTRODUCTION: Fractures in the pyriform buttress area adversely affect facial appearance and nasal airway patency. Nasal airway function has received less attention than aesthetic problems in the literature. This retrospective study classified the different fracture types in this area and determined their impact on nasal airway function. MATHODS: Three-dimensional computed tomography images of patients with fractures in the pyriform buttress area were analyzed to identify the exact fracture pattern. The nasal airway functions were evaluated and compared between patients with different fracture patterns using acoustic rhinometry, rhinomanometry, and the nasal obstruction symptom evaluation scale. RESULTS: Overall, 47 patients, including 16 with type I fractures (high fracture line; group I), 16 with type II fractures (intermediate fracture line; group II), and 15 with type III fractures (low fracture line; group III), were included in the study. The mean minimal cross-sectional area (MCA), total nasal inspiratory resistance (Tri) and total nasal expiratory resistance (Tre) of group I were 0.51 ± 0.06 cm2, 1.67 ± 0.11 kPa L-1 s-1, and 1.66 ± 0.12 kPa L-1 s-1, respectively; those of group II were 0.48 ± 0.07 cm2, 1.89 ± 0.15 kPa L-1 s-1, and 1.88 ± 0.14 kPa L-1 s-1, respectively; and those of group III were 0.36 ± 0.04 cm2, 1.94 ± 0.21 kPa L-1 s-1, and 2.01 ± 0.34 kPa L-1 s-1, respectively. The nasal obstruction symptom evaluation (NOSE) scale scores for groups I, II, and III were 7.188, 9.813, and 13.27, respectively. CONCLUSION: Therefore, the severity of the nasal airway obstruction depends on the displacement of the fractured bones in patients with fractures in the pyriform buttress area. The most profound nasal obstruction occurs in patients with the lowest fracture line.

Peak Nasal Inspiratory Flow (PNIF) for Nasal Breathing Evaluation.

Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or dimensions provide valuable data but are time-consuming and require expensive equipment and trained technicians, thus making these methods less practical for clinical practice. Peak nasal inspiratory flow (PNIF) measurement is fast, unexpensive, noninvasive, and able to provide an objective evaluation of nasal airflow in real-time. Unilateral PNIF measurements allow separated evaluation of each side of the nasal airway and may prove particularly useful when clinical assessment detects significant asymmetry between both nasal cavities.PNIF measurements are most useful for assessing changes in nasal airflow achieved by any form of therapy, including surgical treatment of the nasal airway. These measurements generally correlate with other objective methods for nasal airway evaluation, but not unequivocally with patient-reported evaluation of nasal breathing. Nevertheless, as low PNIF values prevent the sensation of a suitable nasal breathing, PNIF measurement may also prove useful to optimize the decision of how to best address patients with complaints of nasal airway obstruction.

Numerical Simulation of Nasal Resistance Using Three-dimensional Models of the Nasal Cavity and Paranasal Sinus.

OBJECTIVE: Previously, we used a nasal cavity model to analyze the intranasal airflow dynamics and numerically calculate the nasal resistance value. In this study, We attempted clarify the parameters influencing nasal resistance by newly developed computer model. METHODS: The computer simulation model was developed from the structures of nasal airway tract adopted from 1.0-mm slice computed tomography (CT) obtained from the 2 of the healthy volunteers. (model 1: the one at 35-year-old man, model 2: 25-year-old man.) We have calculated the nasal resistance by computer simulation calculations of both model 1 and model 2. These calculated values were compared with the values obtained from the established method of rhinomanometry. For the simulation, Fluent 17.2® (ANSYS, American) was employed for f luid a nalysis u sing the continuity equation for 3D incompressible flow and the Navies-Stokes equation for the basic equations. Both models were laminar models. The SIMPLE calculation method using the finite volume method was employed here, and the quadratic precision upwind difference method was used to discretize the convection terms. RESULTS: The measured (simulation) values in Model 1 were 0.69 (0.48), 1.10 (0.41), and 0.42 (0.22) Pa/cm3/s on the right, left, and both sides, whereas those in Model 2 were 0.72 (0.21), 0.32 (0.09), and 0.22 (0.06) Pa/cm3/s, respectively. CONCLUSION: Our results suggest that nasal resistance is possibly affected by the length of the inferior turbinate and the cross-sectional area of the choana and nasopharynx. Further experiments using additional nasal cavity and paranasal sinus models are warranted.

[Substantiating reference values of active anterior rhinomanometry in children aged 4-14]. / Obosnovanie referensnykh znachenii perednei aktivnoi rinomanometrii u detei v vozraste 4­14 let.

RELEVANCE: Objective diagnostics of nasal breathing disorders in children is a vital issue given frequent inconsistency between patients' subjective feelings and actual nasal patency. Active anterior rhinomanometry (AAR) is an objective procedure and the golden standard for nasal breathing evaluation. But still, there are no actual data in literature on relevant criteria used to evaluate nasal breathing in children. OBJECTIVE: To determine reference values for indicators evaluated by active anterior rhinomanometry in Caucasian children aged 4-14 based on statistical data. MATERIAL AND METHODS: Overall, we examined 659 healthy children of both sexes who were divided into 7 groups as per their height. All children included into our research underwent AAR according to the conventional procedure. AAR indicators (Summary Flow left, Summary Flow right, Summary Flow, Summary Resistance left, Summary Resistance right and Summary Resistance Flow) are given as median (Me) and values of 2.5, 25, 75, and 97.5 percentiles. RESULTS: We determined direct moderate, significant and strong correlations between summary speed of the flow and resistance in both nasal passages and separate speeds of the flow and right and left resistance in inhalation and exhalation (r=0.46-0.98, p<0.001). We also established weak correlations between AAR indicators and age (r= -0.08-0.11), and between ARR indicators and height (r= -0.07-0.15). Reference values for AAR indicators were successfully determined. CONCLUSIONS: AAR indicators are likely to be determined bearing a child's height in mind. Determined reference intervals can be applied in clinical practice.

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome.

Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50-66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7-61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4-3.9)/hour and the usage time was 318 (IQR 226-397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.

Correlations between objective and subjective tests of nasal patency in patients undergoing septoplasty.

OBJECTIVE: This study assessed correlations between pre- and post-operative objective and subjective nasal patency test results in patients undergoing septoplasty to treat nasal septum deviation. METHOD: Eighty nasal septum deviation patients who underwent septoplasty were prospectively enrolled. Nasal Obstruction Symptom Evaluation questionnaire scores, anterior rhinomanometry and acoustic rhinometry data were compared pre-operatively and three months after surgery. The left, right and total volume and left, right and total minimum cross-sectional area acoustic rhinometry values were compared. RESULTS: The left volume, total volume, left minimum cross-sectional area and total minimum cross-sectional area differed significantly between the two time-points (all p < 0.05). The total resistance, inspiratory total airflow, expiratory total resistance and expiratory total airflow rhinomanometric data did not differ between the two timepoints (all p > 0.05). CONCLUSION: This study suggested that subjective tests such as the Nasal Obstruction Symptom Evaluation questionnaire are optimal to identify complaints and assess post-operative satisfaction.

Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales.

BACKGROUND: Dorsal preservation techniques have been preferred and gained popularity in recent years. The current study compares the effects of dorsal preservation and dorsal reduction rhinoplasty on nasal patency and aesthetic outcomes by using Patient-Reported Outcome Measures (PROMs) and rhinomanometry. To our knowledge, this is the first study to compare dorsal preservation and dorsal reduction techniques with rhinomanometry. METHODS: This is a prospective study of 34 patients who underwent rhinoplasty between January 2021-June 2022. The patients were randomly selected preoperatively and divided into two groups as structural rhinoplasty (SR) and preservation rhinoplasty (PR). Nasal Obstruction and Symptom Evaluation (NOSE), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scales and rhinomanometric evaluation were performed preoperatively, at 3rd month and 12th month postoperatively. RESULTS: Nineteen patients (10 female, 9 male) were in SR group, 15 patients (7 female, 8 male) were in PR group. There was not significant difference in terms of age and gender between groups. In both groups, NOSE, SCHNOS-O and SCHNOS-C results were found to be significantly lower at postoperative 3rd and 12th month compared to preoperatively (p < 0.001 for the entire SR group, p = 0.001 for the entire PR group). There was no significant difference between groups in terms of PROMs. Mean total nasal volume (TNV) at 12th month were statistically higher than preoperative value in PR group (p = 0.031). Also there was no significant difference in SR group and between groups in terms of rhinomanometry results. CONCLUSION: Dorsal preservation with pushdown technique provides good functional and aesthetic results comparable with structural rhinoplasty. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . A well-designed prospective clinical trial.

Evaluation of nasal airway resistance in a cohort of children with primary snoring and maxillary deficiency.

BACKGROUND: The aim of this study was to test whether rapid palatal expansion is effective to improve nasal airway patency in a sample of pediatric patients with primary snoring. METHODS: A group of 21 subjects, 11 girls (52%) and 10 boys (48%), with a mean age of 7.1 years (SD=1.3; range 4-9 years) were treated with a rapid maxillary expansion (RME) device. Nasal airway resistance was assessed via rhinomanometric exam before (pre-) and 6 months after (post-) the rapid palatal expansion treatment. RESULTS: Data analysis showed a statistically significant increase in the mean scores of the results of the rhinomanometric exam between the pre- and post-measurements with a significant reduction in total inspiratory and expiratory air resistance values after rapid palatal expansion. CONCLUSIONS: Our results show that RME treatment is associated with an improvement in nasal airway resistance due to a substantial reduction in nasal resistance associated with the orthopedic action of the orthodontic device.

Systematic Review of Surgical Interventions for Inferior Turbinate Hypertrophy.

BACKGROUND: Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique. OBJECTIVE: This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques. METHODS: PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT). RESULTS: A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery.All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3-6 months follow-up. CONCLUSIONS: All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year.