J Gandhara Med Dent Sci

ORIGINAL ARTICLE

July - September 2026

How to cite this article

COMPARISON OF OUTCOMES OF PARTIAL TURBINECTOMY VERSUS MUCOSAL DIATHERMY

IN PATIENTS WITH INFERIOR TURBINATE HYPERTROPHY

Aqsa Yaqub Muhammad Zeeshan Ashraf

, Sarfraz Latif

, Rabia Aftab

, Muhammad Israr

, Zia Us Salam

Ashraf MZ, Yaqub A, Latif S, Aftab

R, Israr M, Salam ZU. Comparison o

Outcomes of Partial Turbinectomy

Versus Mucosal Diathermy in Patients

with Inferior Turbinate Hypertrophy. J

Gandhara Med Dent Sci.

2026;13(3):03-08.

Date of Submission: 15-01-2026

Date Revised: 04-06-2026

Date Acceptance: 18-06-2026

Associate Professor, Department of

ENT, Shaikh Zayed Hospital, Lahore

Consultant, Department of ENT, Shaikh

Zayed Hospital, Lahore

Correspondence

Muhammad Zeeshan Ashraf,

Postgraduate Resident, Department of

ENT, Shaikh Zayed Hospital, Lahore

+92-348-6504550

zeeshansmdc@gmail.com

ABSTRACT

OBJECTIVES

To compare the outcomes of partial turbinectomy versus mucosal diathermy

in patients with inferior turbinate hypertrophy.

METHODOLOGY

The ENT Department at Sheik Zayed Hospital, Lahore, conducted this

single-center, non -randomized, controlled study. Sixty adults aged 18-60

years with clinically and radiologically conrmed inferior turbinate

hypertrophy were selected and sequentially assigned to two equal groups

upon screening and informed consent. Group A had partial inferior

turbinectomy (PIT), whereas Group B had submucosal diathermy (SMD).

Comparison of the groups with the baselines was conducted. Variability in

operators was minimized using a standardized operative protocol. The pain

after the operation was measured using a 10-point Visual Analog Scale

(VAS), nasal obstruction was measured on a 0-3 scale, nasal crusting was

graded using the Lund and Kennedy system, and endoscopic assessment

assessed tissue healing. The three-month follow-up was made.

RESULTS

There was similarity between groups in baseline demographic and clinical

variables. Mean postoperative pain was signicantly lower in the SMD g roup

than in the PIT group on day 1 (mean dierence 2.67; 95% CI 2.14-3.20;

Cohen's d=2.61; p=0.0001) and at one month (mean dierence 1.83; 95% CI

1.43-2.23; Cohen's d=2.36; p=0.0001). Nasal obstruction, crusting, and

bleeding outcomes in the nasal passages were numerically predisposed to

SMD, although a majority of between-group comparisons were non-

signicant. The SMD group exhibited a statistically signicantly higher

(0.003) good tissue healing at three months (76.67%) compared with the PIT

group (33.33%).

CONCLUSION

SMD, in this non-randomized study, was associated with less postoperative

pain and faster tissue healing at 3 months compared to PIT. Other clinical

outcomes showed positive trends in SMD but should be used with caution due

to small sample sizes, non-random subject allocation, and limited follow-up..

KEYWORDS: Submucosal Diathermy, Partial Turbinectomy, Nasal

Obstruction

effectiveness often diminishes with long-term use.

Surgery aims to reduce the bulk of the inferior

turbinates, enhance nasal patency, and preserve

physiological nasal function.

To achieve signicant

patient outcomes, surgical treatment options have been

devised to address the symptoms of turbinate

hypertrophy. Examples of traditional methods of

surgery include partial inferior turbinectomy (PIT),

submucosal diathermy (SMD), electrocautery, laser

cautery, cryosurgery, and radiofrequency ablation.

Turbinectomy oers instant relief by removing

hypertrophic tissue, but its mainstream acceptability is

restricted by the hazards involved, including bleeding,

crust development, synechiae, and postoperative pain.

4,5

As a result, minimally invasive methods like

submucosal diathermy have drawn interest since they

INTRODUCTION

The hypertrophy of the inferior turbinate is a major

cause of nasal airow obstruction, leading to persistent

nasal congestion and reduced quality of life. It usually

results from chronic inammatory disorders, such as

allergic rhinitis and vasomotor rhinitis, or secondary

compensatory hypertrophy due to septal deviation, and

is regularly seen in otolaryngology clinical practice.

Mucosal thickening and submucosal brosis are

common symptoms of chronic inammatory

alterations, which eventually result in persistent nasal

blockage that is resistant to medical intervention.

Examples of conservative treatment options include

intranasal corticosteroids, antihistamines,

decongestants, and immunotherapy; however, their

https://doi.org/10.37762/jgmds.13-3.852

J Gandhara Med Dent Sci

July - September 2026

can successfully lower turbinate volume while causing

the least amount of tissue damage. High-frequency

electrical currents are used in submucosal diathermy to

produce controlled submucosal thermal injury and

consequent brosis, resulting in a long-term decrease in

turbinate size. Notwithstanding its widespread use,

submucosal diathermy has been linked to postoperative

side eects, including crusting, nasal dryness, adhesion

formation, and sporadic hypertrophy recurrence. As a

result, physicians are looking into alternative surgical

methods that may yield better results.

6,7,8

There is still a

conspicuous lack of clear evidence to guide clinicians

over the best surgical method between submucosal

diathermy and partial inferior turbinectomy, despite the

abundance of research. The conicting ndings of

previous studies on both the immediate safety and long-

term eectiveness of the treatment make it critically

important to conduct more comparative studies. The

current study aims to bridge this gap by systematically

assessing clinical outcomes, complication rates, and the

sustainability of symptom relief following these two

common surgical procedures. This research should lead

to better patient outcomes in the treatment of inferior

turbinate hypertrophy, provide valuable clinical

guidance, and support evidence-based therapeutic

decision-making.

METHODOLOGY

This is a single-center, non-randomized controlled

study conducted in the ENT Department at Sheik Zayed

Hospital, Lahore, between September 2025 and

December 2025, with the consent of the institutional

ethical review committee. The research was structured

as a pragmatic comparison since the practice of both

interventions was common in the department.

Randomization and allocation concealment were not

performed. Eligible patients were sequentially assigned

to two equal treatment groups after eligibility screening

and written informed consent, based on the intended

surgical procedure in routine departmental practice; this

pragmatic allocation approach was used because both

procedures were already routinely performed in the

unit. It has been recognized that this allocation method

could introduce selection bias and, therefore, limit

internal validity. Given a condence level of 95 and a

power of 80, assuming that the percentage of excellent

healing would be 60 percent with PIT and 84 percent

with SMD, with 30 patients in each group, patients aged

18-60 years old with inferior turbinate hypertrophy

(enlargement of the inferior turbinate to produce a

clinically signicant nasal obstruction) were the

participants. Clinical evaluation and diagnostic nasal

endoscopy, performed by a consultant ENT specialist,

were used to make the diagnosis. When the inferior

cavity, hypertrophy was deemed clinically signicant,

which is grade 2 (moderate hypertrophy, 50-75 percent

of the nasal cavity) or grade 3 (severe hypertrophy, > 75

percent of the nasal cavity or touching the nasal

septum). Radiological conrmation Computed

tomography (CT) of the coronal, axial, and sagittal

sections of the scan, with a slice thickness of 2 mm and

a maximum diameter of the turbinate, was used to

obtain radiological conrmation. Other inclusion

criteria included persistent nasal obstruction for over six

months and an ineective response to at least three

months of conservative medical treatment, including

intranasal corticosteroids and antihistamines. Patients

who had nasal obstruction that had been treated with

nasal polyps, septal deviation, sinuitis or any other

major sinonasal disease; uncontrolled allergic rhinitis or

ongoing immunotherapy; previous nasal or turbinate

surgery; defective state of the nasal mucosa, including

Wegener granulomatosis, sarcoidosis, or cystic brosis;

bleeding disorders or anticoagulant therapy; inability to

comply with the study protocol; and cognitive

impairment to hinder understanding and compliance

were excluded. All participants had written informed

consent. Age at baseline, sex, symptom duration,

preoperative grade of hypertrophy of the turbinate, and

preoperative grade of nasal obstruction were measured

prior to surgery to compare the groups. They were all

carried out in accordance with a prescribed

departmental protocol, under the direct supervision of

the same senior ENT consultant, to minimize operator

variability. All surgeries were performed by means of

oral intubation and general anesthesia. Premedication -

Cotton pledgets moistened with noradrenaline

(1:200000) were placed in each nasal canal for about 5

minutes to reduce bleeding and enhance visibility.

Group A: Partial Inferior Turbinectomy (PIT): The

inferior turbinate was seen with an endoscope or nasal

speculum following just sucient decongestion and

anesthesia. The scissors were turbinectomy scissors

used to excise the medial one-third of the superior

hypertrophied inferior turbinate, including the mucosal

and bony portions. Only the anterior two-thirds of the

turbinate was resected to avoid leaving the posterior

turbinate and to minimize the possible loss of too much

tissue. Bleeding points were managed with caution of

bipolar or nasal packing, when necessary. Group B:

Submucosal Diathermy (SMD): The inferior turbinate

was exposed, then an insulated diathermy needle was

inserted into the submucosal space at the anterior of the

turbinate and moved parallel to the bone. A low volume

of coagulation current was used, with a 70-watt low-

voltage current applied as the needle was gradually

drawn out. The superior, middle, and inferior portions

of the turbinate were covered by two to three passes

until there was blanching and visible shrinkage of the

turbinate occupied 50 percent or more of the nasal

Comparison of Outcomes of Partial Turbinectomy Versus Mucosal Diathermy

J Gandhara Med Dent Sci

July - September 2026

mucosa. The mucosal surface was maintained as much

as possible, and submucosal thermal injury was

restricted to induce brosis and reduce the volume.

Before the procedure was completed, Hemostasis was

achieved. In both groups, the bilateral nostrils were

packed with ribbon gauze immersed in antibiotics

overnight. Patients were given systemic decongestants,

antibiotics, and analgesics as per the departmental

postoperative protocol, and packing was done after 48

hours. Patients were advised not to blow their noses or

manipulate them. To enhance comfort and promote

mucosal healing, nasal saline irrigation was

recommended 1 month after the pack was removed.

Postoperative treatment involved the use of systemic

decongestants, antibiotics, and painkillers. Patients

were advised not to rub their noses or blow them. Nasal

saline irrigation was advised to be performed over one

month after nasal packs were removed at 48 hours to

facilitate healing and comfort. Each problem was

risk dierences or Cramér's V (categorical outcomes).

A p-value less than 0.05 was taken as statistically

significant.

addressed in accordance with the accepted guidelines.

Predened criteria and predetermined intervals were

used to evaluate outcomes. On the rst day of the

postoperative period and at one-month follow-up, a 10-

point Visual Analog Scale (VAS), a commo n patient-

reported pain scale, was used to measure postoperative

nasal pain. The patients were graded on a structured

ordinal scale (0-3) to assess nasal obstruction before

surgery and at 1 and 3 months after surgery. At two

weeks and three months, endoscopy was used to

measure nasal crusting by the standardized Lund and

Kennedy system. At 3 months, diagnostic nasal

endoscopy and the Lund and Kennedy indices were

used to assess tissue healing. Direct inspection of nasal

packing and clinical records categorized bleeding

within 48 hours of surgery as minimal, moderate, or

severe. Due to the apparent postoperative appearance

depending on the procedure, formal blinding of the

assessor was not feasible, but prespecied scales were

to be used to minimize observer bias. There was no

inter-rater reliability. The data analysis was conducted

with SPSS version 26.0. Descriptive statistics have been

used to summarize demographic and baseline clinical

data, including age, gender, duration of nasal

obstruction symptoms, preoperative turbinate grade,

and preoperative nasal obstruction grade, and to

compare them across groups to determine baseline

comparability. Categorical data (postoperative nasal

obstruction grade, nasal crusting grade, severity of

bleeding, and Tissue healing grade) were represented

by frequencies and percentages. Mean +/standard

deviation was used to display continuous data, such as

pain VAS values. Chi-square test and independent

samples t-test were used. Besides p-values, which are

also presented where necessary, are condence

intervals, such as 95% condence intervals for mean

dierences and Cohen d (continuous outcomes), and

RESULTS

Table 1: Distribution of Dierent Variables (n=60)

Number (%)

Age (years)

18-40

41-60

Gender

Male

Female

Duration of symp

toms (months)

≤12

>12

Grading of

Inferior

T urbinate

Hypertrophy

Nasal

obstruction

grade

(53.33%)

(46.67%)

(60.0%)

(40.0%)

(36.67%)

(63.33%)

(10.0%)

(23.33%)

(40.0%)

(26.67%)

(0.0%)

(20.0%)

(26.67%)

(53.33%)

(50.0%)

(63.33%)

(36.67%)

(40.0%)

(60.0%)

(6.67%)

(30.0%)

(36.67%)

(26.67%)

(3.33%)

(23.33%)

(30.0%)

(43.33%)

Group A(n=30) Group B (n=30)

Table 2: Comparison of VAS Score

V AS

score

Group A (n=30) Group B (n=30) P-Value

Mean ± SD Mean ± SD

Day 1

4.87 ± 1.14 2.20 ± 0.89 0.0001

1 month

2.90 ± 0.78 1.07 ± 0.77 0.0001

Table 3: Comparison of Outcome at 2 Weeks.

(n=30)

P-

V alue

00 07

(23.33%)

(46.67%)

0.299

01 09

(30.0%)

(23.33%)

02 08

(26.67%)

(16.67%)

03 06

(20.0%)

(13.33%)

Nasal

obstruction

grade

Nasal

crusting

grade

00 13

(43.33%)

(63.33%)

0.298

01 09

(30.0%)

(20.0%)

02 08

(26.67%)

(16.67%)

Hemorrhage

severity

Minimal 14

(46.67%)

(70.0%)

0.167

Moderate 11

(36.67%)

(23.33%)

Severe 05

(16.67%)

(6.67%)

Tissue

Healing

Poor 15

(50.0%)

(26.67%)

0.087

Moderate 07

(23.33%)

(20.0%)

Good 08

(26.67%)

(53.33%)

Group A Group B

Comparison of Outcomes of Partial Turbinectomy Versus Mucosal Diathermy

J Gandhara Med Dent Sci

July - September 2026

Table 4: Comparison of Outcomes at 3 Months

value

Nasal

obstruction

grade

00 20

(66.67%)

(83.33%)

0.394

01 04

(13.33%)

03 (10.0%)

02 05

(16.67%)

(6.67%)

03 01

(3.33%)

00 (0.0%)

Nasal

crusting

grade

00 19

(63.33%)

(76.67%)

0.385

(33.33%)

07 (23.33%)

02 01

(3.33%)

00 (0.0%)

Hemorrhage

severity

Minimal 22

(73.33%)

26 (86.67%)

0.341

Moderate 07

(23.33%)

(13.33%)

Severe 01

(3.33%)

00 (0.0%)

Tissue

Healing

Poor 06

(30.0%)

(6.67%)

0.003

Moderate 14

(46.67%)

05 (16.67%)

Good 10

(33.33%)

(76.67%)

(n=30)

Group A Group B

DISCUSSION

One of the most frequent reasons patients come to the

ENT OPD is nasal blockage. One of the most common

causes of nasal blockage is hypertrophy of the inferior

turbinates, which can be caused by allergic or

vasomotor rhinitis. Although a wide range of treatment

options are available, the comparative benets of the

various treatments are highly disputed.

10,11,12

In the

present study, the mean age was 46.90/+ 7.86 years.

The average age of the patients in groups A and B was

46.07 ± 7.92 and 46.73 ± 8.61 years, respectively. The

mean age of the groups did not dier signicantly

(p>0.05). The study mean of the groups that have

undergone partial inferior turbinectomy and

submucosal diathermy was 28.35 + 8.12 and 30.93 +

7.72 years respectively, as explained by Saleem et al.

a dierent study, Nawaz et al. found that PIT group had

a mean age of 26.5 years, whereas SMD group had a

mean age of 27.2 years.

13,14

Males predominated in both

groups in this study (60.0% in the PIT group and

63.33% in the SMD group). Similarly, group B (partial

inferior turbinectomy group) had 67.5% men, and

group A (submucosal diathermy group) had 72.5%

males, according to Nawaz et al. Of the 60 patients

enrolled in the trial, 20 (66.7%) were male and 10

(33.3%) were female in Group B (PIT), while 12

(40.0%) were male and 18 (60.0%) were female in

Group A (SMD), according to Vishnu and

Rajamma.

14,15

Nasal blockage decreased signicantly in

both treatment groups, but in the current study, the

dierences in nasal obstruction grade between the two

groups at 2 weeks and 3 months were not signicant.

Even though the percentage of patients who were

completely relieved of obstruction was greater in the

SMD group at the two follow-ups, the condence

intervals are wide, indicating that the extent of benet

is not certain. Thus, the ndings need to be viewed as a

positive outcome for SMD rather than as conclusive

short-term obstruction relief. Gomaa et al. also reported

no statistically signicant dierence in the eect of

nasal obstruction between PIT and SMD at early

follow-up, but Saleem et al. and Nawaz et al. reported

better short-term outcomes of obstruction on

turbinectomy.

9,13,14

Conversely, Gangararaj et al. found

the initial relief with SMD but overall reversals with

PIT at six months.

These variations can include

dierences in surgical procedure, initial severity,

follow-up period, grading of outcomes, and sample

size. In the current study, there was a signicant

reduction in postoperative pain after SMD, and eect

sizes were large at both day 1 and one-month follow-

up. The discovery is biologically plausible, as SMD

preserves the surface mucosa and causes controlled

submucosal damage, and PIT destroys mucosa and

bony tissue, which may lead to increased raw surface

area, inammation, and postoperative pain. Vishnu and

Rajamma and Gangaraj et al. have reported similar

patterns of diminished pain in the aftermath of SMD;

however, studies published on the topic have found a

mixed pattern of pain depending on the situation of

tissue removal, cautery settings, analgesic practices,

and timing.

15,16

All these could justify the disparity

between the current results and those that found a less

pronounced pain dierence in their studies. In this

study, bleeding severity was numerically greater in PIT

cases than in SMD cases, but the dierence was

statistically insignicant. It is comparable to the

mechanism of PIT, where direct excision of tissue

exposes vascular surfaces, whereas SMD can be applied

by accomplishing volume reduction via submucosal

mucosal coagulation, which preserves the mucosal

integrity. Vishnu and Rajamma obtained similar results,

as did Imad et al., Al-Baldawi, and Gangaraj et al., who

reported increased rates of bleeding following

PIT.

15,16,18,19

However, the given sample size of only 30

patients per group may have been underpowered to

detect moderate dierences in bleeding severity. Three

months showed tissue healing was better in the SMD

group, and crusting favored SMD numerically but was

not signicant. The mucosal surface could clarify the

advancement of healing following SMD and the

minimized raw area postoperatively. Conversely, PIT

can cause an immediate decrease in turbinate volume

but may be associated with increased mucosal injury,

crust formation, and a slower recovery of epithelial

cells. Inconclusive eects have been reported in

previous research, with some showing lower crusting

following SMD and others showing no signicant

dierences in the long term.

9,15,16

The variability in the

results among the research could be attributed to the

differences in postoperative campaigns in using the

nasal toilet, saline irrigation adherence, cauterization

settings, and the time of the endoscopic follow-up.

Comparison of Outcomes of Partial Turbinectomy Versus Mucosal Diathermy

J Gandhara Med Dent Sci

July - September 2026

Notably, the current ndings cannot be used to

generalize conclusions about the superiority of SMD

across all outcomes; the most convincing data in this

dataset pertain to reduced pain scores and enhanced

tissue healing at 3 months.

LIMITATIONS

The current research has several limitations. To start

with, the non-randomized design and lack of allocation

concealment limit internal validity and create potential

selection bias. Despite the comparability testing at

baseline not showing statistically signicant dierences

among groups, residual confounding was not corrected,

and multivariable adjustment was not performed due to

the small sample size. Second, the sample size in this

case was relatively small and selected from a single

center, which minimizes statistical power and limits

generalizability. Third, a three-month follow-up was

not long enough to evaluate long-term outcomes such

as recurrent turbinate hypertrophy, sustained symptom

relief, synechiae, or late crusting. Fourth, VAS, nasal

obstruction grading, and Lund and Kennedy grading

were found to be clinically useful, but some outcomes

were partially subjective; it was not possible to blind

the assessor, and inter-rater reliability was not

evaluated. Fifth, they did not include patient

satisfaction, disease-specic quality of life, or validated

scales of nasal symptoms, such as the NOSE scale or

SNOT-22. It is advised that multicenter randomized

controlled trials include allocation concealment, blinded

outcome assessment where possible, increased sample

sizes, validated patient-reported outcome measures, and

extended follow-up duration.

CONCLUSIONS

In this study, SMD was associated with less pain and

enhanced tissue healing at 3 months after the operation

compared to PIT. The outcomes of nasal obstruction,

crusting, and hemorrhage showed a numerical

advantage for SMD, although the results were not

considered statistically signicant. Therefore, SMD

may be considered a safe and helpful option to manage

inferior turbinate hyperplasia, but the results should be

interpreted with caution, as it is a non-randomized

study of smaller size or lacks sucient follow-up.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Comparison of Outcomes of Partial Turbinectomy Versus Mucosal Diathermy

J Gandhara Med Dent Sci

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AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

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Muhammad Zeeshan Ashraf

Concept &

Design; Data

Acquisition; Data Analysis/Interpretation; Drafting

Manuscript;

Critical Revision;

Final Approval

Aqsa Yaqub