Reply to “Inferior Turbinate Outfracture Alone Has Not Been Studied in Randomized Controlled Trials”

We thank Dr Man and Dr Schmale for their critical appraisal of our meta-analysis of randomized trials comparing inferior turbinoplasty techniques.1 Our meta-analysis sought to establish that turbinate reduction techniques that included either removal of tissue or outfracture provided longer-lasting relief of nasal obstruction than techniques which did not utilize these measures. As mentioned in our article, the data is very limited regarding long-term outcomes of inferior turbinate reduction techniques, especially regarding randomized controlled trials. The authors mention a concern with our conclusions, namely that inferior turbinate outfracture alone provided equal outcomes as microdebrider-assisted turbinate reduction or submucosal resection of inferior turbinate. In careful review of this concern, we can understand how Dr Man and Dr Schmale may have arrived at the conclusion that we were suggesting outfracture alone provides as long-lasting relief of nasal obstruction as tissue removal techniques; however, this was not our intent. Our intent was to demonstrate that based on the available literature, procedures involving removal of tissue or in combination with outfracture have longer-lasting results than those that do not remove tissue or outfracture. Upon careful review of our manuscript, we now understand that the wording within the results and table sections may be confusing to readers and lead them to similar conclusions, so we thank Dr Man and Dr Schmale for bringing this to our attention and providing the opportunity to provide clarity. Regarding the long-term outcome data supplied by Liu et al and Chen et al, we thank the authors for their thoughtful analysis.2, 3 The concerns mentioned by the authors work to further highlight the need for more randomized controlled trials with long-term follow-up in outcomes, as there is scarce literature available to support different techniques. The views expressed in this invited response are those of the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, Department of Defense, nor the US Government. Nolan N. Jones, MD, drafted, reviewed, edited and approved final manuscript; Sungjin A. Song, MD, reviewed, edited, and approved final manuscript; Macario Camacho, MD, reviewed, edited, and approved final manuscript. None. None.