Temporal divergence in symptom relief after submucosal diathermy versus endoscopic partial inferior turbinectomy – a prospective randomized study in a central Indian tertiary care cohort

Background: Inferior turbinate hypertrophy (ITH) is the commonest structural cause of chronic nasal obstruction. Submucosal diathermy (SMD) and endoscopic partial inferior turbinectomy (EPT) are both widely used, but their comparative outcome over time is incompletely characterized. Methods: In this prospective, randomized, single-centre study, 100 adults with bilateral grade II-IV ITH refractory to medical therapy were randomized to SMD (n=50) or EPT (n=50). The nasal obstruction symptom evaluation (NOSE) score was recorded pre-operatively and at day 7, 1, 3 and 6 months; complications and operative time were recorded. t-tests and Chi-square/Fisher’s exact test were used; p<0.05 was taken as significant. Results: Groups were comparable for baseline NOSE score (74.10±8.19 versus 75.14±9.57; p=0.56). Improvement was equivalent at Day 7 (p=0.72) and 1 month (p=0.25). A significant divergence favouring EPT emerged at 3 months (31.32±5.42 versus 22.50±4.72; p<0.0001) and consolidated at 6 months (33.92±5.98 versus 7.54±2.53; p<0.0001), a 54.22% versus 89.97% reduction from baseline. EPT had greater early morbidity, including bleeding in 76% versus 2% of patients at Day 3, but every complication was self-limiting. Operative time was shorter with SMD (18.6±3.4 versus 27.8±5.1 minutes; p<0.0001). No atrophic rhinitis or empty nose syndrome occurred. Conclusions: SMD and EPT gave equivalent short-term relief, but outcomes diverged from three months onward: SMD relapsed while EPT produced durable, near-complete resolution at the cost of transient early morbidity. Technique selection should be individualized to the patient and the predominant component of hypertrophy.