The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on powered microdebrider turbinoplasty for inferior turbinate hypertrophy in July 2014.
Inferior turbinates are ridges inside the nose, covered by mucous membrane, which increase the surface area within the nose and help to filter and humidify inspired air. Inflammation of the mucous membrane (rhinitis) can cause inferior turbinates to swell (turbinate hypertrophy). This narrows the nasal passage, and may cause complete nasal obstruction. Symptoms include breathing difficulties, excessive mucous secretion (rhinorrhoea), postnasal drip, facial discomfort or pain and mid-facial headaches.
Treatment options depend on the duration and severity of turbinate hypertrophy. Medical treatments include corticosteroid injections, nasal corticosteroid sprays and decongestants. Surgical treatments include radiofrequency-assisted turbinoplasty and laser-assisted turbinoplasty. These procedures are reserved for symptomatic patients with persistent hypertrophy of the turbinates who have had no response to medical management, or for whom medical management is contraindicated.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.