Exploring the Role of Turbinate Reduction in Alleviating Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Pediatric Patients

Background Sleep-disordered breathing (SDB) and attention-deficit/hyperactivity disorder (ADHD) symptoms frequently co-occur in children and may be exacerbated by nasal obstruction. While adenotonsillar hypertrophy has been extensively studied, the role of inferior turbinate hypertrophy remains underrecognized. Objective To evaluate the effects of inferior turbinate reduction (ITR) on nasal breathing, SDB symptoms, and ADHD-type behaviors in pediatric patients. Methods We performed a retrospective cohort study of children undergoing ITR between December 2020 and May 2023. Patient selection included all children aged 3-17 years who underwent ITR via bipolar cautery, either as an isolated procedure or combined with adenotonsillectomy, septoplasty, or functional endoscopic sinus surgery. Twelve-month parent-reported outcomes were collected through chart reviews and supplemental telephone interviews when needed. Primary outcomes included subjective improvement in nasal breathing, resolution of SDB symptoms (snoring, witnessed apneas, restless sleep), and parent-reported changes in ADHD-type behaviors (hyperactivity, inattention, impulsivity). Statistical analyses included McNemar tests, χ²/Fisher's exact tests, and multivariable logistic regression. Results Among 326 children (mean age 9.0±4.1 years; 212/326 [65%] male), 106/326 (32.5%) had baseline ADHD-type symptoms. Concurrent procedures included adenotonsillectomy (198/326 [60.7%]), septoplasty (45/326 [13.8%]), and functional endoscopic sinus surgery (24/326 [7.4%]). In the ADHD subgroup, 95/106 (89.6%) reported improved nasal breathing, 89/106 (84.0%) had resolution of SDB symptoms, and 51/106 (48.1%) reported improvement in ADHD symptoms. Improvement in ADHD symptoms was significantly associated with nasal breathing improvement (χ²=11.38, p<0.001), although no independent predictors were identified on logistic regression. In the ITR-only subgroup (59/326 [18.1%]; 21/59 with ADHD), 11/21 (52.4%) reported ADHD improvement, with no significant difference compared to patients undergoing concurrent procedures (p=0.66). Conclusion ITR is associated with significant improvements in nasal obstruction, SDB, and ADHD-related behaviors. However, the retrospective design, lack of control group, and absence of validated assessment tools limit causal inference. Prospective controlled studies utilizing validated instruments are essential to establish causality.