Radiofrequency versus electrocautery for inferior turbinate hypertrophy: a systematic review and meta-analysis

To compare the effectiveness and safety of radiofrequency ablation (RFA) versus electrocautery (EC) for the surgical management of inferior turbinate hypertrophy (ITH) in patients with persistent nasal obstruction unresponsive to medical therapy. This systematic review and meta-analysis followed PRISMA guidelines. Random-effects models were used to pool effect estimates. Prespecified subgroup analyses examined EC device settings (20 W vs. 40 W) and RFA probe types (bipolar vs. monopolar). Sensitivity analyses were conducted to test robustness. Nine studies ( n = 2,314; 892 RFA) met inclusion. Nasal obstruction showed no clinically meaningful difference between RFA and EC, either for post-treatment VAS scores (MD 0.08, 95% CI − 0.37 to 0.53; p = 0.73; I² = 76%) or for change from baseline (MD − 0.16, 95% CI − 0.61 to 0.29; p = 0.48; I² = 75%), and both estimates showed high heterogeneity and were unstable on leave-one-out analysis. In the late follow-up subgroup, post-treatment VAS scores were statistically lower after RFA (MD − 0.09, 95% CI − 0.17 to − 0.02; p = 0.009), a difference of 0.09 points on a 10-point scale that falls well below established minimal clinically important difference thresholds.Postoperative crusting did not differ significantly (RR 0.10, 95% CI 0.01–1.04; p = 0.05). Synechiae were less frequent after RFA (RR 0.08, 95% CI 0.01–0.62; p = 0.02), but this estimate derived from only two small studies and did not persist when a large cohort reporting synechiae requiring revision surgery was added (RR 0.27, 95% CI 0.04 to 1.76). An exploratory subgroup analysis by EC wattage showed no significant subgroup interaction; the prespecified comparison by RFA probe type could not be performed because electrode polarity was not reported by two of the five contributing studies. RFA and EC achieve comparable improvement in nasal obstruction, with no clinically meaningful difference in subjective or objective outcomes. A lower rate of synechiae after RFA rests on sparse, low-certainty data and did not persist on sensitivity analysis; crusting did not differ significantly. Overall, the current evidence does not establish the superiority of either technique, and the certainty of evidence is low to very low.