(240) What's better for breathing in nasal valve collapse - bioabsorbable implants or radiofrequency ablation?

Introduction: Nasal obstruction is a common presenting complaint in otolaryngology, with septoplasty and turbinate reduction serving as traditional treatments. Increasing recognition of lateral wall insufficiency (LWI), encompassing internal and external nasal valve collapse, as a distinct contributor to nasal airflow limitation has driven interest in minimally invasive interventions. Bioabsorbable implants (Latera) and radiofrequency ablation (VivAer) are two emerging modalities, but their comparative effectiveness remains unclear.

Methods: A systematic review and meta-analysis were conducted to evaluate outcomes of Latera and VivAer in adults with LWI. Studies reporting quantifiable nasal airway improvement, preferably NOSE scores, were included. Exclusion criteria removed studies with confounding nasal surgeries, non-extractable data, or non-original research. 17 studies were included. A random-effects model was used to account for methodological variability and differences in patient populations across studies. Publication bias was assessed with Egger’s test, funnel plots, and trim-and-fill analysis.

Results: Across included studies, both Latera and VivAer were associated with significant reductions in NOSE scores from baseline at all evaluated follow-up intervals. Pooled mean differences demonstrated substantial symptom improvement as early as 1 month and persisting through 24 months, with mean reductions ranging from approximately 37 to 48 points despite moderate to high heterogeneity. Although the magnitude of improvement varied by time point, the direction and clinical benefit remained consistent over time (p = 0.0365). Bias-adjusted effect estimates for both Latera and radiofrequency ablation were similar to the observed pooled estimates.

Conclusions: Bioabsorbable implants and radiofrequency ablation yield similar, clinically meaningful improvements in nasal obstruction due to LWI. With comparable efficacy demonstrated, future research should focus on differences in complications, cost, and long-term durability to guide personalized treatment selection.