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DOI: 10.1055/s-0043-1776730
Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study
Funding The authors declare that they have received no financial support for conduction of the present research.
Abstract
Introduction Despite the high level of patient satisfaction with functional endoscopic sinus surgery (FESS) and the clinical improvement, polyp recurrence is observed in 23% to 87% of patients and requires reoperation.
Objective To assess the prognostic value of polypoid changes of the middle turbinate (PCMT) in relapse of paranasal sinus polyps in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) after FESS and the effect of partial middle turbinectomy (PMT) on the outcome of surgery.
Methods We conducted a prospective clinical study on 60 patients with CRSwNP with and without PCMT. The patients were allocated into three groups: group I included twenty patients without PCMT; group II, twenty patients with PCMT; and group III included twenty patients with PCMT submitted to PMT. The patients were evaluated endoscopically according to the Lund-Kennedy endoscopic scoring system, radiologically according to the Lund-Mackay scoring system, and symptomatically through the 22-item Sinonasal Outcome Test (SNOT-22).
Results The total postoperative Lund-Kennedy score differed significantly among the 3 groups (p < 0.001), with a group II presenting a significantly higher total score compared to groups I and III. The Preoperative SNOT-22 score differed significantly among the three groups (p = 0.013), with group II presenting a significantly higher score compared to group I. There was a significant association involving the 3 groups and relapse at 12 months (p = 0.029); relapse was higher in group II (50.0%) than in groups I (20%) and III (15.0%).
Conclusion There was a significant association between PCMT and the relapse of nasal polyps. Also, nasal polyposis recurred at a lower rate in the group submitted to middle turbinate resection compared to the group in whom it was preserved.
Keywords
allergic rhinitis - chronic rhinosinusitis - nasal endoscopy - nasal polyposis - nasal turbinateEthical Considerations
- Ethics approval and consent to participate: The institutional Ethics in Research Committee approved the present study (under number MS 17–9-2020), and informed consent had been obtained even before the study had been approved.
Publication History
Received: 23 December 2022
Accepted: 08 June 2023
Article published online:
29 November 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Halderman AA, Stokken J, Sindwani R. The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses. Int Forum Allergy Rhinol 2016; 6 (10) 1056-1061 DOI: 10.1002/alr.21791.
- 2 Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25-year experience. Laryngoscope 2014; 124 (01) 29-33 DOI: 10.1002/lary.24213.
- 3 Bai J, Huang JH, Price CPE. et al. Prognostic factors for polyp recurrence in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2022; 150 (02) 352-361.e7
- 4 Bassiouni A, Wormald P-J. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope 2013; 123 (01) 36-41
- 5 Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope 2004; 114 (05) 811-813
- 6 Jankowski R, Pigret D, Decroocq F, Blum A, Gillet P. Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A retrospective study. Rev Laryngol Otol Rhinol (Bord) 2006; 127 (03) 131-140
- 7 Amali A, Bidar Z, Rahavi-Ezabadi S, Mikaniki N, Sadrehosseini SM. Polypoid change of middle turbinate is associated to an increased risk of polyp recurrence after surgery in patients with chronic rhinosinusitis with nasal polyps. Eur Arch Otorhinolaryngol 2018; 275 (08) 2021-2025 DOI: 10.1007/s00405-018-5032-2.
- 8 Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg 1997; 117 (3 Pt 2): S35-S40 DOI: 10.1016/S0194-59989770005-6.
- 9 Składzeń J, Obtułowicz K, Miodoński A, Nowogrodzka-Zagórska M. Allergic nasal polyps under scanning electron microscope. Med Sci Monit 2001; 7 (03) 477-481
- 10 Orlandi RR, Terrell JE. Analysis of the adult chronic rhinosinusitis working definition. Am J Rhinol 2002; 16 (01) 7-10
- 11 Stewart MG, Donovan DT, Parke Jr RB, Bautista MH. Does the severity of sinus computed tomography findings predict outcome in chronic sinusitis?. Otolaryngol Head Neck Surg 2000; 123 (1 Pt 1): 81-84 DOI: 10.1067/mhn.2000.105922.
- 12 Marchioni D, Alicandri-Ciufelli M, Mattioli F. et al. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol 2008; 128 (09) 1019-1026 DOI: 10.1080/00016480701827541.
- 13 Soler ZM, Hwang PH, Mace J, Smith TL. Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope 2010; 120 (04) 832-837 DOI: 10.1002/lary.20812.
- 14 Garrel R, Gardiner Q, Khudjadze M. et al. Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology 2003; 41 (02) 91-96
- 15 Scangas GA, Remenschneider AK, Bleier BS, Holbrook EH, Gray ST, Metson RB. Does the Timing of Middle Turbinate Resection Influence Quality-of-Life Outcomes for Patients with Chronic Rhinosinusitis?. Otolaryngol Head Neck Surg 2017; 157 (05) 874-879 DOI: 10.1177/0194599817706929.