Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A retrospective study.

OBJECTIVE: To compare the 5-year outcomes of two endoscopic surgical approaches for diffuse and severe nasal polyposis.

STUDY DESIGN: A natural experimental situation gave us the opportunity to compare the results 5 years after radical ethmoidectomy (nasalisation) (n= 39), and functional ethmoidectomy (n= 37). The two surgical procedures were performed by two different surgeons on 76 consecutive patients. There was no random assignment for this retrospective study.

METHODS: Five years after surgery, the criteria for comparison were 1) functional results based on a questionnaire using visual analogue scales in patients free of revision surgery; 2) endoscopic and CT-scan assessments of anatomical results. The CT-scans were blinded and randomized, and opacities were measured using a computerized model; 3) the recurrence rate of nasal polyps.

RESULTS: Five years after surgery, the overall nasal functional benefit was scored 8.41 +/- 0.40 (mean +/- SEM) after nasalisation, and 5.69 +/- 0.83 after ethmoidectomy P= 0.002) in patients free of revision surgery. The endoscopic appearance of the mucosa was methodically scored according to a pre-defined scale. Results were significantly better in the nasalisation group (6.03 +/- 0.7 versus 3.27 +/- 1.0, P= 0.02). A good correlation was found between the endoscopic and CT-scan scores (r= -0.78, P= 0.0001 for nasalisation, and r= -0.65, P= 0.001 for ethmoidectomy). The total recurrence rate was 22.7% in the nasalisation group, and 58.3% in the ethmoidectomy group (chi2= 10.41, P< 0.01).

CONCLUSION: Our study suggests that in the treatment of nasal polyposis complete ethmoidectomy leads to better long term results than incomplete ethmoidectomy.