Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis.

CONCLUSION: Relapse in patients affected by nasal polyposis and subjected to endoscopic surgery appears to be a relevant feature. Surgical treatment shows a significant increase in quality of life in all the patients aside from surgical technique used. Our results show a better control of relapse of nasal pathology in patients subjected to more radical surgery (group B) vs patients subjected to conservative surgery on middle turbinate (group A). Allergic patients in group B had a smaller number of relapses during the follow-up period compared with allergic patients in group A and this was statistically significant.

OBJECTIVES: Different endoscopic surgical techniques have been applied for the treatment of nasal polyposis. During ethmoidectomy, some authors prefer to remove the middle turbinate while others preserve this structure. To date, there have been no studies comparing the results, in a homogeneous case series of patients operated exclusively for nasal polyposis, between those whose middle turbinate was resected and those whose middle turbinate was preserved. The aim of our study was to compare results in these two groups of patients.

PATIENTS AND METHODS: A prospective study was performed. Nasal polyposis was studied on the basis of endoscopic examination and all the patients were classified on the basis of CT of paranasal sinuses using the Kennedy CT staging system. In the study group, only subjects affected by nasal polyposis with stage II-III at endoscopic evaluation and a Kennedy score of III-IV, affected by nasal polyposis, and not responsive to medical treatment were recruited. The presence of allergy was evaluated by skin prick test results and that of asthma by spirometric examination. Recurrence rates and quality of life were evaluated in a 3-year follow-up.

RESULTS: In total, 56 patients were selected and all were observed over a 3-year follow-up period. We identified two groups: group A, 34 patients (60.71%) affected by nasal polyposis who underwent endoscopic surgery with the conservation of middle turbinate; group B, 22 patients (39.29%) affected by nasal polyposis who underwent more radical endoscopic sinus surgery. Analyzing the entire study group, during the 3-year follow-up, 20 (35.71%) of the 56 patients had a relapse of nasal polyposis. Analyzing time to relapse curves in the allergic and non-allergic patients, we obtained a p value of 0.0589, i.e. at the limit of statistical significance. The comparison between preoperative and postoperative Cologne test in the whole study group was statistically significant for a symptomatic improvement (p < 0.001). Trends within the two groups were also evaluated: there was a statistically significant difference in behavior upon time to relapse of the patients in group B vs group A (p = 0.0102). The patients in group A developed nasal recurrence more frequently during the follow-up periods. In patients affected by allergy vs patients not affected by allergy in group A, a statistically significant difference was noted (p = 0.0074); the allergic patients developed nasal recurrence more frequently during the follow-up period. We could not find a statistically significant difference between those patients affected by allergy and those not affected by allergy, as regards the number of relapses in patients in group B.