Evaluation of the effect of endoscopic partial middleturbinectomy surgery on the quality of life of patients with chronic rhinosinusitis and nasal polyps

Abstract

Background: Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease. Endoscopic sinus surgery is recommended as a standard method when medical treatment fails. The effectiveness of various complementary surgical methods such as endoscopic partial middle-turbinectomy is controversial in the improvement of CRS symptoms in these patients. This study aimed to investigate the effect of endoscopic partial middle-turbinectomy on the quality of life (QOL) of patients with chronic rhinosinusitis and nasal polyps (CRSwNP) in Iran.Method: Ninety patients with CRSwNP of grades 3 and 4 were randomly assigned to either an intervention (45 patients) or control group (45 patients). In the control group, endoscopic sinus surgery without middle turbinectomy was performed and in the intervention group, endoscopic partial middle-turbinectomy was performed in addition to endoscopic sinus surgery. To evaluate the outcomes, the SNOT-22 QOL questionnaire was used, and the results were analyzed using SPSS version 24.Results: Most of the patients were male and had a mean age of 39 years. The mean SNOT-22 QOL questionnaire scores were 49.13±16.72 and 52.51±16.95 before surgery in the control and intervention groups respectively, which did not show any significant difference. In contrast, after endoscopic surgery these scores changed to 28.46±12.38 and 11.13±5.55 in the control and intervention groups, respectively< and there was a significant difference between both groups. Although there was a significant improvement in both groups, the patients in the intervention group experienced more improvement than the control group (41.4 (±16.46) vs 30.7 (±18.27), respectively Conclusion: According to this study, it appears that the use of endoscopic partial middle-turbinectomy in addition to endoscopic sinus surgery improves CRS symptoms and the QOL of patients compared with endoscopic sinus surgery alone.

Anosmia following middle nasal concha resection: An anatomic and developmental review with clinical correlation

“…Although the original descriptions of the Messerklinger technique stressed tissue preservation and a “functional” approach, some surgeons advocate varying degrees of middle nasal concha resection as a matter of routine practice, and clinical investigations report few problems. (Dayal et al, 2016; Delarestaghi et al, 2020; Akiyama et al, 2018; Tomoum et al, 2021; Pinther et al, 2019.) Each time the surgeon resects a middle nasal concha and the patient does not experience a complication, it reinforces the practice as safe in the mind of the surgeon.…”

“…This reasoning would translate into tens of thousands of healthy middle turbinates resected annually. (Rice et al, 2003)In an effort to avoid total resection of the middle nasal concha and limit resection of olfactory tissue, rhinologic surgeons have developed and advocated limited middle turbinectomy techniques, for example, partial middle turbinectomy that limits resection to the lower bulbous portion of the concha while preserving the lamellar portion with its superior and posterior extension/element (Delarestaghi et al, 2020). Others have developed and advocated submucosal resection of the lower bulbous portion, removing only the bone element while preserving the submucosa and mucosal tissue to preserve olfactory function, mucoiliary clearance and humidification (Akiyama et al).…”

A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion

“…26 Another research by Delarestaghi et al, suggested that the addition of partial middle-turbinectomy in endoscopic sinus surgery improves QOL of patients. 27 de Carvalho et al evaluated olfactory loss in patients who underwent expanded endoscopic approach with partial middle turbinectomy and NSF reconstruction and they found that the deterioration in the sense of smell was transient up to 3 months. 28 Several studies utilized the SNOT-22 to evaluate QOL in patients operated for pituitary lesions.…”

Therapeutic Options for Chronic Rhinosinusitis in N-ERD Patients

“…Furthermore, ESS can be extended by aggressive removal of all sinus mucosa (so-called "reboot surgery"). As neatly summarized in EPOS2020, a debate is ongoing on the needed extent of surgery and as yet, no firm conclusions can be drawn on the added value of more aggressive approaches (18)(19)(20).…”