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Two different therapies for the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

A Correction to this article was published on 01 August 2020

This article has been updated

Abstract

Background

The population of patients with chronic rhinosinusitis (CRS) has greatly increased. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. In the present study, the value of two different therapies for the middle turbinate to optimize surgical outcomes was observed. Our objective was to determine a better management approach for the middle turbinate to effectively preserve the middle turbinate mucosa and function and avoid complications following ESS, such as nasal adhesions on the operative side.

Methods

Thirty patients [group A; treated prior to 2015 (primary surgery)] undergoing resection of the middle turbinate bone during complete ESS for CRS and 30 patients [group B; treated after 2015 (later surgery)] undergoing middle turbinate preservation and multiapproach therapy during complete ESS for CRS were observed. Nasal cavities were compared using perioperative sinus endoscopy (POSE) and Lund–Kennedy (LKES) scores preoperatively and at 15 days, 2 months and 1 year after ESS.

Results

Preoperatively, the POSE (8.83 ± 3.81 vs 9.15 ± 3.85, p = 0.45, for groups A and B, respectively) and LKES (4.23 ± 0.74 vs 4.13 ± 0.70, p = 0.34) scores were similar between groups. In group A, anterior adhesions were reported on six sides of the middle turbinate, severe adhesions were observed on two sides, mild adhesions were observed on one side, and adhesions occurred on two sides during follow-up. After retreatment, adhesions were still observed on two sides at 1 year. In group B, only mild anterior adhesions were observed on two sides. There was no difference between group A and group B at 15 days, and the POSE (4.31 ± 1.19 vs 4.07 ± 1.42, p = 0.11, for groups A and B, respectively) and LKES (3.35 ± 0.82 vs 3.33 ± 0.90, p = 0.91) scores were similar between groups. There was no significant difference in LKES (0.22 ± 0.49 vs 0.10 ± 0.35, p = 0.15) scores at 1 year between the two groups. There was a significant difference in the nasal cavities between group A and group B at 2 months and 1 year, where group B showed a better endoscopic appearance than group A at 2 months and 1 year (with POSE scores of 3.48 ± 0.83 vs 2.43 ± 1.38 (p = 0.00) and LKES scores of 1.35 ± 0.86 vs 1.15 ± 0.90 (p = 0.02) at 2 months for groups A and B, respectively, and POSE scores of 1.00 ± 0.96 vs 0.62 ± 0.87 (p = 0.001) at 1 year for groups A and B, respectively).

Conclusions

Our results show that middle turbinate preservation and combined therapy was a better ESS method for CRS. Multiapproach middle conchoplasty, which is predominately a submucoperiosteal surgery, can preserve more of the mucosa and functions of the middle turbinate. Unlike the single-approach middle conchoplasty described in previous research, multiapproach middle conchoplasty is achieved by combining a three-step surgical procedure (“surgery, packing and removal”) with “cocktail-style” postoperative packing and removal.

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Change history

  • 01 August 2020

    In the original publication of the article, Fig. 1a was missing and caption of Fig. 1a was published as caption of Fig. 1b. The correct Fig. 1 and captions are provided below.

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Author notes

  1. Meichan Zhu and Yongyi Yan contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Guangzhou Twelfth People’s Hospital (Guangzhou Otolarynology-Head and Neck Surgery Hospital), Tianhe District, No 1. Tianqiang Road, Guangzhou, 510620, Guangdong, China

    Meichan Zhu, Yongyi Yan, Huicheng Gong, Yunwen Wu & Guojie Tan

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  1. Meichan Zhu
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  2. Yongyi Yan
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Correspondence to Meichan Zhu or Yongyi Yan.

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This study was approved by Human Research Ethics Committee in Guangzhou Twelfth People’s Hospital and written consent was obtained from all the participants.

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The original version of this article was revised due to Fig 1a was missed and caption of Fig 1b was incorrect. The figure 1a, 1b are published correctly in this version.

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Zhu, M., Yan, Y., Gong, H. et al. Two different therapies for the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis. Eur Arch Otorhinolaryngol 277, 3079–3089 (2020). https://doi.org/10.1007/s00405-020-06184-4

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  • DOI: https://doi.org/10.1007/s00405-020-06184-4

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