Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study

Abdelsamie, Alaa Mohamed; Abdelazeem, Hossam Mohamed; Dawood, Gena Kerollos; Abdelaal, Taha Mohamed

doi:10.1055/s-0043-1776730

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Original Research • Int Arch Otorhinolaryngol 28 (2) • 2024 • https://doi.org/10.1055/s-0043-1776730 linkcopy

Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 turbinate

		Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Age (in years): mean ± standard deviation		37 ± 12	38 ± 13	39 ± 8	0.841
Gender: male/female – n (%)		12 (60.0)/8 (40.0)	11 (55.0)/9 (45.0)	9 (45.0)/11 (55.0)	0.626

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Maxillary: median (range)	2 (1–2)	2 (1–2)	2 (1–2)	0.579
Anterior ethmoid: median (range)	2 (1–2)	2 (1–2)	2 (2–2)	0.355
Posterior ethmoid: median (range)	2 (1–2)	2 (1–2)	2 (1–2)	0.125
Sphenoid: median (range)	1 (1–2)	2 (1–2)	2 (1–2)	0.426
Frontal: median (range)	2 (1–2)	2 (1–2)	1 (1–2)	0.426
Ostiomeatal complex: median (range)	2 (0–2)	2 (2–2)	2 (2–2)	0.368
Total: median (range)	10 (5–12)	11 (9–12)	11 (10–12)	0.334

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Polyp: median (range)	2 (2–2)	2 (2–2)	2 (2–2)	1.0
Edema: median (range)	2 (2–2)	2 (2–2)	2 (2–2)	1.0
Discharge: median (range)	2 (2–2)	2 (2–2)	2 (2–2)	1.0
Crusting: median (range)	2 (1–2)	1 (1–2)	2 (1–2)	0.158
Total: median (range)	8 (7–8)	7 (7–8)	8 (7–8)	0.076

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Preoperative SNOT-22 score: median (range)	76 (70–81)	79 (75–81)	78 (75–82)	0.118
Origin of middle turbinate polypi: n (%)				0.985
Anterior border	9 (45.0)	9 (45.0)	9 (45.0)
Lateral border	2 (10.0)	4 (20.0)	4 (20.0)
Medial border	4 (20.0)	3 (15.0)	3 (15.0)
Posterior border	5 (25.0)	4 (20.0)	4 (20.0)

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Polyp: median (range)	1 (0–1)^a	1 (0–2)^a	0 (0–0)^b	< 0.001
Edema: median (range)	1 (1–2)^a	1 (1–2)^a	0 (0–0)^b	< 0.001
Discharge: median (range)	1 (1–1)^a	1 (1–1)^a	1 (0–1)^b	< 0.001
Crusting: median (range)	0 (0–1)^a	0 (0–1)^a	2 (1–2)^b	< 0.001
Total: median (range)	3 (2–4)	3 (2–4)	3 (2–3)	0.087

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Polyp: median (range)	1 (1–2)^a,b	1 (1–2)^a	1 (1–1)^b	0.022
Edema: median (range)	1 (1–2)^a	2 (1–2)^b	1 (1–2)^a	< 0.001
Discharge: median (range)	1 (1–2)^a	2 (1–2)^b	1 (1–1)^a	< 0.001
Crusting: median (range)	1 (0–1)	1 (0–1)	1 (0–1)	0.194
Total: median (range)	4 (4–5)^a	6 (5–6)^b	4 (3–5)^a	< 0.001

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Polyp: median (range)	1 (0–2)^a,b	2 (0–2)^a	1 (0–2)^b	0.025
Edema: median (range)	2 (1–2)^a,b	2 (1–2)^a	1 (1–2)^b	0.002
Discharge: median (range)	1 (1–2)^a	2 (1–2)^b	1 (1–2)^a	< 0.001
Crusting: median (range)	1 (0–1)	1 (0–2)	1 (1–2)	0.104
Total: median (range)	4 (2–7)^a	7 (5–8)^b	5 (3–8)^a	< 0.001

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
At 1 month: median (range)	3 (2–4)	3 (2–4)	3 (2–3)
				0.087
At 6 months: median (range)	4 (4–5)^a	6 (5–6)^b	4 (3–5)^a
				< 0.001
At 12 months: median (range)	4 (2–7)^a	6 (5–8)^b	5 (3–8)^a
				< 0.001

	Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Preoperative: median (range)	76 (70–81)^a	80 (75–81)^b	78 (75–82)^a,b	0.013
Postoperative: median (range)	7 (6–70)^a	45 (10–80)^b	7 (6–77)^a	< 0.001
Percentage change: median (range)	-90.7 (-92.6–-6.8)^a	-43.7 (-87.7–-2.6)^b	-90.9 (-92.4–-4.9)^a	< 0.001

		Group I (n = 20)	Group II (n = 20)	Group III (n = 20)	p-value
Relapse at 12 months: n (%)		4 (20.0)	10 (50.0)	3 (15.0)	0.029

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[TFN1] Notes: One-way analysis of variance (ANOVA) was used for age, and the Chi-squared test was used for gender.