Subtotal Middle Turbinate Resection in Patients with Chronic Rhinosinusitis with Nasal Polyps is Unlikely to Cause Empty Nose Syndrome: A Multi-Institutional Prospective Study.

Nasal polyps empty nose syndrome middle turbinate

Journal

The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378

Informations de publication

Date de publication:
13 Aug 2024
Historique:
revised: 03 07 2024
received: 15 05 2024
accepted: 24 07 2024
medline: 13 8 2024
pubmed: 13 8 2024
entrez: 13 8 2024
Statut: aheadofprint

Résumé

Empty nose syndrome (ENS) is a poorly understood, debilitating condition affecting a minority of patients who underwent nasal airway surgery, most commonly following inferior turbinate surgery. Few publications have demonstrated middle turbinate resection (MTR) causing ENS, but MTR is still considered a potential cause of ENS. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) is validated for ENS diagnosis, with ENS6Q ≥ 11 considered highly suggestive of ENS. The purpose of this multicenter study was to determine the incidence of patients with ENS6Q ≥ 11 following subtotal MTR during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) by comparing preoperative and postoperative ENS6Q scores. A multi-institutional prospective cohort study (8 US institutions) was conducted on patients who underwent bilateral subtotal MTR during ESS for CRSwNP. Preoperative and postoperative ENS6Q scores were compared after at least 12 months of postoperative follow-up. Of 110 patients, mean age was 51.6 years and 59.1% were male. Mean follow-up was 14.5 ± 2.5 months (range 12.1-22.3 months). Mean preoperative and postoperative ENS6Q were 7.7 and 2.2, respectively, demonstrating a mean 5.5 point decrease postoperatively (p < 0.0001). At final follow-up, no patient had an ENS6Q ≥ 11. Of note, 20% of patients had preoperative ENS6Q scores ≥11, but all decreased to <11 postoperatively. Based on prospective multicenter data over 1-2 years postoperatively, subtotal MTR for CRSwNP never led to ENS6Q scores ≥11, and patients experienced significant decreases in ENS6Q postoperatively. Subtotal MTR during ESS for CRSwNP was, therefore, unlikely to cause ENS even with long-term follow-up. 4 Laryngoscope, 2024.

Sections du résumé

BACKGROUND BACKGROUND
Empty nose syndrome (ENS) is a poorly understood, debilitating condition affecting a minority of patients who underwent nasal airway surgery, most commonly following inferior turbinate surgery. Few publications have demonstrated middle turbinate resection (MTR) causing ENS, but MTR is still considered a potential cause of ENS. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) is validated for ENS diagnosis, with ENS6Q ≥ 11 considered highly suggestive of ENS. The purpose of this multicenter study was to determine the incidence of patients with ENS6Q ≥ 11 following subtotal MTR during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) by comparing preoperative and postoperative ENS6Q scores.
METHODS METHODS
A multi-institutional prospective cohort study (8 US institutions) was conducted on patients who underwent bilateral subtotal MTR during ESS for CRSwNP. Preoperative and postoperative ENS6Q scores were compared after at least 12 months of postoperative follow-up.
RESULTS RESULTS
Of 110 patients, mean age was 51.6 years and 59.1% were male. Mean follow-up was 14.5 ± 2.5 months (range 12.1-22.3 months). Mean preoperative and postoperative ENS6Q were 7.7 and 2.2, respectively, demonstrating a mean 5.5 point decrease postoperatively (p < 0.0001). At final follow-up, no patient had an ENS6Q ≥ 11. Of note, 20% of patients had preoperative ENS6Q scores ≥11, but all decreased to <11 postoperatively.
CONCLUSIONS CONCLUSIONS
Based on prospective multicenter data over 1-2 years postoperatively, subtotal MTR for CRSwNP never led to ENS6Q scores ≥11, and patients experienced significant decreases in ENS6Q postoperatively. Subtotal MTR during ESS for CRSwNP was, therefore, unlikely to cause ENS even with long-term follow-up.
LEVEL OF EVIDENCE METHODS
4 Laryngoscope, 2024.

Identifiants

pubmed: 39136246
doi: 10.1002/lary.31694
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 The American Laryngological, Rhinological and Otological Society, Inc.

Références

Han JK, Bosso JV, Cho SH, et al. Multidisciplinary consensus on a stepwise treatment algorithm for management of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2021;11(10):1407‐1416. https://doi.org/10.1002/alr.22851
Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double‐blinded placebo‐controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol. 2018;8(4):461‐470. https://doi.org/10.1002/alr.22093
Li W, Ho J, Grayson JW, et al. Evaluation of diffuse type 2 dominant or eosinophilic chronic rhinosinusitis with corticosteroid irrigation after surgical Neosinus cavity formation. JAMA Otolaryngol Head Neck Surg. 2021;147(4):360‐367. https://doi.org/10.1001/jamaoto.2020.5286
Kidwai SM, Parasher AK, Khan MN, et al. Improved delivery of sinus irrigations after middle turbinate resection during endoscopic sinus surgery. Int Forum Allergy Rhinol. 2017;7(4):338‐342. https://doi.org/10.1002/alr.21894
Halderman AA, Stokken J, Sindwani R. The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses. Int Forum Allergy Rhinol. 2016;6(10):1056‐1061. https://doi.org/10.1002/alr.21791
Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection. Ann Otol Rhinol Laryngol. 2000;109(7):634‐640. https://doi.org/10.1177/000348940010900704
Su B, Han Q, Xi X, Zhou Z. Effect of modified endoscopic sinus surgery combined with middle turbinate resection on olfactory function and stress response in patients with refractory chronic rhinosinusitis with nasal polyps. Am J Transl Res. 2022;14(2):1279‐1287.
Soler ZM, Hwang PH, Mace J, Smith TL. Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope. 2010;120(4):832‐837. https://doi.org/10.1002/lary.20812
Marchioni D, Alicandri‐Ciufelli M, Mattioli F, et al. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol. 2008;128(9):1019‐1026. https://doi.org/10.1080/00016480701827541
Wu AW, Ting JY, Platt MP, Tierney HT, Metson R. Factors affecting time to revision sinus surgery for nasal polyps: a 25‐year experience. Laryngoscope. 2014;124(1):29‐33. https://doi.org/10.1002/lary.24213
Zhang L, Zhang Y, Gao Y, et al. Long‐term outcomes of different endoscopic sinus surgery in recurrent chronic rhinosinusitis with nasal polyps and asthma. Rhinology. 2020;58(2):126‐135. https://doi.org/10.4193/Rhin19.184
Pinther S, Deeb R, Peterson EL, Standring RT, Craig JR. Complications are rare from middle turbinate resection: a prospective case series. Am J Rhinol Allergy. 2019;33(6):657‐664. https://doi.org/10.1177/1945892419860299
Choby GW, Hobson CE, Lee S, Wang EW. Clinical effects of middle turbinate resection after endoscopic sinus surgery: a systematic review. Am J Rhinol Allergy. 2014;28(6):502‐507. https://doi.org/10.2500/ajra.2014.28.4097
Sozansky J, Houser SM. Pathophysiology of empty nose syndrome. Laryngoscope. 2015;125(1):70‐74. https://doi.org/10.1002/lary.24813
Manji J, Nayak JV, Thamboo A. The functional and psychological burden of empty nose syndrome. Int Forum Allergy Rhinol. 2018;8(6):707‐712. https://doi.org/10.1002/alr.22097
Lamb M, Bacon DR, Zeatoun A, et al. Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis. Int Forum Allergy Rhinol. 2022;12(11):1340‐1349. https://doi.org/10.1002/alr.22997
Velasquez N, Thamboo A, Habib AR, Huang Z, Nayak JV. The empty nose syndrome 6‐item questionnaire (ENS6Q): a validated 6‐item questionnaire as a diagnostic aid for empty nose syndrome patients. Int Forum Allergy Rhinol. 2017;7(1):64‐71. https://doi.org/10.1002/alr.21842
Thamboo A, Velasquez N, Habib AR, Zarabanda D, Paknezhad H, Nayak JV. Defining surgical criteria for empty nose syndrome: validation of the office‐based cotton test and clinical interpretability of the validated empty nose syndrome 6‐item questionnaire. Laryngoscope. 2017;127(8):1746‐1752. https://doi.org/10.1002/lary.26549
Moore EJ, Kern EB. Atrophic rhinitis: a review of 242 cases. Am J Rhinol. 2001;15(6):355‐361.
Houser SM. Empty nose syndrome associated with middle turbinate resection. Otolaryngol Head Neck Surg. 2006;135(6):972‐973. https://doi.org/10.1016/j.otohns.2005.04.017
Chhabra N, Houser SM. The diagnosis and management of empty nose syndrome. Otolaryngol Clin North Am. 2009;42(2):311‐330, ix. https://doi.org/10.1016/j.otc.2009.02.001
Tan NC, Goggin R, Psaltis AJ, Wormald PJ. Partial resection of the middle turbinate during endoscopic sinus surgery for chronic rhinosinusitis does not lead to an increased risk of empty nose syndrome: a cohort study of a tertiary practice. Int Forum Allergy Rhinol. 2018;8(8):959‐963. https://doi.org/10.1002/alr.22127
Law RH, Ahmed AM, Van Harn M, Craig JR. Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively. Am J Otolaryngol. 2021;42(4):102931. https://doi.org/10.1016/j.amjoto.2021.102931
Dekkers OM, Egger M, Altman DG, Vandenbroucke JP. Distinguishing case series from cohort studies. Ann Intern Med. 2012;156(1 Pt 1):37‐40. https://doi.org/10.7326/0003-4819-156-1-201201030-00006
Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213‐739. https://doi.org/10.1002/alr.22741
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1‐s39. https://doi.org/10.1177/0194599815572097
Kanjanawasee D, Campbell RG, Rimmer J, et al. Empty nose syndrome pathophysiology: a systematic review. Otolaryngol Head Neck Surg. 2022;167(3):434‐451. https://doi.org/10.1177/01945998211052919
Houser SM. Surgical treatment for empty nose syndrome. Arch Otolaryngol Head Neck Surg. 2007;133(9):858‐863. https://doi.org/10.1001/archotol.133.9.858
Maza G, Li C, Krebs JP, et al. Computational fluid dynamics after endoscopic endonasal skull base surgery‐possible empty nose syndrome in the context of middle turbinate resection. Int Forum Allergy Rhinol. 2019;9(2):204‐211. https://doi.org/10.1002/alr.22236
Li C, Farag AA, Maza G, et al. Investigation of the abnormal nasal aerodynamics and trigeminal functions among empty nose syndrome patients. Int Forum Allergy Rhinol. 2018;8(3):444‐452. https://doi.org/10.1002/alr.22045
Malik J, Li C, Maza G, et al. Computational fluid dynamic analysis of aggressive turbinate reductions: is it a culprit of empty nose syndrome? Int Forum Allergy Rhinol. 2019;9(8):891‐899. https://doi.org/10.1002/alr.22350
Jankowski R, Pigret D, Decroocq F, Blum A, Gillet P. Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A retrospective study. Rev Laryngol Otol Rhinol (Bord). 2006;127(3):131‐140.
Tang DM, Roxbury CR. Management of the middle turbinate during and after sinus surgery. Curr Opin Otolaryngol Head Neck Surg. 2022;30(1):40‐45. https://doi.org/10.1097/moo.0000000000000777
Ramadan HH. Surgical causes of failure in endoscopic sinus surgery. Laryngoscope. 1999;109(1):27‐29. https://doi.org/10.1097/00005537-199901000-00006
Fortune DS, Duncavage JA. Incidence of frontal sinusitis following partial middle turbinectomy. Ann Otol Rhinol Laryngol. 1998;107(6):447‐453. https://doi.org/10.1177/000348949810700601
Leopold DA. The relationship between nasal anatomy and human olfaction. Laryngoscope. 1988;98(11):1232‐1238. https://doi.org/10.1288/00005537-198811000-00015
Swanson PB, Lanza DC, Vining EM, Kennedy DW. The effect of middle turbinate resection upon the frontal sinus. Am J Rhinol. 1995;9(4):191‐196.
Lemogne C, Consoli SM, Limosin F, Bonfils P. Treating empty nose syndrome as a somatic symptom disorder. Gen Hosp Psychiatry. 2015;37(3):e9–10. https://doi.org/10.1016/j.genhosppsych.2015.02.005
Tian P, Hu J, Ma Y, et al. The clinical effect of psychosomatic interventions on empty nose syndrome secondary to turbinate‐sparing techniques: a prospective self‐controlled study. Int Forum Allergy Rhinol. 2021;11(6):984‐992. https://doi.org/10.1002/alr.22726

Auteurs

Jacob G Eide (JG)

Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, USA.

Edward C Kuan (EC)

Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, CA, USA.

Nithin D Adappa (ND)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Jeremy Chang (J)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Do-Yeon Cho (DY)

Department of Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA.

Rohit Garg (R)

Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Anaheim, CA, USA.

Satish Govindaraj (S)

Department of Otorhinolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Jessica Grayson (J)

Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Anaheim, CA, USA.

Eunice Im (E)

Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, USA.

David Keschner (D)

Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Anaheim, CA, USA.

Michael Kohanski (M)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Tran Locke (T)

Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.

James N Palmer (JN)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Kevin C Welch (KC)

Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Bradford A Woodworth (BA)

Department of Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA.

Frederick Yoo (F)

Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Orange County, Anaheim, CA, USA.

John R Craig (JR)

Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, USA.

Classifications MeSH