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<p>Chronic rhinosinusitis with nasal polyps (CRSwNP) isan inflammatory condition, which has a significant impact on patients’quality of life. Endoscopic sinus surgery (ESS) is indicated for patientswho are refractory to maximal medical treatment, however, highrecurrence rates and revision surgeries are common. Efforts are made bysurgeons at all times to device ways to reduce recurrence rates. To explore the role of middle and superior turbinates inrecurrent sinonasal polyposis after primary surgery. To evaluate theadvantages and consequences of removal of middle (MT) and superiorturbinates (ST) along with total ethmoidectomy.This is a retrospective analysis of 450 patients operated attwo centres. 215 of these patients (Arm A) were operated at SpecialityE.N.T. Hospital, Kandivali, Mumbai. 235 patients (Arm B) underwentendonasal surgery at Govt. Medical College &amp; S.S.G. Hospital, Vadodara,Gujarat. Patients in Arm A were operated for the endonasal sinus &amp;turbinate surgery with novel concept (ethmo-turbinectomy includingsubtotal excision of middle and superior turbinate) for CRSwNP.Conventional FESS was performed in patients in Arm B (preservingcomplete bony architecture of the middle and superior turbinate)between June 2015 to June 2020. All the patients in both arms werereviewed post-surgery up to 5 years for recurrence, olfactory changesand empty nose syndrome.In Arm A, ethmo-turbinectomy resulted in disease clearancewithout the need of revision surgery in the operating room in all the 215patients studied. Two patients who had stopped use of intranasalcorticosteroid sprays (INCS) in the post-operative period and one patientin spite of using INCS regularly, needed outpatient based endoscopicclearance. In Arm B, out of the 235 patients about 22 had recurrent polyps onendoscopic examination, out of which 19 required revision surgery.The SNOT-22 scores demonstrated a better improvement in Arm A in thefollow-ups at sixth month, with mean difference in scores between thetwo arms of about 4 points.Telephonic surveys revealed Empty Nose Syndrome 6-item Questionnaire(ENS6Q) scores to be &lt; 3 and not significantly different in both arms.Most patients experienced improved olfaction post-surgery as comparedwith pre-surgery, with no cases of complete olfactory loss in both arms. This novel technique which is proposed to be named as“Agrawal’s ethmoturbinectomy” as a part of ESS affords better long termdisease control in CRSwNP, thus reducing the need for revision surgerywhen compared to conventional FESS.The technique is based on already researched and accepted fact that theethmoturbinals are a single embryological and functional unit. Theincidence of the long-feared complication of ENS (Empty NoseSyndrome) is also not significantly higher, when compared toconventional FESS. This could be the missing piece of puzzle in thetreatment of CRSwNP.</p>

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Ethmoturbinectomy - A Novel Concept in Endoscopic Sinus Surgery for Polyposis to Prevent Recurrence/ Revision Surgery

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Vikas K. Agrawal,
  • Devina Chitranshi,
  • Rahul R. Gupta,
  • Suheb Patel,
  • Akanksha Bakre

摘要

Chronic rhinosinusitis with nasal polyps (CRSwNP) isan inflammatory condition, which has a significant impact on patients’quality of life. Endoscopic sinus surgery (ESS) is indicated for patientswho are refractory to maximal medical treatment, however, highrecurrence rates and revision surgeries are common. Efforts are made bysurgeons at all times to device ways to reduce recurrence rates. To explore the role of middle and superior turbinates inrecurrent sinonasal polyposis after primary surgery. To evaluate theadvantages and consequences of removal of middle (MT) and superiorturbinates (ST) along with total ethmoidectomy.This is a retrospective analysis of 450 patients operated attwo centres. 215 of these patients (Arm A) were operated at SpecialityE.N.T. Hospital, Kandivali, Mumbai. 235 patients (Arm B) underwentendonasal surgery at Govt. Medical College & S.S.G. Hospital, Vadodara,Gujarat. Patients in Arm A were operated for the endonasal sinus &turbinate surgery with novel concept (ethmo-turbinectomy includingsubtotal excision of middle and superior turbinate) for CRSwNP.Conventional FESS was performed in patients in Arm B (preservingcomplete bony architecture of the middle and superior turbinate)between June 2015 to June 2020. All the patients in both arms werereviewed post-surgery up to 5 years for recurrence, olfactory changesand empty nose syndrome.In Arm A, ethmo-turbinectomy resulted in disease clearancewithout the need of revision surgery in the operating room in all the 215patients studied. Two patients who had stopped use of intranasalcorticosteroid sprays (INCS) in the post-operative period and one patientin spite of using INCS regularly, needed outpatient based endoscopicclearance. In Arm B, out of the 235 patients about 22 had recurrent polyps onendoscopic examination, out of which 19 required revision surgery.The SNOT-22 scores demonstrated a better improvement in Arm A in thefollow-ups at sixth month, with mean difference in scores between thetwo arms of about 4 points.Telephonic surveys revealed Empty Nose Syndrome 6-item Questionnaire(ENS6Q) scores to be < 3 and not significantly different in both arms.Most patients experienced improved olfaction post-surgery as comparedwith pre-surgery, with no cases of complete olfactory loss in both arms. This novel technique which is proposed to be named as“Agrawal’s ethmoturbinectomy” as a part of ESS affords better long termdisease control in CRSwNP, thus reducing the need for revision surgerywhen compared to conventional FESS.The technique is based on already researched and accepted fact that theethmoturbinals are a single embryological and functional unit. Theincidence of the long-feared complication of ENS (Empty NoseSyndrome) is also not significantly higher, when compared toconventional FESS. This could be the missing piece of puzzle in thetreatment of CRSwNP.