Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function

Eugene H Wong; Carolyn A Orgain; E Ritter Sansoni; Raquel Alvarado; Jessica Grayson; Larry Kalish; Raymond Sacks; Richard J Harvey

doi:10.1016/j.amjoto.2019.102316

Turbinate loss from non-inflammatory sinonasal surgery does not correlate with poor sinonasal function

Am J Otolaryngol. 2020 Jan-Feb;41(1):102316. doi: 10.1016/j.amjoto.2019.102316. Epub 2019 Oct 17.

Authors

Eugene H Wong¹, Carolyn A Orgain², E Ritter Sansoni², Raquel Alvarado², Jessica Grayson², Larry Kalish³, Raymond Sacks⁴, Richard J Harvey⁴

Affiliations

¹ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia. Electronic address: eugene.hl.wong@gmail.com.
² Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.
³ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.
⁴ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

PMID: 31732317
DOI: 10.1016/j.amjoto.2019.102316

Abstract

Objective: The impact of turbinate resection on nasal function remains a controversial topic. In surgery for inflammatory sinonasal disease, turbinate resection is often avoided. In contrast, turbinate tissue is routinely sacrificed in endoscopic tumor and skull base surgery to achieve negative margins or gain adequate exposure. Anecdotally, these patients experience good self-reported post-operative nasal function despite extensive turbinate tissue loss. This study investigates the impact of turbinate resection on self-reported sinonasal function following endoscopic tumor or skull base surgery.

Study design: Retrospective case series.

Setting: Tertiary Australian Hospitals.

Subjects and methods: A retrospective review was performed on consecutive post-surgical patients after management for non-inflammatory sinus disease such as tumor resection or endoscopic skull base reconstruction. Outcome variables assessed included a 6-point Likert score for nasal obstruction, a 13-point Likert score for global nasal function and a 5-question sleep score. The degree of turbinate tissue loss (0-4) was determined by the number of inferior or middle turbinate subtotal resections. Regression analysis was performed, accounting for the effect of relevant demographic variables (smoking; asthma; allergic status; gastroesophageal reflux; malignancy; vestibule mucositis) and treatment variables (subtotal septectomy; Draf III; nasal radiotherapy.) RESULTS: 294 patients (age 52.9 ± 17.6 years, 51.0% female) were assessed. Number of turbinates resected was not associated with poorer nasal obstruction score, global nasal function score or sleep score (OR = 1.77[0.93-3.38], OR = 0.60[0.33-1.12], B = 0.56[-1.58-2.69] respectively). Allergy and Draf3 were found to improve postoperative global nasal function score (OR = 2.07[1.04-4.13], P = 0.04, OR = 3.97[1.08-14.49], P = 0.04, respectively).

Conclusion: In patients where surgery was performed for non-inflammatory sinus disease, turbinate resection is not correlated with poorer postoperative nasal obstruction, sinonasal function nor sleep quality.

Keywords: Endoscopic; Inferior turbinate; Middle turbinate; Nasal function; Nasal obstruction; Paradoxical; Patient reported outcome measure; Skull base repair; Skull base surgery; Turbinectomy.

MeSH terms

Australia
Endoscopy / methods*
Female
Humans
Male
Middle Aged
Nasal Obstruction / physiopathology*
Nasal Obstruction / surgery*
Paranasal Sinus Diseases / surgery*
Retrospective Studies
Skull Base / surgery*
Turbinates / surgery*