Comparison of radical (nasalisation) and functional ethmoidectomy in patients with severe sinonasal polyposis. A...

To compare the 5-year outcomes of two endoscopic surgical approaches for diffuse and severe nasal polyposis.

A natural experimental situation gave us the opportunity to compare the results 5 years after radical ethmoidectomy (nasalisation) (n= 39), and functional ethmoidectomy (n= 37). The two surgical procedures were performed by two different surgeons on 76 consecutive patients. There was no random assignment for this retrospective study.

Five years after surgery, the criteria for comparison were 1) functional results based on a questionnaire using visual analogue scales in patients free of revision surgery; 2) endoscopic and CT-scan assessments of anatomical results. The CT-scans were blinded and randomized, and opacities were measured using a computerized model; 3) the recurrence rate of nasal polyps.

Five years after surgery, the overall nasal functional benefit was scored 8.41 +/- 0.40 (mean +/- SEM) after nasalisation, and 5.69 +/- 0.83 after ethmoidectomy P= 0.002) in patients free of revision surgery. The endoscopic appearance of the mucosa was methodically scored according to a pre-defined scale. Results were significantly better in the nasalisation group (6.03 +/- 0.7 versus 3.27 +/- 1.0, P= 0.02). A good correlation was found between the endoscopic and CT-scan scores (r= -0.78, P= 0.0001 for nasalisation, and r= -0.65, P= 0.001 for ethmoidectomy). The total recurrence rate was 22.7% in the nasalisation group, and 58.3% in the ethmoidectomy group (chi2= 10.41, P< 0.01).

Our study suggests that in the treatment of nasal polyposis complete ethmoidectomy leads to better long term results than incomplete ethmoidectomy.