Clinical significance of middle turbinate lateralization after endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: To investigate the clinical significance of middle turbinate lateralization (MTL) occurrence postendoscopic sinus surgery (ESS) for chronic rhinosinusitis, namely, association with postoperative symptoms and eventual need for undergoing revision surgery. STUDY DESIGN: Retrospective chart review of consecutive postoperative follow-up appointments (November 2009-May 2011) for patients who had had full-house ESS (post hoc analysis). METHODS: Endoscopic video recordings were reviewed by a blinded reviewer to determine occurrence of MTL (any portion of the middle turbinate touching the lateral nasal wall). Postoperative symptom questionnaires using the Adelaide scoring system were collected. Records were reviewed to determine the need for revision surgeries during follow-up. RESULTS: A total of 151 patients had follow-up with video endoscopy from 2009 to 2011. No statistically significant association between MTL and symptoms was found (P > .05). Of the patients with MTL, 21% required revision versus 9% in those who had no MTL (P = .07). Log-rank test showed that there was a statistically significant difference between the revision surgery survival curves for the MTL and no-MTL groups (P = .03). Controlling for the inability to examine the frontal sinus, the difference between the two survival functions increased (P = .005). CONCLUSIONS: MTL was not associated with patient-reported symptoms, but may be associated with a more rapid need for future revision surgery. We hypothesize that this effect is related to interference with the frontal sinus.Ahmed Bassiouni, Philip G. Chen, Yuresh Naidoo and Peter-John Wormal