Resection versus preservation of anterior end of middle turbinate in eosinophilic chronic rhinosinusitis

Abstract Background Eosinophilic chronic rhinosinusitis (eCRS) is a subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by significant eosinophilic inflammation, although type 2 eosinophilic inflammation can also be identified in CRS without nasal polyps. Patients with ECRS often require surgery to clear the sinonasal passages, but revision endoscopic sinus surgery (RESS) is often necessary. The role of the middle turbinate (MT) in functional endoscopic sinus surgery (FESS) remains controversial. Some studies support MT resection to improve access for nasal irrigation and topical corticosteroids, which may reduce polyp recurrence, while others prefer preservation to maintain normal nasal anatomy. This study aims to compare the outcomes of middle turbinate resection versus preservation in patients with eCRS. Patients and methods A prospective, randomized, comparative study was conducted in 64 patients suspected of eCRS, using the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scoring system. Of these, 56 patients were confirmed histopathologically and included in the final analysis. Patients were randomly assigned to either MT preservation (n = 29) or partial MT resection (n = 27). Outcomes were assessed using the Smell Identification Test (SIT), Sinonasal Outcome Test (SNOT-22), modified Lund–Kennedy (MLK), and Lund–Mackay (LM) scores at baseline and at 1, 3, and 6 months postoperatively. Results At 6 months, the resection group demonstrated significantly better outcomes than the preservation group in SNOT-22 (p = 0.001), MLK (p = 0.004), and LM (p = 0.007) scores. Notable differences were seen at the 3rd and 6th months after surgery. However, there was no significant difference in SIT scores between the two groups after adjustment (p = 0.190). Conclusion Partial resection of the middle turbinate improved postoperative outcomes compared with preservation in patients with ECRS, with no significant impact on olfactory function.