EFFECTIVENESS OF ETHMOID NASALIZATION IN PATIENTS WITH POLYPOUS RHINOSINUSIS
DOI:
https://doi.org/10.37219/pg6evk05Keywords:
chronic rhinosinusitis with nasal polyps, ethmoid nasalization, functional endoscopic sinus surgery, SNOT-22, visual analog scale, type 2 inflammationAbstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical condition characterized by a high recurrence rate after conventional surgical treatment. Increasing attention has recently been paid to ethmoidal nasalization, a more radical surgical approach targeting inflamed mucosa as a potential source of type‑2 inflammation.
Objective: To evaluate the effectiveness of modified ethmoid nasalization compared to classical functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and type 2 inflammation.
Materials and methods: Twenty patients with CRSwNP, bronchial asthma, and eosinophilic inflammation (100% type 2) were enrolled. Patients were divided into two groups (n=10 each): group 1 – classical FESS with maximal mucosal preservation; group 2 – modified ethmoid nasalization with complete removal of ethmoid mucosa followed by free mucosal flap coverage from the nasal floor. Quality of life was assessed using the SNOT-22 questionnaire and reverse visual analog scale (VAS, 0-10, higher scores indicate better condition) preoperatively and at 3, 6, and 12 months postoperatively. Statistical analysis was performed using the independent samples t-test.
Results: Groups were comparable at baseline (Lund-Mackay score: 22 vs 20; SNOT-22: 60.2 vs 62.6). At 12 months, mean reverse VAS score was 2.1 (95% CI 0.67-3.53) in the FESS group versus 7.1 (95% CI 5.67-8.53) in the nasalization group (p<0.001). SNOT-22 scores at 12 months were 21.4 (95% CI 8.52-34.28) versus 11.1 (95% CI -1.78-23.98), respectively (p=0.217). The most pronounced difference was observed at late follow-up time points, indicating more sustained improvement after nasalization.
Conclusions: Modified ethmoid nasalization provides significantly better long-term subjective outcomes in quality of life compared to classical FESS in patients with eosinophilic CRSwNP. The technique appears promising for reducing recurrence rates and the need for systemic corticosteroids and biologic therapy.
Keywords: chronic rhinosinusitis with nasal polyps, ethmoid nasalization, functional endoscopic sinus
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