Large middle meatal antrostomy vs undisturbed maxillary ostium in the endoscopic sinus surgery of nasal polyposis.

ABSTRACT

BACKGROUND: There is controversy of creating the drainage lumen in endoscopic sinus surgery for diffuse nasal polyposis. OBJECTIVE: To compare the patency rate of drainage lumen between large middle meatal antrostomy and undisturbed maxillary ostium in endoscopic sinus surgery for nasal polyposis. SETTING: Department of Otolaryngology, King Chulalongkorn Memorial Hospital. DESIGN: Randomized double-blind control trial. SUBJECT Patients diagnosed at the King Chulalongorn hospital who had chronic maxillary sinusitis developed by nasal polyposis. METHOD: Sixty patients who had similar degree of bilateral nasal polyps and chronic maxillary sinusitis were enrolled. The sides of which each surgical technique would be applied were randomized by simple randomization. The patients did not know which treatment technique was applied to which side of the nose. The evaluator evaluated the objective endoscopic examination from the recorded videotape of each side separately at the third month till one year after surgery without notifying the patients. RESULTS: The patency rate of a large middle meatal antrostomy was 71.7 per cent-85 per cent compared to 61.7 per cent-65 per cent of the undisturbed maxillary ostium. There was a statistically significant difference only in early phase evaluation between the two surgical techniques (p-value = 0.002). Thirty-six of 60 cases (60%) had good results with adequate drainage lumens, no infection and no recurrent polyps at the final evaluation. Early and small nasal polyps (grade I polyp) was the main correlation factor to the success of endoscopic sinus surgery for nasal polyposis (p-value = 0.017). The occlusion of the drainage system after surgery was mainly from recurrent polyps. CONCLUSION: The large middle antrostomy group had a better statistically significant patency rate than undisturbed maxillary ostium only in the early phase after surgery. Recurrent polyp was the main cause of stenosis. Early surgical intervention of the small nasal polyposis had a better result compared to large diffuse nasal polyps.