Does the Middle Turbinate Share the Clinical and Pathological Changes with Paranasal Sinuses in Chronic Rhinosinusitis?

Abstract

Introduction: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammation of the nose and paranasal sinus (PNS) mucosa for at least 12 weeks with the formation of nasal polyps. This is a multi-factorial disease. Nasal polyposis represents 4% of the population. Few studies have looked at the histopathological changes in ethmoid mucosa and compared them with those of the mucosa of the nasal septum, inferior turbinate (IT), and middle turbinate (MT) in patients with CRS. Objective: To compare clinical and histopathological findings of the middle turbinate and ethmoidal polyp in CRSwNP patients refractory to medical treatment. Methods: Forty patients with CRSwNP refractory to treatment were included. Endoscopic and histopathological findings of MT and ethmoid sinus samples were compared. Results: By endoscopic(macroscopic) examination, there was a statistically significant difference between MT and ethmoidal polyp. Polyps in the ethmoid were present in all cases. Polypoidal MT mucosa was present in a quarter of patients. In the rest of the patients, the MT mucosa was edematous or normal. By microscopic examination, there was no statistically significant difference between the two sites in the degree of basement membrane (BM) thickness, goblet cell hyperplasia, eosinophils, and polymorphs. Statistically, a significant difference was present in the degree of sub-epithelial edema, the number of sub-mucous glands, and lymphocytes. Conclusion: Although MT does not share the macroscopic changes with the ethmoid sinus in patients with CRSwNP, at the microscopic level, both sites share the pathologic changes to a far extent. It is better to address the MT in the medical and surgical management of CRSwNP for better results.

Study of Acute and Chronic Sinusitis – Symptoms, Diagnosis and Treatment: A Review article

“…In 2021, Hamza Elshafie Ahmed et al discovered that in patients with CRSwNP, the middle turbinate (MT) did not share macroscopic changes with the ethmoid sinus. It is preferable to address the MT during the medicinal and surgical treatment of CRSwNP for optimal results [40]. In 2022, a study highlights the importance of informing patients about the risks connected with the use of steroids to treat chronic rhinosinusitis (CRS) during the COVID-19 pandemic [41].…”