Download PDF
Laryngorhinootologie 2013; 92(05): 326-331
DOI: 10.1055/s-0033-1334888
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Riechvermögen nach Medialisierung der mittleren Nasenmuschel bei der endonasalen Siebbeinoperation

Ability of Smell after Medialization of the Middle Nasal Turbinate in Endoscopic Sinus Surgery
T. Koch
1   HNO-Gemeinschaftspraxis, Calenberger Esplanade, Hannover
,
L. Iwers
2   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
,
T. Lenarz
2   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
,
S. Stolle
2   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover
› Author Affiliations
Further Information

Publication History

eingereicht19 September 2012

akzeptiert 30 January 2013

Publication Date:
02 April 2013 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund:

Die endonasale Siebbeinopera­tion erfordert beim üblichen Zugangsweg eine Verlagerung der mittleren Muschel nach medial, um Einsicht in den Siebbeinschacht zu schaffen. Dabei können Schleimhautverletzungen zu einer späteren narbigen Lateralisierung der Muschel führen. Die Fixierung der mittleren Muschel am Septum verhindert dies, allerdings ist durch die Verlegung des oberen Nasengangs eine Reduk­tion des Riechvermögens möglich.

Material:

In einer prospektiven Studie mit 83 konsekutiven Patienten mit chronischer Sinusitis (55% CRS +, 45% CRS−) erfolgte am Ende des Eingriffes eine Fixierung der mittleren Nasenmuschel am Nasenseptum mittels eines 4×0 Fadens. Präoperativ, sowie 6 Wochen, 3 Monate und 5 Monate postoperativ erfolgte eine Messung der Riechschwelle mittels sniffin’sticks.

Ergebnisse:

Postoperativ blieben die Siebbeinschächte übersichtlich ohne nennenswerte Synechien oder Vernarbungen. Das Riechvermögen sank zunächst durch die Verlegung der Riechspalte ab, erholte sich dann jedoch wieder. Nach Abschwellung und Entfernung des Fixierungsfadens war der obere Nasengang wieder frei belüftet, sodass 5 Monate postoperativ im Mittel ein besseres Riechvermögen resultierte als präoperativ. Nach Testung der Messwerte in 3 zweiseitigen verbundenen t-Tests unterschieden sich die Mittelwerte für präoperativ vs. 5 Monate postoperativ signifikant (p<0,001).

Schlussfolgerung:

Die Methode der Medialisierung und temporären Fixierung der mittleren Nasenmuschel am Nasenseptum gewährleistet eine bleibende Ventilation des Siebbeinschachtes ohne spätere Lateralisation. Durch die zeitlich begrenzte Anheftung der Nasenmuschel an das Septum kommt es zu keiner bleibenden Obstruktion der Riechspalte. Die Riechschwelle wird durch die dargestellte Methode nicht negativ ­beeinflusst.

Abstract

Ability of Smell after Medialization of the Middle Nasal Turbinate in Endoscopic Sinus Surgery

Background:

Endoscopic sinus surgery usually requires a move of the middle nasal turbinate into the midline to achieve a better sight into the ethmoidal sinuses. In this procedure damages of the turbinate are possible, which later can lead to a scarred fixation of the turbinate. Fixing of the turbinate to the septum can avoid this effect, but could reduce smell ability by blocking of the upper nasal duct.

Material:

In a prospective study with 83 patients with chronic sinusitis (55% CRS with polyps, 45% CRS without polyps) at the end of the operation the middle nasal turbinates were fixed at the nasal septum with a 4×0 stitch. Before the operation and 6 weeks, 3 and 5 months after operation the smell was tested using the “sniffin’sticks” threshold test.

Results:

After operation the ethmoidal area remained open without developing of relevant synechiae or scars. The smell ability decreased after surgery due to the obstruction of the upper nasal duct, but improved again later. After 5 months the average threshold of smell was better than before operation. Testing of the threshold values with the t-test showed a significant difference (p<0.001) between the pre- and postoperative status.

Conclusion:

The method of medialization and temporary septal fixation of the middle nasal turbinate allows a sufficient ventilation and drainage of the paranasal sinuses after sinus surgery. Due to only temporary fixation of the turbinate at the septum, a permanent obstruction of the upper nasal duct and the olfactory area is prevented. Thus the threshold of smell is not reduced.

Schlüsselwörter

Medialisierung - mittlere Nasenmuschel - chronische Sinusitis - Riechvermögen - endoskopische Nasennebenhöhlenoperation

Key words

medialization - middle nasal turbinate - chronic sinusitis - olfactory function - endoscopic sinus surgery
 

  • Literatur

  • 1 Weber R, Keerl R, Hosemann W, Leuwer R, Draf W, Lund V, Toffel P. Endonasal sinus surgery. Postoperative care, physiology and pathophysiology (1998) Videofilm auf CD ROM. In: Keerl R. ed. Virtual Clinic. Vol. III.
    Google Scholar
  • 2 Bolger WE, Kuhn FA, Kennedy DW. Middle turbinate stabilization after functional endoscopic sinus surgery: the controlled synchiae technique. Laryngoscope 1999; 109: 1852-1853
    CrossrefPubMedGoogle Scholar
  • 3 Friedman M, Landsberg R, Tanyeri H. Middle turbinate medialization and preservation in endoscopic sinus surgery. Otorhinol Head Neck Surg 2000; 123: 76-78
    CrossrefPubMedGoogle Scholar
  • 4 Friedman M, Schalch P. Middle turbinate medialization with bovine serum albumin tissue adhesive (BioGlue). Laryngoscope 2008; 118: 335-338
    CrossrefPubMedGoogle Scholar
  • 5 Moukarzel N, Nehme A, Mansour S, Yammine FG, Moukheiber A. Middle turbinate medialization technique in functional endoscopic sinus surgery. J Otolaryngol 2000; 29: 144-147
    PubMedGoogle Scholar
  • 6 Bhalla RK, Carpentier J. Reconstituting middle turbinate anatomy after pituitary surgery. Br J Neurosurg 2005; 19: 71-73
    CrossrefPubMedGoogle Scholar
  • 7 Hewitt KM, Orlandi RR. Suture medialization of the middle turbinates during endoscopic sinus surgery. Ear Nose Throat J 2008; 87: 11
    PubMedGoogle Scholar
  • 8 Lindemann J, Keck T, Rettinger G. Septal-turbinate-suture in endonasal sinus surgery. Rhinology 2002; 40: 92-94
    PubMedGoogle Scholar
  • 9 Shrime MG, Tabaee A, Hsu AK, Rickert S, Close LG. Synechia formation after endoscopic sinus surgery and middle turbinate medialization with and without FloSeal. Am J Rhinol 2007; 21: 174-179
    CrossrefPubMedGoogle Scholar
  • 10 Thornton RS. Middle turbinate stabilization technique in endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 1996; 122: 869-872
    CrossrefPubMedGoogle Scholar
  • 11 Rettinger G, Lindemann K, Ashoor M, Scheithauer M, Sommer F, Lindemann J. Langzeitergebnisse der transseptalen Naht der mittleren Nasenmuscheln bei Siebbeinoperationen. Laryngo-Rhinol-Otol 2011; 90: 471-475
    PubMedGoogle Scholar
  • 12 Brescia G, Pavin A, Giacomelli L, Boninsegna M, Florio A, Marioni G. Partial middle turbinectomy during endoscopic sinus surgery for extended sinunasal polyposis: short- and mid-term outcomes. Acta Otolaryngol 2008; 128: 73-77
    CrossrefPubMedGoogle Scholar
  • 13 Friedman M, Caldarelli DD, Venkatesan TK, Pandit R, Lee Y. Endoscopic sinus surgery with partial middle turbinate resection: effects on olfaction. Laryngoscope 1996; 106: 977-981
    CrossrefPubMedGoogle Scholar
  • 14 Jankowski R, Bodino C. Olfaction in patients with nasal polyposis: effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization). Rhinology 2003; 41: 220-230
    PubMedGoogle Scholar
  • 15 Marchioni D, Alicandri-Ciufelli M, Mattioli F, Marchetti A, Jovic G, Massone F, Presutti L. Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis. Acta Otolaryngol 2008; 128: 1019-1026
    CrossrefPubMedGoogle Scholar
  • 16 Shih C, Chin G, Rice DH. Middle turbinate resection: impact on outcomes in endoscopic sinus surgery. Ear Nose Throat J 2003; 82: 796-797
    PubMedGoogle Scholar
  • 17 Soler ZM, Hwang PH, Mace J, Smith TL. Outcomes after middle turbinate resection: revisiting a controversial topic. Laryngoscope 2010; 120: 832-837
    CrossrefPubMedGoogle Scholar
  • 18 Grützenmacher S, Lang C, Mlynski G. The combination of acoustic rhinometry, rhinoresistometry and flow simulation in noses before and after turbinate surgery: a model study. J Otorhinolaryngol 2003; 65: 341-347
    PubMedGoogle Scholar
  • 19 Mlynski G, Grützenmacher S, Mlynski B, Koch B. Modelluntersuchungen zur Nasenmuschelchirurgie. Laryngo-Rhinol-Otol 1993; 72: 614-617
    PubMedGoogle Scholar
  • 20 Lindemann J, Keck T, Wiesmiller KM, Rettinger G, Brambs HJ, Pless D. Numerical simulation of intranasal air flow and temperature after resection of the turbinates. Rhinology 2005; 43: 24-28
    PubMedGoogle Scholar
  • 21 Koch T. Medialisierung und Fixierung der mittleren Nasenmuschel bei der endonasalen Siebbeinoperation. Laryngo-Rhinol-Otol 2008; 87: 6-9
    PubMedGoogle Scholar
  • 22 Hummel T, Kobal G, Gudziol H, Mackay-Sim A. Normative data for the “Sniffin’Sticks” including tests of odor identification, odor discrimination and olfactory thresholds: an upgrade based on a group of more than 3000 subjects. Eur Arch Otorhinolaryngol 2007; 264: 237-243
    CrossrefPubMedGoogle Scholar
  • 23 Kobal G, Hummel T, Sekinger B, Barz S, Roscher S, Wolf S. Sniffin’sticks: screening of olfactory performance. Rhinology 1996; 34: 222-226
    PubMedGoogle Scholar
  • 24 Friedman M, Tanyeri H, Landsberg R, Caldarelli D. Effects of middle turbinate medialization on olfaction. Laryngoscope 1999; 109: 1442-1445
    CrossrefPubMedGoogle Scholar
  • 25 Delank KW, Stoll W. Olfactory function after functional endoscopic sinus surgery for chronic sinusitis. Rhinology 1998; 36: 15-19
    PubMedGoogle Scholar
  • 26 Hummel T, Hüttenbrink KB. Olfactory dysfunction due to nasal sinus disease. Causes, consequences, epidemiology and therapy. HNO 2005; 53 (Suppl. 01) 26-32
    CrossrefPubMedGoogle Scholar
  • 27 Jiang RS, Lu FJ, Liang KL, Shiao JY, Su MC, Wsin CH, Chen WK. Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery. Am J Rhinol 2008; 22: 445-448
    CrossrefPubMedGoogle Scholar
  • 28 Litvack RJ, Mace J, Smith TL. Does olfactory function improve after endoscopic sinus surgery?. Otolaryngol Head and Neck Surg 2009; 140: 312-319
    CrossrefPubMedGoogle Scholar
  • 29 Minovi A, Hummel T, Ural A, Draf W, Bockmühl U. Predictors of the outcome of nasal surgery in terms of olfactory function. Eur Arch Otorhinolaryngol 2008; 265: 57-61
    CrossrefPubMedGoogle Scholar
  • 30 Pade J, Hummel T. Olfactory function following nasal surgery. Laryngoscope 2008; 118: 1260-1264
    CrossrefPubMedGoogle Scholar
  • 31 Litvack JR, Fong K, Mace J, James KE, Smith TL. Predictors of olfactory dysfunction in patients with chronic rhinosinusitis. Laryngoscope 2008; 118: 2225-2230
    CrossrefPubMedGoogle Scholar
  • 32 Biedlingmaier JF. Endoscopic sinus surgery with middle turbinate resection: results and complications. Ear Nose Throat J 1993; 72: 351-355
    PubMedGoogle Scholar
  • 33 Dutton JM, Hinton MJ. Middle turbinate suture conchopexy during endoscopic sinus surgery does not impair olfaction. Am J Rhinol Allergy 2011; 25: 125-127
    CrossrefPubMedGoogle Scholar