Middle Turbinate Variations Don’t Justify Sinus Surgery

Are anatomic variations of the middle turbinate (MT), such as concha bullosa and paradoxical MT, associated with nasal septal deviation or chronic rhinosinusitis (CRS)?

Background: CRS has multiple underlying causes. Although anatomic variations of nasal and sinus structures have been implicated as a possible risk factor for CRS, there is no agreement in the literature.

Study design: Comparative CT study.

Setting: Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea.

Synopsis: CT scans of 73 control patients and 461 patients with sinonasal complaints were evaluated for the presence of MT anatomic variations (concha bullosa and paradoxical MT), nasal septal deviation and CRS. The presence of MT variations was correlated with nasal septal deviation and the presence of CRS.

There was no difference in the incidence of MT anatomic variation or septal deviation between controls and symptomatic patients. MT variation was found to correlate with deviation of the nasal septum to the contralateral side, but there was no relationship between MT variation or septal deviation and CRS.

Bottom line: Middle turbinate anatomic variation is associated with contralateral nasal septal deviation, but this study shows no correlation with CRS. When surgery of the MTs is performed, it should be conservative. The presence of MT variations in the absence of CRS is not a justification for sinus surgery.

Citation: Cho JH, Park M, Chung YS, et al. Do anatomic variations of the middle turbinate have an effect on nasal septal deviation or paranasal sinusitis? Ann Otol Rhinol Laryngol. 2011;120(9):569-574.

—Reviewed by John M. DelGaudio, MD