A prospective cohort study comparing the effects of different middle turbinate treatments on olfactory function recovery in CRSwNP patients after FESS

BACKGROUND: The factors affecting postoperative olfactory recovery in chronic rhinosinusitis with nasal polyps (CRSwNP) remain unclear. This study explores postoperative pathological classification and the impact of different middle turbinate management strategies on olfactory recovery. METHODOLOGY: Seventy-two CRSwNP patients undergoing functional endoscopic sinus surgery (FESS) with ≥6 months follow-up were classified into eosinophilic (ECRSwNP) and non-eosinophilic (nECRSwNP) groups. Based on middle turbinate management, patients were further divided into resection (partial/complete) and preservation groups. Olfactory scores, clinical characteristics, and nasal endoscopy findings were analyzed, and multifactorial analysis identified factors influencing olfactory recovery. RESULTS: TDI scores in the ECRSwNP group remained lower than those in the nECRSwNP group preoperatively and postoperatively. However, olfactory score improvement and the proportion of significantly improved patients did not differ significantly between the two groups. Middle turbinate management was associated with greater olfactory improvement, particularly in nECRSwNP patients. Although the complete middle turbinate resection group had lower preoperative olfactory scores than the partial resection group, no significant difference was observed in postoperative olfactory improvement between the two approaches.Higher preoperative polyp scores and middle turbinate management predicted olfactory improvement. CONCLUSIONS: FESS significantly improves the olfactory function in CRSwNP patients, and the extent of olfactory improvement is independent of pathological type. Patients with higher preoperative Lildholdt polyp scores and those who underwent middle turbinate management during FESS were more likely to exhibit improved olfactory function at 6 months postoperatively.