Efficacy and safety of middle turbinate resection versus preservation during endoscopic sinus surgery in patients with chronic rhinosinusitis: a systematic review and meta-analysis.

Abstract

Background: Chronic rhinosinusitis (CRS) is a common inflammatory disease that significantly impairs quality of life. When symptoms persist despite medical therapy, endoscopic sinus surgery (ESS) is performed. During ESS, whether to resect or preserve the middle turbinate remains controversial: resection may improve access and reduce postoperative obstruction, while preservation maintains anatomy and may support normal healing and airflow. Evidence comparing both approaches is limited and inconsistent, so their relative efficacy and safety remain unclear.

Methods: A comprehensive literature search was conducted across various databases until January 2026 to identify relevant studies. The quality was assessed using the ROB2 and Newcastle-Ottawa Scale (NOS) tools and the analysis was performed using R software.

Results: The search identified 4,265 records; after screening and full-text assessment, 31 studies were included. Compared with preservation, middle turbinate resection showed a statistically significant improvement in Lund-Kennedy endoscopic score (MD = - 0.58), while symptom improvement measured by SNOT showed no significant difference. Resection significantly reduced postoperative adhesion/synechiae (RR = 0.35) and sinus ostium restenosis (RR = 0.41). For secondary outcomes, olfaction and POSE scores did not differ significantly between groups, and crustation and middle meatal antrostomy patency were not significantly different. Postoperative bleeding risk was higher with resection (RR = 2.24), whereas lateralization (RR = 0.29) and polyp recurrence (RR = 0.58) were lower with resection.

Conclusion: Middle turbinate resection during ESS for CRS appears to improve postoperative endoscopic healing and patency-related outcomes (including reduced synechiae and ostial restenosis), but it does not confer a consistent advantage in patient-reported symptoms and is associated with a higher risk of postoperative bleeding; therefore, MT management should be individualized and anatomy-/risk-guided rather than routine.