Elsevier

American Journal of Otolaryngology

Volume 24, Issue 6, November–December 2003, Pages 366-369
American Journal of Otolaryngology

Original contribution
Subjective improvement of olfactory function after endoscopic sinus surgery for chronic rhinosinusitis

https://doi.org/10.1016/S0196-0709(03)00067-XGet rights and content

Abstract

Objective

The purpose of this study was to determine the effect of functional endoscopic sinus surgery (FESS) on subjective olfactory dysfunction in patients with chronic rhinosinusitis.

Materials and methods

Prospective collection of data on consecutive patients undergoing FESS after failing prolonged medical therapy for chronic rhinosinusitis at a tertiary institution. Patients were asked to grade their olfactory dysfunction from 0 to 10, with 0 representing normal function and 10 complete anosmia. In addition, data such as computed tomography scores, presence or absence of nasal polyps, and the presence or absence of asthma were recorded and analyzed. Patients were followed up to 1 year after surgery.

Results

Data were collected on 178 patients who had sinus surgery over a 2-year period. The average olfactory dysfunction score before surgery was 4.9. This improved to 0.9 at 1 year after surgery (P = .00). Higher computed tomography scores as per Lund and MacKay correlated with higher olfactory dysfunction scores (r = 0.62, P < .01) and greater improvement after surgery (r = 0.82, P < .01). Asthmatics and patients with polyps had higher subjective olfactory dysfunction scores than nonasthmatics and patients without polyps (6.8 and 7.2 v 4.4 and 4.1, respectively). All groups had subjective improvement at 1 year (2.3 and 1.5 v 0.6 and 0.7, respectively; P = .00).

Conclusion

Patients with subjective olfactory dysfunction despite appropriate medical management for rhinosinusitis benefit from FESS.

Section snippets

Materials and methods

One hundred seventy-eight patients undergoing endoscopic sinus surgery for chronic rhinosinusitis by a single surgeon were included in our study. All patients were treated with and failed maximal medical therapy (inhaled nasal steroids, guaifenesin, nasal saline douches, and antibiotics if indicated) for at least 1 month before surgery. All surgeries were performed between 1999 and 2001. The senior author and resident physicians under his supervision, using the Messerklinger technique,6, 7, 8

Results

One hundred seventy-eight patients met the criteria for entry into the study. The average preoperative subjective olfactory score for all patients was 4.9 ± 1.8. At 3 months postoperatively, 154 of 178 (86%) indicated improvement of their olfactory function, 19 (11%) reported no change, and 5 (3%) reported worsening of their olfactory function. One year after surgery, 173 (97%) patients reported olfactory function improvement, 3 (2%) reported no change, and 2 (1%) reported worsening. The

Discussion

Olfactory function is a complex process whereby small air-borne hydrophobic molecules are transported to respiratory epithelium where they are converted into a neuronal signal.10 Several hypotheses have been put forth to explain hyposmia in the setting of chronic rhinosinusitis. Odorants may be physically blockaded by swollen or hypertrophied mucosa and prevented from reaching the olfactory epithelium. Originally, this was thought to be the mechanism for hyposmia in chronic rhinosinusitis.

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