Nasal Airway Resistance and Olfactory Acuity following Transsphenoidal Pituitary Surgery

Abstract

Rhinological problems after a transseptal transsphenoidal approach for pituitary tumors were prospectively investigated in 25 patients with special reference to nasal airway resistance and olfactory acuity. Five patients showed a significant increase in the unilateral and/or total nasal airway resistance. Endoscopic observation of the nasal cavity revealed the presence of crust formation, hypertrophy of the inferior turbinate, or synechiae. Three patients showed a significant deterioration in olfactory acuity. Coronal CT views with good visualization of the olfactory cleft were helpful in evaluating causes of hyposmia postoperatively.

Olfactory outcomes after endoscopic transsphenoidal pituitary surgery

“…However, these articles only demonstrated self‐reported changes in olfaction, subject to recall bias, rather than using validated measures to assess changes in olfactory function. Ikeda et al4 used validated measures and found 12% of patients tested showed significant olfactory impairment following the surgery. Although all of these articles have found cause to question the impact on olfaction of transsphenoidal pituitary surgery, none intentionally employed a mucosal sparing protocol and none commented on postoperative mucosal preservation or injury; hence, the presence of confounding nasal damage was not accounted for.…”

“…Surgery has since evolved, from transcranial to sublabial to current technique of the endoscopic transsphenoidal approach 1. Although many of the risks and side effects of this approach have been well documented, the effect on olfaction remains unclear 2–4. Loss of olfaction can result in hazardous events such as ingesting spoiled foods or the inability to detect a gas leak or a fire 5, 6.…”

Clinical and histologic studies of olfactory outcomes after nasoseptal flap harvesting

“…It not only guides a person's attention to environmental hazards, such as smoke and poisonous fumes, but also influences our eating habits, nutritional intake, and interpersonal relationships. [3][4][5] Given the critical impact of smell loss on daily life, preservation of olfaction cannot be overemphasized in all types of endonasal surgery. 2 Some patients with a normal sense of smell experience smell loss following various endonasal surgeries, such as septoplasty, rhinoplasty, and transsphenoidal pituitary surgery.…”

“…4,6,7 After the introduction of endoscopic transsphenoidal pituitary surgery, however, this method was reported to have no significant effect on olfaction. Because the primary goal of surgery was the complete removal of the tumor, less attention was paid to preservation of olfactory function.…”

“…The incidence of olfactory loss has been variously reported, in the range of 10% to 30%. 4,6,7 After the introduction of endoscopic transsphenoidal pituitary surgery, however, this method was reported to have no significant effect on olfaction. Although patients experienced transient loss of smell in the first postoperative month, olfactory function was recovered by 3 months postoperatively.…”