Olfactory Disorder is The Specific Symptom to Distinguish Eosinophilic From Non-Eosinophilic Nasal Polyps

Abstract

Background: Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) have poorer outcomes after endoscopic sinus surgery and a higher recurrence rate. This study aimed to investigate the profile of clinical symptoms of eCRSwNP and the related risk factors.Methods: We prospectively enrolled 298 CRSwNP inpatients from February 2019 to December 2019. Patients were divided into eCRSwNP and non-eCRSwNP groups based on the percentage of blood eosinophils. Clinical data on questionnaires, visual analogue scale (VAS) scores, and laboratory tests were collected. The differences in clinical symptoms, including nasal congestion, rhinorrhea, olfactory disorders, and head/facial pain, between the two groups were analyzed to identify the influential factors. Logistic analysis and receiver operating characteristic curves were used to determine the diagnostic benefit for the specific symptom in eCRSwNP patients.Results: Of the four major clinical symptoms, nasal congestion and olfactory disorders were significantly different between eCRSwNP and non-eCRSwNP groups. Patients with eCRSwNP more frequently complained about olfactory disorders (P = 0.002), while patients with non-eCRSwNP mostly had nasal congestion (P = 0.001). The logistic analysis showed that the primary risk factors for olfactory disorders of eCRSwNP were disease duration (P = 0.014) and alcohol intake (P = 0.012). Olfactory disorders were not associated with the disease course of eCRSwNP but were correlated with the disease duration of non-eCRSwNP (P = 0.008). When the clinical duration was less than 10 years, there was a significant difference in olfactory disorders between eCRSwNP and non-eCRSwNP groups (P < 0.01). However, when the clinical duration was over 10 years, the difference was not statistically significant (P = 0.264). The VAS score of olfactory disorders of over 5.75 could be used to predict the diagnosis of eCRSwNP (area under the curve ＝0.674, 95% confidence intervals: 0.559–0.689, P = 0.000). Conclusions: Olfactory disorder was the major nasal symptom that could be used to distinguish eCRSwNP and non-eCRSwNP. ECRSwNP patients were more prone to have olfactory dysfunction. Our findings suggest that evaluation of nasal symptoms will help diagnose eCRSwNP and determine subsequent clinical treatment strategies.