Olfactory Function and Disease Severity in Chronic Rhinosinusitis

Abstract

Background Olfactory dysfunction is deemed to be a significant contributor to poor quality of life (QOL). However, little is known about the relationship of olfactory testing to other measures of disease burden in patients with chronic rhinosinusitis (CRS). Objective In this study, we examine the relationship of olfactory function to computed tomography (CT) scores, endoscopy scores, and QOL measures in patients with CRS. Methods A multi-institutional, cross-sectional analysis of 367 patients was performed. Several objective measures were collected: the Smell Identification Test, Lund-MacKay CT score, Lund-Kennedy endoscopy score, two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey, and a general health-related QOL instrument, the Medical Short Form-36. Analysis of variance was performed. Correlation coefficients were calculated. Results Patients with olfactory dysfunction had significantly worse mean endoscopy scores (normosmics: 4.16 (± 3.97); hyposmics: 6.26 (± 4.21); anosmics: 9.61 (± 4.48); p<0.001) and significantly worse CT scores (normosmics: 9.11 (± 5.40); hyposmics: 11.16 (± 5.96); anosmics: 17.62 (± 5.37); p<0.001). Endoscopy scores were moderately correlated with olfactory scores (r= -0.46, 95% CI -0.38, -0.54; p<0.001). CT scores were moderately correlated with olfactory scores (r= -0.53, 95% CI -0.45, -0.60; p<0.001). Olfactory function was not correlated with disease-specific or general health-related QOL measures. Conclusions Although previous studies have suggested that olfactory impairment is associated with poor QOL, this study found no such correlation. In contrast, olfaction scores correlated well with other objective measures of CRS, namely endoscopy and CT scores.

Chronic Rhinosinusitis and Olfactory Dysfunction

“…On contrast, studies agree that semi-objective olfactory testing are not correlated with disease-specific or general health-related quality of life instruments (Litvack et al, 2009a;Hox et al, 2010) 7. Effects of treatment on olfactory function…”

“…Litvack et al (2009a) have shown that the severity of quantitative olfactory disorder is associated with the importance of the sinonasal disease and that mean CT score is significantly higher in patients with hyposmia and anosmia than in normosmic patient. It was also demonstrated that the opacification of the olfactory cleft has a negative correlation with the olfactory function in patients with CRS and that it is significantly correlated with the postoperative olfactory results; patients with mild opacification having better postoperative results than patients with moderate and severe anterior olfactory cleft result (Kim et al, 2011).…”

“…Indeed, the mean endoscopy score and the mean CT score are significantly higher (more abnormal) in patients with hyposmia and anosmia than in patients with normosmia (Litvack et al, 2009a). Also, the opacification of the olfactory cleft on the CT scan seems to have a negative correlation with the olfactory function (Chang et al, 2009).…”

“…Some studies have described that the severity of quantitative disorders is related to the importance of the sinonasal disease (Litvack et al, 2008(Litvack et al, , 2009a. Indeed, the mean endoscopy score and the mean CT score are significantly higher (more abnormal) in patients with hyposmia and anosmia than in patients with normosmia (Litvack et al, 2009a).…”

Effect of ESS on Olfactory Threshold of Patients with CRS without Nasal Polyps

“…Olfactory dysfunction is common among CRS patients with a prevalence ranging from 48% to 83% [2][3][4][5] . Some previous studies believe that medical therapy is beneficial for improving olfactory function in CRS; nevertheless, endoscopic sinus surgery (ESS) is the treatment of choice in CRS patients who do not respond to medical therapy 1,6 .…”