Predictors of the outcome of nasal surgery in terms of olfactory function

Abstract

Nasal surgery is frequently performed. Predictors of surgical outcome in terms of chemosensory function are not clear. A total of 64 patients were included in this prospective study (41 men, 23 women; age range 22-67 years). Prior to surgery, patients received a detailed otorhinolaryngological examination including nasal endoscopy, and CT scans used to establish the Lund-Mackay score. Olfactory function was analyzed using a custom-built odor identification test which allowed separation of chemosensory function into "olfactory" and "trigeminal" portions. Retest was performed 6 months after surgery. In terms of the sense of smell, nasal surgery produced the highest success rates in women, high degree of polyposis, and aspirin-intolerance. Neither age, presence of asthma, nor the number of preoperative surgical interventions had a significant impact on the outcome of surgery in terms of chemosensory function. Although "trigeminal scores" changed to a lesser degree than "olfactory scores", the present results indicated that nasal surgery may also improve trigeminal function, although this needs further corroboration. Improvement of olfactory function following nasal surgery appears to last, on average, for at least 6 months. While the present results may be seen as an encouraging step towards the description of more detailed prognostic factors related to nasal surgery, results from the present investigation also point towards the idea that nasal polyposis is due to a multifactorial process that, so far, is not adequately addressed by current research. Future work is needed to identify further predictors of postoperative outcome in terms of olfactory function.

Does olfactory function improve after endoscopic sinus surgery?

“…Pade et al found nasal polyposis to be the most important factor in determining olfactory improvement 4 months after ESS 7. Minovi et al found patients with nasal polyposis had a higher success rate of olfactory improvement at six month follow up than other patients 6. Although patients with nasal polyposis are at risk for recurrent disease, the removal of mechanical obstruction from the olfactory cleft and consequent increase in intranasal volume likely improve olfactory function over the one-year postoperative period.…”

Smell and taste disorders

“…Age and number of previous operations have little bearing on the success of the operation on the smell disorder. With regards to the smell function, septum operations, for example, only result in significant improvement in 13% of patients, whilst with paranasal sinus operations this figure is 23% [126], [127]. The relatively low success rate indicates on the one hand that there is room for improvement and on the other hand that the olfactory impairment before surgery is much more moderate than in polyposis patients.…”

Comparative effectiveness of medical and surgical therapy on olfaction in chronic rhinosinusitis: a prospective, multi‐institutional study

“…Prior studies have examined the effectiveness of endoscopic sinus surgery (ESS) in patients with CRS and olfactory dysfunction. 7,9–11 These studies report mixed results with a variety of outcome measures, but are uniformly limited by lack of a medical control group. To date, no study has compared the olfactory outcomes in CRS of medical management to surgical management.…”