Short‐term outcomes of olfaction in patients with eosinophilic chronic rhinosinusitis after endoscopic sinus surgery and an assessment of prognostic factors

Abstract

Background Olfactory dysfunction is one of the common symptoms of eosinophilic chronic rhinosinusitis (ECRS), for which endoscopic sinus surgery (ESS) is the standard treatment. Although the success rates of ESS for restoring olfaction in CRS have been reported, those for ECRS, as defined by new Japanese diagnostic criteria, remain unclear and the parameters affecting improvement rates have not yet been identified. Methods Eighty‐four patients with ECRS who underwent full‐house ESS were retrospectively investigated. Olfactory function was examined using T&T recognition thresholds before and 3 months after surgery. Results The total positive improvement rate in olfaction was 76.2% (64 of 84) and the mean T&T recognition threshold decreased significantly from 5.2 ± 1.1 to 3.0 ± 1.8 after surgery (p < 0.001). Some factors, including negative intravenous olfaction test, presence of olfactory cleft (OC) lesions, a history of sinus surgery, age ≥ 45 years, and being male, were more frequent in the olfaction refractory group. Furthermore, improvement of the T&T recognition threshold was significantly lower for factors of negative intravenous olfaction testing, the presence of OC lesions, and being male. Age and the proportion of blood eosinophils correlated with improvement. Conclusion Herein we examined prognostic factors for olfactory outcomes in ECRS treated with ESS. The intravenous olfaction test, presence of OC lesions, sex differences, and age (the cut‐off value was 45 years) were identified as independent prognostic factors for olfactory outcomes 3 months after surgery.

International consensus statement on allergy and rhinology: Olfaction

“…1672 A positive response to an intravenous olfactory test (eg, prosultiamine), absence of OC lesions, female sex, and younger age were also identified as independent prognostic factors for better olfactory outcomes 3 months after ESS. 1673 In PVOD, multivariate analysis showed that younger age and residual OF were significantly associated with better olfactory recovery. 1540 A study in Japan showed that onset latency in the intravenous olfactory test may help predict when olfaction in patients with PVOD will improve.…”

Early postoperative endoscopic score can predict the long-term endoscopic outcomes in eosinophilic chronic rhinosinusitis (ECRS) patients

“…The disease specific QOL or symptom score is not significantly correlated with endoscopic examination. 14 , 18 Although olfactory disorder is thought to exacerbate over time after ESS, the degree of disorder may depend on other factors, such as the condition of the olfactory cleft, age, or preoperative function; 20 , 21 therefore, the Escore alone cannot account for the change. Although, endoscopic examination is essential as an objective test, long-term evaluation combined with the subjective QOL/symptom score is more desirable.…”

好酸球性副鼻腔炎手術症例における嗅覚障害自覚症状の変化

“…These results suggest the need to inform patients that there is likely to be no improvement of olfactory dysfunction after surgical treatment in about 30% of cases with ECRS. 行われている報告 8,9) と比べて低値である(表 1) 。 「治 癒」と「軽快」を合わせた割合に注目すると，佐藤ら 8) 73％，Akiyama et al…”