Surgical Approaches for Possible Positions of an Olfactory Implant to Stimulate the Olfactory Bulb.

INTRODUCTION: Current scientific developments seem to allow for an "olfactory implant" in analogy to cochlear implants. However, the position and surgical approaches for electrical stimulation of the olfactory system are unclear. METHODS: In a human anatomic cadaver study, we investigated different endoscopic approaches to electrically stimulate the olfactory bulb (OB) based on the following considerations: (1) the stimulating electrode should be close to the OB. (2) The surgical procedure should be as non-invasive and safe as possible and (3) as easy as possible for an experienced ENT surgeon. RESULTS: In summary, the endoscopic intracranial positioning of the electrode via a widened ostium of the fila olfactoria or a frontal sinus surgery like a Draf IIb procedure is a good option in terms of patients' risk, degree of difficulty for ENT surgeons, and position to the OB. Endoscopic intranasal positioning appeared to be the best option in terms of patient risk and the degree of difficulty for ENT surgeons. Although a bigger approach to the OB using a drill and the combined intranasal endoscopic and external approach enabled a close placement of the electrode to the OB, they do not seem relevant in practice due to their higher invasiveness. CONCLUSION: The study suggested that an intranasal positioning of a stimulating electrode is possible, with placements beneath the cribriform plate, extra- or intracranially, applying elegant surgical techniques with low or medium risk to the patient and a close placement to OB.

Presurgical olfactory function as an indicator of the outcome of functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to impaired olfactory function and reduced quality of life. When conservative treatments such as nasal irrigation and topical steroids fail, functional endoscopic sinus surgery (FESS) is often necessary, because it improves symptoms and enhances quality of life. MATERIALS AND METHODS: A total of 88 patients was included in this prospective study. All subjects underwent an extensive examination both presurgically and 4 months after operations including nasal endoscopy and psychophysical olfactory testing (Sniffin' Sticks). Moreover, disease-specific quality of life was assessed and presurgical CT scans were rated regarding the opacification of the paranasal sinuses. RESULTS: Presurgically psychophysical tests showed an overall olfactory dysfunction. Olfactory test results (TDI score) correlated with endoscopic (Lund-Kennedy and Lildtholdt score) and CT scores (Lund-Mackay and TOCS scores). Four months after surgery olfactory function was enhanced and quality of life significantly showed an overall improvement. However, the outcome was dependent on the extent of presurgical olfactory function: olfaction and quality of life improved most pronounced in anosmics compared to hyposmic and especially normosmic patients. CONCLUSIONS: This study confirmed that FESS in CRSwNP leads to a significant improvement of both olfaction and disease-specific quality of life. Moreover, preoperative psychophysical assessment of the extent of olfactory dysfunction can help to objectively assess possible risks and expected benefits of the surgery in terms of olfaction and quality of life.

Sinonasal surgery alters brain structure and function: Neuroanatomical correlates of olfactory dysfunction.

Olfactory dysfunction (OD) is more common than hearing loss, partial blindness, or blindness and can have a significant impact on the quality of life. Moreover, unexplained OD is an early biomarker in neurodegenerative diseases and increases 5-year mortality risk. Structural alterations in olfactory eloquent brain regions may represent the neuroanatomical correlates of OD. Previous studies have demonstrated reduced gray matter (GM) volume in areas of presumed olfactory relevance in patients with OD. However, being cross-sectional in nature, these studies do not provide evidence of causality, for which longitudinal work is required. At present, however, longitudinal studies addressing olfactory structural plasticity are limited, both in number and methodological approach: to our knowledge, such work has not included parallel functional imaging to confirm the relevance of structural change. We therefore performed a longitudinal multimodal neuroimaging study investigating structural and functional plasticity in 24 patients undergoing surgical treatment for chronic rhinosinusitis, compared with 17 healthy controls. We demonstrated functionally significant structural plasticity within the orbitofrontal, anterior cingulate and insular cortices, and temporal poles in patients 3 months after surgery. Of interest, GM volume decreased in these regions, in association with increased psychophysical scores and BOLD signal. To our knowledge, this is the first study to demonstrate both structural and functional plasticity of the central olfactory networks, thereby confirming these areas as neuroanatomical correlates of olfactory function/dysfunction.

A novel surgical treatment for long lasting unilateral peripheral parosmia: Olfactory cleft blocking technique.

The treatment of qualitative olfactory disease is challenging. We aimed to treat parosmia using a new minimally invasive surgical technique-the olfactory cleft blocking technique- by preventing odorants from reaching the olfactory epithelium. A novel surgical procedure for blocking the anterior and inferior openings of the olfactory cleft was accomplished in a patient with unilateral persistent peripheral parosmia. The HRCT and endoscopy were performed preoperatively and postoperatively to evaluate the anatomical structure of the olfactory cleft. The T&T olfactometer was used to assess the preoperative and postoperative olfactory function. After surgery, the patient's parosmia disappeared. Endoscopic examination and CT scan showed complete obstruction of the anterior and inferior portions of the olfactory cleft. No recurrence was reported during a 2-year follow-up. No surgical complications were reported except olfactory loss in the operative nostril. For patients with long-term unilateral peripheral olfactory dysfunction, the olfactory cleft blocking technique seems a novel, simple, safe and effective treatment. Further studies are required with a larger number of patients in order to access success rate.

Olfactory changes after endoscopic sinus surgery for chronic rhinosinusitis: A meta-analysis.

BACKGROUND: Endoscopic sinus surgery (ESS) is an important treatment modality for chronic rhinosinusitis (CRS). However, its effect on olfaction remains controversial. OBJECTIVE OF REVIEW: To assess the olfactory impact of ESS in patients with CRS. TYPE OF REVIEW: A meta-analysis. SEARCH STRATEGY: A systematic literature search in the PubMed, EMBASE and Cochrane Library databases was conducted to identify studies that assessed change in olfaction after ESS in patients with CRS. Search terms were related to paranasal sinus diseases, smell and endoscopy. EVALUATION METHOD: The extracted data included authors, publication year, study type, age, sex, diagnostic criteria, surgical mode, sample size, follow-up time, olfaction measurement tool and outcome. We analysed the olfactory changes as continuous variables. RESULTS: Thirty-five studies including 3164 patients with CRS were eligible for the meta-analysis. Among patients having CRS with nasal polyps, olfactory dysfunction improved, as assessed by the Sniffin' Sticks total score (P = .000), Sniffin' Sticks discrimination score (P = .023), Sniffin' Sticks identification score (P = .005), University of Pennsylvania Smell Identification Test (P = .046) and Visual Analogue Scale (P = .000). However, the threshold score of the Sniffin' Sticks test did not improve significantly (P = .361). Olfactory dysfunction did not improve in patients having CRS without nasal polyps according to the University of Pennsylvania Smell Identification Test (P = .404). In non-classified CRS patients, improvement in olfactory dysfunction was observed according to the University of Pennsylvania Smell Identification Test (P = .000), Visual Analogue Scale (P = .001) and Questionnaire of Olfactory Disorders-Negative Statements (P = .001). However, there were no significant improvements according to the Brief Smell Identification Test (P = .325), Sniffin' Sticks threshold score (P = .160) and Sniffin' Sticks identification score (P = .079). CONCLUSION: Endoscopic sinus surgery may be beneficial for improvement in olfactory conditions in patients with CRS. Further thorough and comprehensive studies need to be conducted.

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

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.

The effects of resection of the peripheral branches of the posterior nasal nerves in the inferior turbinate, with special focus on olfactory dysfunction.

OBJECTIVE: There are few detailed studies about peripheral branch resection of the posterior nasal nerves in the inferior turbinate; thus, this study aimed to investigate this. METHODS: Patients who underwent submucosal turbinoplasty with or without resection of the peripheral branches of posterior nasal nerves in the inferior turbinate were included. RESULTS: The resection of the posterior nasal nerves with turbinoplasty significantly reduced detection and recognition thresholds on olfactory testing. The rhinorrhoea severity, detection threshold and recognition threshold were significantly lower after resection of the posterior nasal nerves with turbinoplasty than after turbinoplasty alone, although there were no significant differences between the two groups before surgery. CONCLUSION: This is the first study to show that the resection of the peripheral branches of the posterior nasal nerves in the inferior turbinate with turbinoplasty more effectively inhibits allergic symptoms compared with turbinoplasty alone. It also showed that the resection of the peripheral branches of the posterior nasal nerves can inhibit olfactory dysfunction.

The relationship between endoscopic and radiologic findings and olfactory status of patients with chronic rhinosinusitis with nasal polyps before and after the endoscopic sinus surgery.

INTRODUCTION: This study was attempted to investigate the relationship between radiologic and endoscopic findings and pre- and post-operative olfactory scores in chronic rhinosinusitis with nasal polyps. MATERIALS AND METHODS: In this study, 40 patients aged 19-64 years with chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing endoscopic sinus surgery were involved. The patients' olfactory status was evaluated using Smell Identification Test (Iran SIT) before and 3 months after the surgery. Patients' nasal endoscopic signs were recorded using Modified Lund-Kennedy scoring system before and 3 months after the surgery and radiological symptoms were recorded based on Lund-Mackay CT scoring before the surgery. Then the relationship between olfactory status and endoscopic and radiological findings was investigated. RESULTS: With respect to mean of olfactory score, a significant difference was observed before and after the surgery (p value = 0.001). There was a significant difference between means of pre- and post-operative endoscopy scores (p value = 0.001). Pre-operative endoscopic and CT scan scores had a negative correlation with pre- and post-operative olfactory scores (p value < 0.05). Pre-op. olfactory scores had negative correlation with post-op. endoscopy scores (p value = 0.02). Post-op. olfactory scores had negative correlation with post-op. endoscopy scores but was not statistically significant (p value = 0.22). CONCLUSION: Our results revealed that pre-operative endoscopy and radiology findings were consistent with the olfactory status of patients with CRSwNP before and after endoscopic sinus surgery.

The effects of adenoidectomy on the smell perception of children.

BACKGROUND: In this study, we employed a novel children's olfactory test in order to more accurately assess the relationship between nasopharyngeal obstruction and odor identification ability. We quantified the impact of adenoidectomy on olfactory function, established whether the influences of the operation were related to the preoperative amount of nasopharyngeal obstruction, and determined whether sex influenced the olfactory measures. METHODS: Fifty-three boys and 23 girls were administered a standardized children's olfactory test, the Pediatric Smell Wheel™, before and 45 days after adenoidectomy. They ranged in age from 5 to 12 years and exhibited varying degrees of adenotonsillar hypertrophy and histories of recurrent adenotonsillitis. Radiographs of the nasopharynx were used to grade the degree of nasopharyngeal obstruction. RESULTS: Significant postoperative improvement in smell function occurred more frequently in children with >50% preoperative obstruction of the nasopharynx. In this group, average function improved 50.8% after surgery (95% confidence interval [CI], 39.1% to 64%). Improvement on 9 of the 11 odors was present, with significant differences occurring for the odors of bubble gum, baby powder, mint, and cinnamon. No sex differences were evident. CONCLUSION: Olfactory dysfunction occurs primarily in children whose nasopharyngeal obstruction is >50%. Removal of the hypertrophied adenoids returned smell function back to normal in these cases. This study suggests that smell loss may be of value in decisions regarding whether or not to perform adenoidectomy in children with nasopharyngeal obstruction.

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

BACKGROUND: Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. METHODS: Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. RESULTS: Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. CONCLUSION: Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID.

Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis.

BACKGROUND: Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD-NS differentially impact QOL. METHODS: Patients with chronic rhinosinusitis (CRS) completed the QOD-NS, 22-item Sino-Nasal Outcome Test (SNOT-22), Medical Outcomes Study Short Form 6-D (SF-6D) health utility measure, and Patient Health Questionnaire-2 (PHQ-2) depression screen. Exploratory factor analysis of the QOD-NS was performed. Associations between QOD-NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS). RESULTS: Outcomes were examined on 132 patients. The QOD-NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF-6D and SNOT-22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ-2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD-NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05). CONCLUSION: The QOD-NS measures 4 distinct factors. Eating-related questions had the greatest improvement after ESS. Health utility and CRS-specific QOL improvement most strongly associated with factor 2, while PHQ-2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD-NS on varying aspects of QOL.

Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis.

INTRODUCTION: The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS). MATERIALS AND METHODS: Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0-20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses. RESULTS: SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group. CONCLUSION: SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.

Improvement of olfactory function after sinus surgery correlates with white matter properties measured by diffusion tensor imaging.

Impaired olfaction is associated with a volume decrease in the olfactory bulb as well as in the gray matter of cortical olfactory areas. On the other hand, restitution of an impaired olfaction results in a regain of volume in these regions. Studies investigating similar changes in the cerebral white matter are virtually not existent. The aim of this prospective study therefore was to investigate cerebral white matter using magnetic resonance diffusion tensor imaging (DTI). 31 patients (54±13years) with olfactory impairment (chronic rhinosinusitis) and planned functional endoscopic sinus surgery (FESS) were included. Magnetic resonance imaging (MRI) data sets were acquired pre-operatively and 3months after surgery. Pre- and postoperative olfactory testing was performed to assess the olfactory threshold, discrimination, and identification (TDI) score. A significant postoperative TDI improvement by 9.06±8.81 points was observed. Two groups were subsequently formed - one with relevant postoperative olfactory gain (ΔTDI≥10 points, 12 patients) and one without gain (ΔTDI<10 points, 19 patients). DTI parameter showed a significant correlation with the TDI score in the left anterior cingulate cortex and the right amygdala. In the group with relevant olfactory improvement higher values of fractional anisotropy and apparent diffusion coefficient were found in the right parahippocampal area and in the white matter below the left inferior temporal sulcus. Tract-specific diffusion property analysis revealed significant group differences in the cingulate cortex in spatial relationship to the perisplenial cortex. Overall, this prospective study indicates structural changes in white matter after postoperative restoration of olfaction.

The Effect of External Approach Septoplasty on Olfactory Function.

OBJECTIVE: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. METHODS: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. RESULTS: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. CONCLUSION: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.

Gross Olfaction Before and After Laparoscopic Gastric Bypass.

BACKGROUND: Obesity leads to olfaction alterations, and this can further impact food choices, appetite, and nutritional status. Bariatric procedures induce weight loss and change in taste and smell perception, but more information is needed, especially using objective olfaction tests. METHODS: A prospective study was conducted during 6 months, with candidates to laparoscopic gastric bypass at a single institution. A preoperative nasofibroscopy and gross smell identification test (The Pocket Smell Test ®) were performed in those meeting the inclusion criteria. After 6 months, a new test was performed, and the primary objective was to determine if there was an improvement in the olfaction score. Weight loss and comorbidities improvement were also analyzed. RESULTS: From the 30 patients with morbid obesity enrolled, 21 met the inclusion criteria and ENT evaluation. At baseline, 42.8% of patients scored 3 points, 53.3% scored 2 points, and 4.7% scored 1 point. After 6 months, there was a -81.1% of change. Seventeen patients scored 3 points (p = 0.002 vs initial) and two scored 2 points (p = 0.006 vs initial). There were no patients with less than 2 points. Weight and comorbidities had a significant improvement as well. CONCLUSION: Laparoscopic gastric bypass improves the olfaction scores of the Pocket Smell Test in morbidly obese patients 6 months after their procedure. More complex tests can be used in candidates to bariatric surgery if low scores are detected initially. Other causes of olfaction dysfunctions should be determined if there is no improvement after weight loss.

Assessment of Smell Function in Syndromic Craniosynostosis Patients.

Craniosynostosis is defined as premature fusion of the cranial suture lines and is part of a syndrome in 15% to 40% of the patients. There is limited literature available regarding these children's ability to smell. Most of them will undergo numerous surgical procedures, some of which may alter their sense of smell, potentially leading to significant social as well as safety implications. Ethical approval was obtained for this pilot study. Children with syndromic craniosynostosis were recruited and underwent anterior rhinoscopy, prior to performing a smell test utilizing the Sensonic pediatric Smell wheel. The results were compared to an age-matched control group. Eight children with syndromic craniosynostosis participated in the study. Of a possible total score of 11, their mean average score was 6.6 and the median was 6. In comparison, the mean average score for the control group was 7.5 and the median was 7. Although the study group was small, this pilot study demonstrates that children with syndromic craniosynostosis have a similar ability to identify smells to an age-matched cohort. Further research can now be undertaken to see whether or not midface advancement procedures affect these children's sense of smell.

Longitudinal improvement and stability of olfactory function in the evaluation of surgical management for chronic rhinosinusitis.

BACKGROUND: Abnormal olfaction is common with chronic rhinosinusitis (CRS) and associates with various measures of sinonasal inflammation. The Brief Smell Identification Test (BSIT) has demonstrated improvements in abnormal olfactory detection following endoscopic sinus surgery (ESS), but olfaction remains understudied using this instrument. Discerning longitudinal, postoperative durability in olfaction is critical for patient counseling. METHODS: Adult participants with medically recalcitrant CRS were prospectively enrolled into a multi-institutional cohort study and observed for 18 months after ESS. Olfaction was operationalized using BSIT scores collected at baseline, 6 months, 12 months, and 18 months postoperatively and compared using repeated measures analysis of variance (ANOVA). RESULTS: A total of 122 participants met inclusion criteria and were recruited between March 2011 and February 2014. Improvement in mean BSIT scores at 6-month follow-up were reported for all participants (p = 0.014) with greatest improvement in subjects with nasal polyposis (p = 0.001). No differences in mean BSIT scores were found between 6 months and 18 months overall; however, subjects with comorbid asthma (F(2) = 5.29; p = 0.010) and nasal polyposis (F(2) = 3.99; p = 0.033) reported significant mean worsening. Prevalence of abnormal olfaction decreased from 28% preoperatively to 17% at 6 months (p = 0.015), for all subjects, without significant change at 12 months (19%; p = 0.791) or at 18 months (21%; p = 0.581) postoperatively. CONCLUSION: Postoperative improvement in olfaction was reported 6 months after ESS using BSIT scores, with greatest improvements in patients undergoing polypectomy. Overall improvement persisted between 6 months and 18 months after ESS for most patient subgroups; however, dysosmia worsened after initial improvement in patients with asthma and nasal polyps, highlighting the need for further identification of prognostic factors associated with abnormal olfaction in CRS.

A Simple Scoring System to Predict the Resectability of Skull Base Meningiomas via an Endoscopic Endonasal Approach.

OBJECTIVE: To identify clinico-radiologic factors associated with incomplete anterior cranial fossa (ACF) meningioma resection via an endoscopic endonasal approach. METHOD: Patients undergoing endoscopic endonasal resection of an ACF meningioma were retrospectively accrued from two university-affiliated centers. Demographic profiles and radiologic findings, including tumor dimensions and morphology, anatomic location, and vascular involvement, were stratified according to the extent of resection. RESULTS: Twenty-five patients were included in this study. Factors associated with incomplete surgical resection via an endonasal route were: presence of hyperostosis (P = 0.04), cavernous internal carotid artery involvement (P = 0.001), maximal dural tail length in the transverse plane (P = 0.006), and its ratio to the inter-fovea ethmoidalis distance (P = 0.01). Using a multiple regression analysis, only cavernous internal carotid artery involvement (P = 0.002) and a large dural tail length to inter-foveal distance ratio (P = 0.04) were significant predictors of incomplete resection (multiple correlation coefficient = 0.71). The combination of predictive factors to determine the likelihood of complete endoscopic resection produced a scoring system with a sensitivity and specificity of 85.7% (95% confidence interval [CI], 42.1-99.6] and 100% (95% CI, 81.5-100), respectively. CONCLUSION: The use of a simple scoring system outlined in our study can facilitate proper patient selection for endoscopic endonasal resection of ACF meningiomas.

Olfactory-specific quality of life outcomes after endoscopic sinus surgery.

BACKGROUND: Olfactory loss is a cardinal symptom of chronic rhinosinusitis (CRS) and affects 40% to 80% of patients. However, common sinus-specific quality-of-life (QOL) instruments include only single questions related to olfaction. Few studies have explored olfactory outcomes after surgery utilizing validated, olfaction-specific QOL questionnaires. METHODS: Patients with CRS were enrolled from 3 centers across North America into a prospective cohort study. Patients completed the short modified version of the Questionnaire of Olfactory Disorders (QOD-NS) and the 40-item Smell Identification Test (SIT-40) before and at least 6 months after endoscopic sinus surgery (ESS). Multivariate linear regression was used to determine whether specific demographic, comorbidity, or disease severity measures were independently associated with QOD scores at baseline or predicted change after surgery. RESULTS: A total of 121 patients, equally split between genders, were enrolled with an average age of 47.9 years (range, 18-80 years). Baseline total QOD-NS scores were significantly associated with SIT-40 scores, with a moderate strength of correlation (Rs = 0.400; p < 0.001). The average QOD-NS score improved after ESS (35.7 ± 13.0 vs 39.7 ± 12.2; p = 0.006). Allergy, polyps, and steroid-dependent conditions were found to be independently associated with worse preoperative QOD-NS scores, whereas septal deviation was associated with better QOD-NS scores. Baseline computed tomography (CT) scores were the only variable that significantly predicted change in QOD-NS after surgery. CONCLUSION: Olfaction-specific QOL is worse in patients with polyps and comorbid allergy. Significant improvements in olfaction-specific QOL are seen after ESS, with the greatest gains seen in those with worse CT scores at baseline.