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.

Machine-Learning Points at Endoscopic, Quality of Life, and Olfactory Parameters as Outcome Criteria for Endoscopic Paranasal Sinus Surgery in Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is often treated by functional endoscopic paranasal sinus surgery, which improves endoscopic parameters and quality of life, while olfactory function was suggested as a further criterion of treatment success. In a prospective cohort study, 37 parameters from four categories were recorded from 60 men and 98 women before and four months after endoscopic sinus surgery, including endoscopic measures of nasal anatomy/pathology, assessments of olfactory function, quality of life, and socio-demographic or concomitant conditions. Parameters containing relevant information about changes associated with surgery were examined using unsupervised and supervised methods, including machine-learning techniques for feature selection. The analyzed cohort included 52 men and 38 women. Changes in the endoscopic Lildholdt score allowed separation of baseline from postoperative data with a cross-validated accuracy of 85%. Further relevant information included primary nasal symptoms from SNOT-20 assessments, and self-assessments of olfactory function. Overall improvement in these relevant parameters was observed in 95% of patients. A ranked list of criteria was developed as a proposal to assess the outcome of functional endoscopic sinus surgery in CRS patients with nasal polyposis. Three different facets were captured, including the Lildholdt score as an endoscopic measure and, in addition, disease-specific quality of life and subjectively perceived olfactory function.

Quality of life following nasal surgery.

OBJECTIVES/HYPOTHESIS: This prospective study aimed to investigate changes in quality of life (QOL) after nasal surgery. STUDY DESIGN: Prospective study. METHODS: A total of 788 patients (492 men and 296 women; age range, 9-81 years; mean age, 41 years) were included in this prospective study. Three hundred thirty-six patients received sinus surgery, 358 received septum surgery, and 94 additional patients received sinus surgery involving the septum. QOL was assessed with a standardized questionnaire for general health and well-being (36-Item Short Form Health Survey [SF-36]). Additionally, subjective sinonasal impairment was collected using the Rhinosinusitis Disability Index (RSBI). QOL and subjective sinonasal impairment were retested 4 months after surgery (63-339 days after surgery; mean, 128 days) in 361 patients. RESULTS: In the RSBI severity scale, 29.5% of the patients rated their sinonasal problems presurgery to be of high severity, 61.2% rated them as medium, and 9.3% as minor. Postsurgery, 2.8% of the patients rated the severity of their sinonasal problems high, 35% medium, and 62.2% minor. Subjective improvement of symptoms was found in more than 80% of the patients. Presurgery, general QOL (SF-36) was impaired in sinus patients and improved significantly after surgery. For most septum patients we found relatively little impact of sinonasal disease on general QOL (SF-36) compared to the German normative sample. CONCLUSIONS: Functional endoscopic surgery seems to be a good technique for reducing sinonasal symptomatology in the majority of patients. It appears to enhance QOL in those patients who were severely affected beforehand. Long-term investigations are currently underway to further explore the patients' subjective QOL following nasal surgery.

Olfactory function following nasal surgery.

OBJECTIVE/HYPOTHESIS: This prospective study aimed to investigate predictors of nasal surgery in terms of olfactory function. STUDY DESIGN: Prospective study. METHODS: A total of 775 patients were included in this prospective study (482 men, 293 women; age range 10-81 years, mean age 41 years, standard deviation = 15.3 y). Prior to surgery, patients received a detailed otorhinolaryngologic examination including nasal endoscopy. Olfactory function was assessed with a standardized odor identification test ("Sniffin' Sticks"). In 356 patients, olfactory function was retested 4 months after surgery (63-339 days after surgery; mean 128 days, standard deviation = 29 days); 206 of these patients received sinus surgery, while 150 received surgery involving the septum. RESULTS: Using a conservative definition of change of olfactory function, following sinus surgery, improvement of the sense of smell was found in 23%, no change was seen in 68%, and decreased function was seen in 9% of the patients; in patients with septum surgery, improvement was seen in 13%, no change in 81%, and decreased function in 7%. Patients exhibiting a postoperative decrease of olfactory function had significantly higher preoperative olfactory scores than patients who experienced improvement. In terms of the sense of smell, nasal surgery produced the highest success rates in patients with eosinophilia and a high degree of polyposis. Neither age nor sex had a major impact on the outcome of surgery in terms of olfactory function. CONCLUSIONS: These results in a large group of patients confirm previous work. Apart from apparent success in 13 to 23% of patients, there is also a small but significant group of patients (7 to 9%) in whom olfactory function decreases after surgery. Because this decrease was mostly found in patients with relatively good preoperative olfactory function, this group should receive specific attention when counseling patients about the potential risks of nasal surgery.