Effectiveness of FESS in Smell Improvement of Sinusitis Patients

Abstract

The aim of this research was to verify the effect of functional endoscopic sinus surgery (FESS) on olfactory dysfunction in patients who suffer from chronic rhinosinusitis. We enrolled prospective consecutive patients at a tertiary institution who were undergoing FESS; for these patients prolonged medical therapy for chronic rhinosinusitis had failed. Patients were asked to grade their olfactory dysfunction from 1 to 5 with 1 representing lack of any smell function and 5 representing a completely normal sense of smell. Moreover, the pre-and postoperative smell identification test of the University of Pennsylvania was performed for all participating patients. In addition, data including computed tomography scores, nasal endoscopy, and the presence or absence of asthma as well as smoking habits were recorded and analyzed. Patients were followed at least 1 year after surgery. Data were collected on 89 patients who had undergone sinus surgery. Postoperative olfactory function was 77% improved for all subjects as a group. Higher involvement of sinus in computed tomography correlated with poorer results in olfactory UPSIT40 score. Patients' olfaction was significantly related to polyp pathology, duration of disease, age, smoking habits and history of asthma. A variety of patients' characteristics have impact on olfactory outcome of sinusitis patients after FESS.

The prevalence of olfactory dysfunction in chronic rhinosinusitis

“…Among demographic factors, higher age was most frequently associated with poorer smell, with seven studies reporting this association . Two studies did not find any association between age and olfactory dysfunction . Within CRS‐specific factors, a higher Lund‐Mackay (LM) computed tomography (CT) score was most frequently associated with poorer smell with 11 studies reporting this relationship .…”

“…Olfactory status using the SIT‐40 is classified as: 0 to 5 malingering, 6 to 19 anosmic, 20 to 33 hyposmic, and 34 to 40 normosmic . Twelve studies presented SIT‐40 scores amenable to combination analysis, yielding a population of 1,576 CRS mixed patients . The pooled SIT‐40 score was 25.96 ± 7.11, which falls in the hyposmic range (Table ).…”

“…29 Twelve studies presented SIT-40 scores amenable to combination analysis, yielding a population of 1,576 CRS mixed patients. 26,[30][31][32][33][34][35][36][37][38][39] The pooled SIT-40 score was 25.96 6 7.11, which falls in the hyposmic range (Table IV).…”

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

“…In their study 77% of patients had improved olfactory function after surgery. The level of olfactory function was significantly associated with polyp pathology, disease duration, age, smoking and asthma 20 .…”

Chronic Rhinosinusitis-Related Smell Loss: Medical and Surgical Treatment Efficacy

“…This finding was confirmed by another prospective surgical trial demonstrating that worse olfactory function preoperatively corresponded to a greater improvement in olfaction in response to surgery. 54 Some investigators have identified polyposis as an important predictor of olfactory response to ESS. 55,56 .…”