Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Kohli, Preeti; Naik, Akash N.; Farhood, Zachary; Ong, Adrian A.; Nguyen, Shaun A.; Soler, Zachary M.; Schlosser, Rodney J.

doi:10.1177/0194599816664879

Cited by 70 publications

(87 citation statements)

References 59 publications

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“…We did our best to minimize the heterogeneity in these studies by grouping our qualitative analysis and meta‐analysis by location of pathology and instruments of olfactory measurement. We also attempted minimize the effect that heterogeneity would have on our meta‐analysis conclusions by using a random‐effects model, similar to prior studies in this field . Nonetheless, we recognize that there is a high degree of heterogeneity in our meta‐analysis.…”

Section: Discussionmentioning

confidence: 99%

“…From the chronic rhinosinusitis literature, it is known that inflammatory changes in the olfactory mucosa and degree of nasal obstruction may both play a role in hyposmia. A systematic review and meta‐analysis in the chronic rhinosinusitis population showed that endoscopic sinus surgery leads to improvements in subjective and objective measures of olfaction …”

Section: Introductionmentioning

confidence: 99%

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Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

et al. 2019

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Objectives Determine the effect of endoscopic skull base surgery (ESBS) on long‐term olfactory outcomes after surgery. Methods An English‐language search was conducted using the Cochrane, MEDLINE, Scopus, and Embase databases from January 2000 to October 2017 for adult patients undergoing ESBS with subjective and objective olfaction outcomes. Two authors independently examined articles to identify those meeting inclusion criteria. Studies examining objective olfactory outcomes after ESBS were included in the meta‐analysis. A random‐effects meta‐analysis of patients undergoing sellar and parasellar ESBS was conducted to compare preoperative and postoperative olfactory outcomes using the University of Pennsylvania Smell Identification Test (UPSIT) and Cross‐Cultural Smell Identification Test (CCSIT). Results Among 339 eligible articles, 29 articles met inclusion criteria. Twenty‐five of these focused on sellar and parasellar tumors. Individual articles not meeting criteria for meta‐analysis were qualitatively reported. Meta‐analysis showed there was no difference in preoperative and postoperative olfactory function after sellar and parasellar ESBS based on the UPSIT (five studies, mean difference [MD] = −1.03; 95% CI: −3.98, 1.93; P = .50) and the CCIST (three studies, MD = −0.77; 95% CI: −3.03, 1.49; P = .50). A pooled overall meta‐analysis revealed similar results (eight studies, effect size = −0.30; 95% CI: −0.79, 0.18; P = .22). However, heterogeneity for all meta‐analyses was high (I2 > 95%, P < .01), suggesting significant variation in the included studies. Conclusions Based on published objective olfaction outcomes after sellar and parasellar ESBS, there was no significant difference between preoperative and postoperative olfaction. Further prospective studies using validated objective measures of olfaction are required to improve our understanding on this subject. Level of Evidence 2a Laryngoscope, 129:1998–2007, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

et al. 2019

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“…A meta‐analysis of the testing results has also been attempted, which faced the following difficulties: the results of different test kits could not be combined, screening tests and more extended tests had been mixed; and, in particular, the study population could not be divided into CRSwNP and CRSsNP.…”

Section: Introductionmentioning

confidence: 99%

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review

Haxel

2019

The Laryngoscope

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Objective Investigation of the postoperative olfactory function after sinus surgery for chronic rhinosinusitis (CRS) with and without polyps in a review. Data Sources PubMed. Review Methods A comprehensive literature search was conducted through June 2018 using relevant keywords. The titles/abstracts were reviewed to identify studies evaluating the sense of smell in CRS‐patients pre‐ and postoperatively by either using the whole or parts of the University of Pennsylvania Smell Identification Test or the Sniffin’ Sticks test. Study characteristics and outcome data of the included studies were extracted. Results In total, 106 studies were retrieved. Twenty‐four studies comprising 1,956 patients were included after quality assessment. The number of patients investigated per study was 19 to 206. In the 24 studies, 959 patients with nasal polyps and 516 without nasal polyps were described. The follow‐up times varied between 0.5 and 28 months. Twenty‐three studies reported an improved sense of smell, at least in certain subgroups. An overall improvement was seen in approximately 50% of the included patients. Nasal polyposis and preoperative anosmia were associated with a higher chance of improvement in olfaction. In those studies that commented on deterioration after sinus surgery, a decrease in olfaction was found in a range from 0% to 10% of cases. Conclusion Olfaction can be improved by sinus surgery in about every second patient, especially if the patient had chronic rhinosinusitis with polyps, was anosmic, and had no prior surgery. A deterioration of sense of smell after surgery is rare. Laryngoscope, 129:1053–1059, 2019

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“…Olfactory dysfunction is common among CRS patients with a prevalence ranging from 48% to 83% [2][3][4][5] . Some previous studies believe that medical therapy is beneficial for improving olfactory function in CRS; nevertheless, endoscopic sinus surgery (ESS) is the treatment of choice in CRS patients who do not respond to medical therapy 1,6 . The effect of ESS on improving olfactory dysfunction has remained controversial due to lack of comprehensive evidence.…”

Section: Introductionmentioning

confidence: 99%

“…They reported that patients with nasal polyposis experienced better improvement; nevertheless, they mentioned that further studies are needed regarding this issue 6 . In the present study we evaluated only patients with chronic rhinosinusitis without nasal polyposis.…”

mentioning

confidence: 99%

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

Yousefi¹,

Madarshahi²,

Akhavan³

et al. 2018

The International Tinnitus Journal

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Objectives: Chronic rhinosinusitis (CRS) is characterized by a long-time inflammatory disease of nasal and sinus mucosa. Olfactory dysfunction is common among CRS patients with a prevalence ranging from 48% to 83%. We aimed to assess the effect of ESS on olfactory function of patients with chronic rhinosinusitis without nasal polyps.Method: This randomized clinical trial was conducted on 30 patients with chronic rhinosinusitis without nasal polyps. Patients were randomly allocated to two intervention and control groups; patients in intervention group underwent endoscopic sinus surgery by a single surgeon and control group continued standard treatment with nasal irrigation of normal saline (4 times daily) and nasal corticosteroids (one puff in each nostril daily). Olfactory threshold was evaluated using smell threshold test (STT) before, one month and three months after intervention. Results:Eventually 33 patients with a mean age of 42.70 ± 15.50 years in intervention and 43.12 ± 11.50 years in control group underwent analysis (p value=0.930). Mean olfactory threshold was 2.79 ± 0.73 in intervention and 2.67 ± 1.05 in control group prior to intervention (p value=0.345). Mean change of olfactory threshold was 0.30 ± 0.79 in intervention and 0.38±1.09 in control group one month after intervention (p value=0.214). Mean change of olfactory threshold was 0.13 ± 0.94 in ESS and 0.33 ± 0.60 in control group three months after intervention (p value=0.196). Conclusion:Our study revealed that changes in olfactory threshold were not significantly different between two ESS and standard medical therapy groups one and three months after intervention.

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Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Abstract: Endoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree.

Cited by 70 publications

References 59 publications

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

Olfactory outcomes after endoscopic skull base surgery: A systematic review and meta‐analysis

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review

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

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