Response to Glucocorticosteroids Predicts Olfactory Outcome After ESS in Chronic Rhinosinusitis

Abstract

Objectives Olfaction is frequently impaired in chronic rhinosinusitis with nasal polyps (CRSwNP) and often improves after endoscopic sinus surgery (ESS). Data about dynamics of olfactory changes after ESS are lacking, and little information is available concerning whether preoperatively administered glucocorticosteroids predict postoperative olfaction. Therefore, the aim of this study was to examine dynamics of olfaction after ESS in relation to the effect of preoperative administration of glucocorticosteroids in CRSwNP. Methods This prospective study included 52 CRSwNP patients (30 men, 22 women, mean age 54 ± 14 years) divided into a control group (n = 31) subjected to ESS without preoperative steroids and a treatment group (n = 21) receiving orally administered glucocorticosteroids preoperatively. Self‐ratings of olfaction and olfactory testing using the extended Sniffin’ Sticks test battery (threshold, discrimination and identification [TDI] score) were performed. Olfaction was measured preoperatively; after termination of glucocorticosteroid treatment (only treatment group); and 2 weeks, 1 month, and 3 months postoperatively. Results After glucocorticosteroids, TDI score significantly improved in 57% of patients, and olfactory function remained unchanged in 43%. In addition, improvement in TDI score after steroids and 3 months postoperatively were significantly correlated (r = 0.66, P = 0.01). Patients whose olfaction did not improve after glucocorticosteroids did not benefit from surgery. Regarding postoperative olfactory dynamics, TDI score reached its maximum 1 month postoperatively and decreased again approximately 3 months after surgery. Conclusion Glucocorticosteroids improved olfaction in CRSwNP comparable to surgery. In addition, changes in relation to steroids predicted olfactory outcome postoperatively. Regarding the olfactory dynamics, it could be demonstrated that olfactory function increased 1 month after surgery and decreased 3 months postoperatively. Level of Evidence 2 Laryngoscope, 130:1616–1621, 2020

ACE2 & TMPRSS2 Expressions in Head & Neck Tissues: A Systematic Review

“…This seems to be the case for a majority of patients. In contrast, with more sustained destruction of neuronal olfactory structures, the recovery time is much longer and may take 2-3 years, given the slow neuroregeneration process [36,37].…”

Olfactory Fluctuation Revisited

“…Taken together, the presence of OF as reported symptom is not explicitly specific for a putative sinonasal etiology but should nevertheless stimulate clinicians for a thorough patient's history assessment, endoscopic examination and if necessary imaging or oral steroid trial 26 to actively seek, confirm, or exclude a sinonasal condition. We strongly emphasize asking actively for the presence of OF when doing patients' workup for OD since this symptom helps deciding for further diagnostic steps in patients where the putative etiology is unclear (Table II).…”

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

“…[123][124][125][126][127] Furthermore, olfactory changes after administration of systemic glucocorticosteroid therapy predicts the olfactory outcome after sinus surgery in CRSwNP. 128 ESS with steroid nasal spray has been compared to steroid nasal spray alone in a recent prospective study. In both groups olfactory function improved after treatment.…”

“…Other research has indicated the following predictors for a positive surgical outcome: anosmia, no prior surgery, opacification of the OC, and favorable wound healing status 123‐127 . Furthermore, olfactory changes after administration of systemic glucocorticosteroid therapy predicts the olfactory outcome after sinus surgery in CRSwNP 128 …”