What is the impact of endoscopic sinus surgery (ESS) on improvement in olfaction and olfactory-specific quality of life (QOL)?
Background: Olfactory loss is a cardinal symptom of chronic rhinosinusitis (CRS), affecting 40% to 80% of patients. Objective assessment of olfactory improvement using instruments such as the 40-item smell identification test (SIT-40) or Sniffin’ Sticks has been reported in 23% to 68% of patients; however, few studies have focused on olfaction-specific QOL using questionnaires such as the questionnaire of olfactory disorders (QOD-NS).
Explore this issue:June 2016
Study design: Adult patients with CRS from an ongoing multi-institutional prospective cohort study were included.
Setting: Rhinology clinics at the Medical University of South Carolina in Charleston, Oregon Health and Sciences University in Portland, and University of Utah in Salt Lake City.
Synopsis: The overall cohort included 121 patients with CRS; 51 had CRS with polyps. Overall baseline SIT-40 scores were 26.4 +/- 10.3, with 28 patients categorized as anosmic (23%) and 59 (49%) hyposmic; significant differences were noted in QOD-NS scores among patients categorized as anosmic, hyposmic, and normosmic. On the Sino-Nasal Outcome Test (SNOT-22) pertaining to olfaction, a significant difference was seen in response to question 21 between anosmic and hyposmic categories (p<0.001) as well as between anosmic and normosmic (p<0.291). Similarly, the average Rhinosinusitis Disability Index (RSDI) physical subdomain question 7 baseline score showed a significant difference between the anosmic and hyposmic categories (p<0.001) as well as the anosmic and normosmic categories (p<0.001), but not between the hyposmic and normosmic categories (p=0.578). Baseline QOD-NS was worse in patients with asthma, allergy, AERD, obstructive sleep apnea, nasal polyps, and steroid dependency. The average QOD-NS score improved after ESS from 35.7 +/- 13.0 to 39.7 +/- 12.2 (p=0.006). When examining demographic, comorbid, and CRS severity measures, baseline CT scores were the only variable that significantly predicted change in QOD-NS after surgery. Changes in QOD-NS scores after surgery did not correlate with SIT-40 change scores; however, these changes did correlate to the olfaction related question in the RSDI and SNOT-22.
Bottom line: ESS improves CRS-related subjective olfactory dysfunction with greatest gains seen in those with poorer CT scores at baseline.