Oka Hideki, Tsuzuki Kenzo, Takebayashi Hironori, Kojima Yusuke, Daimon Takashi, Sakagami Masafumi
Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Auris Nasus Larynx. 2013 Oct;40(5):452-7. doi: 10.1016/j.anl.2012.12.001. Epub 2013 Jan 11.
To address the controversy over whether olfactory function is improved or not after endoscopic sinus surgery (ESS) in patients with eosinophilic (ECRS) and non-eosinophilic chronic rhinosinusitis (non-ECRS).
Between June 2006 and March 2012, 89 adult patients with CRS underwent ESS at Hyogo College of Medicine. There were 55 men and 34 women with a mean age of 53 years old, ranging from 23 to 79 years. The average follow-up period was 10.7 months (3-24) after ESS. Peripheral blood examination, sinonasal CT imaging, and four kinds of olfaction tests [self-administered olfaction test (SAOQ), visual analog scale (VAS), T&T recognition threshold tests (T&T) and intravenous olfaction test using prosultiamine] were performed. We diagnosed ECRS when (i) symptoms of nasal congestion and olfactory disorder, (ii) bilateral chronic rhinosinusitis with nasal polyps (CRSwNPs), (iii) peripheral blood eosinophilia (>7.0%), and (iv) ethmoid sinus dominant opacification in preoperative CT findings (i.e. ethmoid sinuses (E) were more bilaterally occupied than those of maxillary sinuses (M), E/M≥1), were completely fulfilled. We divided the patients into two groups of ECRS (group A) and non-ECRS (group B). Olfaction tests before operation, and at the 3rd, 6th, 12th, and 24th month postoperation were analyzed. The severity and therapeutic evaluation of olfaction were based on criteria of T&T recognition thresholds.
The mean SAOQ and VAS scores showed significant improvement within 6 months after ESS in both group A and group B. In total, the improvement rates were 52.0% (26/50) at 3 months, 58.5% (24/41) at 6 months, 40.5% (15/37) at 12 months, and 41.2% (7/17) at 24 months. The significant improvement of T&T recognition thresholds in group B was maintained for 24 months, whereas those in group A, showing transient improvement, deteriorated after 12 months or more. A significant difference in postoperative T&T recognition between groups A and B was found at the 12th postoperative month. In both A and B, 84% of patients had a response to prosultiamine (positive group) in the preoperative stage. T&T thresholds in the positive group were significantly better that those in the negative groups in the postoperative stage.
Olfactory disorders due to ECRS showed transient improvement that deteriorated as time passed after surgery. The olfaction in the non-ECRS patients recovered comparatively well. Postoperative olfactory results were unfavorable in patients without a preoperative reaction to prosultiamine.
探讨嗜酸性粒细胞性慢性鼻-鼻窦炎(ECRS)和非嗜酸性粒细胞性慢性鼻-鼻窦炎(非ECRS)患者在内镜鼻窦手术(ESS)后嗅觉功能是否改善的争议。
2006年6月至2012年3月,89例成年慢性鼻-鼻窦炎患者在兵库医科大学接受了ESS。其中男性55例,女性34例,平均年龄53岁,年龄范围为23至79岁。ESS术后平均随访时间为10.7个月(3 - 24个月)。进行了外周血检查、鼻窦CT成像以及四种嗅觉测试[自我嗅觉测试(SAOQ)、视觉模拟量表(VAS)、T&T识别阈值测试(T&T)和使用丙硫硫胺的静脉嗅觉测试]。当满足以下条件时,我们诊断为ECRS:(i)鼻塞和嗅觉障碍症状;(ii)双侧慢性鼻-鼻窦炎伴鼻息肉(CRSwNPs);(iii)外周血嗜酸性粒细胞增多(>7.0%);(iv)术前CT检查结果显示筛窦为主的混浊(即双侧筛窦(E)比上颌窦(M)占据更多,E/M≥1)。我们将患者分为ECRS组(A组)和非ECRS组(B组)。分析术前以及术后第3、6、12和24个月的嗅觉测试结果。嗅觉的严重程度和治疗评估基于T&T识别阈值标准。
A组和B组在ESS术后6个月内,SAOQ和VAS平均评分均有显著改善。总体改善率在3个月时为52.0%(26/50),6个月时为58.5%(24/41),12个月时为40.5%(15/37),24个月时为41.2%(7/17)。B组T&T识别阈值的显著改善持续了24个月,而A组虽有短暂改善,但在12个月及以后恶化。术后第12个月,A组和B组的术后T&T识别存在显著差异。A组和B组中,84%的患者在术前阶段对丙硫硫胺有反应(阳性组)。术后阶段,阳性组的T&T阈值明显优于阴性组。
ECRS导致的嗅觉障碍术后有短暂改善,但随时间推移会恶化。非ECRS患者的嗅觉恢复相对较好。术前对丙硫硫胺无反应的患者术后嗅觉结果不佳。