Lin H P, Li N, Xu T, Jiang Y, Yu L G
Department of Otolaryngology Head and Neck Surgery,the Affiliated Hospital of Qingdao University,Qingdao,266003,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Aug 20;30(16):1283-1286. doi: 10.13201/j.issn.1001-1781.2016.16.006.
The aim of this study is to investigate the impacts of endoscopic sinus surgery(ESS) with middle turbinate and superior turbinate resection on quality of life and olfactory function in patients with chronic rhinosinusitis with nasal polyps(CRSwNP) and with dysosmia. All of the 81 patients with CRSwNP and with dysosmia recieved ESS with middle turbinate and superior turbinate resection.The patients were given standardized drug treatments during the preoperative period,such as nasal irrigation,using local hormone spray,mucus decorporation agent by oral,using macrolide antibiotics according to the circumstances and so on.We used SNOT-20 to evaluate the quality of life preoperatively and postoperatively in patients;and used the T&T olfactory testing and VAS to evaluate the olfactory function of the patients.The SNOT-20 test showed that "need to blow nose", "lack of a good sleep", "thick nasal discharge", "difficult to go to sleep",and "awkward" influence on the quality of life severely.The scores of all items showed decreasing tread in 2 weeks,1 month and 3 months after operation( <0.05).Olfactory:Among the 81 patients(162 side),54 patients(108 sides) lost sense of smell completely in preoperative period and 27 patients' olfaction lost in varying degrees(10 patients are bilateral symmetry hyposmia and 17 patients are bilateral asymmetry hyposmia).Compared with the preoperative period,70 patients'(86.4%) olfactory function were improved at 3 months after the operation,in which 43 patients'(53.1%) olfactory function recovered to normal,and 27 patients'(33.3%) olfactory function improved in varying degrees;however,11 patients'(13.6%) olfactory function had not improvement at all.Sixty-one patients were followed up for more than one year.One year after operation,53 patients'(86.9%) olfactory function were improved,in which the 31 patients' (50.8%) olfactory function recovered to normal and 22 patients'(36.1%)olfactory function improved in varying degrees;8 patients'(13.1%) olfactory function had no improvement;the remaining 20 patients are being followed up.There was a significant difference between preoperative T&T olfactory testing and postoperative's( <0.05);and so was VAS assessment( <0.05). For the patients with CRSwNP and with dysosmia,the operation of ESS with middle turbinate and superior turbinate resection combined with standardized drug treatment in preoperative period can effectively improve the patients' quality of life and olfactory function.Hyperventilation and nasal dryness caused by excessive resection were not found.
本研究旨在探讨鼻内镜鼻窦手术（ESS）联合中鼻甲及上鼻甲切除术对慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）及嗅觉障碍患者生活质量和嗅觉功能的影响。81例CRSwNP伴嗅觉障碍患者均接受了ESS联合中鼻甲及上鼻甲切除术。术前给予患者标准化药物治疗，如鼻腔冲洗、局部使用激素喷雾剂、口服黏液促排剂、视情况使用大环内酯类抗生素等。我们采用SNOT-20评估患者术前及术后的生活质量；采用T&T嗅觉测试及视觉模拟评分（VAS）评估患者的嗅觉功能。SNOT-20测试显示，“需要擤鼻”“睡眠不佳”“鼻分泌物浓稠”“难以入睡”及“尴尬”对生活质量影响严重。术后2周、1个月及3个月时所有项目得分均呈下降趋势（P<0.05）。嗅觉方面：81例患者（162侧）中，术前54例患者（108侧）嗅觉完全丧失，27例患者嗅觉不同程度减退（10例为双侧对称性嗅觉减退，17例为双侧不对称性嗅觉减退）。与术前相比，术后3个月时70例患者（86.4%）嗅觉功能改善，其中43例患者（53.1%）嗅觉功能恢复正常，27例患者（33.3%）嗅觉功能不同程度改善；然而，11例患者（13.6%）嗅觉功能无改善。61例患者随访1年以上。术后1年，53例患者（86.9%）嗅觉功能改善，其中31例患者（50.8%）嗅觉功能恢复正常，22例患者（36.1%）嗅觉功能不同程度改善；8例患者（13.1%）嗅觉功能无改善；其余20例患者仍在随访中。术前T&T嗅觉测试与术后比较差异有统计学意义（P<0.05）；VAS评估结果亦是如此（P<0.05）。对于CRSwNP伴嗅觉障碍患者，ESS联合中鼻甲及上鼻甲切除术并在术前联合标准化药物治疗可有效改善患者生活质量和嗅觉功能。未发现因过度切除导致的通气过度及鼻腔干燥情况。
