Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093, Nantes cedex 01, France.
Service de pneumologie, Centre Hospitalier Universitaire de Nantes, Hôtel-Dieu, 1, place A.-Ricordeau, BP 1005, 44093, Nantes cedex 01, France.
Eur Arch Otorhinolaryngol. 2019 Dec;276(12):3359-3366. doi: 10.1007/s00405-019-05537-y. Epub 2019 Jul 3.
Anticipating the possibility of olfactory recovery after functional endoscopic surgery (FES) in nasal polyposis (NP) is difficult. The main objective of this study was to assess the predictive factors of recovering the sense of smell after radical bilateral ethmoidectomy. Secondary objectives were to identify other predictors of olfactory recovery.
Open prospective study was conducted at the Nantes University Hospital including all patients with NP operated on in the Ear, Nose, and Throat Department between January 2011 and September 2017. These patients underwent functional endoscopic surgery (radical ethmoidectomy) after medical treatment failure. Olfaction was quantified prospectively and systematically during the preoperative consultation using a visual analog scale. Multivariate analysis evaluated the presence of predictive factors of postoperative olfactory recovery.
One hundred nineteen patients were included in the study. Overall, olfaction was partially improved after surgery. For patients who presented greater than 50% recovery of olfaction after systemic corticosteroid therapy before surgery, we observed a predictive better rate of olfactory recovery after surgery (p < 0.001). Age over 65 years, a history of sinonasal surgery, associated asthma, and bacterial colonization were not associated with less postoperative olfactory recovery.
This study identified an objective factor that may influence olfactory recovery after FES using a therapeutic trial for olfactory recovery after oral corticosteroid treatment taken before surgery.
预测鼻息肉（NP）患者功能性内镜鼻窦手术（FES）后嗅觉恢复的可能性较为困难。本研究的主要目的是评估双侧筛窦根治性切除术患者嗅觉恢复的预测因素。次要目的是确定嗅觉恢复的其他预测因素。
本研究为前瞻性开放性研究，纳入 2011 年 1 月至 2017 年 9 月期间在南特大学医院耳鼻喉科接受治疗失败后行 FES（根治性筛窦切除术）的 NP 患者。在术前咨询期间，使用视觉模拟量表前瞻性和系统性地对嗅觉进行量化。多变量分析评估了术后嗅觉恢复的预测因素。
共纳入 119 例患者。总体而言，术后嗅觉有部分改善。对于术前全身皮质类固醇治疗后嗅觉恢复大于 50%的患者，我们观察到术后嗅觉恢复的预测率更高（p<0.001）。年龄大于 65 岁、鼻-鼻窦手术史、伴发哮喘和细菌定植与术后嗅觉恢复较差无关。
本研究通过术前口服皮质类固醇治疗嗅觉恢复的治疗试验，确定了一个可能影响 FES 后嗅觉恢复的客观因素。
