Haxel B R, Fischer L, Pade J, Reden J, Hummel T
Department of Otolaryngology, Head and Neck Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Germany; Department of Otolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universitat Dresden, Dresden, Germany.
Rhinology. 2022 Apr 1;60(2):102-108. doi: 10.4193/Rhin21.361.
Chronic rhinosinusitis (CRS) is typically accompanied by impairment of olfaction. Despite of this, until today the efficacy of endonasal sinus surgery (ESS) in terms of olfactory function is still unclear. So far it is known that patients with nasal polyps are most likely to experience post-operative recovery. Within the present study we investigated the sense of smell and other parameters of impairment in CRS before and after ESS in relation to the degree of nasal polyposis, determined with the nasal endoscopic Lildholdt-score.
Patients with different degrees of severity of nasal polyposis were included. Olfactory function was assessed for odor thresholds [T], odor discrimination [D] and odor identification [I] and the changes of these parameters were investigated postoperatively.
For 72 patients baseline measures were available and in 47 patients, postoperative changes were described. There was a correlation between olfactory scores and nasal anatomy/polyposis scores (Lildholdt scores, Lund-Mackay CT score), rated nasal health, and nasal quality of life (sinonasal outcome test). Three months after surgery the average TDI-Score improved by 3.1 points with 30% of patients showing significant clinical improvement. Patients with severe polyposis (Lildholdt score of 5 or 6) benefited most in terms of olfaction. Other significant prognostic indicators of a postoperative increase of olfactory scores included younger age, low pre-operative TDI-scores and high CT-scores.
This study shows that not only the presence of polyps in CRS, but also the degree of nasal polyposis - measured by a grading system - predicts the results in olfactory test results. Additionally, the degree of recovery of olfaction after ESS seems to be most relevant in patients with high polyp scores.
慢性鼻窦炎（CRS）通常伴有嗅觉障碍。尽管如此，迄今为止，鼻内镜鼻窦手术（ESS）在嗅觉功能方面的疗效仍不明确。目前已知鼻息肉患者术后恢复的可能性最大。在本研究中，我们根据鼻内镜Lildholdt评分确定的鼻息肉程度，调查了ESS前后CRS患者的嗅觉及其他损伤参数。
纳入不同严重程度鼻息肉患者。评估嗅觉功能的气味阈值[T]、气味辨别[D]和气味识别[I]，并研究术后这些参数的变化。
72例患者有基线测量数据，47例患者描述了术后变化。嗅觉评分与鼻腔解剖结构/息肉评分（Lildholdt评分、Lund-Mackay CT评分）、鼻腔健康评级和鼻腔生活质量（鼻窦结局测试）之间存在相关性。术后三个月，平均TDI评分提高了3.1分，30%的患者有显著临床改善。重度息肉患者（Lildholdt评分为5或6）在嗅觉方面获益最大。术后嗅觉评分增加的其他显著预后指标包括年龄较小、术前TDI评分较低和CT评分较高。
本研究表明，不仅CRS中息肉的存在，而且通过分级系统测量的鼻息肉程度，都可以预测嗅觉测试结果。此外，ESS后嗅觉恢复程度似乎在息肉评分高的患者中最为相关。
