Ohtori N, Fukami M, Yanagi K, Asai K, Moriyama H
Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1995 Apr;98(4):642-9. doi: 10.3950/jibiinkoka.98.642.
Olfactory disturbance is the one of the most important symptoms of chronic sinusitis. In the present study, we followed up the postoperative clinical course of olfactory disturbance in patients who underwent surgery for chronic sinusitis. Ninety patients with severe olfactory disturbance or anosmia who underwent endoscopic endonasal surgery for chronic sinusitis with severe olfactory disturbance or anosmia in the preceding three-year period were enrolled in this study. We obtained a high postoperative improvement rate of 78.8%. We compared and examined our cases' postoperative clinical course concerning their olfactory disturbance and various factors in other patients before and after surgery, and obtained the following results: a) Young patients, 30 years old or under at the time of surgery, showed significantly higher rates of improvement than patients who were 50 years old or more at the time of surgery. b) Even though revision surgery was performed, the improvement rates were almost the same as after the initial surgery. c) Although the Alinamin intravenous olfaction test is regarded as an olfaction threshold test, we have seen quite a few cases in which improvement was achieved despite the absence of a preoperative response to the Alinamin intravenous olfaction test. d) There was no clear correlation between the presence of preoperative lesions of the ethmoid sinus and the olfactory cleft and the improvement rates. e) The cases with unsatisfactory results concerning the paranasal sinuses and nasal cavity--those accompanied by postoperative adhesions of the olfactory cleft, recurrence of polyps, etc.,--showed significantly lower improvement rates than cases with satisfactory postoperative results. During surgery in patients with severe olfactory disturbance, we conclude that it is particularly important to adequately clean the lesions of the olfactory cleft and the anterior and posterior ethmoid sinus endoscopically. This ensures leaving clear the olfactory cleft.
嗅觉障碍是慢性鼻窦炎最重要的症状之一。在本研究中，我们对接受慢性鼻窦炎手术患者术后嗅觉障碍的临床病程进行了随访。本研究纳入了90例在过去三年中因严重嗅觉障碍或嗅觉丧失而接受鼻内镜鼻窦手术的患者。我们获得了78.8%的高术后改善率。我们比较并检查了我们病例术后嗅觉障碍的临床病程以及其他患者手术前后的各种因素，得出以下结果：a) 手术时30岁及以下的年轻患者的改善率明显高于手术时50岁及以上的患者。b) 即使进行了翻修手术，改善率与初次手术后几乎相同。c) 尽管阿尼西敏静脉嗅觉试验被视为嗅觉阈值试验，但我们发现相当多的病例，尽管术前对阿尼西敏静脉嗅觉试验无反应，但术后仍有改善。d) 术前筛窦和嗅裂病变的存在与改善率之间没有明显的相关性。e) 鼻窦和鼻腔结果不理想的病例——伴有嗅裂术后粘连、息肉复发等——的改善率明显低于术后结果满意的病例。在严重嗅觉障碍患者的手术中，我们得出结论，在内镜下充分清理嗅裂以及前后筛窦的病变尤为重要。这能确保嗅裂保持通畅。
