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This study from Germany investigates the correlation between nasal polyp size and return of olfactory function following endoscopic sinus surgery. Olfaction is affected more in patients with CRSwNP than with CRSsNP and the best chance of smell recovery occurs in those having their first sinus surgery who are anosmic prior. A prospective study was designed involving all patients undergoing ESS in Dresden following a failure of medical treatment. Postoperatively, all patients were recommended to use saline washes and INCS for three months prior to reassessment. Inclusion criteria were bilateral chronic sinus disease, aged 18 or over, and revision cases were included. Those excluded were neurodegenerative cases, pregnancy and those with a potential history of olfactory loss due to other conditions, such as head injury. Polyp score was using the Lidholdt classification, into mild, moderate or severe depending on position in relation to the inferior turbinate. Olfactory function was determined using Sniffin’ Sticks, which evaluated three sensory dimensions of odours comprising olfactory threshold, odour discrimination and identification. A SNOT22 and VAS was also completed. Seventy-two patients were assessed preoperatively but only 47 postoperatively had complete data sets for analysis. Olfactory scores preoperatively were better in women and worse in patients with CT evidence of more advanced disease and higher Lildholdt scores. A significant difference in the preoperative scores for threshold and identification of odours was found between the polyp severity groups but not for discrimination. It is also noted that most patients were in a lower severity polyp group and, therefore, had retained some olfaction. The postoperative patients revealed a significant increase in their olfactory score after surgery from baseline and also after three months in a linear regression analysis when grouped by their Lildholdt scores. This indicates that patients with a higher burden of polyp disease had a better olfactory outcome.

Nasal polyp load determines the recovery of olfaction after surgery for chronic rhinosinusitis.
Haxel B, Fischer L, Pade J, et al.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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