| Summary: | 博士 === 中山醫學大學 === 醫學研究所 === 96 === Objectives: This study aims to investigate the change of olfactory function in patients with chronic rhinosinusitis after functional endoscopic sinus surgery and explore the potential prognostic factors.
Methods: Patients with chronic rhinosinusitis who had previously undergone functional endoscopic sinus surgery were enrolled in the study. On the day before FESS, olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test (STT), the University of Pennsylvannia Smell Identification Test (UPSIT) and a short-term odor memory/discrimination test, and re-evaluated by the same methods 6 months after FESS. The potential prognostic factors (nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps, allergic rhinitis, concurrent septoplasty and turbinal surgery, postoperative steroid treatment) for improvement in olfaction after FESS were also evaluated in these patients.
Results: A total of 70 patients with chronic rhinosinusitis were enrolled in the study. Fifty-two patients noticed their olfactory function was impaired before surgery, but the olfactory threshold was above –6 in 66 patients, and 62 patients’ UPSIT scores were below 30. After surgery, the olfactory function was improved in 27 patients using patients’ reports, in 30 patients by STT and in 36 patients by UPSIT. A good agreement existed between STT and UPSIT results and patients’ reports. Among potential prognostic factors, nasal obstruction, cross-sectional area of nasal cavity, rhinosinusitis severity, preoperative olfactory loss, nasal polyps and allergic rhinitis were not significantly reliable to predict improvement in olfaction after surgery, but patients with severe rhinosinusitis and severe preoperative olfactory loss and those with allergic rhinitis or without nasal polyps tended to show olfactory improvement. Concurrent septoplasty and turbinal surgery did not increase the rate of olfactory improvement after FESS, but postoperative use of nasal steroids did increase the rate of olfactory improvement, although the difference was not significant.
Conclusion: Although many methods have been used to evaluate olfactory function, and the domains of olfactory function evaluated were not the same among these methods, our study showed that UPSIT should be the test of choice for evaluating olfactory function in patients with chronic rhinosinusitis. For these patients, disease severity, coexistence of nasal polyps and allergic rhinitis, and postoperative use of nasal steroids were found to be more reliable prognostic factors for improvement in olfaction after FESS, but these factors were not significantly reliable.
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