The Laryngoscope C 2015 The American Laryngological, V
Rhinological and Otological Society, Inc.
Can Surgeons Predict the Olfactory Outcomes After Endoscopic Surgery for Nasal Polyposis? Duc Trung Nguyen, MD, PhD, MPH; Ayoub Bey, MD; Fabien Arous, MD; Phi-Linh Nguyen-Thi, MD, PhD; Marylisa Felix-Ravelo, MD; Roger Jankowski, MD, PhD Objectives/Hypothesis: The aim of this study is to identify predictors for olfactory outcomes in patients with nasal polyposis (NP) after surgery on the ethmoidal labyrinths, either with or without resection of the polyps of the olfactory cleft (OC). Study Design: Prospective study. Methods: Ninety-six patients endoscopically operated on for NP were enrolled in this study. Olfactory measurements were performed 1 day prior to surgery and 6 weeks after surgery, using odor thresholds and identification tests of the Sniffin’ Sticks kit and a 0- to 10-point visual analog scale. The multivariate logistic regression model was also used to assess independent predictors for olfactory outcomes after surgery. Results: Twenty-seven patients with preoperative normosmia demonstrated normal olfactory function 6 weeks after surgery. Out of 69 patients with preoperative hypo-anosmia, 33 patients (47.83%) improved their olfactory function after surgery on the basis of the Sniffin’ Sticks results. History of previous sinus surgery was reported by 77.78% of patients without olfactory improvement and by 51.52% with olfactory improvement (P 5.022). By multivariate analysis, history of previous sinus surgery for NP remained a strong predictor of poor olfactory outcomes after surgery (adjusted odds ratio 5 4.14, 95% confidence interval: 1.29-13.32, P 5.017). Histopathological types of lesions inside the OC as well as the resection of moderate/big lesions in the OC were not predictors of olfactory outcomes. Conclusions: The more previous sinus surgeries, the smaller the chance for patients to recover their olfactory function after each surgical revision. Key Words: Endoscopic sinus surgery, nasal polyposis, olfactory clefts, ethmoidal labyrinths, respiratory epithelial adenomatoid hamartomas. Level of Evidence: 2b Laryngoscope, 00:000–000, 2015
INTRODUCTION Olfactory disturbance is usually the leading symptom among other chronic sinonasal complaints in patients with nasal polyposis (NP).1,2 The loss of smell might be used as a clinical tool to identify the severity of both NP and asthma.3 Some studies have attempted to identify predictive factors for olfactory improvement following endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) patients with and without polyps.4–6 In contrast with the zero predictive factors identified in Jiang et al.’s study,6 other studies have demonstrated that predictors of olfactory improvement include the
presence of NP5,7 and eosinophila.5 It has been shown that inflammatory eosinophilic polyps (EP) or respiratory epithelial adenomatoid hamartomas (REAH) can be observed in the olfactory clefts (OC) in patients with NP. 8–11 Therefore, OC surgery is required for patients with NP but not for patients suffering from CRS without nasal polyps. The aim of our study was to identify predictive factors for olfactory outcomes in patients with NP after endoscopic surgery on the ethmoidal labyrinths, either with or without resection of the polyps of the OC.
MATERIALS AND METHODS From the Department of ENT–Head and Neck Surgery (D.T.N., A.B., M.F.-R., R.J.) and Clinical Epidemiology and Evaluation Department (P.-L.N.-T.), Regional University Hospital of Nancy, Nancy, France; and the Department of Medicine (F.A.), University of Lorraine, Lorraine, France. Editor’s Note: This Manuscript was accepted for publication January 30, 2015. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Duc Trung Nguyen, MD, Service d’Otorhinolaryngologie et Chirurgie Cervico-Faciale, H^ opitaux de Brabois, Centre Hospitalier Universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, France. E-mail: [email protected] DOI: 10.1002/lary.25223
Laryngoscope 00: Month 2015
Patient Population Patients operated on for NP by the same surgeon (R.J.) at our tertiary hospital, between September 2009 and March 2012, were enrolled in this prospective study. Patients with isolated REAH, as well as those with traumatic anosmia or any neurological disorder known to influence the olfactory function, were excluded. All patients were operated on both ethmoidal labyrinths using the nasalization procedure with the preservation of the superior turbinates. The middle turbinates were preserved whenever possible. Surgery on the olfactory clefts was performed during the nasalization procedure only if moderate/big polypoid masses emanating from the OC were present. Small polyps, or edematous mucosa of the OC, were not removed.
Nguyen et al.: Olfactory Outcomes After Endoscopic Surgery
1
The classification of lesions inside the OC was assessed, as small, moderate, or big, with endoscopy during surgery. Lesions
Rhinological and Otological Society, Inc.
Can Surgeons Predict the Olfactory Outcomes After Endoscopic Surgery for Nasal Polyposis? Duc Trung Nguyen, MD, PhD, MPH; Ayoub Bey, MD; Fabien Arous, MD; Phi-Linh Nguyen-Thi, MD, PhD; Marylisa Felix-Ravelo, MD; Roger Jankowski, MD, PhD Objectives/Hypothesis: The aim of this study is to identify predictors for olfactory outcomes in patients with nasal polyposis (NP) after surgery on the ethmoidal labyrinths, either with or without resection of the polyps of the olfactory cleft (OC). Study Design: Prospective study. Methods: Ninety-six patients endoscopically operated on for NP were enrolled in this study. Olfactory measurements were performed 1 day prior to surgery and 6 weeks after surgery, using odor thresholds and identification tests of the Sniffin’ Sticks kit and a 0- to 10-point visual analog scale. The multivariate logistic regression model was also used to assess independent predictors for olfactory outcomes after surgery. Results: Twenty-seven patients with preoperative normosmia demonstrated normal olfactory function 6 weeks after surgery. Out of 69 patients with preoperative hypo-anosmia, 33 patients (47.83%) improved their olfactory function after surgery on the basis of the Sniffin’ Sticks results. History of previous sinus surgery was reported by 77.78% of patients without olfactory improvement and by 51.52% with olfactory improvement (P 5.022). By multivariate analysis, history of previous sinus surgery for NP remained a strong predictor of poor olfactory outcomes after surgery (adjusted odds ratio 5 4.14, 95% confidence interval: 1.29-13.32, P 5.017). Histopathological types of lesions inside the OC as well as the resection of moderate/big lesions in the OC were not predictors of olfactory outcomes. Conclusions: The more previous sinus surgeries, the smaller the chance for patients to recover their olfactory function after each surgical revision. Key Words: Endoscopic sinus surgery, nasal polyposis, olfactory clefts, ethmoidal labyrinths, respiratory epithelial adenomatoid hamartomas. Level of Evidence: 2b Laryngoscope, 00:000–000, 2015
INTRODUCTION Olfactory disturbance is usually the leading symptom among other chronic sinonasal complaints in patients with nasal polyposis (NP).1,2 The loss of smell might be used as a clinical tool to identify the severity of both NP and asthma.3 Some studies have attempted to identify predictive factors for olfactory improvement following endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) patients with and without polyps.4–6 In contrast with the zero predictive factors identified in Jiang et al.’s study,6 other studies have demonstrated that predictors of olfactory improvement include the
presence of NP5,7 and eosinophila.5 It has been shown that inflammatory eosinophilic polyps (EP) or respiratory epithelial adenomatoid hamartomas (REAH) can be observed in the olfactory clefts (OC) in patients with NP. 8–11 Therefore, OC surgery is required for patients with NP but not for patients suffering from CRS without nasal polyps. The aim of our study was to identify predictive factors for olfactory outcomes in patients with NP after endoscopic surgery on the ethmoidal labyrinths, either with or without resection of the polyps of the OC.
MATERIALS AND METHODS From the Department of ENT–Head and Neck Surgery (D.T.N., A.B., M.F.-R., R.J.) and Clinical Epidemiology and Evaluation Department (P.-L.N.-T.), Regional University Hospital of Nancy, Nancy, France; and the Department of Medicine (F.A.), University of Lorraine, Lorraine, France. Editor’s Note: This Manuscript was accepted for publication January 30, 2015. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Duc Trung Nguyen, MD, Service d’Otorhinolaryngologie et Chirurgie Cervico-Faciale, H^ opitaux de Brabois, Centre Hospitalier Universitaire de Nancy, rue du Morvan, 54511 Vandoeuvre-les-Nancy Cedex, France. E-mail: [email protected] DOI: 10.1002/lary.25223
Laryngoscope 00: Month 2015
Patient Population Patients operated on for NP by the same surgeon (R.J.) at our tertiary hospital, between September 2009 and March 2012, were enrolled in this prospective study. Patients with isolated REAH, as well as those with traumatic anosmia or any neurological disorder known to influence the olfactory function, were excluded. All patients were operated on both ethmoidal labyrinths using the nasalization procedure with the preservation of the superior turbinates. The middle turbinates were preserved whenever possible. Surgery on the olfactory clefts was performed during the nasalization procedure only if moderate/big polypoid masses emanating from the OC were present. Small polyps, or edematous mucosa of the OC, were not removed.
Nguyen et al.: Olfactory Outcomes After Endoscopic Surgery
1
The classification of lesions inside the OC was assessed, as small, moderate, or big, with endoscopy during surgery. Lesions
