Olfactory Outcomes after Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Polyps

Background: Chronic rhinosinusitis (CRS) is regarded as a multi factorial disease that causes different symptoms such as nasal obstruction, headache, nasal discharge and olfactory dysfunction due to inflammation of the nasal and sinonasal mucosa. It is a common health problem and has several effects on quality of life, along with high treatment costs. Nasal polyps are frequently associated with loss of smell which is a common symptom affecting 61-83% of patients of CRS with nasal polyps (CRSwNP). The ability to monitor our environment depends to a large degree on our sense of smell. The aim of the study was to evaluate olfaction in patients of CRSwNP and how functional endoscopic sinus surgery (FESS) modified olfaction in patients. Materials and Methods: In our study, in 40 patients of CRSwNP, olfactory dysfunction was assessed before and after FESS. Subjective assessment of disease was done using visual analog scale of SNOT-22 questionnaire. Olfaction was tested using odor identification test and threshold tests and objective assessment of disease was done using endoscopic grading according to Lund and Kennedy endoscopic scoring. NCCT scores were also obtained using Lund and Mackay staging system. All patients underwent FESS. Symptom scores, endoscopy scores and olfaction were compared in patients before and after surgery by statistical analysis. Results: Only 27 out of 40, i.e (67.5%) patients had complaints of olfactory dysfunction. 92.59% patients had improvement in olfaction post-surgery. There was a significant improvement in olfaction after surgery shown by olfactory scores assessment before and after surgery. Surgery had a positive outcome in improvement of the mental health of patients suffering from CRSwNP. 100% of the patients had improvement of SNOT-22 scores and hence a significant reduction of symptoms. Maxillary sinus was found to have the highest incidence of involvement (95%) as per CT assessment. Improvement in endoscopic scores was seen best at 1 month post op, and recurrence of polyps was seen in 8 patients at the end of 3 months. Conclusion: Our study was able to establish a significant correlation between olfaction and parameters of disease severity like SNOT-22, endoscopic score and CT scores. We concluded that FESS has a positive outcome in terms of improvement of olfactory dysfunction in patients of CRSwNP.