Long-term follow-up of surgically treated phantosmia.
OBJECTIVE
To determine whether transnasal excision of olfactory epithelium is a safe, effective therapy and to learn more of the pathogenesis of phantosmia by studying the histological features of the excised mucosa.


METHODS
A retrospective study consisting of a medical record review and telephone survey. Follow-up ranged from 1 to 11 years (average, 5.4 years). Excised tissues were histologically processed and descriptively compared with normal and other abnormal olfactory tissues.


METHODS
Tertiary university medical referral centers.


METHODS
All patients who presented to the primary author (D.A.L.) from 1988 to 1999 with unremitting phantosmia lasting longer than 4 years.


METHODS
Olfactory testing and transnasal endoscopic excision of olfactory mucosa.


METHODS
Tested olfactory function, patients' perception of phantom odor resolution, and histological findings.


RESULTS
Of 8 patients, 7 have complete and permanent resolution of their phantosmia. Postoperatively, the single nostril olfactory ability in the operated-on nostril is decreased in 2 nostrils, remains unchanged in 7, and is improved in 1. The excised olfactory mucosa generally shows a decreased number of neurons, a greater ratio of immature to mature neurons, and disordered growth of axons with some intraepithelial neuromas.


CONCLUSIONS
Surgical excision of olfactory epithelium is an effective and safe method to relieve phantosmia while potentially preserving olfactory ability. The abnormal histological features of the excised olfactory tissue suggest at least some pathological condition in the peripheral olfactory system. This nasal surgery requires intensive olfactory evaluation and follow-up. It is also extremely difficult with significant risks, and therefore should be limited to specialized centers.
Leopold
Donald A
DA
Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, USA. dleopold@unmc.edu
Loehrl
Todd A
TA
Schwob
James E
JE
D000328:Adult; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009831:Olfactory Mucosa / Q000473:pathology* / Q000601:surgery*; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome