Ethmoid histopathology does not predict olfactory outcomes after endoscopic sinus surgery.
BACKGROUND
Histological inflammation correlates with the degree of baseline olfactory dysfunction in patients with chronic rhinosinusitis (CRS); however, factors associated with improvement in olfactory status after endoscopic sinus surgery (ESS) remain elusive. Our purpose was to compare histopathological findings in CRS patients with olfactory loss and evaluate whether inflammatory markers can predict long-term olfactory improvement after ESS.


METHODS
Adult (> or = 18 years) patients with CRS were prospectively enrolled after electing ESS due to failed medical management. Mucosal tissue specimens were collected at the time of surgery and underwent pathological review in a blinded fashion. Subjects completed the 40-item Smell Identification Test (SIT) preoperatively and at least 6 months postoperatively. Multivariate logistic regression was used to identify histological factors associated with postoperative improvement in SIT score.


RESULTS
The final cohort was comprised of 101 patients with a mean follow-up of 16.7 +/- 6.0 months. Mean mucosal eosinophil count was higher in patients with hyposmia and anosmia (p < 0.001). Patients with preoperative anosmia were more likely to have greater severity of basement membrane (BM) thickening compared with subjects with hyposmia or normosmia (p = 0.021). In patients with olfactory dysfunction, 54.7% reported olfactory improvement of at least 4 points on postoperative SIT scores. After controlling for nasal polyposis, histological variables were not associated with postoperative improvement in olfaction.


CONCLUSIONS
Patients with severe olfactory dysfunction were more likely to have mucosal eosinophilia and BM thickening on ethmoid histopathological examination compared with normosmic patients. The presence of specific histological inflammatory findings did not, however, predict olfactory improvement after surgery.
Soler
Zachary M
ZM
Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Sauer
David A
DA
Mace
Jess C
JC
Smith
Timothy L
TL
D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D004724:Endoscopy; D004802:Eosinophilia; D005005:Ethmoid Sinus / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D009298:Nasal Polyps; D000857:Olfaction Disorders; D011379:Prognosis; D020127:Recovery of Function; D012220:Rhinitis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012852:Sinusitis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
D015415:Biomarkers
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