title: Ethmoid histopathology does not predict olfactory outcomes after endoscopic sinus surgery.
abstract: 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.
authors.affiliation: 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.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: David A
authors.initials: DA
authors.lastname: Sauer
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: 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
chemical_list: D015415:Biomarkers
references.citation: Rhinology. 1993 Dec;31(4):183-4
references.pmid: 8140385
references.citation: Vital Health Stat 13. 1998 Nov;(139):1-119
references.pmid: 9866429
references.citation: Otolaryngol Head Neck Surg. 1997 Jul;117(1):12-7
references.pmid: 9230316
references.citation: Laryngoscope. 2000 Jul;110(7):1071-7
references.pmid: 10892672
references.citation: Laryngoscope. 2004 Nov;114(11):1895-905
references.pmid: 15510011
references.citation: Laryngoscope. 2004 Feb;114(2):279-85
references.pmid: 14755203
references.citation: Ear Nose Throat J. 1994 Aug;73(8):574-80
references.pmid: 7956852
references.citation: Laryngoscope. 1998 Feb;108(2):151-7
references.pmid: 9473061
references.citation: Otolaryngol Head Neck Surg. 2003 Sep;129(3 Suppl):S1-32
references.pmid: 12958561
references.citation: Laryngoscope. 2001 Mar;111(3):409-23
references.pmid: 11224769
references.citation: Otolaryngol Head Neck Surg. 2009 Oct;141(4):454-61
references.pmid: 19786212
references.citation: Ann Otol Rhinol Laryngol Suppl. 1995 Oct;167:17-21
references.pmid: 7574265
references.citation: Am J Rhinol Allergy. 2009 Jan-Feb;23(1):64-70
references.pmid: 19379615
references.citation: Laryngoscope. 2008 Dec;118(12):2225-30
references.pmid: 19029858
references.citation: Laryngoscope. 2004 Aug;114(8):1383-8
references.pmid: 15280712
references.citation: Otolaryngol Clin North Am. 2004 Dec;37(6):1143-57, v-vi
references.pmid: 15563907
references.citation: Am J Rhinol Allergy. 2009 Mar-Apr;23(2):139-44
references.pmid: 19401037
references.citation: Arch Neurol. 1997 Sep;54(9):1131-40
references.pmid: 9311357
references.citation: JAMA. 1997 Oct 22-29;278(16):1357-62
references.pmid: 9343468
references.citation: Otolaryngol Head Neck Surg. 2010 Jan;142(1):64-71
references.pmid: 20096225
references.citation: Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31
references.pmid: 17761281
references.citation: Am J Rhinol. 2008 May-Jun;22(3):297-301
references.pmid: 18588763