title: Olfactory outcomes after endoscopic transsphenoidal pituitary surgery.
abstract: BACKGROUND
  Olfaction has been demonstrated to have a great impact on patients' lives. Transsphenoidal endoscopic pituitary surgery is associated with potentially significant damage to olfactory tissues, but to date this issue has been only poorly documented in the literature.
  
  
  METHODS
  Prospective cohort study comparing olfactory outcomes pre- and postpituitary surgery.
  
  
  METHODS
  Patients were administered the University of Pennsylvania Smell Identification Test (UPSIT) preoperatively and again at 6 months postoperatively. The endoscopic transsphenoidal pituitary surgery was carried out using a full middle turbinate preservation protocol. A Hadad-Bassagasteguy (HB) vascularized septal flap was raised in each case. Secondary outcomes included Lund-Kennedy endoscopy scores (LKES) and patient self-report of olfactory disturbance. The results were analysed using a paired t-tests.
  
  
  RESULTS
  Seventeen patients met inclusion criteria for the study. Mean preoperative UPSIT value was 37.2 (normosmia), and mean postoperative UPSIT value was 30.8 (moderate hyposmia) (P < .001). All patients were fully healed with normal LKES scores by 6 months. All patients complained of their olfactory dysfunction.
  
  
  CONCLUSIONS
  This study is the first to describe postoperative olfactory perturbations suffered by patients undergoing endoscopic transsphenoidal pituitary surgery. We hypothesize that olfactory impairment results from use of the HB flap. We recommend that the possibility of permanent olfactory changes be added to routine patient counseling and consent for this procedure, and that HB flaps be raised judiciously during trannssphenoidal endoscopic procedures.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Western Ontario, London, Canada. brian.rotenberg@sjhc.london.on.ca
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.forename: Samantha
authors.initials: S
authors.lastname: Saunders
authors.forename: Neil
authors.initials: N
authors.lastname: Duggal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000857:Olfaction Disorders / Q000209:etiology*; D010902:Pituitary Gland / Q000601:surgery*; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000098:blood supply