title: The effect of endoscopic olfactory cleft polyp removal on olfaction.
abstract: BACKGROUND
  The presence of olfactory cleft polyps in chronic rhinosinusitis with nasal polyposis is well documented, but the effect of endoscopic olfactory cleft polyp surgery on olfaction, versus observation, has not been well studied. This analysis assessed if microdebridement of olfactory cleft polyps yields significant objective smell improvements in those with anosmia or hyposmia.
  
  
  METHODS
  A randomized prospective single-blinded study was performed on patients undergoing bilateral endoscopic sinus surgery with profound bilateral nasal polyposis, excluding those younger than 18 years or without olfactory polyps. A preoperative University of Pennsylvania Smell Identification Test (UPSIT), visual analog scale (VAS), and sinonasal outcomes 20 score (SNOT-20), and a follow-up at 6 months was performed. Two cohorts were created, including one with cleft polyp removal (group A) and one with cleft polyps left in place (group B).
  
  
  RESULTS
  There were 10 patients in group A and 7 in group B. By using the Wilcoxon signed rank test, the two groups were individually analyzed for changes in the preoperative UPSIT, VAS, and SNOT-20 versus the 6-month test results. In group A, the improvement in the UPSIT, VAS, and SNOT-20 were statistically significant at p < 0.05. For group B only the improvement in the VAS was statistically significant, at p < 0.05. There was a statistically significant difference in clinical smell improvement between group A and B at 6 months (p = 0.00512).
  
  
  CONCLUSIONS
  Evidence exists that olfactory cleft polyp surgery improves olfactory function outcomes. Long-term data beyond 6 months is needed to further validate these early promising outcomes.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Arjuna B
authors.initials: AB
authors.lastname: Kuperan
authors.forename: Seth M
authors.initials: SM
authors.lastname: Lieberman
authors.forename: Deya N
authors.initials: DN
authors.lastname: Jourdy
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Al-Bar
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Goldstein
authors.forename: Roy R
authors.initials: RR
authors.lastname: Casiano
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002972:Cleft Palate / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000209:etiology / Q000601:surgery*; D059747:Nasal Surgical Procedures / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D000857:Olfaction Disorders / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012220:Rhinitis / Q000209:etiology / Q000601:surgery*; D016037:Single-Blind Method; D012852:Sinusitis / Q000209:etiology / Q000601:surgery*; D012903:Smell; D016896:Treatment Outcome