Smell Decline as a good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery.
BACKGROUND
To evaluate the most sensitive symptom to predict early recurrence of nasal polyposis. Prospective longitudinal cohort study. Tertiary university referral center with accredited otorhinolaryngology residency programs.


METHODS
In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. The author-devised questionnaire relating to the four major symptoms of chronic rhinosinusitis were answered by patients at the pre-operative visit and at 1, 3, 6, 12, and 24 months after surgery. Patients were followed up with serial endoscopic examinations, and a computed tomography (CT) scan was performed if indicated.


RESULTS
All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. All major symptoms showed significant improvement after surgery (P=0.000); however, the severity of symptoms gradually increased in patients with a recurrence of polyposis, but at different points in time (P= 0.008). Sense of smell was the first symptom to deteriorate in patients with relapse (mean, 6 months) followed by nasal secretion (12 months), obstruction and pain(24 months). Patients with asthma, Samter's triad, allergic fungal rhinosinusitis (AFRS) and allergic rhinitis showed symptoms of recurrence sooner than other patients (P<0.05).


CONCLUSIONS
The most sensitive symptom for the early detection of recurrence of nasal polyposis is a decrease in the sense of smell. Nasal obstruction and facial pain were observed in the late stage of relapse when frank polyposis formation was established.
Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mahdi
M
Bakhshaee
Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Reza
MR
Sharifian
Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Amir Hossain
AH
Ghazizadeh
Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Kianoosh
K
Nahid
Department of Otorhinolaryngology Head and Neck Surgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Karim
K
Jalaeian Samani
Allergic rhinitis; Asthma; Endoscopic sinus surgery; Nasal obstruction; Nasal secretion; Recurrence; Sinonasal polyposis; Smell.