Elsevier

Auris Nasus Larynx

Volume 40, Issue 5, October 2013, Pages 465-469
Auris Nasus Larynx

Risk factors for olfactory dysfunction in chronic rhinosinusitis

https://doi.org/10.1016/j.anl.2012.12.005Get rights and content

Abstract

Objective

Although risk factors for olfactory dysfunction in patients with chronic rhinosinusitis (CRS) have been examined, most studies did not distinguish between classified eosinophilic chronic rhinosinusitis (ECRS) and noneosinophilic chronic rhinosinusitis (NECRS). The incidence of eosinophilic disease in Japan differs from that in the West. Thus, when olfaction in CRS is investigated, ECRS and NECRS should be examined separately. In the present study, we examined the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study.

Methods

Olfactory examination results, demographic data, clinical factors, and comorbidity data were analyzed for 418 patients with CRS at 3 tertiary care centers. We used T&T olfactometry, intravenous olfactory test (the Alinamin test) and Likert scale to assess subjects’ olfactory function. Data were analyzed with univariate and multivariate analyses.

Results

Olfactory dysfunction was more severe and more prevalent in ECRS than in NECRS. We found that olfactory cleft polyps (odds ratio [OR], 3.24), ethmoid opacification (OR, 2.64), asthma (OR, 2.29), current smoking (OR, 1.74) and age ≥50 years (OR, 1.66) were associated with olfactory dysfunction in CRS. Ethmoid opacification (OR, 3.09) and olfactory cleft polyps (OR, 3.05) were associated with olfactory dysfunction in NECRS. Olfactory cleft polyps (OR, 3.98), current smoking (OR, 2.67), IgE ≥400 IU/ml (OR, 2.65), ethmoid opacification (OR, 2.51), and asthma (OR, 2.34) were associated with olfactory dysfunction in ECRS.

Conclusions

Olfactory dysfunction was more severe and prevalent in ECRS than in NECRS. Physician should pay attention to these clinical findings to diagnose olfactory dysfunction, especially in ECRS, and should provide appropriate explanation, guidance, and care. In addition, smokers should be advised to stop smoking to help prevent olfactory dysfunction.

Introduction

Olfactory function is an essential sensory function in animals and is deeply involved in appetite, motivation, and libido. Patients with anosmia often feel isolated and emotionally impaired [1], and their quality of life is decreased [2]. However, many people are unaware of olfactory dysfunction [3], because information can be obtained via the other senses. There is also a general lack of awareness regarding the problem of olfactory dysfunction, even on the part of clinicians. Olfactory dysfunction may not directly cause systemic problems, but if left untreated, harmful effects may manifest in regard to nutrition, reproductive activity, and even survival.

Little data are available regarding olfactory dysfunction in Japan, but 40–50% of cases of olfactory dysfunction are caused by chronic rhinosinusitis (CRS) [4], [5]. In the West, approximately 90% of patients with nasal polyps show a mixed cellular infiltrate with prominent eosinophilia [6]. Tissue eosinophilia [7], [8] and local increases in IgE levels [9] are hallmarks of nasal polyps and are thought to be risk factors for disease recurrence. In Japan, eosinophilic chronic rhinosinusitis (ECRS) has recently been classified and induces severe olfactory dysfunction even at an early stage [10], [11]. However, the incidence of eosinophilic disease in Japan is lower than in the West, but the incidence of noneosinophilic chronic rhinosinusitis (NECRS) is much higher in Japan [11]. Thus, when olfaction in CRS, ECRS, and NECRS are investigated, they should be considered distinct entities. Age, nasal polyposis, smoking, and asthma are considered risk factors for olfactory dysfunction in patients with CRS [12]. However, the risk factors and severity remain unclear for ECRS and NECRS. In the present study, we examined the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study.

Section snippets

Study population

We performed a multicenter prospective cohort study of 621 patients who underwent endoscopic sinus surgery (ESS) from April 2007 through March 2008 at the Department of Otorhinolaryngology, The Jikei University School of Medicine, Ota General Hospital, or Tokyo Dental College Ichikawa General Hospital. Of these patients, 418 (67.3%) for whom preoperative olfactory data were available were included in the analyses. The Ethics Committee of The Jikei University School of Medicine approved the

Characteristics of patients, comparison between NECRS and ECRS

Table 1 summarizes the demographic and clinical characteristics of patients with CRS, NECRS, or ECRS. The mean peripheral eosinophil count, total IgE level, and degree of total ethmoid opacification of patients with ECRS were significantly greater than those in patients with NECRS. Allergic rhinitis, asthma, and a past smoking history were more common in patients with ECRS than in patients with NECRS. However, there were no statistically significant differences in regards to sex, age, %VC,

Discussion

The present study is, to the best of our knowledge, the first to examine the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study. We found, on the basis of 3 different olfactory examinations, that olfactory dysfunction was more severe and more prevalent in patients with ECRS than in patients with NECRS. These findings suggest that eosinophils may act as important effectors of olfaction.

Conflict of interest

There is no financial and material support for this research. Conflict of interest is none.

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