Risk factors for olfactory dysfunction in chronic rhinosinusitis☆
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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Comparison of olfactory and taste functions between eosinophilic and non-eosinophilic chronic rhinosinusitis
2020, Auris Nasus LarynxCitation Excerpt :This signifies that olfactory disorder occurs more frequently than taste disorder among patients with CRS. Nevertheless, in some previous studies, these two functional disorders were used indiscriminately in questionnaires [16,17]. In addition, no functional studies have distinguished between olfactory and taste functions according to the subtypes classified as ECRS and NCRS.
A novel pathophysiologic link between upper and lower airways in patients with chronic rhinosinusitis: Association of sputum periostin levels with upper airway inflammation and olfactory function
2020, World Allergy Organization JournalCitation Excerpt :Anosmia is a major symptom of CRS and it is often refractory to topical corticosteroids.31 Eosinophilic inflammation in sinus or NP tissues has been associated with the prevalence and severity of anosmia in CRS patients.32,33 Asthma is also known as one of risk factors of olfactory dysfunction in CRS patients as has been confirmed in this study (Table 2) in addition to aging, the presence of NPs (Table 3), and current smoking.33–35
Long-term postoperative control of eosinophilic chronic rhinosinusitis recurrence by inserting a steroid-eluting, sinus-bioabsorbable device reduces the dosage of oral steroid
2019, Auris Nasus LarynxCitation Excerpt :At the same time, the postoperative sense of smell improves [3]. The quality of the change in the olfactory dysfunction is considered a good indicator of the fluctuation in the inflammatory state in ECRS [3,4]. One of the many clinical features of ECRS is the efficacy of oral steroid.
Predictive markers of long-term recurrence in chronic rhinosinusitis with nasal polyps
2020, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Some studies defined tissue eosinophilia based on eosinophil count per hpf (400× magnification), while others on the proportion of eosinophil cell count as a percentage of the total inflammatory cell count in the sample. Although some investigators have suggested “5” [12,13,31], “8” [32], “10” [33], “70” [10], “100” [34,35], “120” [36] or as high as “350” [37] eosinophils absolute count per hpf as appropriate cut-off points; others have suggested “5%” [38], “10%” [39–41], “11%” [42], “20%” [43], or as high as “50%” [44,45] eosinophils percentage count as relevant cutoff values. Because specific criteria for what constitutes clinically relevant mucosal eosinophilia remain undefined, we decided to use as parameter the eosinophilic, neutrophilic and lymphocytic percentage per field (1 mm2) and not the absolute count because we thought that this was a more reliable measure considering the edema and the tissue architectural alterations typical of nasal polyps.
Predictors of olfactory improvement after endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps
2023, Journal of Laryngology and Otology
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This article was presented at the 2010 International Symposium on Infection and Allergy of Nose held in Geneva, Switzerland, from June 20th to 24th, 2010.