Smell Decline as a Good Predictor of Sinonasal Polyposis Recurrence after Endoscopic Surgery

Abstract

Objectives:

Evaluate the most sensitive symptom that predicts recurrence of nasal polyposis.

Methods:

In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. Sino-Nasal Outcome Test (SNOT-22) was answered by patients at preoperative visit and 1, 3, 6, 12, and 24 months after surgery. All of the patients were on maintenance therapy with nasal corticosteroid and saline irrigation postoperatively for 6 months. Patients were followed up with serial endoscopic examination, and 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. Allergic rhinitis and asthma existed in 45% and 43.5% of cases respectively. Seven patients (11.3%) underwent revision surgery during the 2-year follow-up period. Fifty-two patients had a smell problem preoperatively, but 98.1% of them regained satisfactory olfaction after the surgery. The severity of symptoms gradually increased in patients with recurrence of polyposis but at a different point of time (P value = .008). Sense of smell was the first symptom that became worse in patients with relapse (mean 6 months) followed by nasal secretion (12 months) and obstruction (24 months). Patients with asthma and allergic rhinitis showed the symptoms of recurrence sooner than other patients (P < .05).

Conclusions:

The most sensitive symptom for the recurrence of nasal polyposis is decrease in sense of smell. Recurrence of nasal obstruction was noticed in the late stage of relapse when frank polyposis formation was established.