Outcomes in endoscopic sinus surgery: olfaction, nose scale and quality of life in a prospective cohort study

Objectives To determine the efficacy of endoscopic sinus surgery ( ESS ) on olfactory function in chronic rhinosinusitis patients with nasal polyps ( CRS w NP ) and without nasal polyps ( CRS s NP ) and to compare the nasal obstruction and symptom evaluation ( NOSE ) scale before and after surgery. Design A prospective cohort study Setting Royal National Throat and Nose and Ear Hospital, London UK . Participants One hundred and thirteen patients with CRS; 60 CRSwNP and 53 CRSsNP. Outcome measurements Olfaction was measured using both the University of Pennsylvania Smell Investigation Test ( UPSIT ) and the ‘sense of smell’ visual analogue scale ( VAS ). The NOSE scale, the sinonasal outcome test ( SNOT 22) and the Lund–Kennedy ( LK ) surgeon reported scores were also measured pre‐ and postoperatively at 6 months. Results The UPSIT psychophysical measurement significantly improved following ESS in the CRS w NP subgroup as did the patients perceived VAS sense of smell. However, in the CRS s NP subgroup, the improved VAS and UPSIT measurements were not significant. The NOSE , SNOT 22 and LK scores all improved significantly. The olfactory improvement as measured by the UPSIT correlated to the SNOT ‐22, but a correlation between the NOSE score and UPSIT was not found. Conclusions Endoscopic sinus surgery significantly improved the patient's perceived and measured sense of smell in the CRS w NP subgroup which is the most surgically responsive CRS subgroup. Additionally, improved olfaction in the CRS w NP subgroup is most likely to improve the patient's quality of life. Endoscopic sinus surgery significantly improved the NOSE scale in both CRS subgroups at 6 months following surgery.