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Volume: 41 - Issue: 4

First page: 220 - Last page: 230

R. Jankowski - C. Bodino

DOI: 10.4193/Rhin

Aim: In this prospective study the effect of medical and surgical treatment on subjective olfaction
was studied in patients with nasal polyposis (NPS). The effects on nasal obstruction,
anterior and posterior rhinorrhea, sneezing and itching are reported in another article in this
issue.
Patients and Methods: Protocol 1. Twenty-four patients with NPS who complained about
anosmia were treated with a 7-days course of systemic steroids. Their subjective overall sense
of smell was determined with a visual analog scale (VAS) before treatment, immediately after
treatment, and two months later. Subsequently all patients underwent surgery bilaterally
according to the nasalisation principles. The sense of smell was re-evaluated at 1, 3, 6, 9, and
12 months postoperatively.
Protocol 2. Thirty-two patients with NPS not responding to medical therapy who, for different
reasons, did not receive oral steroid treatment, received surgery only and were followed up during
one year after nasalisation. Of these patients, 25 were anosmic and 7 normosmic.
Results: Protocol 1. Following the 7-day treatment with systemic steroids the olfactory score
increased significantly. During the waiting time for surgery (64±39 days) this score deteriorated
again in a significant way. One month after nasalisation which included a depot injection
of triamcinolone 80mg the day after surgery, the olfactory score ameliorated again and
remained stable at 3,6,9, and 12 months. None of the patients reported any intake of systemic
steroids during the one-year of follow-up. Statistically, there was a trend suggesting that the 12
month post-nasalisation score was better than the immediate post-oral steroid score. A good
correlation between the improvement of the sense of smell after 7 days of systemic steroids
and one year after nasalisation was found.
Protocol 2 One month after the nasalisation protocol, olfaction in patients of the hypo-anosmic
group had improved considerably. Scores at 3, 6,9, and 12 remained very stable. The
sense of smell in the normosmic group did not change after surgery and remained stable during
the year of follow-up.
In total, 49 patients with a severe loss of smell showed a significant improvement at 12
months after surgery.
Conclusion: The presemt study shows that 1) long-lasting correction of polfactory dysfunction
produced by nasal polyposis can be achieved through the combination of nasalisation and
low dose of nasal steroids, 2) middle turbinate resection does not alter the possibilities to
restore the sense of smell.

Rhinology 41-4: 220-230, 2003