International Rhinologic Society Rhinology 0300-0729 2025 11 30 Corticosteroid responsive olfactory dysfunction in chronic rhinosinusitis: what does it mean? EN K.A. Archer Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA J.C. Mace Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA T.L. Smith Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR, USA Z.M. Soler Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA R.J. Schlosser Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA J.A. Alt Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA J. Mattos Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VI, USA V.R. Ramakrishnan Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA Journal Article 3356 10.4193/Rhin24.207 BACKGROUND: In the setting of chronic rhinosinusitis (CRS), olfactory improvement with corticosteroids suggests reversibility and preserved function. While self-rated olfactory function does not replace psychophysical measures of olfactory function, our goal is to investigate if self-reported pre-operative corticosteroid-responsive olfactory dysfunction (CROD) is a predictor of post-operative olfactory improvement in patients with CRS undergoing sinus surgery. METHODOLOGY: We performed a prospective, observational study of patients with refractory CRS with and without nasal polyposis and pre-operative olfactory dysfunction undergoing sinus surgery. Patients were characterized into corticosteroid-responsive and non-corticosteroid-responsive based on a survey response. Patient outcome measures for Sniffin Sticks, Olfactory Cleft Endoscopy Score (OCES), Questionnaire of Olfactory Disorders (QOD-NS), and Sino-nasal Outcomes Test (SNOT-22) were recorded pre- and post-operatively. RESULTS: A total of 253 participants were included. Patients with CROD were more likely to have comorbid nasal polyposis, asthma, and aspirin sensitivity. Patients with CROD had significantly better post-operative improvement in OCES total scores and QOD-NS total scores compared to patients without CROD. CONCLUSIONS: In conclusion, patients with CRS and CROD are more likely to have a greater improvement in olfactory dysfunction post-operatively by several measures of olfactory outcomes. This suggests that corticosteroid responsiveness is a clinical predictor of preserved function and reversibility and can be used as a simple clinical prognostic factor.