慢性鼻窦炎伴鼻息肉患者过敏状态与嗅觉及鼻部症状的关系
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摘要
目的:探讨伴或不伴过敏的慢性鼻窦炎伴鼻息肉(CRSwNP)患者嗅觉障碍与鼻部相关症状存在的差异。方法:连续收集288例拟行鼻内镜手术的CRSwNP患者的过敏原检查结果、嗅觉评分、鼻部相关症状及CT评分并进行分析。结果:288例CRSwNP患者中有71.3%的患者伴有嗅觉下降,34.5%的患者伴有嗅觉障碍。发现嗅觉障碍程度和鼻部症状(鼻塞和流涕)及CT评分有关(P<0.01),但是和患者的过敏状态无明显相关。多项逻辑回归分析显示鼻塞和CT评分是CRSwNP患者嗅觉障碍的危险因素(OR为1.293和1.349,P<0.01)。结论:过敏状态并不直接影响CRSwNP患者的嗅觉障碍,局部炎症的严重程度对嗅觉的影响较大,通过手术治疗可以改善患者的嗅觉功能,从而进一步改善患者的生活质量。
Objective:Olfactory impairment is commonly observed in chronic rhinosinusitis with nasal polyps(CRSwNP)and has a significant impact on quality of life.However,the risk factors for olfactory impairment have not been fully understood,and whether atopy is predisposed to olfactory impairment in CRSwNP patients remains unclear.The present study aims to unveil differences in olfaction and sinonasal symptoms between CRSwNP with and without atopy by means of a hospital-based,cross-sectional survey.Method:In this study,288 CRSwNP patients ready for sinus surgery were consecutively enrolled,and atopy,olfaction,sinonasal symptoms and CT scores were evaluated.Result:We found 71.3%of CRSwNP patients presented olfactory loss and 34.5%of them presented olfactory complaint in this cohort(In this study,olfactory impairment has been defined when VAS≥ 1 and olfactory dysfunction has been defined when VAS≥5).The decreased olfactory function was associated with sinonasal symptoms(nasal congestion and rhino rhea)and total CT scores(P<0.01),but not with atopy.Multivariate logistic regression revealed that nasal congestion score and total CT score were risk factors for olfactory dysfunction(OR,1.293 and 1.349;P<0.01)in CRSwNP patients.Conclusion:Our findings indicate atopic condition may not directly cause olfactory impairment,and physician should pay attention to the surgical treatment for local disease severity to improve the olfactory function and quality of life.
Objective:Olfactory impairment is commonly observed in chronic rhinosinusitis with nasal polyps(CRSwNP)and has a significant impact on quality of life.However,the risk factors for olfactory impairment have not been fully understood,and whether atopy is predisposed to olfactory impairment in CRSwNP patients remains unclear.The present study aims to unveil differences in olfaction and sinonasal symptoms between CRSwNP with and without atopy by means of a hospital-based,cross-sectional survey.Method:In this study,288 CRSwNP patients ready for sinus surgery were consecutively enrolled,and atopy,olfaction,sinonasal symptoms and CT scores were evaluated.Result:We found 71.3%of CRSwNP patients presented olfactory loss and 34.5%of them presented olfactory complaint in this cohort(In this study,olfactory impairment has been defined when VAS≥ 1 and olfactory dysfunction has been defined when VAS≥5).The decreased olfactory function was associated with sinonasal symptoms(nasal congestion and rhino rhea)and total CT scores(P<0.01),but not with atopy.Multivariate logistic regression revealed that nasal congestion score and total CT score were risk factors for olfactory dysfunction(OR,1.293 and 1.349;P<0.01)in CRSwNP patients.Conclusion:Our findings indicate atopic condition may not directly cause olfactory impairment,and physician should pay attention to the surgical treatment for local disease severity to improve the olfactory function and quality of life.
引文
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[5] HIRSCH A G,STEWART W F,SUNDARESAN A S,et al.Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample[J].Allergy,2017,72:274-281.
[6] KERN R C.Chronic sinusitis and anosmia:pathologic changes in the olfactory mucosa[J].Laryngoscope,2000,110:1071-1077.
[7] ISHITOYA J,SAKUMA Y,TSUKUDA M.Eosinophilic chronic rhinosinusitis in Japan[J].Allergol Int,2010,59:239-245.
[8] HAO J,PANG Y T,WANG D Y.Diffuse mucosal inflammation in nasal polyps and adjacent middle turbinate[J].Otolaryngol Head Neck Surg,2006,134:267-275.
[9] BA L,DU J,LIU F,et al.Distinct inflammatory profiles in atopic and nonatopic patients with chronic rhinosinustis accompanied by nasal polyps in Western china[J].Allergy Asthma Immunol Res,2015,7:346-358.
[10] HAMIZAN A W,CHRISTENSEN J M,EBENZER J,et al.Middle turbinate edema as a diagnostic marker of inhalant allergy[J].Int Forum Allergy Rhinol,2017,7:37-42.
[11] WHITE L J,ROTELLA M R,DELGAUDIO J M.Polypoid changes of the middle turbinate as an indicator of atopic disease[J].Int Forum Allergy Rhinol,2014,4:376-380.
[12]LUND V J,MACKAY I S.Staging in rhinosinusitus[J].Rhinology,1993,31:183-184.
[13]KOHLI P,SCHLOSSER R J,STORCK K,et al.Olfactory cleft computed tomography analysis and olfaction in chronic rhinosinusitis[J].Am J Rhinol Allergy,2016,30:402-406.
[14]HOUSER S M,KEEN K J.The role of allergy and smoking in chronic rhinosinusitis and polyposis[J].Laryngoscope,2008,118:1521-1527.
[15]OKA H,TSUZUKI K,TAKEBAYASHI H,et al.Olfactory changes after endoscopic sinus surgery in patients with chronic rhinosinusitis[J].Auris Nasus Larynx,2013,40:452-457.
[16]DECONDE A S,MACE J C,ALT J A,et al.Comparative effectiveness of medical and surgical therapy on olfaction in chronic rhinosinusitis:aprospective,multiinstitutional study[J].Int Forum Allergy Rhinol,2014,4:725-733.
[17]KIM D H,KIM S W,HWANG S H,et al.Prognosis of Olfactory Dysfunction according to Etiology and Timing of Treatment[J].Otolaryngol Head Neck Surg,2017,156:371-377.
[2] AKDIS C A,BACHERT C,CINGI C,et al.Endotypes and phenotypes of chronic rhinosinusitis:a PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy,Asthma&Immunology[J].J Allergy Clin Immunol,2013,131:1479-1490.
[3] HSU J,PETERS A T.Pathophysiology of chronic rhinosinusitis with nasal polyp[J].Am J Rhinol Allergy,2011,25:285-290.
[4] KOHLI P,NAIK A N,HARRUFF E E,et al.The prevalence of olfactory dysfunction in chronicrhinosinusitis[J].Laryngoscope,2017,127:309-320.
[5] HIRSCH A G,STEWART W F,SUNDARESAN A S,et al.Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample[J].Allergy,2017,72:274-281.
[6] KERN R C.Chronic sinusitis and anosmia:pathologic changes in the olfactory mucosa[J].Laryngoscope,2000,110:1071-1077.
[7] ISHITOYA J,SAKUMA Y,TSUKUDA M.Eosinophilic chronic rhinosinusitis in Japan[J].Allergol Int,2010,59:239-245.
[8] HAO J,PANG Y T,WANG D Y.Diffuse mucosal inflammation in nasal polyps and adjacent middle turbinate[J].Otolaryngol Head Neck Surg,2006,134:267-275.
[9] BA L,DU J,LIU F,et al.Distinct inflammatory profiles in atopic and nonatopic patients with chronic rhinosinustis accompanied by nasal polyps in Western china[J].Allergy Asthma Immunol Res,2015,7:346-358.
[10] HAMIZAN A W,CHRISTENSEN J M,EBENZER J,et al.Middle turbinate edema as a diagnostic marker of inhalant allergy[J].Int Forum Allergy Rhinol,2017,7:37-42.
[11] WHITE L J,ROTELLA M R,DELGAUDIO J M.Polypoid changes of the middle turbinate as an indicator of atopic disease[J].Int Forum Allergy Rhinol,2014,4:376-380.
[12]LUND V J,MACKAY I S.Staging in rhinosinusitus[J].Rhinology,1993,31:183-184.
[13]KOHLI P,SCHLOSSER R J,STORCK K,et al.Olfactory cleft computed tomography analysis and olfaction in chronic rhinosinusitis[J].Am J Rhinol Allergy,2016,30:402-406.
[14]HOUSER S M,KEEN K J.The role of allergy and smoking in chronic rhinosinusitis and polyposis[J].Laryngoscope,2008,118:1521-1527.
[15]OKA H,TSUZUKI K,TAKEBAYASHI H,et al.Olfactory changes after endoscopic sinus surgery in patients with chronic rhinosinusitis[J].Auris Nasus Larynx,2013,40:452-457.
[16]DECONDE A S,MACE J C,ALT J A,et al.Comparative effectiveness of medical and surgical therapy on olfaction in chronic rhinosinusitis:aprospective,multiinstitutional study[J].Int Forum Allergy Rhinol,2014,4:725-733.
[17]KIM D H,KIM S W,HWANG S H,et al.Prognosis of Olfactory Dysfunction according to Etiology and Timing of Treatment[J].Otolaryngol Head Neck Surg,2017,156:371-377.