内镜鼻窦手术对慢性鼻-鼻窦炎伴鼻息肉患者嗅觉功能转归的影响
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摘要
目的:通过嗅觉主客观功能测试的方法评估手术对慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者嗅觉功能转归的影响。方法:采用回顾性研究方法。选取2015—2017年行内镜鼻窦手术(ESS)的CRSwNP患者40例,术后时间为6～46个月,于2018年10月对患者进行随访,行Sniffin'sticks嗅觉测试和嗅觉诱发电位检测,将术中留取的鼻息肉组织进行嗜酸粒细胞计数和百分比计算,将患者分成嗜酸性CRSwNP(ECRS组)和非嗜酸性CRSwNP(NECRS组),分别比较2组术前和术后的嗅觉主客观功能,并将术后与术前的Sniffin'sticks嗅觉测试进行配对t检验,并采用协方差分析调整术后不同时间对术后嗅觉恢复差异的影响。结果:40例鼻息肉患者中21例(52.5%)ECRS和19例(47.5%)NECRS,2组间仅Lund-Mackay后筛评分和后嗅裂区评分差异有统计学意义(P<0.05)。按照嗅觉改善时TDI总值提高≥5.5的标准,术后21例患者的嗅觉功能获得改善,改善率为52.5%,ECRS组嗅觉功能无论是单侧T/TDI还是双侧T/D/TDI均有明显提高,而NECRS组只有单侧T/TDI得到提高,术后2组间Sniffin'sticks嗅觉测试结果差异无统计学意义,而嗅觉诱发电位潜伏期差异有统计学意义(P<0.05)。结论:ESS对CRSwNP患者嗅觉功能的改善率超过50%,ECRS组双侧嗅觉功能改善较NECRS组好,但术后ECRS组嗅觉功能仍较NECRS组差。嗅觉诱发电位可以更客观准确的反映嗜酸性炎症相关的嗅觉障碍的严重程度。
Objective To evaluate the effect of surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)by subjective and objective olfactory tests.Method:This was a retrospective study.Forty patients with CRSwNP who underwent endoscopic sinus surgery(ESS)from 2015 to 2017 in Beijing Anzhen Hospital were enrolled.Postoperative time was 6-46 months.The patients were followed up in October2018 and examined using Sniffin'sticks olfactory test and olfactory event-related potentials(oERP).The polyps collected during surgery were performed to eosinophil count and percentage calculation.They were divided into eosinophilic CRSwNP(ECRS)and non-eosinophilic CRSwNP(NECRS).The subjective and objective olfactory functions between the two groups were compared before and after surgery respectively and the paired T test was performed between the postoperative and the preoperative Sniffin'sticks olfactory test.Covariance analysis was used to adjust the effect of different postoperative time on postoperative olfactory recovery.Result:There were 21(52.5%)ECRS and 19(47.5%)NECRS patients of the 40 patients with nasal polyps.There was statistical difference in the posterior ethmoid score and the posterior olfactory cleft score of CT.According to the criterion of total TDI increased more than 5.5,olfactory function in 21(52.5%)patients had improved.In addition,there was a significant improvement in olfactory function in ECRS group either in unilateral T/TDI or bilateral T/D/TDI,but only unilateral T/TDI increased in NECRS group.There was no significant difference in Sniffin'sticks olfactory test between the two groups,but there was a statistically significant difference in the latency of oERP after surgery.Conclusion:ESS could improve olfactory function in patients with CRSwNP by more than 50%.Bilateral olfactory improvement in ECRS was better than that in NECRS,but olfactory function in postoperative ECRS was still lower than that in NECRS.oERP can more objectively and accurately reflect the severity of olfactory disorders associated with eosinophilic inflammation.
Objective To evaluate the effect of surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)by subjective and objective olfactory tests.Method:This was a retrospective study.Forty patients with CRSwNP who underwent endoscopic sinus surgery(ESS)from 2015 to 2017 in Beijing Anzhen Hospital were enrolled.Postoperative time was 6-46 months.The patients were followed up in October2018 and examined using Sniffin'sticks olfactory test and olfactory event-related potentials(oERP).The polyps collected during surgery were performed to eosinophil count and percentage calculation.They were divided into eosinophilic CRSwNP(ECRS)and non-eosinophilic CRSwNP(NECRS).The subjective and objective olfactory functions between the two groups were compared before and after surgery respectively and the paired T test was performed between the postoperative and the preoperative Sniffin'sticks olfactory test.Covariance analysis was used to adjust the effect of different postoperative time on postoperative olfactory recovery.Result:There were 21(52.5%)ECRS and 19(47.5%)NECRS patients of the 40 patients with nasal polyps.There was statistical difference in the posterior ethmoid score and the posterior olfactory cleft score of CT.According to the criterion of total TDI increased more than 5.5,olfactory function in 21(52.5%)patients had improved.In addition,there was a significant improvement in olfactory function in ECRS group either in unilateral T/TDI or bilateral T/D/TDI,but only unilateral T/TDI increased in NECRS group.There was no significant difference in Sniffin'sticks olfactory test between the two groups,but there was a statistically significant difference in the latency of oERP after surgery.Conclusion:ESS could improve olfactory function in patients with CRSwNP by more than 50%.Bilateral olfactory improvement in ECRS was better than that in NECRS,but olfactory function in postoperative ECRS was still lower than that in NECRS.oERP can more objectively and accurately reflect the severity of olfactory disorders associated with eosinophilic inflammation.
引文
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[7]周兵.慢性鼻窦炎围手术期处理意义的再认识[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1261-1265.
[8]KOHLI P,NAIK A N,HARRUFF E E,et al.The prevalence of olfactory dysfunction in chronic rhinosinusitis[J].Laryngoscope,2017,127:309-320.
[9]WU D,BLEIER BS,WEI Y.Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment[J].Eur Arch Otorhinolaryngol,2018,275:2193-2202.
[10]ROMBAUX P,HUART C,LEVIE P,et al.Olfaction in Chronic Rhinosinusitis[J].Curr Allergy Asthma Rep,2016,16:41-41.
[11]LAVIN J,MIN J Y,LIDDER A K,et al.Superior turbinate eosinophilia correlates with olfactory deficit in chronic rhinosinusitis patients[J].Laryngoscope,2017,127:2210-2218.
[12]INVITTO S,PIRAINO G,CICCARESE V,et al.Potential Role of OERP as Early Marker of Mild Cognitive Impairment[J].Front Aging Neurosci,2018,10:272.
[13]HAUSER L J,CHANDRA R K,LI P,et al.Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss[J].Int Forum Allergy Rhinol,2017,7:957-962.
[2]YOUSEFI J,MADARSHAHI H,AKHAVAN A,et al.Effect of ESS on Olfactory Threshold of Patients with CRS without Nasal Polyps[J].Int Tinnitus J,2018,22:89-92.
[3]HELLINGS P W.EPOS2020and beyond[J].Rhinology,2019,57:161-161.
[4]HAXEL B R.Recovery of olfaction after sinus surgery for chronic rhinosinusitis:A review[J].Laryngoscope,2019,129:1053-1059.
[5]VANDENHENDE-SZYMANSKI C,HOCHET B,CHEVALIER D,et al.Olfactory cleft opacity and CTscore are predictive factors of smell recovery after surgery in nasalpolyposis[J].Rhinology,2015,53:29-34.
[6]HUMMEL T,WHITCROFT K L,ANDREWS P,et al.Position paper on olfactory dysfunction[J].Rhinol Suppl,2017,54:1-30.
[7]周兵.慢性鼻窦炎围手术期处理意义的再认识[J].临床耳鼻咽喉头颈外科杂志,2016,30(16):1261-1265.
[8]KOHLI P,NAIK A N,HARRUFF E E,et al.The prevalence of olfactory dysfunction in chronic rhinosinusitis[J].Laryngoscope,2017,127:309-320.
[9]WU D,BLEIER BS,WEI Y.Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment[J].Eur Arch Otorhinolaryngol,2018,275:2193-2202.
[10]ROMBAUX P,HUART C,LEVIE P,et al.Olfaction in Chronic Rhinosinusitis[J].Curr Allergy Asthma Rep,2016,16:41-41.
[11]LAVIN J,MIN J Y,LIDDER A K,et al.Superior turbinate eosinophilia correlates with olfactory deficit in chronic rhinosinusitis patients[J].Laryngoscope,2017,127:2210-2218.
[12]INVITTO S,PIRAINO G,CICCARESE V,et al.Potential Role of OERP as Early Marker of Mild Cognitive Impairment[J].Front Aging Neurosci,2018,10:272.
[13]HAUSER L J,CHANDRA R K,LI P,et al.Role of tissue eosinophils in chronic rhinosinusitis-associated olfactory loss[J].Int Forum Allergy Rhinol,2017,7:957-962.