Patient-reported olfactory function following endoscopic sinus surgery with modified endoscopic Lothrop procedure / Draf 3

Abstract

The Modified Endoscopic Lothrop procedure (MELP) or Draf 3 is a complex procedure, performed for chronic frontal sinusitis that is refractory to standard functional endoscopic sinus surgery. The procedure involves drilling of the frontal T (formed by the septum and middle turbinate`s attachment to the skull base) onto the olfactory fossa often with exposure of the first olfactory neuron and may affect olfactory function. This study was performed to assess patients` subjective sense of smell following this procedure. Prospective study of retrospective data. Sixty-eight patients, who underwent modified endoscopic Lothrop by the senior author (PJW) between 2003 and 2008, completed a post-operative questionnaire asking about their perception of olfactory function. All patients had their pre-operative subjective sense of smell documented prior to undergoing surgery. Patient records were reviewed for pertinent medical information such as the presence of asthma, aspirin sensitivity and nasal polyps. This study found that the majority of patients reported improvement in their sense of smell post-operatively, while only a small number reported a negative impact on their smell. Thirty-nine patients reported an improvement in their post-operative smell grade. Twenty patients reported no change in their smell grade, while the remaining 9 patients stated that their sense of smell worsened after surgery. No statistically significant correlation was found between patient outcome and the presence of asthma, nasal polyps, or Samter`s triad. The Modified endoscopic Lothrop procedure/Draf 3 had a positive effect on subjective sense of smell post-operatively in this cohort of patients.