Abstract
Purpose This study was conducted to evaluate the effect of endoscopic olfactory cleft (OC) opening on olfaction in patients with obstructed OC disease. Materials and Methods. Patients with obstructed OC disease who underwent endoscopic OC opening for treatment were enrolled. The endoscopic olfactory cleft opening was performed under local anesthesia. Under an endoscopy, the middle and superior turbinates were gently lateralized to open the OC using an elevator. The phenyl ethyl alcohol threshold test was performed to evaluate the olfactory function both before and after surgery. Results An endoscopic OC opening was performed on 42 patients. Amongst them, the etiology of OC obstruction revealed anatomic anomalies in 14 patients, inflammatory process in 14, and anatomic anomalies as well as inflammatory process in 14. The phenyl ethyl alcohol threshold levels improved in 32 (76.2%) of the patients after surgery. The olfactory function was better improved in patients experiencing OC obstructed by inflammatory process than those by anatomic anomalies. Conclusions This study showed that endoscopic OC opening seemed to be effective in treating olfactory dysfunction in patients with obstructed OC disease caused by inflammatory process.
Highlights
Free access of air to the olfactory cleft (OC) is a key element towards maintaining normal olfactory function [1]
Patients who had complained of olfactory dysfunction were asked about their medical histories and examined by nasal endoscopy and a sinus CT. e olfactory function was evaluated by a phenyl ethyl alcohol (PEA) threshold test. ose who were suspected to be suffering from sensorineural olfactory loss, such as a history of loss of olfactory function during childhood or after an accident involving head trauma or an episode of upper respiratory infection, were excluded. ose whose nasal endoscopy revealed mucopurulent discharge, polyps, or tumor masses in the nasal cavities, including the OC, or scar tissue in the OC due to a prior sinus surgery were excluded from the study
When the CT uncovered that the olfactory cleft was obstructed, but the sinuses were clear or the disease severity of the sinusitis was mild, they were diagnosed with obstructed OC disease based on Biacabe et al.’s definition [2] and enrolled in the study. e etiology of olfactory cleft obstruction is classified into anatomic deformity, inflammatory process, or both based upon the CT findings (Figures 1(a)–1(c))
Summary
Free access of air to the olfactory cleft (OC) is a key element towards maintaining normal olfactory function [1]. E second group was the OC obstructed by anatomic deformities associated with an inflammatory process. E third group was the OC obstructed only by an inflammatory process. An intranasal corticosteroid application produces fewer side effects than do oral corticosteroids [4]. A conventional intranasal corticosteroid application has been considered as having little effect on olfactory dysfunction due to the inability of topical corticosteroids to reach the OC [3, 5]. A 25% improvement rate in olfactory thresholds was achieved in those with OC disease after medical therapy with an oral corticosteroid (prednisolone 1 mg/kg weight/day) for 6 days, along with an intranasal corticosteroid for 1 month [2]
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