Original Article
Analysis of factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps
Zhang Lichuan, Sun Jingwu, Hu Chunhua, Han Xingyu, Wu Dawei, Sun Zhifu, Yao Linyin, Wei Yongxiang
Published 2020-04-07
Cite as Chin J Otorhinolaryngol Head Neck Surg, 2020,55(04): 350-357. DOI: 10.3760/cma.j.cn115330-20190614-00383
Abstract
ObjectiveTo analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
MethodsThis was a retrospective analysis. Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled, including 22 males and 66 females, with the age of (48.1±11.3) years old(Mean±SD). Sniffin′ Sticks olfactory test, Lund-Mackay score and modified sinus CT olfactory cleft score, nasal resistance and acoustic reflex examination, blood routine and blood biochemistry test, serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery. According to bilateral total TDI score, the patients were divided into normal olfactory function group and olfactory disfunction group. The clinical baseline data were compared between the two groups. According to the results of single factor analysis, factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis, then a model predicting olfactory disfunction in patients with CRSwNP was initially established. P<0.05 was considered statistically significant.
ResultsAmong 88 patients with CRSwNP, 32 (36.4%) patients were with normal olfaction and 56 (63.6%) patients were with olfactory disfunction, including 40 (45.5%) of hyposmia and 16 (18.2%) of anosmia. Tissue eosinophil count, blood eosinophil percentage and blood urea concentration had significant difference between the two groups (12.7[2.0, 52.3]/HP (M[P25, P75]) vs 38.6[16.2, 87.0]/HP, 2.75[1.60, 4.80]% vs 4.35[2.50, 6.60]%, (5.56±1.15) mmol/L vs (4.98±1.33) mmol/L, all P<0.05). Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant, in addition, the bilateral and total olfactory cleft score was a risk factor (OR=2.108, 95%CI: 1.407-3.159, P<0.001) and blood urea within a certain concentration was a protective factor (OR=0.461, 95%CI: 0.240-0.884, P=0.020). Further studies found that the area under the ROC curve of the model with tissue eosinophil count, blood eosinophil percentage, bilateral and total olfactory cleft score, total inspiratory volume and blood urea concentration was 0.888 (P<0.01), which had good predictive value for olfactory disorders in CRSwNP.
ConclusionsThe modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP. A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.
Key words:
Nasal polyps; Eosinophil; Olfaction; Sinus CT; Urea
Contributor Information
Zhang Lichuan
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Sun Jingwu
Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei 230026, China
Hu Chunhua
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Han Xingyu
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Wu Dawei
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Sun Zhifu
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Yao Linyin
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Wei Yongxiang
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
±s，下同）。所有入选患者均于术前行Sniffin′ Sticks嗅觉测试、Lund-Mackay评分及改良鼻窦CT嗅区评分、鼻阻力及声反射检查、血常规及血生化等实验室检测、血清特异性IgE检测；术中取鼻息肉组织进行嗜酸粒细胞计数。根据Sniffin′ Sticks嗅觉测试结果将患者分成嗅觉功能正常组和嗅觉功能障碍组，两组之间进行临床基线资料比较，根据单因素分析结果，结合临床有意义的指标进一步行多因素Logistic回归模型分析，并初步建立CRSwNP嗅觉障碍的预测模型。设P<0.05为差异有统计学意义。
