Assessment of Post Operative Olfactory Dysfunction, Nasal Morbidity and Quality Of Life in patients Undergoing Expanded Endoscopic Approach

Lidia Dennis Chiramal, (2020) Assessment of Post Operative Olfactory Dysfunction, Nasal Morbidity and Quality Of Life in patients Undergoing Expanded Endoscopic Approach. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Human beings rely on their sense of smell for the detection of potential harms. Any dysfunction of the sense of smell can hence cause distress to the patient. In endoscopic approach to the skull base, especially the expanded approach the pristine normal native nasal mucosa undergoes aggressive mucosal resection for exposure. There is a lacunae of information about the long term impact of this approach. The importance of informing the patient about the possible nasal morbidity and olfactory dysfunction associated with this approach was explored. AIM OF THE STUDY: To assess the post-operative olfactory impairment, quality of life and nasal morbidity in expanded endoscopic approach (EEA). OBJECTIVES: In patients undergoing expanded endoscopic approach for skull base tumors: 1. To assess the extent of olfaction impairment following an expanded endoscopic approach. 2. To follow up these patient over 3 months and to see the extent of recovery olfaction in these patients. 3. To assess how quality of life affected in the context of sinonasal symptoms in these patients. METHODS: This was a prospective observational study in a hospital set up. Patients over the age of 18 who were diagnosed with skull base tumours planned for expanded endoscopic approach were recruited. We assessed the olfactory function in these patients using the CCCRC olfaction test and quality of life was evaluated with the baseline SNOT -22 questionnaire pre-operatively, and post-operatively at 2 weeks and 3 months. RESULTS: There was a female preponderance with age ranging from 23 to 66 years. The most common diagnosis was noted to be growth hormone secreting pituitary adenoma, followed by non-functioning pituitary adenoma. It was found that 92% had normosmia and 8% mild hyposmia at pre- operative visit. At the 2 week post-operative visit, only 1 subject had normosmia, 48% had moderate hyposmia, 20% had anosmia, 12% had severe hyposmia and 16% had mild hyposmia. At the 3 month follow up visit, the olfactory scores seemed to have improved with almost half the subjects (48%) with a normal olfaction score and the rest with mild hyposmia. Only 1 subject had persistent moderate hyposmia at 3 month visit. Quality of life scores significantly increased in the immediate post- operative period and although it decreased over 3 months, it did not touch baseline at 3 months. CONCLUSION: There is significant post-operative morbidity in the context of sinonasal symptoms in patients undergoing the expanded endoscopic approach in the immediate post- operative period. There was statistically significant olfactory disturbance in the first 2 weeks post operatively. However, most patients recovered their olfactory function almost upto normal levels by 3 months post operatively, although some patients continued to have mild dysfunction. Loss of smell/taste, nasal obstruction, runny nose were the main symptoms patients faced immediately post operatively. However, 3 months post operatively most of these symptoms resolved. We need to keep in mind the risk of olfactory damage and nasal morbidity by patients while planning for this approach.

Item Type: Thesis (Masters)
Additional Information: 221714353
Uncontrolled Keywords: Expanded Endoscopic Approach, Connecticut Chemosensory Clinical Research Centre (CCCRC), SNOT-22, nasal morbidity.
Subjects: MEDICAL > Otolaryngology
Depositing User: Subramani R
Date Deposited: 15 Feb 2021 05:23
Last Modified: 15 Feb 2021 05:23

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