Surgery and sense of smell

[Guest guest]

This article shows that FESS surgery improves the sense of smell, but

logically more so in patients without polyps (strong improvement) that

in patients with polyps (important improvement, but still some partial

dysfunction after surgery).

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Am J Otolaryngol. 2003 Nov-Dec;24(6):366-9.Click here to read Links

Subjective improvement of olfactory function after endoscopic sinus

surgery for chronic rhinosinusitis.

BF, Kountakis SE.

Department of Otolaryngology-Head and Neck Surgery, University of

Virginia, Augusta, GA 30912-4060, U

OBJECTIVE: The purpose of this study was to determine the effect of

functional endoscopic sinus surgery (FESS) on subjective olfactory

dysfunction in patients with chronic rhinosinusitis.Materials and

methods Prospective collection of data on consecutive patients

undergoing FESS after failing prolonged medical therapy for chronic

rhinosinusitis at a tertiary institution. Patients were asked to grade

their olfactory dysfunction from 0 to 10, with 0 representing normal

function and 10 complete anosmia. In addition, data such as computed

tomography scores, presence or absence of nasal polyps, and the presence

or absence of asthma were recorded and analyzed. Patients were followed

up to 1 year after surgery.

RESULTS: Data were collected on 178 patients who had sinus surgery over

a 2-year period.

The average olfactory dysfunction score before surgery was 4.9. This

improved to 0.9 at 1 year after surgery (P =.00).

Higher computed tomography scores as per Lund and MacKay correlated with

higher olfactory dysfunction scores (r = 0.62, P <.01) and greater

improvement after surgery (r = 0.82, P <.01).

Asthmatics and patients with polyps had higher subjective olfactory

dysfunction scores than nonasthmatics and patients without polyps (6.8

and 7.2 v 4.4 and 4.1, respectively).

All groups had subjective improvement at 1 year (2.3 and 1.5 v 0.6 and

0.7, respectively; P =.00).

CONCLUSION: Patients with subjective olfactory dysfunction despite

appropriate medical management for rhinosinusitis benefit from FESS.

[Guest guest]

I was wondering, how does the neti pot prevent polyp regrowth? I thought the polyps grew because of leucotrine production--an internal rather than external cause. I use the neti to clean out my sinuses, but I didn't think they did anything for polyps.Cheers,Becca"Dogs have masters, while cats have staff."

--unknown

[Guest guest]

> From: Becca <rebeebit@...>

>

> I was wondering, how does the neti pot prevent polyp regrowth? I thought the

> polyps grew because of leucotrine production--an internal rather than external

> cause. I use the neti to clean out my sinuses, but I didn't think they did

> anything for polyps.

I don't understand either, but my experience with irrigation is very

positive.

1. Using a pulsing device, Grossan or Waterpik, is proably more effective

than the neti pot.

2. I use 600ml each time, again, probably more effective.

3. I think the irrigation clears away the gunk which otherwise facilitates

the growth of polyps, even if they are triggered by internal conditions.

4. Irrigation allows steroidal nasal sprays to be more fully effective.

[Guest guest]

Right ; as pointed out, even basic saline irrigation can help some

measure against polyps by draining away all the inflammatory substances

contained in the mucus, and by making the mucosa more accessible to

treatment.

Of course, the irrigation has to be done in a way that respects the

mucosa : if you feel that you are irritated and that more irrigation

diminishes the irritation, that's fine ; if, however, the irrigation is

too aggressive and more irrigation increases the irritation, then it has

to be toned down a bit.

Normally, the mucus is clear and relatively fluid ; it contains

anti-microbial agents and constitutes the first line of defense for the

mucosa against external aggression. Mucus is produced by goblet cells,

and is carried out of the nasal cavities (same thing for the lungs) by a

synchronized, rolling movement caused by ciliated cells (or ciliae). So,

when a pathogen like, say, a bacteria, enters the nose, it lands on

mucus, which is supposed to trap it, attack it, and evacuate it away to

the stomach, where it is destroyed for good. If, for some reason, the

above mechanism doesn't work, other forms of immunity take the relay to

fight the pathogen.

Now, many conditions alter this mechanism. Polyps, for instance, arise

for any number of reasons, one of them being Samter's, and once polyps

begin to grow, they start producing inflammatory molecules that get

released locally and in turn propagate the inflammation to surrounding

tissues. Allergy is also a possible source of perturbation of the local

mucus chemistry, because inflammatory substances such as histamine are

released. Germ biofilms also release all sorts of inflammatory

substances locally. These inflammatory conditions tend to reinforce one

another. They also shut down the normal mucus evacuation by the ciliae,

which don't appreciate inflammatory substances, so that not only is the

mucus full of undesirable susbtances, but it also doesn't get flushed

out. In a simple model, a vicious circle can form, where inflammation

stops the natural cleaning process, and no cleaning means accumulating

more inflammation.

Normally, washing out the mucus is not useful, perhaps even not

indicated, because it is an individual's first line of defense ; but

when the mucus becomes full of inflammatory substances and starts to

accumulate, it becomes on the contrary necessary to flush it out.

In addition to saline (isotonic, hypotonic or hypertonic, but isotonic

is the standard), some drugs can be added to the irrigation liquid in

the hope of killing germs (antibiotics, dilute baby shampoo - see an

old abstract on that one, etc), calming the inflammation

(corticosteroids, DSCG), reducing the allergy locally (anti-histamines),

etc. Corticosteroids have many side effects, but they sometimes do help

control, or even reduce, polyp size over time ; so does DSCG (disodium

cromoglycate) ; anti-histamines may help by reducing the production of

histamine and will also reduce the production of mucus, so that can help

too.

If you have undergone surgery and have had your sinus ostia widened,

your sinuses are then accessible for irrigation ; otherwise, their

openings are usually so small that a drop of water can't get in, only a

fine mist (nebulized mist) can.

In the manipulation of additives to irrigation, some caution is needed.

First, this is not like applying a drug to outside skin, but you are

rather treating an internal mucosa, which is far more sensitive. Second,

making a dosage error is unfortunately very easy. Third, there are some

critical anatomical features around the nose, such as the eyes, the

optical nerves, and the brain, and this requires extra vigilance ; you

would not want to become blind or poorsighted after drowning your

optical nerves in excess corticosteroids, for example. As a rule of

thumb, and unless you want to experiment some, I would recommend not

irrigating with higher doses than those that have been prescribed to you

in spray form. For instance, if you sprayed two puffs of Nasonex every

day in your nostrils, it would not be unreasonable to spray the Nasonex

inside a Nasopure or NeilMed bottle instead, add a little saline, and

then irrigate to reach further that the spray alone could.

>

> > From: Becca rebeebit@...

> >

> > I was wondering, how does the neti pot prevent polyp regrowth? I

thought the

> > polyps grew because of leucotrine production--an internal rather

than external

> > cause. I use the neti to clean out my sinuses, but I didn't think

they did

> > anything for polyps.

>

> I don't understand either, but my experience with irrigation is very

> positive.

>

> 1. Using a pulsing device, Grossan or Waterpik, is proably more

effective

> than the neti pot.

>

> 2. I use 600ml each time, again, probably more effective.

>

> 3. I think the irrigation clears away the gunk which otherwise

facilitates

> the growth of polyps, even if they are triggered by internal

conditions.

>

> 4. Irrigation allows steroidal nasal sprays to be more fully

effective.

>