Ethmoid-to-maxillary opacification ratio: a predictor of postoperative olfaction and outcomes in nasal polyposis?

Daniel M Beswick; Timothy L Smith; Jess C Mace; Jeremiah A Alt; Nyssa F Farrell; Vijay R Ramakrishnan; Rodney J Schlosser; Zachary M Soler

doi:10.1002/alr.22625

Ethmoid-to-maxillary opacification ratio: a predictor of postoperative olfaction and outcomes in nasal polyposis?

Int Forum Allergy Rhinol. 2021 Jan;11(1):48-57. doi: 10.1002/alr.22625. Epub 2020 Jun 18.

Authors

Daniel M Beswick¹, Timothy L Smith², Jess C Mace², Jeremiah A Alt³, Nyssa F Farrell², Vijay R Ramakrishnan¹, Rodney J Schlosser⁴, Zachary M Soler⁴

Affiliations

¹ Department of Otolaryngology, University of Colorado, Aurora, CO.
² Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
³ Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.
⁴ Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC.

Abstract

Background: Inflammatory profiles for patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) vary between North American and Asian populations. An elevated ethmoid-to-maxillary (E/M) opacification ratio on preoperative imaging is associated with certain postoperative outcomes in Asian populations and populations that are non-type 2 dominant. In this study we explore this factor in North American/type 2-based populations.

Methods: Adult patients (n = 165) from a North American population with CRSwNP who underwent endoscopic sinus surgery (ESS) were prospectively enrolled into an observational, multi-institutional study. The 22-item Sino-Nasal Outcome Test (SNOT-22), Brief Smell Identification Test (BSIT), and Lund-Kennedy (LK) endoscopic scores were obtained pre- and postoperatively. Patients were stratified according to increasing E/M ratios based on Lund-Mackay (LM) scores.

Results: On average, significant within-subject postoperative improvement was found in all patients for SNOT-22 total and domain scores, and also BSIT results (p ≤ 0.019). Preoperatively, elevated E/M ratio correlated with worse BSIT scores (r = -0.343, p < 0.001). Postoperatively, elevated E/M ratio correlated with BSIT improvement (r = 0.284, p = 0.002), but did not correlate with SNOT-22 improvement or polyp recurrence. An elevated E/M ratio was associated with greater likelihood of reporting a minimal clinically important difference in BSIT scores (χ² = 9.96, p = 0.041).

Conclusion: Elevated E/M ratios were found to associated with worse baseline olfaction and an increased likelihood of achieving a clinically meaningful postoperative improvement in olfaction in this North American population with CRSwNP. Elevated E/M ratios did not predict postoperative changes in SNOT-22 measures or polyp recurrence. This suggests that prognostic factors may vary according to geography and generalized inflammatory profiles (type 2 vs non-type 2) in patients with CRS.

Trial registration: ClinicalTrials.gov NCT02720653.

Keywords: chronic disease; outcome assessment (health care); quality of life; sinusitis.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Chronic Disease
Endoscopy
Humans
Nasal Polyps* / surgery
Rhinitis* / surgery
Sinusitis* / surgery
Smell
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02720653

Grants and funding

R01 DC005805/DC/NIDCD NIH HHS/United States