Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients

Alberto Macchi; Alessia Giorli; Elena Cantone; Giorgia Carlotta Pipolo; Flavio Arnone; Umberto Barbone; Giacomo Bertazzoni; Chiara Bianchini; Andrea Ciofalo; Federica Cipolla; Alessio De Massimi; Carla De Vita; Cristina Di Lieto; Angelo Ghidini; Marco Govoni; Giulia Gramellini; Alessandro Maselli Del Giudice; Giancarlo Ottaviano; Veronica Seccia; Federico Sireci; Giacomo Sollini; Claudia Staffieri; Stefania Gallo; Enrico Heffler; Ignazio La Mantia; Eugenio De Corso; Frank Rikki Canevari; Nicola Lombardo; Luca Malvezzi; Gabriele Orietti; Ernesto Pasquini; Livio Presutti; Giulia Monti

doi:10.3389/falgy.2023.1083964

Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients

Front Allergy. 2023 Apr 21:4:1083964. doi: 10.3389/falgy.2023.1083964. eCollection 2023.

Authors

Alberto Macchi¹, Alessia Giorli², Elena Cantone³, Giorgia Carlotta Pipolo⁴, Flavio Arnone⁴, Umberto Barbone⁵, Giacomo Bertazzoni⁶, Chiara Bianchini⁷, Andrea Ciofalo⁸, Federica Cipolla⁹, Alessio De Massimi¹⁰, Carla De Vita¹¹, Cristina Di Lieto¹¹, Angelo Ghidini¹², Marco Govoni¹³, Giulia Gramellini¹⁴, Alessandro Maselli Del Giudice¹⁵, Giancarlo Ottaviano¹⁶, Veronica Seccia¹⁷, Federico Sireci¹⁸, Giacomo Sollini¹⁹, Claudia Staffieri²⁰, Stefania Gallo¹, Enrico Heffler²¹, Ignazio La Mantia⁹, Eugenio De Corso²², Frank Rikki Canevari²³, Nicola Lombardo²⁴, Luca Malvezzi²¹, Gabriele Orietti¹³, Ernesto Pasquini²⁵, Livio Presutti¹⁹, Giulia Monti²⁶

Affiliations

¹ ENT Clinic Asst Sette Laghi – University of Insubria, Varese, Italy.
² ENT Unit, University of Siena, Siena, Italy.
³ Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, Naples, Italy.
⁴ Otorhinolaryngology Unit ASST Santi Paolo e Carlo Hospital. Department of Health Sciences, University of Milan, Milan, Italy.
⁵ ENT Department, Ospedale Provinciale Bolzano, Bolzano, Italy.
⁶ Ent Clinic, Asst Cremona, Cremona, Italy.
⁷ ENT Department, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy.
⁸ Organ of Sense Department, Sapienza University of Rome, Roma, Italy
⁹ ENT Clinic, University of Catania, Catania, Italy.
¹⁰ SS ORL San Vito al Tagliamento - Azienda Sanitaria Friuli Occidentale, S. Vito al Tagliamento, Italy.
¹¹ Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant-Orsola, Bologna, Italy.
¹² ENT Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
¹³ ENT Department, University of Parma, Parma, Italy.
¹⁴ UOC Otorinolaringoiatria, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
¹⁵ ENT Unit Bari Adria Trani, Bari, Italy.
¹⁶ ENT Clinic, Azienda Università Padova, Padova, Italy.
¹⁷ ENT Clinic, University of Pisa, Pisa, Italy.
¹⁸ Otorhinolaryngology Section, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy.
¹⁹ ENT Unit Metropolitan Area, AUSL Bologna, Bologna, Italy.
²⁰ ENT Clinic Treviso, Treviso, Italy
²¹ IRCCS Humanitas Research Hospital, Humanitas University Rozzano, Milano, Italy.
²² 22 Humanitas University, Pieve Emanuele (MI), Milano, Italy.
²³ Istituto di ORL, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
²⁴ Unit of Otorhinolaryngology - IRCCS Ospedale Policlinico San Martino, Genova, Italy.
²⁵ UOC Azienda Ospedaliero Universitaria Mater Domini, Catanzaro, Italy.
²⁶ ENT Clinic, University of Insubria, Varese, Italy.

Abstract

Introduction: The impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery.

Methods: The present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin' Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients' quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available.

Results: Data showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients' characteristics.

Discussion: The present study confirms that olfactory function weights on patients' QoL and it represents an important therapeutic goal that can also improve patients' compliance when achieved. In a future - and present - perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available.

Keywords: CRSwNP; QoL (quality of life); olfactory dysfunction; smell; type 2.

© 2023 Macchi, Giorli, Cantone, Carlotta Pipolo, Arnone, Barbone, Bertazzoni, Bianchini, Ciofalo, Cipolla, De Massimi, De Vita, Di Lieto, Ghidini, Govoni, Gramellini, Maselli Del Giudice, Ottaviano, Seccia, Sireci, Sollini, Staffieri, Gallo, Heffler, Mantia, De Corso, Canevari, Lombardo, Malvezzi, Orietti, Pasquini, Presutti and Monti.