2025 Proffered Presentations
S356: SINONASAL AND CHEMOSENSORY QUALITY OF LIFE FOLLOWING ENDOSCOPIC ENDONASAL SKULL BASE SURGERY
Rachel A Stemme, BS1; Anmol Warman, BS1; Varun Vohra, BA1; Hayden Dux, BS2; Debraj Mukherjee, MD, MPH3; Nicholas R Rowan, MD4; 1Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; 2Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA; 3Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; 4Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
Introduction: Disruptions in sinonasal quality of life (QoL) following endoscopic endonasal skull base surgery (EESBS) are increasingly acknowledged; however, concurrent changes in chemosensation, including olfactory dysfunction and gustatory dysfunction continue to be overlooked. Though recognized to be largely transient in routine EESBS, the contributing factors and timing of postoperative chemosensory dysfunction are not well understood. This remains a limitation in managing patient expectations and symptomatology following EESBS. This prospective investigation examined the longitudinal trajectory of comprehensive patient-reported sinonasal and chemosensory-specific QoL following EESBS for sellar pathology.
Methods: This prospective cohort study followed patients who underwent transsphenoidal EESBS for sellar-based pathology at a single institution from November 2018 to April 2023. Quality of life was assessed preoperatively and postoperatively at 2 weeks, 1 month, and 3 months using the the Sinonasal Outcome Test (SNOT-22), the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12), the smell/taste item from the SNOT-22, the Questionnaire of Olfactory Disorders – Negative Statements (QOD-NS), and a gustation-specific survey. Pre- and post-operative QoL scores were compared with paired t-tests. Multivariable logistic regression was performed to assess clinical characteristics predictive of worse postoperative sinonasal and chemosensory QoL.
Results: A total of 109 patients were enrolled (60.4% female, mean age 51.5 years (range 18-89)). The most common pathology was non-functional pituitary adenoma (n=65) followed by functional pituitary adenoma (n=22) and other sellar-based pathology (n=22). The mean preoperative SNOT-22 scores (19.45 ± 17.16) worsened postoperatively at 2 weeks (48.39 ± 20.09, P<0.0001), resolved within 1 month (23.24 ± 17.57, P=0.338), and improved from baseline at 3 months (11.70 ± 9.38, P=0.043). ASK Nasal-12, QOD-NS, and single item SNOT-22 smell/taste scores all significantly worsened in the acute postoperative period, with return to baseline by 3 months. Uniquely, taste scores worsened from baseline (0.36 ± 0.80) at 2 weeks (10.84 ± 10.06, P<0.0001), 1 month (6.79 ± 7.72, P<0.0001), and remained significantly different at 3 months postoperatively (2.94 ± 5.37, P=0.008). Similarly, the average ASK Nasal-12 taste item scores (0.25 ± 0.69) worsened in the acute postoperative period (2.28 ± 1.88, P<0.0001) and remained significantly impaired at the 3 month follow-up (0.75 ± 1.21, P=0.001). On multivariate analysis, clinical characteristics associated with worse sinonasal-specific QoL scores at 2 weeks postoperatively included intraoperative CSF leak, nasoseptal flap, and formal septoplasty, without persistent difference at 1 or 3 months. Conversely, female gender and non-functional pituitary adenoma pathology were associated with significantly improved sinonasal-specific QoL at 2 weeks postoperatively, but no difference in associated outcomes was detected at 1 or 3 months.
Conclusion: Transient disruptions in sinonasal QoL, including olfactory and gustatory disturbances are common following EESBS. Despite a return to baseline of sinonasal and olfaction-specific metrics by three months postoperatively, patients with sellar-based pathology reported persistent taste dysfunction, suggesting a potentially underdetected postoperative QoL disruption. Given the substantial contributions of retronasal olfaction on flavor perception, and the experience of eating and tasting food, future investigations should characterize potential changes in retronasal olfaction to better understand this novel sequeale among patients undergoing EESBS.