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. 2023 Jun;280(6):2821-2830.
doi: 10.1007/s00405-022-07813-w. Epub 2022 Dec 26.

Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study

Sara Costa Gomes  1 , Tim Delemarre  2 , Gabriele Holtappels  2 , Thibaut Van Zele  2 , Lara Derycke  2 , Ellen Bonne  2 , Anne-Sophie Eeckels  2 , Nan Zhang  2 , Richard Louis Voegels  1 , Claus Bachert  3   4
Affiliations

Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study

Sara Costa Gomes et al. Eur Arch Otorhinolaryngol. 2023 Jun.

Abstract

Purpose: To report biomarkers present in the olfactory mucosa in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with nasal polyps and to nasal mucosal tissues from control patients. To evaluate the kinetics of smell over 6 months in patients who underwent Reboot surgery.

Methods: Cohort study from May 2021 to May 2022. We collected samples of olfactory mucosa and nasal polyps from 16 CRSwNP patients and inferior turbinate samples from 20 control subjects. The study was not randomized for surgical and/or medical treatment. Samples were analyzed by Luminex and Unicap 100 to measure biomarkers of inflammation (IL1-β, IL4, IL5, IL6, IL17, CCL3, CCL4, G-CSF, SE-IgE, total IgE and ECP). 12 of the CRSwNP patients underwent Extended Sniffin'tests at timepoints 1-4 days pre-surgery, and 1, 3 and 6 months after Reboot surgery.

Results: Type-2 markers were significantly elevated in OM and polyp tissue in CRSwNP (n = 16) vs. controls (n = 20), P < 0.05. TDI scores improved already 1 month (P < 0.05) after surgery and remained stable for 6 months. Type-2 inflammation in nasal polyps was associated with decreased sense of smell and taste before surgery, but improved after surgery (P = 0.048). Type-3 inflammation was present in the olfactory mucosa and was associated with a better sense of smell before surgery, but a smaller improvement of smell afterward.

Conclusions: Type-2 inflammation is present in the olfactory mucosa in CRSwNP patients and is associated with smell loss. Reboot surgery, aiming to completely remove inflamed sinus mucosa, significantly improves the smell in this group of patients.

Keywords: Anosmia; Nasal polyps; Nasal surgical procedures; Olfaction disorders; Sinusitis; Smell.

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Conflict of interest statement

Claus Bachert is an Advisory Board member and speaker for Novartis, GSK, Astra-Zeneca, Sanofi, ALK, and Mylan. Other authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Biomarker concentrations in olfactory mucosa and nasal polyps obtained from CRSwNP at surgery. Inferior turbinates from patients without CRS were control samples. Plot graphics show similarity between OM and NP markers for type-2 inflammation. Significances were expressed as *P < 0.05, **P < 0.01, ***P < 0.001 and ****P < 0.0001. P values < 0.05 were considered statistically significant; IL interleukin, ECP eosinophil cationic protein, IgE immunoglobulin E, G-CSF granulocyte colony stimulating factor, CCL chemokine ligand, SE-IgE specific IgE for Staphylococcus aureus enterotoxin, OM olfactory mucosa, NP nasal polyps
Fig. 2
Fig. 2
Kinetics of smell (subjectively and objectively) and taste in a follow-up from prior to surgery at least up to 6 months after Reboot surgery. 0 = 1–4 days before surgery; 1 = 1 month after; 3 = 3 months after; 6 = 6 months after Reboot surgery. *P < 0.05, **P < 0.01. % = subjective scores in percentage. Threshold, discrimination, identification and TDI = parts of Sniffin’Sticks test
Fig. 3
Fig. 3
Smell and taste scores pre-operatively are positively associated with levels of type 3 cytokines in the olfactory mucosa prior reboot. Nevertheless, these scores are negatively associated with interleukin-5 in the nasal polyp prior reboot
See this image and copyright information in PMC

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