Central Compartment Atopic Disease and Its Surgical Outcomes: Olfactory Changes and Technical Notes

Abstract

Background: Central compartment atopic disease (CCAD) is a recent, novel phenotype of chronic rhinosinusitis. Only a few studies have assessed olfactory function in patients with CCAD.

Objectives: We aimed to investigate olfactory function changes after functional endoscopic sinus surgery (FESS) in patients with CCAD and proposed some surgical techniques to enhance the postoperative olfactory outcomes in such patients.

Design: A retrospective cohort study.

Methods: We collected data from 23 patients (8 men and 15 women) with CCAD who underwent FESS performed by a surgeon in Taiwan, between June 2018 and December 2021. The demographic data, olfactory function, and serum and tissue eosinophil percentages of the included patients were analyzed. The Top International Biotech Smell Identification Test (TIBSIT; Top International Biotech, Taipei, Taiwan) was used to assess olfactory function.

Results: Of the 23 patients, most (95%) showed a positive reaction to aeroallergens, and 2 patients (8.7%) had asthma. Ten patients (43.5%) had peripheral eosinophilia, and 9 (39%) had eosinophilic nasal polyps. Moreover, the patients presented with variable olfactory dysfunction; the mean preoperative TIBSIT (pr-TIBSIT) score was 12.8 ± 2.3 (range: 0-43), whereas the mean postoperative TIBSIT (po-TIBSIT) score was 29.2 ± 1.9 (range: 16-44). The po-TIBSIT score was significantly better than the pre-TIBSIT score (paired t test, P < .0001). The improvement in olfactory function was not significantly correlated with the patients' age, serum eosinophil percentages, and nasal polyp eosinophil counts.

Conclusion: Our findings indicate that CCAD is significantly associated with olfactory dysfunction and that FESS can effectively improve olfactory function. To optimize postoperative olfactory outcomes, precise removal of polyps from the olfactory cleft without damaging the neuroepithelium is recommended. Our study provides valuable insights into the management of CCAD patients undergoing FESS and can guide surgical decision-making to achieve optimal olfactory function outcomes.

Keywords: central compartment atopic syndrome; chronic rhinosinusitis; functional endoscopic sinus surgery.

Figure 1.

Typical central compartment atopic disease (CCAD): severe central compartment soft tissue thickening (white arrow head) with bil. osteomeatal complex obstructed.

Figure 2.

Nasoendoscopy image of typical central compartment atopic disease (CCAD): mucosal polypoid change of posterosuperior nasal septum (white arrow head) and polyps in medial aspect of middle turbinate. (white arrow) MT, middle turbinate; S, septum.

Figure 3.

The microdebrider blade sucked the polyp in then gently debride it, and carefully preserved the mucosa of middle turbinate and septum. MT, middle turbinate; B, blade side of microdebrider; S, septum.

Figure 4.

“Sanwich”packing fashion: “Sandwich” packing fashion for central compartment atopic disease (CCAD) patients on the right sinus cavity. The middle turbinate was maintained in the central position between middle turbinate and septum. The forceps shown in this figure are in between the septum and middle turbinate.

Figure 5.

The preop Top International Biotech Smell Identification Test (TIBSIT) score was significantly better than the postop TIBSIT score (paired t test, P < .0001), whereas the lv-TIBSIT score (follow up, f/u) was not significantly different from the post-op TIBSIT score (P = .10).