Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis

Christine M Liu¹, Jakob L Fischer¹, Michelle J Lee¹, Jess C Mace², Adam J Kimple³, Karolin Markarian⁴, Jeremiah A Alt⁵, Todd E Bodner⁶, Naweed I Chowdhury⁷, Sei Y Chung⁸, Patricia H Eshaghian⁹, Yuqing A Gao⁹, Anne E Getz¹⁰, Peter H Hwang¹¹, Ashoke Khanwalkar¹⁰, Jivianne T Lee¹, Douglas A Li⁹, Meghan Norris³, Jayakar V Nayak¹¹, Jonathan B Overdevest¹², Cameran Owens¹⁰, Zara M Patel¹¹, Lindsay E Pappas⁹, Katie Poch¹³, Rodney J Schlosser¹⁴, Kristine A Smith⁵, Timothy L Smith², Zachary M Soler⁵, Jeffrey D Suh¹, Grant A Turner², Marilene B Wang¹, Jennifer L Taylor-Cousar^{13

15}, Milene T Saavedra¹³, Daniel M Beswick¹

Affiliations

¹ Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
⁴ CTSI, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
⁶ Department of Psychology, Portland State University, Portland, Oregon, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ Department of Pulmonary Medicine, University of California, Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alta, California, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
¹³ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁵ Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.

PMID: 40156369
PMCID: PMC12230906
DOI: 10.1002/lary.32155

Observational Study

Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis

Christine M Liu et al. Laryngoscope. 2025 Jul.

. 2025 Jul;135(7):2476-2488.

doi: 10.1002/lary.32155. Epub 2025 Mar 29.

Authors

Affiliations

¹ Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
⁴ CTSI, David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
⁶ Department of Psychology, Portland State University, Portland, Oregon, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ Department of Pulmonary Medicine, University of California, Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alta, California, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
¹³ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁵ Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.

PMID: 40156369
PMCID: PMC12230906
DOI: 10.1002/lary.32155

Abstract

Objectives: Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF) and chronic rhinosinusitis (CRS). OD is associated with impaired quality of life (QOL) and dietary alterations in certain non-CF populations. This study explored relationships between OD, QOL, and modulator use in PwCF.

Methods: This is a cross-sectional analysis of an ongoing multicenter, prospective study (2019-2023) investigating PwCF with comorbid CRS. Participants completed the 40-Question Smell Identification Test (SIT-40), 22-question SinoNasal Outcome Test-(SNOT-22), Questionnaire of Olfactory Disorders (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Clinical and sinus CT data were collected. After stratification by SIT-40 score, data was analyzed by chi-square, Kruskal-Wallis, Spearman correlation, and logistic regression to identify factors associated with OD.

Results: Of 59 participants, those with anosmia (n = 12) had worse eating-related QOL (CFQ-R eating) compared to individuals with normosmia (n = 16) and hyposmia (n = 31). Participants with anosmia had worse sinus CT scores than those with hyposmia. Although PwCF treated with highly effective modulator therapy (HEMT; n = 30) had better CT scores vs. non-HEMT individuals (n = 23), rates of OD in both groups were comparable. Higher SNOT-22 total scores were associated with increased odds of hyposmia or anosmia. In an eating-related QOD-NS subscore, those with worse CFQ-R eating had 2.38 times higher odds of having OD. Each point decrease in CFQ-R eating domain score was associated with 10% increased odds of OD.

Conclusion: In PwCF, OD was associated with increased CRS severity, impaired olfactory QOL, and decreased CFQ-R eating. There were no differences in SIT-40 or QOD-NS scores based on HEMT status.

Trial registration: NCT04469439.

Keywords: CFTR modulator therapy; chronic rhinosinusitis; cystic fibrosis; elexacaftor/tezacaftor/ivacaftor; olfactory dysfunction.

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Conflict of interest statement

C.M.L.: NIDCD grant related to work. J.C.M.: Grant support from CF Foundation related to this work BESWIC20A0. A.J.K.: Grant support from the CFF and consultant for AcclarENT not related to this work. J.A.A.: Consultant for OptiNose and Medtronic. Speaker panel GSK. GlycoMira board and equity holder. Grant support from CF Foundation related to this work BESWIC20A0. T.E.B.: Received grant support from CF Foundation related to this work in the past 36 months (BESWICZOAD). N.I.C.: Unrelated to this work, N.I.C. has received grant support from the Burroughs Wellcome Fund, American Rhinologic Society, and the National Cancer Institute. P.H.H.: Consultant for Stryker, Medtronic, Slate Therapeutics; Equity ownership in Sound Health Systems. D.A.L.: In the last 36 months, D.A.L. has received grant support from the CF Foundation unrelated to this work. Z.M.P.: Consultant/Advisory Board for Optinose, Medtronic, Dianosic, Wyndly, Third Wave Therapeutics, Regeneron/Sanofi, Mediflix, ConsumerMedical. Equity in Olfera Therapeutics. J.B.O.: Grant support from NIDCD K23DC019678 for investigation not affiliated with this project. R.J.S.: Consultant for OptiNose, Medtronic, Stryker, Cyrano. Medical Directory for Healthy Humming. R.J.S. is supported by grants from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD (1R01DC019078‐01A1; PI: R.J.S.). T.L.S.: Grant support from CF Foundation related to this work BESWIC20A0. Z.M.S.: Consultant for OptiNose, Regeneron, SanofiGenzyme, and Lyra. Medical Directory for Healthy Humming. G.A.T.: In the last 36 months, G.A.T. has received grants from the CF Foundation unrelated to this work. J.L.T.‐C.: In the last 36 months, J.L.T.‐C. has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants to her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; has received fees from Vertex Pharmaceuticals Incorporated related to consultation on clinical research design, participation on advisory boards, and speaking engagements; and has served on advisory boards and/or provided clinical trial design consultation for Insmed, and 4DMT. She served on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation's Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN's Sexual Health, Reproduction and Gender Research Working Group, on the scientific advisory board for Emily's Entourage, and on the ATS Respiratory Health Awards Working Group. She currently serves as the Chair‐elect of the ATS International Conference Committee (and associated committees) and previously served on the ATS Scientific Grant Review and Clinical Problems Assembly Programming Committees. She is a member of the International Advisory Board for Lancet Respiratory Medicine and the Editorial Board for the Journal of Cystic Fibrosis. D.M.B.: In the last 36 months, D.M.B. has received grant support from the NIH/NHBLI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity). The other authors declare no conflicts of interest.

Figures

**FIGURE 1**
Chronic rhinosinusitis severity, quality of life outcome measures, and nutritional status stratified by olfactory function. Plotted values are median scores, and error bars represent interquartile range. Values above upper error bar are median [first quartile, third quartile]. Pairwise comparisons with p < 0.1 are plotted. Remaining p values are not significant. (A) Lund Mackay CT sinus scores stratified by olfactory function. (B) SNOT‐22 total scores stratified by olfactory function. (C) SNOT‐22 rhinologic domain scores stratified by olfactory function. (D) QOD‐NS total scores stratified by olfactory function. (E) QOD‐NS eating domain scores stratified by olfactory function. (F) CFQ‐R eating domain scores stratified by olfactory function. (G) Body weight stratified by olfactory function. (H) BMI stratified by olfactory function. BMI, body mass index; CFQ‐R, Cystic Fibrosis Questionnaire‐Revised; CT, computed tomography; NS, negative statements; QOD, Questionnaire of Olfactory Dysfunction; SNOT‐22, 22‐item SinoNasal Outcome Test.^aFor the normosmic group in (F), 14/16 participants reported a score of 100.0, which resulted in an interquartile range of 0. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

See this image and copyright information in PMC

References

1. Chang E. H., “New Insights Into the Pathogenesis of Cystic Fibrosis Sinusitis,” International Forum of Allergy & Rhinology 4, no. 2 (2014): 132–137, 10.1002/alr.21252. - DOI - PMC - PubMed
1. Illing E. A. and Woodworth B. A., “Management of the Upper Airway in Cystic Fibrosis,” Current Opinion in Pulmonary Medicine 20, no. 6 (2014): 623–631, 10.1097/MCP.0000000000000107. - DOI - PMC - PubMed
1. Di Lullo A. M., Iacotucci P., Comegna M., et al., “Cystic Fibrosis: The Sense of Smell,” American Journal of Rhinology & Allergy 34, no. 1 (2019): 35–42, 10.1177/1945892419870450. - DOI - PubMed
1. Lindig J., Steger C., Beiersdorf N., et al., “Smell in Cystic Fibrosis,” European Archives of Oto‐Rhino‐Laryngology 270, no. 3 (2012): 915–921, 10.1007/s00405-012-2124-2. - DOI - PubMed
1. Miller J. E., Liu C. M., Zemanick E. T., et al., “Olfactory Loss in People With Cystic Fibrosis: Community Perceptions and Impact,” Journal of Cystic Fibrosis 23, no. 6 (2024): 1195–1198, 10.1016/j.jcf.2023.11.006. - DOI - PMC - PubMed

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Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis

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Olfaction, Eating Preference, and Quality of Life in Cystic Fibrosis Chronic Rhinosinusitis

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