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Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery


  • Potential conflict of interest: None provided.

  • Presented orally at the Combined Otolaryngology Spring Meeting in April 2012, San Diego, CA.

Correspondence to: Erin D. Wright, MDCM, MEd, FRCSC, Alberta Sinus Centre, University of Alberta Hospital, Room 1E4 Walter Mackenzie Centre, 8440 – 112 Street, Edmonton, AB T6G 2B7, Canada; e-mail:



Endoscopic anterior skull-base surgery has been previously suggested to cause a significant deterioration in olfactory function. Given the impact on quality of life, the objective of this study was to determine the effect of a unilateral middle-turbinate–sacrificing approach on olfactory function and sinonasal outcome.


Prospective cohort study comparing olfactory and sinonasal outcomes pre- and post-transsphenoidal skull-base surgery. Olfaction was the primary outcome and was measured prospectively using the University of Pennsylvania Smell Identification Test (SIT). Sinonasal symptoms were assessed subjectively via sinonasal-specific questions from the 22-item Sino-Nasal Outcome Test (SNOT-22), and objectively via the Lund-Kennedy Endoscopic Scoring system (LKES).


Twenty-two patients met study inclusion criteria and completed all data acquisition. The mean preoperative SIT score was 34.8 and the mean postoperative SIT value was 35.1 (p = 0.37). The average change in score (delta) was an increase of 0.3, with changes ranging from −3 to +4. When examined categorically, 91% of patients maintained their preoperative olfactory function classification. There was no significant difference in mean pre- and postoperative symptom scores. A small increase in the LKES was noted, from a mean of 0.6 to 2.5 (p = 0.001) in the early postoperative period.


Olfactory function, as measured by the SIT test, was preserved with a middle-turbinate–sacrificing skull-base approach. Subjective sinonasal symptom scores were unaffected, but a slight worsening of objective endoscopic appearance was noted.