A prospective study of postoperative symptoms in sinonasal quality-of-life following endoscopic skull-base surgery: dissociations based on specific symptoms

Authors

  • Jeffrey C. Bedrosian MD,

    1. Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
    2. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, Maine Medical Center, Portland, ME
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  • Edward D. McCoul MD, MPH,

    1. Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
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  • Roheen Raithatha MD,

    1. Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
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  • Olga A. Akselrod PA-C, MCMS,

    1. Department of Neurological Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
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  • Vijay K. Anand MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
    • Correspondence to: Vijay Anand, MD, Weill Cornell Medical Center, Department of Otolaryngology–Head and Neck Surgery, 772 Park Ave, New York, NY 10021; e-mail: vijayanandmd@gmail.com

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  • Theodore H. Schwartz MD

    1. Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
    2. Department of Neurological Surgery, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
    3. Department of Neurology and Neuroscience, New York-Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY
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  • Potential conflict of interest: None provided.

Abstract

Background

Endoscopic skull-base surgery (ESBS) is a minimal access approach to cranial base pathology; however, it significantly disrupts the intranasal mucosa and intranasal structures, the long-term effects of which are still being studied. We prospectively assessed postoperative changes in sinonasal QOL symptoms following ESBS.

Methods

Eighty-five patients were prospectively assessed with the Anterior Skull Base Questionnaire (ASBQ), a validated QOL instrument, preoperatively and up to 1 year postoperatively at each subsequent office visit. A subset of these data was analyzed to assess the effect of endoscopic pituitary surgery on postoperative taste, smell, appetite, nasal secretions, and vision.

Results

ESBS patients were divided into 2 cohorts: those undergoing pituitary adenoma surgery and those undergoing ESBS for all other pathologies. Preoperative smell (3.11 vs 3.76, p = 0.03) and taste (3.04 vs 3.69, p = 0.03) were significantly lower in the nonpituitary group. Within the pituitary group both taste (3.69 vs 2.95, p = 0.03) and smell (3.76 vs 2.61, p ≤ 0.001) were significantly decreased by 6 weeks postoperatively. However, by 12 months both taste and smell scores returned to baseline. Vision scores improved by 3 weeks postoperatively with durable results at 1 year (2.80 vs 3.33, p = 0.04 vs 3.59, p = 0.03, respectively). Within the nonpituitary group, smell was decreased at 3 weeks, but was not significantly changed at any other time points.

Conclusion

Our study indicates a dissociation between the nasal and visual QOL after ESBS. While nasal QOL transiently decreases, visual QOL progressively improves. These data should not be lumped together for the purposes of statistical analysis.

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