| Objective:To investigate the efficacy of functional endoscopic sinus surgery（FESS）in the treatment of olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps（CRSwNP）,and to verify the relationship between eosinophils and olfactory function,and to explore the change characteristics of olfactory event-related potentials（o ERPs）,which provide further evidence for FESS treatment of olfactory dysfunction in patients with CRSwNP,at the same time,it provides reference for the prognosis evaluation of olfaction and the clinical application of o ERPs to evaluate the plasticity of olfaction cortex.Method:From October 2021 to October 2022,45 patients with CRSwNP who underwent FESS nine-step standardized treatment in our department were recruited as the research subjects,aged 24 to 55 years,divided into 22 patients with eosinophilic CRSwNP（ECRSwNP）and 23 patients with non-eosinophilic CRSwNP（nECRSwNP）.Sinusitis VAS score,SNOT-22 score,sinus CT Lund-Mackay score and olfactory cleft CT score,nasal endoscopic Lund-Kennedy score and olfactory cleft endoscopy scale（OCES）,Sniffin’Sticks test and o ERPs collection and processing were performed before operation.All items were evaluated again 3 months after operation.Results:The overall subjective olfactory improvement rate of CRSwNP was 93.3%（42/45）,with 44.4%（20/45）inECRSwNP group and 48.9%（22/45）in nECRSwNP group.Subjective olfactory function:VAS-olfactory degeneration（VAS-OD）,SNOT-22 olfactory score and OCES were significantly lower in all CRSwNP patients after operation than those before operation(F（1,43）=357.429,P<0.001;F（1,43）=185.657,P<0.001;F（1,43）=414.321,P<0.001),the scores of T,D,I and TDI in Sniffin’Sticks test were significantly higher than those before operation(F（1,43）=126.302,P<0.001;F（1,43）=311.301,P<0.001;F（1,43）=131.401,P<0.001;F（1,43）=295.885,P<0.001);The decrease of VAS-OD and SNOT-22 olfactory score inECRSwNP group was smaller than that in nECRSwNP group(F（1,43）=4.825,P=0.033;F（1,43）=9.916,P=0.003),T,D and TDI score were significantly lower in nECRSwNP group than those in nECRSwNP group(F（1,43）=6.719,P=0.013;F（1,43）=4.890,P=0.032;F（1,43）=4.469,P=0.040);There was a positive correlation between preoperative ELR and SNOT-22 olfactory score and how much it changes（r=0.455,P=0.002;r=-0.414,P=0.005）,a negative correlation between T,TDI score and how much they change respectively（r=-0.431,P=0.003;r=-0.385,P=0.009;r=-0.383,P=0.010;r=-0.316,P=0.035）.Objective olfactory function:the latencies of N1 and P2 were significantly shorter in all CRSwNP patients after operation than those before operation(F（1,17）=28.360,P<0.001;F（1,17）=50.818,P<0.001),the amplitudes were larger than those before operation(F（1,17）=21.273,P<0.001;F（1,17）=12.691,P=0.002);and the latency of P3 was significantly shorter after operation than that before operation(F（1,14）=24.840,P<0.001);The amplitude of left frontotemporal was significantly larger than that of right frontotemporal when stimulated by mint odor(preoperative F（1,14）=8.328,P=0.012;postoperative F（1,14）=20.370,P<0.001).Conclusion:FESS could significantly improve the olfactory function of CRSwNP patients with a higher improvement rate,while the olfactory improvement effect of ECRSwNP patients was significantly worse than that of nECRSwNP patients,in addition,the preoperative peripheral blood eosinophil granulocyte level can predict the postoperative olfactory improvement;In patients with CRSwNP,the olfactory cortex underwent plastic changes after surgery,and FESS had a certain degree of improvement on objective olfactory function,and the cognitive function and the level of lateralization of different odors are different. |
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