Relative Independent Risk Factors For Poor Olfactory Improvement After Endoscopic Sinus Surgery In Patients With Chronic Sinusitis

Objective: To provide clinical guidance by constructing a model of poor olfactory improvement after endoscopic sinus surgery in patients with chronic sinusitis.We also used systematic evaluation to explore the risk factors for poor olfactory improvement after endoscopic sinus surgery in patients with CRS with olfactory disorders.METHODS:(1)The clinical data of 125 patients with CRS with OD who underwent ESS in the Department of Otolaryngology,Affiliated Hospital of Hangzhou Normal University from March 2018 to March 2021 were retrospectively analyzed.According to the postoperative olfactory improvement,they were divided into satisfactory and unsatisfactory groups,and the factors affecting olfactory improvement were screened by univariate analysis and subjected to logistic multifactor analysis to construct a prediction model and analyze its predictive efficacy.(2)Pubmed,Embase,Cohrane Library,Web of science,China Knowledge Network,Wanfang Medical Database,China Journal Full Text Database,China Biomedical Literature Database,American Clinical Trials Registry and China Clinical Trials Registry were searched by computer,and the search time limit was from the establishment of the database to January 31,2023.The search terms include "chronic sinusitis","olfaction","surgery","risk factors The search terms included "chronic sinusitis","olfaction","surgery","risk factors" and their free words,and included case-control studies and cohort studies of CRS with OD for ESS.Data from relevant studies were collected as comprehensively as possible,and the quality of the included literature was evaluated according to the inclusion and exclusion criteria and using the Newcastle-Ottawa Scale(NOS)literature quality evaluation form.Meta-analysis was performed using Review Manager 5.3 and Stata 14 software to derive risk factors for poor olfactory improvement after sinus endoscopy in patients with chronic rhinosinusitis with olfactory disturbance.Results: In the construction of the clinical prediction model,the clinical data of125 patients were finally included for analysis,including 84 patients in the satisfactory group and 41 patients in the unsatisfactory group.logistic multifactorial analysis suggested that previous history of allergic diseases(B = 1.145,OR = 3.141,95%CI:1.282 ～ 7.693),nasal polyps(B = 0.905,OR = 2.472,95% CI:1.025 to 5.962)and long-term decongestants(B = 1.043,OR = 2.837,95% CI:1.164 to 6.917)were risk factors for poor olfactory improvement,and adherence to postoperative combination therapy(B=-1.225,OR= 0.294,95% CI: 0.107 to 0.807)was a protective factor for poor olfactory improvement.The Concordance index(C-index)of 0.745(0.739 ～ 0.819)and the AUC of 0.832 for the prediction of poor olfactory improvement after ESS in CRS patients were well differentiated,and the corrected curves showed that The column line graph model predicted the absolute error of likelihood of 0.043 with good agreement.The meta-analysis of risk factors finally included 17 papers with a cumulative number of cases and controls of 1117 and 968 cases,respectively.The metaresults showed that the risk factors for poor olfactory improvement after ESS in patients with CRS with OD were: allergic rhinitis(OR=5.23,95% CI:2.65-10.30),smoking history(OR=1.71,95% CI.1.08 to 2.72),Lund-Mackay score(OR=1.58,95%CI: 1.22 to 2.04),and concomitant nasal polyps(OR=2.92,95%CI: 1.72 to 4.97).gender was a protective factor for poor postoperative olfactory improvement in patients with CRS(OR=0.19,95%CI: 0.05 to 0.72).Conclusion: History of allergic disease,nasal polyps,long-term decongestants,and adherence to comprehensive postoperative treatment are influential factors for olfactory recovery,and the columnar line graph model based on the above indicators can be used to predict olfactory improvement after nasal endoscopic treatment in patients with CRS.A meta-analysis of risk factors for poor olfactory improvement after ESS in patients with chronic rhinosinusitis with olfactory disturbance found that allergic rhinitis,smoking history,Lund-Mackay score,and concomitant nasal polyps were risk factors for olfactory improvement after surgery in patients with CRS.Gender was a protective factor for postoperative olfactory improvement in patients with CRS.Age and nasal septal deviation were nonsignificant indicators.This helps to perform a more accurate risk assessment before performing ESS for patients with CRS with OD.