Patient-reported olfactory function following endoscopic sinus surgery with modified endoscopic Lothrop procedure / Draf 3

Abstract

OBJECTIVES/HYPOTHESIS: The Modified Endoscopic Lothrop procedure (MELP) or Draf 3 is a complex procedure, performed for chronic frontal sinusitis that is refractory to standard functional endoscopic sinus surgery. The procedure involves drilling of the frontal T (formed by the septum and middle turbinate`s attachment to the skull base) onto the olfactory fossa often with exposure of the first olfactory neuron and may affect olfactory function. This study was performed to assess patients` subjective sense of smell following this procedure. STUDY DESIGN: Prospective study of retrospective data. METHODS: Sixty-eight patients, who underwent modified endoscopic Lothrop by the senior author (PJW) between 2003 and 2008, completed a post-operative questionnaire asking about their perception of olfactory function. All patients had their pre-operative subjective sense of smell documented prior to undergoing surgery. Patient records were reviewed for pertinent medical information such as the presence of asthma, aspirin sensitivity and nasal polyps. RESULTS: This study found that the majority of patients reported improvement in their sense of smell post-operatively, while only a small number reported a negative impact on their smell. Thirty-nine patients reported an improvement in their post-operative smell grade. Twenty patients reported no change in their smell grade, while the remaining 9 patients stated that their sense of smell worsened after surgery. No statistically significant correlation was found between patient outcome and the presence of asthma, nasal polyps, or Samter`s triad. CONCLUSIONS: The Modified endoscopic Lothrop procedure/Draf 3 had a positive effect on subjective sense of smell post-operatively in this cohort of patients.