慢性鼻及鼻竇炎病患手術前後之嗅覺功能評估

Perioperative Evaluation of Olfactory Function in Patients with Chronic Rhinosinusitis

江榮山(Rong-Shan Jiang) ； 蘇茂昌(Mao-Chang Su) ； 辛宗翰(Chung-Han Hsin)

《台灣耳鼻喉頭頸外科雜誌》 44卷5期 (2009/10) Pp. 140-147

https://doi.org/10.6286/2009.44.5.140

摘要

背景：慢性鼻及鼻竇炎病患常會合併嗅覺功能喪失，目前已有許多方法被用來評估慢性鼻及鼻竇炎病患的嗅覺功能，但何種方法較適切尚未有定論。本研究嘗試比較4種不同方法在評估慢性鼻及鼻竇炎病患嗅覺功能的結果。
方法：收集接受功能性內視鏡鼻竇手術治療的慢性鼻及鼻竇炎病患。在手術前一日，這些病患的嗅覺功能用問卷、乙酚乙二醇氣味偵測閾值檢查、賓州大學嗅覺識別檢查及短時間氣味記憶分辨檢查來評估。手術6個月後，這些病患的嗅覺功能再用問卷、乙酚乙二醇氣味偵測閾值檢查、賓州大學嗅覺識別檢查及短時間氣味記憶分辨檢查來評估。
結果：本研究共收集70名慢性鼻及鼻竇炎病患。其中52名病患注意到他們的嗅覺功能在手術前就有受損，但是閾值檢查顯示66名病患的閾值高於－6，識別檢查顯示62名病患的分數低於30，氣味記憶分辨檢查顯示26名病患的分數低於正常人分數的十分位。手術後，在術前嗅覺功能異常病患中27名說他們的嗅覺功能有進步，閾值檢查顯示30名病患的閾值有進步，識別檢查顯示36名病患的分數有進步，氣味記憶分辨檢查顯示20名病患的分數有進步。問卷、乙酚乙二醇氣味偵測閾值檢查和賓州大學嗅覺識別檢查的結果有好的一致性。雖然嗅覺閾值檢查比病患本身或賓州大學嗅覺識別檢查能更敏感來發現嗅覺異常，但是對於嗅覺改善的偵測卻不如病患本身或賓州大學嗅覺識別檢查。
結論：雖然許多方法被用來評估嗅覺功能，而且評估嗅覺功能的面向各個方法也不盡相同但是本研究顯示賓州大學嗅覺識別檢查是個較好的評估慢性鼻及鼻竇炎病患嗅覺功能的方法。

關鍵字

慢性鼻及鼻竇炎 ； 嗅覺 ； 氣味記憶分辨檢查 ； 乙酚乙二醇氣味偵測閾值檢查 ； 賓州大學嗅覺識別檢查

並列摘要

BACKGROUND: Patients with chronic rhinosinusitis often suffered from olfactory loss. At present, many methods have been used to assess the olfactory function in patients with chronic rhinosinusitis, but it has not been concluded that which one is the method of choice. This study tried to compare 4 different methods in assessing the olfactory function in patients with chronic rhinosinusitis.
METHOD: Patients with chronic rhinosinusitis who had previously undergone functional endoscopic sinus surgery were enrolled in the study. On the day before FESS, the olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test (STT), the University of Pennsylvannia Smell Identification Test (UPSIT) and a short-term odor memory/discrimination test (SMT), and re-evaluated by the same methods 6 months after FESS.
RESULT: A total of 70 patients with chronic rhinosinusitis were enrolled in the study. Fifty-two patients noticed their olfactory function was impaired before surgery, but the olfactory threshold was above -6 in 66 patients, 62 patients' UPSIT scores were below 30, and the SMT score was below 10% of the provided norms in 26 patients. Among these patients with olfactory dysfunction, the olfactory function was improved in 27 patients using patients' reports, in 30 patients by STT, in 36 patients by UPSIT, and in 20 patients by SMT after surgery. A good agreement existed between STT and UPSIT results and patients' reports. Although STT was more sensitive than patients' recognition or UPSIT in detecting olfactory loss, it was less sensitive in diagnosing postoperative olfactory improvement.
CONCLUSION: Although many methods have been used to evaluate olfactory function, and the domains of olfactory function evaluated were not the same among these methods, our study showed that UPSIT should be the method of choice for evaluating olfactory function in patients with chronic rhinosinusitis.

並列關鍵字

chronic rhinosinusitis ； olfaction ； odor memory/discrimination test ； phenyl ethyl alcohol odor detection threshold test ； University of Pennsylvannia Smell Identification Test