Assessment of health-related quality of life and olfactory loss in relation to nasal polyp recurrence after endoscopic sinus surgery in patients with chronic rhinosinusitis: a real life-study.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts the health-related quality of life (HrQoL) and sense of smell. The association between recurrent NPs after surgery and patient-reported outcomes has not been extensively studied.

Objective: To investigate whether patients with recurrent NPs can be distinguished from non-recurrent cases based on pre- and postsurgical evaluations of HrQoL, sense of smell, blood eosinophils and fractional exhaled nitric oxide (FeNO).

Methods: Thirty-five patients with CRSwNP were recruited pre-surgery and followed up to 12 months post-surgery. HrQoL was assessed with RAND-36 and SNOT-22, olfactory dysfunction with smell test and self-reported.

Results: SNOT-22 scores improved 6 months post-surgery but deteriorated 12 months post-surgery with no significant difference related to recurrent NPs. Patients with recurrent NPs had lower smell test scores and more frequent self-reported anosmia or hyposmia as well as higher blood eosinophil counts at pre-surgery. FeNO did not change post-surgery and was not related to NP recurrence.

Conclusion: A low smell test result before surgery may serve as an early indicator of recalcitrant NPs, whereas preoperative scores from HrQoL questionnaires may not be a good predictor. We confirm a significant role for blood eosinophils in refractory CRSwNP, while FeNO may not predict rapid NP recurrence.