Chronic Sinusitis With Nasal Polyps and Olfactory Dysfunction: Comparing Olfactory Training and Glucocorticoid Treatment.

OBJECTIVE

Few studies have compared the effectiveness of olfactory training (OT) and glucocorticoids (GC) in the phenotype of chronic sinusitis with nasal polyps (CRSwNP) with olfactory dysfunction (OD). To evaluate the effects of GC and OT on OD in patients with eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) and non-eosinophilic chronic rhinosinusitis with nasal polyps (NonECRSwNP).

METHODS

After 2 weeks of endoscopic sinus surgery, patients with a composite threshold discrimination identification score (TDIS) of less than 30.5 were randomly assigned to receive GC (n = 38), OT (n = 36), or both (n = 34). Retrospective phenotypic stratification of CRSwNP patients was performed based on whether eosinophils in the tissue exceeded 10% (ECRSwNP and NonECRSwNP). Follow-up assessments were conducted at 1, 3, and 6 months postintervention. Evaluations included TDIS, the 22-item Sino-Nasal outcome test (SNOT-22), Lund-Kennedy endoscopic scores (LKES), and the frequency of olfactory fluctuations (OF).

RESULTS

SNOT-22 and LKES improved significantly over time. At 1 month, TDIS change was higher in the GCwOT group than in the GC or OT groups. By 6 months, GCwOT remained superior to GC but not to OT. Follow-up showed no difference between GC and OT. In ECRSwNP patients, GCwOT showed greater TDIS changes at 3 and 6 months versus GC, with lower OF incidence (p < 0.0125). In NonECRSwNP, GCwOT outperformed OT only at 1 month.

CONCLUSION

GC combined with OT can reduce OF in patients with ECRSwNP and consistently enhance olfactory function.

TRIAL REGISTRATION: ChiCTR2100049551.