| Objective:1. To observe the relationship between the lesion of cribriformplate and superior meatus and the evaluation of preoperative andpostoperative olfactory function for patients with chronic sinusitis；2. Through an appropriate score through observing the preoperative andpostoperative VAS score (visual analogue scale), olfactory test, nasalendoscopy, acoustic rhinometry examination and CT scan. We could provethat the modified Lund-Mackay score plays a more significant role thanLund-Mackay score in predicting the Olfactory sensation of chronicnasosinusitis patients before and after surgery.Methods: A total of65cases of hospitalized patients with chronicrhinosinusitis at the Bethune International Peace Hospital during the period ofFebruary2012to August2013were chosen as the observed, of which56caseswere bilateral,9cases were unilateral, totaling121sides, all patients were inline with2012(Kunming) chronic nasal-sinusitis diagnosis and classificationcriteria. The olfactory dysfunction factors were excluded related to the heartand lung disease,trauma, acute inflammation, cancer, and other diseasescaused by the olfactory nerve.10Datas were recorded for the eligiblepatients,including history taking, gender, age, medical history, olfactoryfunction, nasal resistance, nasal volume, three truncated cross-sectional area(former distance nostril were1.86cm,3.78cm,5.95cm), endoscopicLund-Kennedy score, visual analog scale (VAS) score and sinus CT modifiedLund-Mackay score. The olfactory functions were divided into five gradesthrough the olfactory function tests using the T&T standard test olfactorymethods: grade (sinuses)1, grade2(mild loss of smell), grade3(moderate lossof smell), grade4(severe loss of smell), and grade5(complete loss of smell).All patients underwent acoustic rhinometry examination, recording nasal resistance, nasal volume data, three truncated cross-sectional area and so on.And Lund-Kennedy endoscopic nasal endoscopy score based on, makemodified Lund-Mackay sinus CT score based on patient CT scan (coronal,horizontal and axial planes). All datas were applied SPSS13.0statisticalsoftware for analysis and processing, respectively, before surgery, nasalresistance, nasal volume, three truncated cross-sectional area, VAS score,endoscopic sinus CT score and modified Lund-Mackay score was given andanalysis of preoperative and postoperative nasal resistance, nasal volume,three truncated cross-sectional area, endoscopic sinus CT scores and improvedLund-Mackay score and olfactory function were statistically analyzed.Results:Taking the olfactory sensation improvement as dependentvariables, improved Lund-Mackay score x1to x8scores each sinus imagesunconditioned Binary Logistic regression as independent variables influencingfactors on postoperative olfactory significant improvement in the superiormeatus and cribriform plate, logistic regression equation: Eq hypothesistesting, p=0.001, on a non-blocking has improved nasal olfactory positivelyassociated with surgery, the risk of superior meatus blockage for olfactorydisorders is0.565times to non-superior meatus blocking. whether thecribriform plate shadows and olfactory improvement has positive correlation,the greater the cribriform plate shadows, the worse the improvement of theolfactory functions, when the cribriform plate shadow increase one score,leading to the risk of olfactory disorders is3.050times the former.Preoperative VAS total score to be variable, x1to x8each sinus imaging scoreas independent variables for multiple linear regression, the independentvariable inclusion criteria was0.05, excluding standard is0.1, for a total scoreof preoperative VAS influential is the maxillary sinus, The regression equationis: hypothesis testing of the equation, F=4.698, p=0.032coefficient ofdetermination was0.038, preoperative VAS total score of the total variancecan be explained3.8%of the maxillary sinus. Postoperative VAS total score tobe variable, x1to x8each sinus imaging score as independent variables formultiple linear regression, the independent variable inclusion criteria was0.1, excluding standard of0.15. The superior meatus and sphenoid sinus devotedmost to postoperative VAS score. The regression equation is:The equations hypothesis testing, F=3.370, p=0.027. Determinationcoefficient0.059. There are5.9%VAS score could be explained by superiormeatus and sphenoid sinus In the preoperative nasal endoscopy as dependentvariables, x1to x8each sinus imaging score as independent variables formultiple linear regression, the inclusion criteria was0.05, excluding standard0.1. preoperative endoscopic score is influenced by maxillary sinus andcribriform plate. The regression equation is:The regression equation for hypothesis testing, F=17.921, p=0.000.Determination coefficient0.236, the total variance of preoperative endoscopicsinus and cribriform plate could explain23.6%. Preoperative nasalendoscopy and preoperative olfactory Y1correlation analysis: The spearmanrank correlation, rs=0.255, p=0.005, improving the availability of smellpreoperative endoscopic score Lund-Kennedy explained25.5%; afterchecking with the inner diameter of the nosal surgery after olfactory y2correlation analysis: The spearman rank correlation, rs=0.280, p=0.003,improving postoperative olfactory available endoscopic score afterLund-Kennedy explained28%; In the preoperative nasal resistance, nasalvolume, csa1be, csa2be, csa3be as independent variables to preoperative VASscore as the dependent variable, the inclusion criteria was0.05, excludingstandard0.1, no argument introduced, indicating that these factors will notaffect the operation former VAS total score. standard With postoperative nasalresistance, nasal volume, csa1af, csa2af, csa3af (af table after) as independentvariables to postoperative VAS score as the dependent variable, the inclusioncriteria was0.05, excluding standard0.1only after the introduction of nasalresistance, regression equation for the regression equation hypothesis testing,F=24.420, p=0.000. determination coefficient0.170, postoperative VASscore of the total variance explained by postoperative nasal resistance by17%.With postoperative nasal resistance, nasal volume, csa1af, csa2af, csa3af asindependent variables to postoperative olfactory test as the dependent variable, the inclusion criteria was0.05, excluding standard0.1, without theintroduction of independent variables, This suggest that these factors could notinfluence the postoperative olfactory function.Conclusion: The preoperative olfactory dysfunction in patients withchronic nasal sinusitis has the relationship with Lund-Kennedy endoscopicscore, improved Lund-Mackay sinus CT scores and acoustic rhinometryexamination; The postoperative olfactory dysfunction has the relationship withLund-Kennedy endoscopic score, modified Lund-Mackay sinus CT score,acoustic reflex examination and nasal mucosal edema; ModifiedLund-Mackay CT scores and postoperative patients test has the correlation.By two non-conditional Logistic regression, the superior meatus andcribriform plate was enrolled in modified Lund-MackayCT score. Anatomicolfactory epithelium covering the cribriform plate and the superior turbinate,middle turbinate and nasal septum, this study suggests that ModifiedLund-Mackay score could predicte preoperative and postoperative olfactoryfunction for chronic rhino-sinusitis patients better than the originalLund-Mackay score. |
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