The Impact of Olfactory Dysfunction on the Psychological Status and Quality of Life of Patients with Nasal Obstruction and Septal Deviation

THIEME Original Research The Impact of Olfactory Dysfunction on the Psychological Status and Quality of Life of Patients with Nasal Obstruction and Septal Deviation Konstantinos Valsamidis1 Athanasia Printza1 1 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece Jannis Constantinidis1 Stefanos Triaridis1 Address for correspondence Stefanos Triaridis MD, MsC, PhD, 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece (e-mail: ). Int Arch Otorhinolaryngol 2020;24(2):e237–e246. Abstract Keywords ► olfactory dysfunction ► septoplasty ► anxiety ► emotional status ► quality of life ► olfaction test received August 5, 2019 accepted December 3, 2019 published online February 27, 2020 Introduction Olfactory dysfunction may be present in patients with nasal obstruction and septal deviation. The impact of olfactory dysfunction on the psychological profile and quality of life (QoL) of these patients remains unexplored. Objective The present study aimed to investigate the emotional status and QoL of patients with olfactory dysfunction and septal deviation and to identify predictors associated with clinically significant improvement of psychological status and QoL, focusing mainly on the role of olfactory recovery after septoplasty. Methods The olfactory function was quantitatively assessed using the ‘‘Sniffin’ sticks’’ test (Burghart Messtechnik GmbH, Wedel, Germany) in 60 patients and 25 controls enrolled in this prospective study. The participants completed validated questionnaires specific for general health (Short Form-36), nasal-symptom related QoL (SinoNasal Outcome Test-22), olfaction-associated QoL (Questionnaire of Olfactory Deficits) and for assessing their psychological state (Short Anxiety Screening Test and Beck Depression Inventory) preoperatively and 6 months postoperatively. The patients used the Glasgow Benefit Inventory to evaluate their personal benefit after septoplasty with. Results Septoplasty led to significantly improved olfactory function. Patients with olfactory impairment had significantly lower nasal-symptom related QoL, higher stress levels, and more depressive mood compared with normosmics and controls before and after septoplasty. Postoperatively, personal benefit from surgery was higher in normosmic patients. Improvement of nasal-symptom related QoL was significantly associated with higher likelihood of clinically significant improvement of patients’ psychological profile and more personal benefit from surgery. Olfactory dysfunction was negatively correlated with the emotional status of the patients. Conclusion Olfactory dysfunction appears to significantly affect the psychological status of patients with nasal obstruction, and olfactory recovery improves the patients’ perception of personal benefit from septoplasty. DOI https://doi.org/ 10.1055/s-0040-1701269. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 237 238 The Impact of Olfactory Dysfunction on Psychological Status and Quality of Life Introduction Olfactory dysfunction due to decreased nasal airflow is a common symptom among patients with nasal obstruction related to nasal septal deviation.1 Olfactory disorders may have a significant negative impact on different areas of daily life, including food appreciation, safety (detection of environmental hazards, such as smoke, fire, gas, and spoiled food), personal hygiene, and social communication. Especially in the case of individuals whose professions depend on a well-functioning sense of smell, such as cooks, wine tasters, perfumers, or firemen, olfactory deficits can be catastrophic.2 Therefore, olfactory impairment due to septal deviation, although underestimated by patients and overlooked by doctors,3 may substantially affect the quality of life (QoL) of patients and potentially be associated to mental health.2,4–6 Nasal septoplasty is the standard treatment of nasal septal deviation because it usually produces an improvement of nasal airflow and resolution of nasal obstruction symptoms.7–10 To date, there are a few studies evaluating the effects of septal surgery on olfactory function.1,11–18 However, the impact of olfactory impairment due to septal deviation on the nasal-symptom related and general QoL of the patients has not been adequately addressed in the literature. In addition, although there are studies investigating predictive factors for QoL outcomes after septoplasty,19–25 there is no data available to the relevance of the olfactory function specifically to patients’ psychological status (anxiety and depression symptoms) and its effect on their satisfaction with the surgical procedure and postoperative QoL recovery. The use of standardized olfactory tests, validated olfaction-specific questionnaires, and mental health psychometric instruments allows a clearer delineation of the psychological profile and evaluation of olfaction of the patients as a codeterminant for QoL and emotional status after septoplasty. The clinical importance is that these data may enable otorhinolaryngologists to better assess their patients and inform them about the anticipated benefit for their QoL after septoplasty. The aim of the present prospective study was to assess the emotional status and QoL outcomes of patients with olfactory dysfunction and nasal obstruction symptoms who undergo septoplasty. Additionally, the study explored differences in QoL and psychological status between normosmic patients and those with olfactory deficits and investigated the prognostic value of demographic and clinical characteristics for clinically significant improvement of QoL, anxiety symptoms, and emotional status of patients with olfactory dysfunction. Materials and Methods This was a prospective observational study. Sixty adult patients with nasal obstruction due to nasal septal deviation were studied. The diagnosis of septal deviation was established based on clinical examination and nasal endoscopy. Twentyfive healthy individuals, who had neither nasal obstruction nor septal deviation, were recruited as controls. All the enrolled International Archives of Otorhinolaryngology Vol. 24 No. 2/2020 Valsamidis et al. participants signed the informed consent. The study protocol was performed according to the Declaration of Helsinki and was approved by the local institutional review board (decision no 3525/10.02.2016). Adult patients younger than 65 years with nasal septal deviation, diagnosed by means of clinical examination and presence of symptoms of nasal obstruction for at least 6 months, were included in the study. Patients were excluded if they met any of the exclusion criteria, such as chronic rhinosinusitis, with or without nasal polyposis; allergic rhinitis; previous nasal surgical procedure; sinonasal malignancy; perforation of the nasal septum; nasal valve collapse; cr (...truncated)