Chronic sinusitis and anosmia: Pathologic changes in the olfactory mucosa

Objectives: To evaluate histological changes in the olfactory mucosa of pat ients with chronic rhinosinusitis, These results are analyzed in light of c urrent understanding of the pathophysiology of anosmia secondary to nasal a nd sinus disease, Study Design: Prospective study of olfaction on patients undergoing sinus surgery for the management of chronic rhinosinusitis, Meth ods: Thirty patients, aged 22 to 39 years, underwent olfactory biopsy at th e time of surgery with evaluation by a pathologist. Inflammatory changes we re graded as mild (normal), moderate, or severe. Clinical olfactory functio n was evaluated using the University of Pennsylvania Smell Identification T est (UPSIT). The results correlated with the degree of olfactory dysfunctio n Results: Of the 30 patients 19 had unequivocal olfactory mucosa in the bi opsy specimen. Eleven had only respiratory or indeterminate mucosa Nine pat ients demonstrated normal olfactory mucosa and nor mal olfactory function ( UPSIT >35). Ten patients demonstrated pathological changes in the olfactory mucosa with an influx of lymphocytes, macrophages, and eosinophils. Of the se 10 patients, 7 had olfactory deficits as determined by UPSIT. The remain ing three patients had normal olfactory function despite moderate chronic i nflammation. These studies indicate that the olfactory mucosa is capable of mounting an inflammatory response similar to that seen in the respiratory mucosa of patients with chronic sinusitis. These data suggest that the olfa ctory deficits in these patients may be the result of inflammatory changes within the olfactory mucosa in addition to any alteration in airflow to the olfactory cleft.