ROLE OF ABSOLUTE EOSINOPHIL COUNT AND OLFACTORY FUNCTION BEFORE AND AFTER ENDOSCOPIC SINUS SURGERY

Abstract

Background: Chronic rhinosinusitis (CRS), with or without nasal polyps (CRSwNP/CRSsNP), is a persistent inflammatory condition of the sinonasal mucosa that significantly impairs olfactory function. Olfactory loss, often resistant to medical therapy, profoundly affects quality of life and reflects underlying disease severity. Endoscopic sinus surgery (ESS) is frequently considered when conservative treatments fail, aiming to restore sinus ventilation and reduce inflammatory burden, particularly in eosinophilic CRS.

Objective: To evaluate the effect of endoscopic sinus surgery on olfactory function and systemic inflammation in patients with chronic rhinosinusitis by comparing preoperative and postoperative Sniffin’ Sticks scores and absolute eosinophil counts.

Methods: A prospective observational study was conducted at the Department of Otolaryngology, Combined Military Hospital, Sialkot, from July to December 2024. Sixty adult patients aged 18–70 years with CRS unresponsive to three months of optimized medical therapy were enrolled. Preoperative and three-month postoperative assessments included peripheral blood absolute eosinophil count (AEC) and olfactory evaluation using the Sniffin’ Sticks test (threshold, discrimination, identification; TDI). Surgical intervention was standardized, and postoperative care included nasal corticosteroids and saline irrigation. Data were analyzed using SPSS version 26.0, with statistical significance set at p < 0.05.

Results: The mean age of participants was 46.4 ± 14.1 years with a mean BMI of 24.4 ± 3.4 kg/m². Preoperative AEC was 0.7793 ± 0.3638 ×10⁹/L, decreasing significantly to 0.4677 ± 0.2184 ×10⁹/L postoperatively (p < 0.05). Sniffin’ Sticks TDI scores improved from 18.26 ± 4.92 to 27.93 ± 8.53 (p < 0.05). Anosmia decreased from 36.7% to 13.3%, while normosmia increased from 0% to 40%. Olfactory function improved in 47 patients (78.3%), with 13 patients (21.7%) showing no significant change.

Conclusion: ESS significantly improves olfactory function and reduces systemic eosinophilic inflammation in CRS patients, supporting its role as a beneficial intervention in refractory cases.