Dissecting of chronic rhinosinusitis nasal symptoms to determine the significance of hyposmia in disease control

Background EPOS2012 recommends hyposmia be assessed as a part of chronic rhinosinusitis (CRS) disease control. Herein we sought to determine the significance of hyposmia in the context of nasal obstruction and drainage symptoms.

Materials and methods Cross-sectional study of 308 CRS patients (102 CRSwNP, 206 CRSsNP) without prior endoscopic sinus surgery. Each patient’s burden of nasal obstruction and hyposmia was assessed using the corresponding item scores (ranging from 0-5) on the 22-item Sinonasal Outcome Test (SNOT-22). Burden of nasal discharge was assessed using the mean of “thick nasal discharge” and “thick post-nasal discharge” SNOT-22 item scores. Patients were all asked to rate their CRS symptom control as “not at all,” “a little,” “somewhat,” “very,” or “completely.”

Results In CRSwNP, only 4.9 % had a hyposmia score >1 but nasal obstruction and drainage scores less than or equal to 1. In CRSsNP, only 1.9 % had a hyposmia score >1 but nasal obstruction and drainage scores less than or equal to 1. On univariate association, CRS symptom control was significantly associated with nasal obstruction, hyposmia and drainage in both CRSwNP and CRSsNP (p < 0.05 in all cases). Using multivariable regression to account for all nasal symptoms, only nasal obstruction and nasal discharge scores (but not hyposmia) were significantly associated with CRS symptom control.

Discussion Hyposmia rarely occurs without nasal obstruction or nasal drainage, and may therefore be redundant to assess for CRS disease control. Moreover, hyposmia was not associated with patient-reported CRS symptom control when accounting for burden of nasal obstruction and drainage.

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Publication History

Article published online:
10 June 2020