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L'olfaction dans la polypose nasosinusienne avec et sans l'hamartome épithéliale respiratoire adématoïde de la fente olfactive

Abstract : Background: The olfactory outcome after surgery of the olfactory clefts (OC) in patients with nasal polyposis (NP) is unknown. Objectifs: 1) to refine the description of the polyps' origin within the different subcompartments of the ethmoidal bone; 2) to investigate correlations, before and after surgery, between the sense of smell self-ratings and measures of olfactory function, and self-ratings of sense of smell and nasal obstruction; 3) to assess the olfactory outcome after surgery of ethmoidal labyrinths and OC for either Eosinophilic Polyps (EP) or Respiratory Epithelial Adenomatoid Hamartoma (REAH) in patients with nasal polyposis (NP). Samples: All patients with NP operated according to the nasalization procedure from September 2009 to November 2010 in our tertiary hospital (CHU de Nancy) were enrolled in these retrospective and prospective studies. Results: 1) Polyps were found in the middle meatus (98%), in the posterior olfactory fossa (75%), in the superior meatus (61%), on the middle turbinate proper (50%) and in the anterior olfactory fossa (40%); 2) Overall, self-ratings and measures of olfactory function correlated strongly preoperatively (r = - 0.66, p < 0.0001) and postoperatively (r = -0.67 at 6 weeks and -0.66 at 7 months, p < 0.0001). This relationship was better in patients with previous surgery. The correlation was weaker before (r = -0.35, p=0.01) than after surgery in hyposmic/anosmic patients (r = -0.74, p < 0.0001 at 6 weeks and r = -0.73, p = 0.0002 at 7 months) and wasn't found in normosmic patients. Self-ratings of nasal patency and smell were not correlated when the two complaints were dissociated; 3) There was a close relationship between the presence of REAH-OC and the duration of NP disease (p=.0009), asthma (p=.004) and previous surgery (p=.0006). Predictors of poor olfactory outcomes after surgery were low TI score before surgery (p = 0.028), history of previous middle turbinate resection (p = 0.0018), and recent middle turbinate resection (p = 0.04). Polyp histology and surgery of the OC were not predictors of poor olfactory outcomes. Conclusion: The evaluation of the sense of smell in patients with NP should be performed in combination of psychophysic tests and self-ratings of the olfactory function. The resection of REAH or EP of the OC in patients with NP does not worsen but instead can improve the postoperative olfaction
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Duc Trung Nguyen. L'olfaction dans la polypose nasosinusienne avec et sans l'hamartome épithéliale respiratoire adématoïde de la fente olfactive. Médecine humaine et pathologie. Université de Lorraine, 2012. Français. ⟨NNT : 2012LORR0233⟩. ⟨tel-01749625⟩

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