Introduction: Olfaction has been demonstrated to have a great impact on patients' lives. Transsphenoidal endoscopic pituitary surgery is associated with potential damage to olfactory tissues, but to date this issue has been poorly documented in the literature. Study Design: Prospective observational study comparing olfactory outcomes pre- and postpituitary surgery. Methods: Patients were administered the University of Pennsylvania Smell Identification Test (UPSIT) preoperatively and again at 6 months postoperatively. The endoscopic transsphenoidal pituitary surgery was carried out using a full middle turbinate preservation protocol, and a Hadad-Bassagasteguy (HB) vascularized septal flap was used in each case. Secondary outcomes included Lund-Kennedy endoscopy scores (LKES) and patient self-reports of olfactory disturbance. The results were analyzed using a paired t test. Results: Seventeen patients met inclusion criteria for the study. Mean preoperative UPSIT value was 37.2 (normosmia), and mean postoperative UPSIT value was 30.8 (moderate hyposmia) (p < 0.001). All patients were fully healed with normal LKES scores by 6 months. All patients complained of olfactory dysfunction. Conclusion: This study is the first to rigorously document the postoperative olfactory perturbations suffered by this patient group. We hypothesize that reduced olfaction results from use of the HB flap. We recommend that the possibility of permanent olfactory changes be added to routine patient counseling and consent for this procedure.
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Rotenberg et al. (2011) studied this question.