ORIGINAL ARTICLE Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery Leigh J. Sowerby, MD, FRCSC 1 , Menachem Gross, MD 2 , Robert Broad, MD, FRCSC 3 and Erin D. Wright, MDCM, MEd, FRCSC 1 Background: Endoscopic anterior skull-base surgery has been previously suggested to cause a significant deterio- ration in olfactory function. Given the impact on quality of life, the objective of this study was to determine the effect of a unilateral middle-turbinate–sacrificing approach on ol- factory function and sinonasal outcome. Methods: Prospective cohort study comparing olfactory and sinonasal outcomes pre- and post-transsphenoidal skull-base surgery. Olfaction was the primary outcome and was measured prospectively using the University of Penn- sylvania Smell Identification Test (SIT). Sinonasal symptoms were assessed subjectively via sinonasal-specific questions from the 22-item Sino-Nasal Outcome Test (SNOT-22), and objectively via the Lund-Kennedy Endoscopic Scoring sys- tem (LKES). Results: Twenty-two patients met study inclusion criteria and completed all data acquisition. The mean preoperative SIT score was 34.8 and the mean postoperative SIT value was 35.1 (p = 0.37). The average change in score (delta) was an increase of 0.3, with changes ranging from −3 to +4. When examined categorically, 91% of patients maintained their preoperative olfactory function classification. There was no significant difference in mean pre- and postoper- ative symptom scores. A small increase in the LKES was noted, from a mean of 0.6 to 2.5 (p = 0.001) in the early postoperative period. Conclusion: Olfactory function, as measured by the SIT test, was preserved with a middle-turbinate–sacrificing skull-base approach. Subjective sinonasal symptom scores were unaffected, but a slight worsening of objective en- doscopic appearance was noted. C  2013 ARS-AAOA, LLC. Key Words: smell; nasal function; skull base; pituitary surgery; endo- scopic surgery How to Cite this Article: Sowerby LJ, Gross M, Broad R, Wright ED. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull- base surgery. Int Forum Allergy Rhinol, 2013; 3:217–220. F or many years, management of lesions of the anterior skull-base has benefited from collaboration between the fields of neurosurgery and otolaryngology. In the past decade, the introduction of the endoscopic endonasal ap- 1 Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada; 2 Department of Otolaryngology–Head and Neck Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel; 3 Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada Correspondence to: Erin D. Wright, MDCM, MEd, FRCSC, Alberta Sinus Centre, University of Alberta Hospital, Room 1E4 Walter Mackenzie Centre, 8440 – 112 Street, Edmonton, AB T6G 2B7, Canada; e-mail: erin.wright@ualberta.ca Potential conflict of interest: None provided. Presented orally at the Combined Otolaryngology Spring Meeting in April 2012, San Diego, CA. Received: 12 March 2012; Revised: 2 August 2012; Accepted: 7 August 2012 DOI: 10.1002/alr.21103 View this article online at wileyonlinelibrary.com. proach for the management of lesions of the anterior skull- base has produced a paradigm shift in the way lesions of this complex anatomic location are managed. This approach has become the preferred technique for treatment of var- ious anterior skull-base lesions, and in particular for the resection of pituitary adenomas. 1 Outcomes research is an integral part of clinical investiga- tion. The morbidity and identification of the long-term ad- verse effects of treatment have become increasingly impor- tant, and 1 major side effect of anterior skull-base surgery is potentially a deterioration of subjective sinonasal func- tion. The reported effect of surgery for pituitary adenomas on olfaction is divided, but the majority of authors report some difficulty with olfaction postoperatively. 2–4 The primary purpose of this study is to evaluate the im- pact on olfaction of endoscopic transsphenoidal skull-base surgery with a unilateral middle-turbinate–sacrificing ap- proach. The secondary objective is to assess sinonasal out- comes in both a subjective and objective fashion. 217 International Forum of Allergy & Rhinology, Vol. 3, No. 3, March 2013