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Abstract(s)
Introdução: A patologia olfativa é muito frequente a nível mundial, atingindo cerca de 1/5
da população, e afeta a qualidade de vida dos pacientes. Os distúrbios olfativos associamse a problemas em vários aspetos do quotidiano, desde a alimentação à vida social. Tendo
em consideração a localização anatómica do sistema olfativo, a cirurgia dos cornetos
nasais pode afetar a função olfativa. A presença de mucosa olfativa nos cornetos nasais
está descrita na literatura existente. Desta forma, importa conhecer o estado da arte
relativamente ao impacto da cirurgia dos cornetos nasais na função olfativa. Assim, o
objetivo do presente estudo é perceber, através de uma revisão sistemática de literatura, o
impacto da cirurgia da parede lateral nasal, nomeadamente dos cornetos nasais médios ou
inferiores, na função olfativa dos doentes.
Metodologia: Foi realizada uma revisão sistemática da literatura, utilizando as bases de
dados eletrónicas PubMed, Cochrane, e Web of Science, sem restrições relacionadas com o
ano de publicação, com artigos escritos em inglês, espanhol ou português. A data da
última pesquisa foi 11 de abril de 2023. Na presente revisão sistemática, foram incluídos
artigos cujo desenho do estudo fosse ensaio clínico, estudo de coorte, estudo de casoscontrolo, ensaio cirúrgico, estudo não randomizado, estudo descritivo, estudo transversal,
e séries de casos que focassem o efeito da cirurgia dos cornetos nasais médios ou inferiores
na função olfativa. No processo de seleção, foram utilizados os critérios Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), bem como os
critérios de inclusão e exclusão previamente estabelecidos. O risco de viés nos
Randomized Controlled Trials (RCTs) foi avaliado usando a ferramenta Revised Cochrane
risk-of-bias tool for randomized trials (RoB 2) e a qualidade dos restantes artigos, cujo
desenho de estudo não era um RCT, foi avaliada usando a escala de Hawker et al.
Resultados: Inicialmente, foram obtidos no total 178 artigos, sendo que, recorrendo ao
Mendeley, uma aplicação de gestão de referências, foram identificados e removidos 43
artigos duplicados, restando 135 artigos. Após leitura do título e resumo dos artigos, foram
excluídos 81 artigos, por não cumprirem os critérios de inclusão. Na fase de leitura
completa, dos 54 artigos foram selecionados 9 artigos para incluir no presente estudo,
tendo sido excluídos 45 artigos nesta fase. No final do processo de seleção e avaliação do
risco de viés ou qualidade, os 9 artigos incluídos na presente revisão sistemática. Todos os
artigos concluíram que a função olfativa dos pacientes submetidos a cirurgia de cornetos
nasais inferiores melhorou. A técnica cirúrgica e o método de avaliação da função olfativa
diferiram entre os vários estudos. A função olfativa foi medida antes e após a cirurgia em todos os estudos incluídos. O método de avaliação da função olfativa mais utilizado foi a
Escala Visual Analógica (EVA), seguido de um kit de teste de olfato disponível
comercialmente, nomeadamente Sniffin' Sticks Test®. Os resultados olfativos foram mais
frequentemente representados pelo número de pacientes cujo olfato melhorou após a
cirurgia e o segundo método mais utilizado foi o score de EVA. Todos os estudos incluídos
concluíram que a função olfativa melhorou após a cirurgia quando comparada com as
medições pré-operatórias.
Discussão/Conclusão: Todos os estudos incluídos nesta revisão sistemática de literatura
concluem que a cirurgia de cornetos nasais inferiores é benéfica para a função olfativa. No
entanto, estudos futuros, idealmente RCTs, devem incluir um grupo controlo com o
objetivo de estabelecer a eficácia real destes procedimentos cirúrgicos, bem como para
estabelecer a técnica cirúrgica mais adequada para cada situação clínica.
Introduction: Olfactory pathology is very common worldwide, affecting about 1/5 of the population, and decreases the quality of life of patients. Olfactory disorders are associated with problems in various aspects of daily life, from eating to social life. Considering the anatomical location of the olfactory system, surgery of the nasal turbinates can change the olfactory function. The presence of olfactory mucosa in the nasal turbinates is described in the existing literature. Thus, it is important to understand the state of the art regarding the impact of turbinate surgery on olfactory function. Therefore, the aim of the present study is to understand, through a systematic review of the literature, the impact of surgery of the lateral nasal wall, namely of the middle or inferior turbinates, on the olfactory function of patients. Methodology: A systematic review of the literature was conducted using the electronic databases PubMed; Cochrane; and Web of Science without restrictions related to year of publication, considering articles in English, Spanish or Portuguese. The date of the last search was April 11th, 2023. The present systematic review included clinical trials, cohort studies, case-control studies, surgical trials, non-randomized studies, descriptive studies, cross-sectional studies, and case series that focused on the effect of surgery of the middle or inferior turbinates on olfactory function. In the selection process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used as well as the previously established inclusion and exclusion criteria. The risk of bias in the Randomized Controlled Trials (RCTs) was assessed using the "Revised Cochrane risk-ofbias tool for randomized trials (RoB 2)" tool and the quality of the remaining articles, which study design was not RCT, was assessed using the Hawker et al. scale. Results: Initially, a total of 178 articles were obtained, and using Mendeley, a reference management application, 43 duplicate articles were identified and removed, remaining 135 articles. After reading the title and abstract of the articles, 81 articles were excluded because they did not meet the inclusion criteria. After the complete reading phase, 9 out of the 54 articles were selected to be included in the present study, and 45 articles were excluded in this phase. At the end of the selection process and assessment of the risk of bias or quality, 9 articles were included in the present systematic review. All the articles concluded that the olfactory function of patients submitted to inferior turbinate surgery improved. The surgical technique and the method of evaluation of the olfactory function differed among the various studies. Olfactory function was measured before and after surgery in the included studies. The most common olfactory function assessment method used was the Visual Analogue Scale and the second most used was a commercially available smell test kit (e.g. Sniffin´ Stick Test®). The olfactory outcomes were represented most frequently by the number of patients whose olfaction improved after surgery and the second most used was the Visual Analogue Scale score. Every study included concluded that the olfactory function improved after surgery when compared to the preoperative measurements. Discussion/Conclusions: Every study included concluded that surgery of the inferior turbinates is beneficial for olfactory function. However, future studies, ideally RCTs, should include a control group aiming to determine the actual efficacy of surgical procedures and to establish the preferred surgical technique.
Introduction: Olfactory pathology is very common worldwide, affecting about 1/5 of the population, and decreases the quality of life of patients. Olfactory disorders are associated with problems in various aspects of daily life, from eating to social life. Considering the anatomical location of the olfactory system, surgery of the nasal turbinates can change the olfactory function. The presence of olfactory mucosa in the nasal turbinates is described in the existing literature. Thus, it is important to understand the state of the art regarding the impact of turbinate surgery on olfactory function. Therefore, the aim of the present study is to understand, through a systematic review of the literature, the impact of surgery of the lateral nasal wall, namely of the middle or inferior turbinates, on the olfactory function of patients. Methodology: A systematic review of the literature was conducted using the electronic databases PubMed; Cochrane; and Web of Science without restrictions related to year of publication, considering articles in English, Spanish or Portuguese. The date of the last search was April 11th, 2023. The present systematic review included clinical trials, cohort studies, case-control studies, surgical trials, non-randomized studies, descriptive studies, cross-sectional studies, and case series that focused on the effect of surgery of the middle or inferior turbinates on olfactory function. In the selection process, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used as well as the previously established inclusion and exclusion criteria. The risk of bias in the Randomized Controlled Trials (RCTs) was assessed using the "Revised Cochrane risk-ofbias tool for randomized trials (RoB 2)" tool and the quality of the remaining articles, which study design was not RCT, was assessed using the Hawker et al. scale. Results: Initially, a total of 178 articles were obtained, and using Mendeley, a reference management application, 43 duplicate articles were identified and removed, remaining 135 articles. After reading the title and abstract of the articles, 81 articles were excluded because they did not meet the inclusion criteria. After the complete reading phase, 9 out of the 54 articles were selected to be included in the present study, and 45 articles were excluded in this phase. At the end of the selection process and assessment of the risk of bias or quality, 9 articles were included in the present systematic review. All the articles concluded that the olfactory function of patients submitted to inferior turbinate surgery improved. The surgical technique and the method of evaluation of the olfactory function differed among the various studies. Olfactory function was measured before and after surgery in the included studies. The most common olfactory function assessment method used was the Visual Analogue Scale and the second most used was a commercially available smell test kit (e.g. Sniffin´ Stick Test®). The olfactory outcomes were represented most frequently by the number of patients whose olfaction improved after surgery and the second most used was the Visual Analogue Scale score. Every study included concluded that the olfactory function improved after surgery when compared to the preoperative measurements. Discussion/Conclusions: Every study included concluded that surgery of the inferior turbinates is beneficial for olfactory function. However, future studies, ideally RCTs, should include a control group aiming to determine the actual efficacy of surgical procedures and to establish the preferred surgical technique.
Description
Keywords
Cirurgia Nasal Corneto Nasal Inferior Hiposmia Olfato Revisão Sistemática