Happiness and smell: overlooked factors in endoscopic sinus surgery?

Abstract

Objective: This study investigates the impact of functional endoscopic sinus surgery (FESS) on happiness levels in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and examines the factors influencing postoperative happiness. Methods: This study included 55 patients (34 males, 21 females; mean age, 41.2±14.7 years) who underwent FESS for CRSwNP. Preoperative and postoperative evaluations included the Sinonasal Outcome Test-22 (SNOT-22), Oxford Happiness Scale (OHS), Visual Analog Scale (VAS) for olfactory function, and saccharin clearance test for mucociliary clearance. Radiological and endoscopic disease severity was assessed preoperatively using the Lund–Mackay (LM) and Mackay–Lund Endoscopic Polyp Scores (MLEPS). A linear regression model was used to identify predictors of postoperative happiness. Results: Postoperatively, SNOT-22 scores significantly decreased (p=0.005), while OHS and olfactory VAS scores significantly increased (p<0.001). Mucociliary clearance times were significantly shorter after surgery (p=0.025). Regression analysis revealed that both the improvement in olfactory VAS scores (p=0.006) and lower preoperative MLEPS values (p=0.01) were independent predictors of increased OHS scores. Conclusion: FESS not only alleviates symptoms and enhances QoL in CRSwNP patients but also is associated with increased happiness at 1month postoperatively. Improvement in olfactory function emerged as the strongest determinant of postoperative happiness, while patients with less extensive polyp disease experienced more favorable emotional recovery. Therefore, efforts aimed at optimizing olfactory outcomes, preserving existing olfactory function, and performing surgical intervention before widespread polyp formation may contribute to more favorable psychological outcomes after FESS.