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Background: This is the largest study in North America investigating olfactory outcomes after pituitary surgery to date. Objective: Characterize factors associated with subjective olfactory dysfunction (OD) and worsened sinonasal quality-of-life (QOL) after endoscopic TSA. Methods: Patients undergoing primary TSA for secreting and non-secreting pituitary adenomas between 2017 and 2021 with pre- and post-operative SNOT-22 scores were included. Subjective OD was determined by the smell/taste dysfunction question on the SNOT-22 (smell-SNOT). Results: 159 patients with pre- and post-operative SNOT-22 scores were included. Average total SNOT-22 scores worsened from pre-operative (16.91 ± 16.91) to POM1 (25.15 ± 20.83, P <.001), with no difference from pre-operative (16.40 ± 15.88) to POM6 (16.27 ± 17.92, P =.936) or pre-operative (13.63 ± 13.54) to POM12 (12.60 ± 16.45, P =.651). Average smell-SNOT scores worsened from pre-operative (0.40 ± 1.27) to POM1 (2.09 ± 2.01, P <.001), and pre-operative (0.46 ± 1.29) to POM6 (1.13 ± 2.45, P =.002), with no difference from pre-operative (0.40 ± 1.07) to POM12 (0.71 ± 1.32, P =.100). Female gender had a 0.9-point (95% CI 0.1 to 1.6) P =.021, increase in smell-SNOT at POM1, resolving by POM6 (0.1 [−0.9 to 1.1], P =.800) and POM12 (0.0 [−1.0 to 0.9], P =.942). Septoplasty with tunnel approach had a 1.1 [0.2 to 2.0] out of 5-point (P =.023) increase in smell-SNOT at POM1, resolving by POM6 (0.2 [−1.1 to 1.6], P =.764) and POM12 (0.4 [−0.9 to 1.6], P =.567). Female gender had a 9.5 (4.0 to 15.1)-point (P =.001) increase in SNOT-22 scores at POM1, resolving by POM6 (3.4 [−3.0 to 9.8], P =.292) and POM12 (6.4 [−5.4 to 18.2], P =.276). Intra-operative CSF leak had an 8.6 [2.1 to 15.1]-point (P =.009) increase in SNOT-22 scores at POM1, resolving by POM6 (5.4 [−1.7 to 12.5], P =.135), and POM12 (1.1 [−12.9 to 15.1], P =.873). Conclusion: Changes in subjective olfaction and sinonasal QOL after TSA may be associated with gender, operative approach, and intra-operative CSF leak, resolving 6-12 months post-operatively. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Chronic frontal sinus infection is managed with a combination of medical and surgical interventions. Frontal bone osteomyelitis due to recurrent infection following trauma or prior open surgery may require more significant debridement. Free tissue transfer may allow for extensive debridement with replacement of tissue, and definitive eradication of osteomyelitis.Study Design: Retrospective chart review.Methods: Patients undergoing free flap obliteration of the frontal sinus for frontal bone osteomyelitis at a single institution were included in the study. Clinical, radiologic, and surgical data were collected. Surgeries before and after free flap obliteration were compared by Wilcoxon signed rank test.Results: Fifteen patients were identified; however, one patient had less than 6 months of follow-up and was excluded from analysis. Of the remaining 14 patients, mean follow-up duration was 26 months (range, 6-120 months). Mean number of surgeries prior to free flap was 3.7 (range, 1-8 surgeries). Free flap obliteration resolved chronic frontal sinusitis in all patients. Two patients experienced postoperative infection, and the overall complication rate was 29%. Eight patients underwent cranioplasty (six immediate, two delayed) without complication. All patients received planned courses of postoperative antibiotics. A statistically significant decrease in the number of surgeries after free flap obliteration was observed P ≤ .01).Conclusions: Extensive debridement followed by free tissue transfer and antibiotics offers a definitive treatment for complicated, recurrent frontal osteomyelitis. Simultaneous cranioplasty provides immediate protective and aesthetic benefit without complication. Consideration should be given for free tissue transfer and cranioplasty earlier in the algorithm for treatment of refractory frontal sinus osteomyelitis.Level Of Evidence: 4 Laryngoscope, 129:1497-1504, 2019. [ABSTRACT FROM AUTHOR]