Olfactory-Related Quality of Life After Endoscopic Transsphenoidal Surgery.

BACKGROUND: To analyze olfactory-related quality of life (QOL), assess subjective and psychophysical olfactory dysfunction, and identify factors associated with changes in olfactory-related QOL following endoscopic endonasal transsphenoidal approach (EETSA). METHODS: This study included 112 patients who underwent an EETSA between August 2019 and June 2022. Participants completed assessments before and after surgery, including the YSK Olfactory Function (YOF) test, the Questionnaire of Olfactory Disorders (QOD; comprising QOD-LQ, QOD-S, QOD-P, and QOD-VAS subscales, with higher scores indicating greater QOL impairment), the 36-Item Short-Form Survey (SF-36), and the 22-Item Sino-Nasal Outcome Test (SNOT-22). Clinical characteristics, intraoperative events, and postoperative complications were reviewed retrospectively. RESULTS: Post-EETSA assessment revealed significant increases in mean QOD-LQ, QOD-P, and QOD-VAS scores, while neither physical health scores (SF-36 PCS) nor mental health scores (SF-36 MCS) showed significant changes following EETSA. Twenty-seven patients (24.1%) reported subjective olfactory dysfunction through SNOT-22 with normal YOF test results. "Decreased sense of smell" scores in SNOT-22 demonstrated significant positive correlations with QOD-LQ, QOD-P, and QOD-VAS scores. Female patients exhibited significantly greater deterioration in QOD-LQ and QOD-VAS than males, with female sex an independent factor for both. Postoperative CSF leakage (n = 3) was independently associated with QOD-LQ deterioration, although the sample size was small. CONCLUSIONS: Post-EETSA evaluation should emphasize both olfactory-related QOL and subjective olfactory dysfunction rather than focusing solely on psychophysical olfactory function. Comprehensive pre- and post-operative counseling addressing these aspects is essential for optimal patient care, with particular attention given to high-risk populations. LEVEL OF EVIDENCE: 4.