Does septoplasty improve smell?
Reviewed by Suki Ahluwalia

This is a study from Barcelona on a very interesting topic: does septoplasty change sense of smell? The theory being that a deviated septum would prevent airflow to the olfactory region and once the anatomical obstruction has been relieved, that this would be of benefit. It’s a meta-analysis of papers found from the last 20 years through the usual databases. The inclusion criteria were septal surgery being performed with or without turbinate surgery for nasal obstruction and assessment of olfaction before and after surgery with no restriction on follow-up length. Exclusion criteria were patients undergoing surgery for other reasons e.g., cosmetic, polyps and having had olfactory testing for each nostril performed individually. Studies not translated into English or Spanish were not included. Main outcome measure was the mean change in olfactory test score after septoplasty. Other outcomes were change in percentage of patients classified as anosmic, hyposmic, and normosmic before and after surgery. Sixteen studies were included; 14 of these were prospective observational studies and two were randomised controlled trials. Different olfactory tests were employed. Eight used Sniffin’ Sticks, five used the Connecticut Chemosensory Test, two used the Brief Smell Identification test and one used UPSIT. Total sample of size recruited was 996, with studies having between 30-150 patients, an age range of 10-85 years. Follow-up ranged from one week to one year. Of the studies, seven were considered to be good methodologically, seven were fair and two were considered poor. Seven studies included data on the distribution of patients as normosmic, hyposmic or anosmic. In four of those studies the majority of patients were normosmic, whereas in three studies the majority of patients had some olfactory dysfunction before surgery. One study included healthy control subjects and found that patients with septal deviation had worse olfaction than controls. Of the 16 studies assessing olfactory function, 11 found a significant improvement in olfactory test scores after septoplasty, whereas five found that septoplasty did not improve smell perception. Three studies found actual worsening of olfactory function after septoplasty in 7%, 14.2%, and 7% of their patients, respectively. The authors state that in conclusion, septal deviation compromises the sense of smell and septoplasty seems effective in resolving nasal obstruction due to septal deviation. The review shows that septoplasty has some effect on improving patient’s olfaction.

Change in olfactory function after septoplasty. A systematic review and meta-analysis.
Grabosky A, Mackers P, Langdon C, Alobid I.
RHINOLOGY
2021;59(2):144-50.