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Impact of patient-reported nasal symptoms on quality of life after endoscopic pituitary surgery: a prospective cohort study

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Abstract

Purpose

Endoscopic transsphenoidal surgery causes nasal morbidity and negatively affects health-related quality of life (HRQoL). Knowledge on actionable symptoms that could improve postoperative HRQoL is therefore important. This study assessed the impact of nasal symptoms on postoperative HRQoL.

Methods

This perioperative cohort study included 103 adult patients undergoing endoscopic pituitary adenoma resection (August 2016–December 2018), with measurements preoperatively, and 5 days, 6 weeks and 6 months after surgery. Nasal symptoms were measured with the Anterior Skull base nasal inventory-12, and HRQoL with the Short Form-36 (SF-36) physical (PCS) and mental component scores (MCS). Linear regression analysis was used to assess (1) determinants of postoperative nasal morbidity, (2) associations between number of symptoms or (3) individual symptoms and HRQoL, and (4) the percentage of variance of HRQoL explained by nasal symptoms.

Results

The number of nasal symptoms transiently increased after surgery. No significant treatment- or disease-related determinants of nasal morbidity were identified. The number of nasal symptoms was significantly associated with a lower PCS (β = − 1.0; 95%CI − 1.5, − 0.4), but not with MCS at 6 weeks. Similar results were observed at 6 months. Headaches (42.2%), problems with smell (42.0%), and taste (36.0%) were the most prevalent symptoms, while sense of smell and taste, and nasal discharge showed the strongest associations with HRQoL.

Conclusions

Postoperative nasal symptoms, in particular problems with smell and taste, significantly affect pituitary patients’ physical HRQoL. Monitoring of these symptoms may aid in determining which patients may benefit from intensified follow-up and treatment, aiming to optimize HRQoL.

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Data availability

Data requests can be directed to DJL: d.j.lobatto@lumc.nl.

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Acknowledgements

We would like to thank Anath N.V. Steffens for her assistance with the collection of the data, Ewout W. Steyerberg for his advice regarding the statistical analysis, and Cornelie D. Andela and Thea P.M. Vliet Vlieland for their input regarding the design of the original study.

Funding

This study was performed with financial support of the MD/PhD grant of the Leiden University Medical Center, and of an ASPIRE young investigator research grant (Grant No. WI219567, Pfizer, New York, USA). Pfizer, however, was not involved in the project; the views expressed in this paper are those of the authors only and are not attributable to Pfizer.

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Author notes

  1. Wouter R. van Furth and Amir H. Zamanipoor Najafabadi have contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Merel van der Meulen, Alberto M. Pereira, Nienke R. Biermasz & Amir H. Zamanipoor Najafabadi

  2. Department of Neurosurgery, Haaglanden Medical Center and Haga Teaching Hospital, University Neurosurgical Center Holland, Leiden University Medical Center, Leiden and The Hague, The Netherlands

    Marco J. T. Verstegen, Daniel J. Lobatto, Wouter R. van Furth & Amir H. Zamanipoor Najafabadi

  3. Department of Ear Nose and Throat—Head and Neck Cancer, Leiden University Medical Center, Leiden, The Netherlands

    Maarten C. Kleijwegt

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  1. Merel van der Meulen
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  2. Marco J. T. Verstegen
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  3. Daniel J. Lobatto
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  4. Maarten C. Kleijwegt
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  5. Alberto M. Pereira
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  6. Nienke R. Biermasz
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  8. Amir H. Zamanipoor Najafabadi
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Contributions

NRB, WRF, DJL, contributed to the study conception and design. Data collection was performed by DJL. Data analysis was performed by MM. The first draft of the manuscript was written by MM and AHZN and all authors commented on previous versions of the manuscript. All authors provided input on the interpretation of the analyses and results, and read and approved the final manuscript.

Corresponding author

Correspondence to Merel van der Meulen.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Medical Ethical Committee of the Leiden University Medical Center (No. p12.067).

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Informed consent was obtained from all individual participants included in the study.

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van der Meulen, M., Verstegen, M.J.T., Lobatto, D.J. et al. Impact of patient-reported nasal symptoms on quality of life after endoscopic pituitary surgery: a prospective cohort study. Pituitary 25, 308–320 (2022). https://doi.org/10.1007/s11102-021-01199-4

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