To Smell, or Not To Smell?

By Chester Griffiths, MD, FACS
Chief, Endoscopic Endonasal Skull Base Surgery
Pacific Brain Tumor Center

“Smell is a potent wizard that transports you across thousands of miles and all the years you have lived.” – Helen Keller

The organ of smell is located in the roof of the nose and is one of the most under-acknowledged of all of the five senses. Smell has the strongest link to memory and subconsciously, it is there for our protection and enjoyment without our providing any conscious control or input. Just try imagining life without the ability to smell. Would food hold the same allure or taste the same? How many environmental cues that we take for granted would we miss? Sociologically, we smell our foe or, for that matter, our mate. Pheromones secreted by our sweat glands and other body fluids signal the time to procreate and for centuries, the French have honored the arousing qualities of smell in their famous perfumes.

“A woman’s perfume tells more about her than her handwriting.”
– Christian Dior

Smell is important as a protective function, signaling danger with identification of smoke or fire, gas, bad food and even disease. Patients who lose their sense of smell report increased incidence of depression, security issues and loss of libido.

As such, the protection and preservation of smell during endoscopic endonasal skull base or pituitary procedures is one of the hallmark efforts of the physicians at the Pacific Brain Tumor Center. Historically, the incidence of smell loss or dysfunction has been reported to be as high as 40% following endoscopic skull base surgery. In 2009, our surgeons developed a novel, olfactory (smell) preserving approach to protect the septal olfactory epithelium (SOS) – the tissue responsible for smell.

This published technique was studied in a prospective study evaluating smell function prior to the skull base/pituitary procedure and then after a 1-3 month interval. The results of over 140 patients studied revealed no patients losing smell function with only 4% having a mild decrease. In fact, over 20% of all patients experienced improved smell function after the procedure as prior nasal-sinus issues were corrected while treating the skull base/pituitary disease.

Nasal-sinus issues treated at the time of the skull base/pituitary disease include correcting deviated septum, draining sinus infections, removing nasal polyps and cysts and correcting swollen nasal turbinate tissues.

Our specialized surgical procedures have the dual benefit of treating the skull base/pituitary issue and the nasal sinus issue at the same time. The function and sense of smell has a significant impact on the quality of life and we strive to protect and, in some cases, enhance this vital sense while taking care of our patient’s skull base or pituitary issues.

“What’s in a name? That which we call a rose by any other name would smell as sweet.” – William Shakespeare