Clinical research indicates that age plays a pivotal role in postoperative olfactory outcomes for patients undergoing skull base surgery. Specifically, surgeons often utilize olfactory strip elevation to preserve sensory function during the endoscopic endonasal approach (EEA). However, older patients demonstrate a higher vulnerability to smell loss despite these meticulous techniques. According to recent findings, individuals aged 50 and older experience more significant declines in objective smell tests compared to their younger counterparts.

The underlying cause involves age-related histological changes within the olfactory mucosa. Specifically, the density of olfactory sensory neurons (OSNs) and horizontal basal cells (HBCs) decreases significantly as patients age. Furthermore, researchers identified a strong correlation between the intensity of S100 expression and successful sensory recovery. Consequently, the reduced regenerative capacity of the aged nasal lining leads to poorer results. Therefore, clinicians must consider these physiological limitations when planning surgical interventions and setting patient expectations.

Optimizing Postoperative Olfactory Outcomes in Older Patients

Surgeons should carefully monitor cellular health to improve postoperative olfactory outcomes in the elderly. Since S100 expression serves as a marker for olfactory ensheathing cells, its reduction predicts a lower potential for neural repair. Additionally, the decrease in horizontal basal cells suggests that the stem cell pool for replacing damaged neurons diminishes over time. Consequently, even with the preservation of an olfactory strip, the intrinsic ability of the tissue to heal often wanes. Surgeons should thus provide comprehensive preoperative counseling regarding these age-associated risks.

Frequently Asked Questions

Why does age affect smell recovery after skull base surgery?

Aging reduces the population of olfactory sensory neurons and basal stem cells, which are essential for regenerating the olfactory epithelium after surgical trauma.

What is the significance of S100 expression in this study?

S100 expression indicates the presence and health of olfactory ensheathing cells; higher levels are associated with better olfactory outcomes and improved mucosal healing.

Does preserving the olfactory strip guarantee smell preservation in older adults?

While strip elevation helps, it may not fully prevent decline in patients over 50 because their inherent regenerative capacity is already significantly lowered.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider for any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Kim J et al. Olfactory vulnerability in older adults undergoing endoscopic skull base surgery: insights from olfactory strip elevation. Rhinology. 2026 Feb 13. doi: 10.4193/Rhin25.450. PMID: 41686484.

Harvey RJ, et al. The olfactory strip and its preservation in endoscopic pituitary surgery maintains smell and sinonasal function. J Neurol Surg B Skull Base. 2015;76(6):464-470.

Qi W, et al. Effects of age on the olfactory function recovery of chronic rhinosinusitis patients after endoscopic sinus surgery. Ear, Nose & Throat Journal. 2021.