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Purpose <p>The endoscopic endonasal approach (EEA) is a widely accepted, safe, and effective technique to treat pituitary lesions. Among postoperative considerations, olfactory function plays a key role in the patient’s quality of life. Although povidone-iodine (PVP-I) is widely used for intranasal antisepsis, its optimal concentration remains unclear. This study evaluated whether the PVP-I concentration during antisepsis influences postoperative olfactory recovery in patients undergoing EEA.</p> Methods <p>We retrospectively reviewed patients with sellar tumors who underwent endoscopic endonasal pituitary surgery at the Mackay Memorial Hospital (August 2015‒March 2022). Olfactory function was assessed using the Taiwan Smell Identification Test (TWSIT) at 1, 3, and 6 months postoperatively. Patients were stratified by the PVP-I concentration used: commercial aqueous 10% PVP-I and diluted 1% PVP-I.</p> Results <p>Of the 65 patients included, 57 had pituitary adenomas. Seventeen patients received 10% PVP-I during COVID-19 pandemic, and 48 received 1% PVP-I. Preoperative olfactory scores were comparable in both groups (1% vs. 10%: 40.9 ± 7.0 vs. 41.2 ± 5.9, <i>p</i> = 0.81). At 6 months, the mean TWSIT score in the 10% PVP-I group significantly decreased to 35.9 ± 9.5 (<i>p</i> = 0.03), whereas the 1% PVP-I group recovered to 40.5 ± 8.7, with no significant difference from baseline (<i>p</i> = 0.85). The intergroup difference in olfactory recovery was significant at 6 months postoperatively (<i>p</i> = 0.01). No patient developed postoperative wound infections or meningitis during follow-up in both groups.</p> Conclusion <p>Both 10% and 1% PVP-I solutions were associated with excellent antiseptic outcomes. Patients receiving 1% PVP-I had better postoperative olfactory recovery than those receiving 10% PVP-I. Accordingly, diluted 1% PVP-I is recommended for nasal antisepsis to optimize olfactory outcomes in EEA.</p>

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Intranasal povidone-iodine concentration and olfactory recovery after endoscopic endonasal pituitary surgery

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Chia-Hsing Lin,
  • Po-Kai Huang,
  • Pei-Yuan Hsu,
  • Yun-Kai Chan,
  • Ying-Piao Wang

摘要

Purpose

The endoscopic endonasal approach (EEA) is a widely accepted, safe, and effective technique to treat pituitary lesions. Among postoperative considerations, olfactory function plays a key role in the patient’s quality of life. Although povidone-iodine (PVP-I) is widely used for intranasal antisepsis, its optimal concentration remains unclear. This study evaluated whether the PVP-I concentration during antisepsis influences postoperative olfactory recovery in patients undergoing EEA.

Methods

We retrospectively reviewed patients with sellar tumors who underwent endoscopic endonasal pituitary surgery at the Mackay Memorial Hospital (August 2015‒March 2022). Olfactory function was assessed using the Taiwan Smell Identification Test (TWSIT) at 1, 3, and 6 months postoperatively. Patients were stratified by the PVP-I concentration used: commercial aqueous 10% PVP-I and diluted 1% PVP-I.

Results

Of the 65 patients included, 57 had pituitary adenomas. Seventeen patients received 10% PVP-I during COVID-19 pandemic, and 48 received 1% PVP-I. Preoperative olfactory scores were comparable in both groups (1% vs. 10%: 40.9 ± 7.0 vs. 41.2 ± 5.9, p = 0.81). At 6 months, the mean TWSIT score in the 10% PVP-I group significantly decreased to 35.9 ± 9.5 (p = 0.03), whereas the 1% PVP-I group recovered to 40.5 ± 8.7, with no significant difference from baseline (p = 0.85). The intergroup difference in olfactory recovery was significant at 6 months postoperatively (p = 0.01). No patient developed postoperative wound infections or meningitis during follow-up in both groups.

Conclusion

Both 10% and 1% PVP-I solutions were associated with excellent antiseptic outcomes. Patients receiving 1% PVP-I had better postoperative olfactory recovery than those receiving 10% PVP-I. Accordingly, diluted 1% PVP-I is recommended for nasal antisepsis to optimize olfactory outcomes in EEA.