Olfactory bulb volume and olfactory function after radiotherapy in patients with nasopharyngeal cancer

Objective

Radiotherapy is the primary method of treatment for nasopharyngeal cancer (NPC) and many side effects were reported in patients receiving radiation to this area. This study was conducted to evaluate the long-term effects of radiotherapy following NPC on olfactory bulb (OB) volume and olfactory function.

Methods

Twenty-four patients with NPC who received radiotherapy at least 12 months ago were recruited. Fourteen healthy subjects with similar demographical characteristics were recruited as the healthy control group. All volunteers were subjected to a nasoendoscopical examination, and abnormalities that could potentially cause olfactory dysfunction were the exclusion criteria from the study. An experienced radiologist segmented the MRI coronal, axial and sagittal slices manually for three-dimensional OB volume measurement in a blinded manner. Olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, and average score (0: worst, 7: best) was calculated as the total CCCRC olfactory score.

Results

The mean CCCRC score was 5.5 ± 1.1 for the nasopharyngeal cancer patients, whereas the mean score of healthy control group was 6.4 ± 0.4. There was a significant difference in the olfactory scores (p = 0.003). The mean OB volume in the NPC group was 46.7 ± 12.1 mm³. Among the patients with NPC, the cisplatin receiving group had a mean OB volume of 47.2 mm³, whereas the cisplatin + docetaxel receiving group had a mean OB volume of 46.5 mm³, and they were similar. The MRI measurement of the healthy control group was 58.6 ± 13.8 mm³. The OB volumes of the healthy control group were significantly higher (p < 0.05).

Conclusion

Radiotherapy following nasopharyngeal cancer results in a diminished OB volume and deteriorated olfactory function. Chemosensory olfactory dysfunction might be a contributing factor to lack of appetite, cancer cachexia and consequent lowered quality of life in NPC patients.     

慢性鼻窦炎嗅觉障碍的嗅粘膜病理学观察

目的观察慢性鼻窦炎嗅觉障碍患者的嗅粘膜病理变化及其与嗅觉障碍的治疗和预后的关系。方法对２３例住院行鼻内窥镜手术治疗的鼻窦炎患者的嗅粘膜进行了组织学观察。术前嗅觉检查均为嗅觉缺失，失嗅时间５～３０年，平均１１．８年。男１５例，女８例，年龄２６～７１岁，平均４８岁。结果２３例（２３侧）嗅粘膜均发现有病理组织学的改变，其中程度不等的嗅上皮萎缩１０侧次（４３．５％），程度不等的嗅细胞减少１６侧次（６９．６％），呼吸上皮化生６侧次（２６．１％），嗅腺粘液腺化生１０侧次（４３．５％）。术后随访２～６个月，嗅觉恢复或改善者１６例（６９．６％），为嗅上皮正常或轻中度病变者。嗅觉无变化７例（３０．４％），为嗅上皮中重度或重度病变者。结论嗅上皮病变程度与术后嗅觉恢复程度成正相关，嗅细胞的数量减少越明显，嗅觉障碍治疗的预后越差。     

帕金森病患者嗅觉障碍的临床研究

[目的]检测帕金森病患者的嗅觉功能，初步探讨帕金森病的嗅觉改变情况及临床意义。[方法]收集105例PD患者和105例年龄、性别与之相匹配的健康成人作对照，分别进行简易嗅觉检查。并按性别、年龄、病程、Hoehn-Yahr分级进行统计学分析。[结果]PD患者的嗅觉障碍发生率．（95．5％）远高于对照组（48．6％），OR值9．048，差异有统计学意义；运动症状出现以前12％的PD患者存在嗅觉障碍。[结论]PD患者存在明显嗅觉障碍。在病程早期及运动症状出现前即可存在.     

Chronic sinusitis and anosmia: pathologic changes in the olfactory mucosa

OBJECTIVES: To evaluate histological changes in the olfactory mucosa of patients with chronic rhinosinusitis These results are analyzed in light of current understanding of the pathophysiology of anosmia secondary to nasal and sinus disease. STUDY DESIGN: Prospective study of olfaction on patients undergoing sinus surgery for the management of chronic rhinosinusitis. METHODS: Thirty patients, aged 22 to 39 years, underwent olfactory biopsy at the time of surgery with evaluation by a pathologist. Inflammatory changes were graded as mild (normal), moderate, or severe. Clinical olfactory function was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT). The results correlated with the degree of olfactory dysfunction. RESULTS: Of the 30 patients 19 had unequivocal olfactory mucosa in the biopsy specimen. Eleven had only respiratory or indeterminate mucosa. Nine patients demonstrated normal olfactory mucosa and normal olfactory function (UPSIT > 35). Ten patients demonstrated pathological changes in the olfactory mucosa with an influx of lymphocytes, macrophages, and eosinophils Of these 10 patients, 7 had olfactory deficits as determined by UPSIT. The remaining three patients had normal olfactory function despite moderate chronic inflammation. These studies indicate that the olfactory mucosa is capable of mounting an inflammatory response similar to that seen in the respiratory mucosa of patients with chronic sinusitis These data suggest that the olfactory deficits in these patients may be the result of inflammatory changes within the olfactory mucosa in addition to any alteration in airflow to the olfactory cleft.     

Insight in taste alterations during treatment with protein kinase inhibitors

The role of Protein Kinase Inhibitors (PKI) in the treatment of various types of cancer is increasingly prominent. Their clinical application is accompanied by the development of side effects, among which patient-reported taste alterations. These alterations are missed frequently, but impair nutritional intake, are associated with weight loss and often result in significant morbidity, especially in the context of chronic administration. Accurate reporting of taste alterations is hampered by lack of modules for symptom objectification and inadequate understanding on the underlying mechanisms. In this review we initially describe the physiology of taste and smell and the mechanism of action of PKIs. We proceed to summarize taste related side effects as reported in major clinical trials and describe possible causal factors. Lastly, an in-depth analysis is given on potential molecular pathways responsible for the PKI-induced taste alterations. Objectification of patient-reported symptoms and universal reporting, along with a better understanding of the underlying mechanisms, will lead to early recognition and optimized treatment, ultimately improving patient adherence and quality of life.     

“鼻三针”配合穴位注射治疗嗅觉障碍疗效观察

目的：观察“鼻三针”配合穴位注射治疗嗅觉障碍的临床疗效。方法：将64例嗅觉障碍患者随机分为两组,治疗组32例,采用“鼻三针”疗法配合穴位注射治疗;对照组32例,给予强的松、维生素、ATP等药物治疗。结果：治疗组显效27例（84.4%）,对照组显效19例（59.4%）,治疗组效果优于对照组,经统计学处理有显著性差异（P〈0.05）。结论：“鼻三针”配合穴位注射治疗嗅觉障碍有较好的临床疗效。     

成纤维生长因子 2在慢性鼻窦炎嗅觉障碍嗅上皮中的表达

目的：探讨慢性鼻-鼻窦炎嗅觉功能障碍的发病机制和成纤维生长因子 2 (fibroblast growth factors 2, FGF2)在嗅上皮表达中的意义。方法：应用免疫组织化学技术检测32例慢性鼻窦炎患者和11例对照嗅黏膜FGF2的表达。结果：和对照组相比，慢性鼻窦炎患者嗅粘膜FGF2的表达明显减少（P＜0.05）。结论：慢性鼻-鼻窦炎嗅粘膜中促进再生因子FGF2明显减少。     

脑深部电刺激双侧丘脑底核治疗PD对嗅觉功能的影响

目的 研究脑深部电刺激双侧丘脑底核治疗帕金森病(PD)对患者嗅觉功能的影响.方法 对15例合并有嗅觉障碍的散发性PD患者行双侧丘脑底核电极植入术,分别于术前1 w、术后6、12个月应用“五味嗅觉测试液”检测PD患者嗅觉觉察阈值(DT)和嗅觉识别阈值(TT),进行统计学分析.结果 术后15例PD患者运动功能症状改善良好.手术前后不服药刺激器“关”状态下患者的DT、IT比较均无明显差异(P＞0.05),术后6、12个月DT在刺激器“开、关”状态下对比均无明显改变(P＞0.05),但IT在刺激器“开”状态下较“关”状态显著改善(P＜0.05).结论 脑深部电刺激双侧丘脑底核(STN DBS)可明显改善PD患者的嗅觉认知功能,可能与改善了纹状体多巴胺代谢及增加了纹状体、中脑、扣带回、前额叶运动区皮质、顶枕叶高级躯体感觉联合区皮质葡萄糖代谢有关.     

Enfermedad renal crónica y olfato

Alterations in the sense of smell (dysosmia, anosmia, hyposmia) are frequently experienced by patients with chronic kidney disease. However, currently, the aetiology and consequences are poorly understood, with no effective treatments available to address such impairment. In general, the capacity of olfactory perception is affected in patients with chronic kidney disease (even in those who have not undergone dialysis therapy), and whether these alterations improve after dialysis is disputed. Patients in peritoneal dialysis and haemodialysis have the same olfactory perception defects. Kidney transplantation improves olfactory perception, and one important consequence of such impairment is the potential impact on the patient's nutritional status.     

布地奈德对变应性鼻炎嗅觉障碍的干预作用探讨

目的探讨布地奈德对变应性鼻炎嗅觉障碍的干预作用。方法选择来该院治疗的变应性鼻炎嗅觉障碍患者30例,患者在接受治疗前,通过T＆T嗅觉检查及对嗅觉事件有关点位进行记录,评估嗅觉功能。之后予以布地奈德混悬液做鼻腔雾化吸入（1mg）,治疗15d,1次/d。每治疗5次后,通过T＆T嗅觉检查对嗅觉功能进行复查。在雾化吸入15次后对T＆T的嗅觉识别阈及嗅觉事件有关点位进行同时复查。结果所选鼻炎嗅觉障碍患者在接受鼻腔雾化治疗后,8例（26.7%）患者恢复了正常的嗅觉功能,15例（50%）患者的嗅觉功能得到显著改善,5例（16.7%）患者的嗅觉功能得到轻微改善,2例患者治疗无效,总有效率为93.3%。结论布地奈德混悬液的鼻腔雾化吸入对治疗变应性鼻炎嗅觉障碍效果良好,此方法便捷、无创,且有较好的患者依从性,是临床较好的治疗方法。