慢性鼻-鼻窦炎患者嗅觉障碍影响因素分析

目的：探讨慢性鼻-鼻窦炎（CRS）患者嗅觉障碍的影响因素。方法：采用视觉模拟量表（VAS）对270例诊断明确的CRS患者的嗅觉障碍程度进行评分,分为嗅觉障碍影响生活质量组（VAS〉5）及未影响生活质量组（VAS≤5）。通过对患者年龄、性别、伴鼻息肉、伴变应性鼻炎、有吸烟史及前期鼻部手术史等临床因素及血清总IgE水平、外周血嗜酸粒细胞和单个核细胞个数等进行分析,在组间进行Mann-Whitney U分析,采用多变量Logistic回归模型对嗅觉障碍的影响因素进行相关性分析。结果：在嗅觉障碍影响生活质量组中伴鼻息肉、伴变应性鼻炎、有前期手术史的患者数量及血清总IgE水平、水肿评分均明显高于未影响生活质量组（均P〈0.05）;性别、年龄、吸烟史、伴鼻中隔偏曲及外周血嗜酸粒细胞数、单个核细胞数在2组患者之间差异无统计学意义（P〉0.05）。多因素Logisitic分析发现血清总IgE增高、水肿评分高是影响嗅觉的危险性因素（OR=1.003、2.483,均P〈0.01）;而前期鼻部手术史是一个保护因素（OR=0.408,P〈0.01）。结论：严重的鼻腔水肿、血清总IgE增高是患者出现严重嗅觉障碍的危险因素,前期鼻部手术则是保护性因素。     

上呼吸道感染后嗅觉障碍患者脑形态学与嗅觉功能相关性分析

目的 通过探究上呼吸道感染后嗅觉障碍脑灰质形态变化,得出上呼吸道感染后嗅觉障碍患者嗅觉中枢结构的影像学特点。方法 选取上呼吸道感染后嗅觉障碍的患者24例与嗅觉功能正常的健康对照受试者20例,通过基于体素的大脑皮质形态学体积测量(VBM)比较患者的大脑灰质和白质体积与对照组的差异。结果 上呼吸道感染后嗅觉障碍组患者TDI[气味察觉阈(T)、气味辨别能力(D)、气味识别能力(I)]总分(16.45±5.62)分,T为(2.33±0.93)分,D为(6.54±2.60)分,I为(7.58±3.22)分;嗅觉障碍平均时长为(19.00±6.33)个月;视觉模拟量表评分(VAS)为(7.79±2.41)分,与对照组比较均存在统计学差异(P<0.05)。上呼吸道感染后嗅觉障碍患者的大脑灰质总体积和嗅皮质体积明显小于对照组(P<0.05),大脑灰质总体积占全脑体积的比例和皮质厚度与嗅觉功能评分TDI值呈正相关(r=0.71,P<0.000 1;r=0.69,P=0.000 9)。结论 上呼吸道感染后嗅觉障碍患者大脑灰质总体积和嗅皮质体积减少,且嗅觉功能与大脑灰质体积比例及皮质厚度呈...     

Intranasal trigeminal chemosensitivity in patients with postviral and post-traumatic olfactory dysfunction

Abstract Conclusions: The olfactory and intranasal trigeminal systems are closely connected. With regard to intranasal trigeminal event-related potential (ERP), patients with olfactory dysfunction (OD) showed longer latency and lower amplitude, which indicated decreased trigeminal sensitivity. Different age, etiology, and olfactory status also affect trigeminal sensitivity differently. Objective: OD is a common symptom in the rhinology clinic. ERP is considered an important method to evaluate chemosensitivity. The aim of this study was to investigate changes of intranasal trigeminal sense in patients with postviral OD (PVOD) and post-traumatic OD (PTOD). Methods: A total of 96 participants (30 healthy adults and 66 patients with OD) aged 20-65 years were investigated. The T&T olfactometer, the Sniffin' Sticks olfactory test, and trigeminal ERPs (tERPs) were used. We evaluated trigeminal sensitivity influenced by different factors (age, etiology, and olfactory status) in healthy subjects with normal olfactory function and in patients with PVOD and PTOD. Results: Patients with OD showed higher trigeminal thresholds than normal controls. Compared with controls, N1/P2 latencies of tERPs increased and amplitudes decreased in patients with OD. Older subjects showed longer latencies and lower amplitudes than young subjects in both controls and the OD group. Patients with PTOD exhibited worse psychophysical olfactory function and decreased trigeminal sensitivity.     

Post-traumatic olfactory dysfunction

OBJECTIVES: This study demonstrates histopathologic and immunocytochemical changes in the olfactory bulb of a patient with post-traumatic olfactory dysfunction. These results are analyzed in light of current understanding of the pathophysiology of anosmia and dysosmia following head trauma. Emphasis is placed on potential mechanisms of human regeneration and recovery. STUDY DESIGN: The current study documents the history of a patient with the initial complaint of complete anosmia following minor head trauma. Two months after the injury the patient developed persistent, severe dysosmia with debilitating weight loss. Neurosurgical treatment, including removal of the olfactory bulbs and tracts, resulted in permanent resolution of dysosmia. METHODS: Histopathologic and immunocytochemical analysis of the olfactory bulbs was undertaken and compared with age-matched control tissue. RESULTS: Pathological analysis of the olfactory bulb revealed a marked reduction in the number of nerve processes with few intact olfactory glomeruli compared with an age-matched control. Specific immunohistochemical staining for the olfactory neuron-specific protein OMP, however, demonstrated the presence of intact axonal projections between the olfactory mucosa and the bulb. CONCLUSIONS: These results support the hypothesis that post-traumatic anosmia involves, at least in part, damage to peripheral olfactory nerve fibers with histological changes in the olfactory bulb. Potential mechanisms for the development of post-traumatic dysosmia are also discussed.     

特发性嗅觉障碍的研究进展

特发性嗅觉障碍(IOD)是一种发病原因尚不明确的嗅觉疾病,以嗅觉下降或完全丧失为主要临床表现。嗅觉是人的基本感知觉之一,在识别气味、预警危险及影响情绪等方面有着重要作用。嗅觉功能一旦受损,对人的饮食、生活质量等方面有着严重影响,嗅觉疾病逐渐被各国学者关注。IOD是一种较为常见的嗅觉疾病,尽管目前在IOD的诊断及发病机制上有所研究,但其临床诊疗工作仍十分具有挑战性。目前国内关于IOD的理论及临床研究较少,本文通过总结目前国内外关于IOD的文献报道,对其发病情况、可能发病机制、诊断、治疗进行综述,以期为IOD的临床诊疗工作提供参考。     

鼻咽癌患者鼻咽组织和血清中EBV检测

目的：比较血清爱泼斯坦－巴尔病毒（ＥＢＶ）抗体滴定度测定与癌组织ＥＢＶ基因组检测对鼻咽癌（ＮＰＣ）的诊断价值。方法：１４６例患者采用双盲法测定血清ＥＢＶ－ＶＣＡ－ＩｇＡ,ＥＢＶ－ＥＡ－ＩｇＡ和活检组织ＥＢＶ－ＤＮＡ（ＰＣＲ）。全组病例按活检病理检查结果分析：ＮＰＣ组,非ＮＰＣ组（对照组）。结果：ＮＰＣ组中ＥＢＶ－ＤＮＡ（ＰＣＲ）,ＥＢＶ－ＶＣＡ－ＩｇＡ和ＥＢＶ－ＥＡ－ＩｇＡ的阳性率分别为９０．８％     

上呼吸道感染后嗅觉障碍患者化学感觉功能评估

目的:观察上呼吸道感染后嗅觉障碍（post-viral olfactory dysfunction,PVOD）患者的嗅觉功能、鼻内三叉神经功能和味觉功能变化,探讨PVOD患者化学感觉功能变化的相关性。方法:回顾性分析2019年1—12月在北京安贞医院耳鼻咽喉头颈外科嗅觉味觉中心就诊的PVOD患者42例,其中男20例,女...     

Analysis of the clinical effect of olfactory training on olfactory dysfunction after upper respiratory tract infection

Background: Olfactory dysfunction is a common symptom during otolaryngology outpatient service.

Objective: To explore the clinical effect of olfactory training on olfactory dysfunction after upper respiratory tract infection (URTI), and its influence factors.

Material and methods: A total of 60 confirmed cases of URTI-induced olfactory dysfunction were enrolled into the present study. The olfactory training lasted for 24 weeks. These patients were tested using Sniffin’ Sticks and threshold-discrimination-identification (TDI) composite scoring before treatment, and at 1, 3 and 6 months after treatment.

Results: It was found that URTI-induced olfactory dysfunction patients had more evident deterioration in odor identification ability. The effective rates of olfactory training on olfactory dysfunction at 1, 3 and 6 months after treatment were 1.67%, 26.67% and 41.67%, respectively. The TDI scores at the 3rd and 6th months, but not at the 1st month, were significantly higher, when compared to those before treatment. The course of diseases was a significant influence factor on the therapeutic effect of olfactory training (OR = 0.805, 95% CI: 0.696–0.931).

Conclusions: Olfactory training can efficiently cure URTI-induced olfactory dysfunction, and in particular, significantly improve the odor discrimination ability and odor identification ability.

Significance: Providing useful data for further research regarding olfactory dysfunction.     

Intravenous olfactory test latency correlates with improvement in post-infectious olfactory dysfunction

Conclusion: This cohort study showed that onset latency in the intravenous olfactory test (IVO) may help predict when olfaction in patients with post-infectious olfactory dysfunction (PIOD) improves.

Objectives: To identify factors that predict the olfactory improvement period in patients with PIOD.

Methodology/Principal: All consecutive patients presenting with PIOD in 1994–2014 who were followed up for 2 years were identified retrospectively. The ability of demographic/clinical factors (age, sex, body mass index, presence/absence of allergic rhinitis, treatment/non-treatment with herbal medicines, patient dependence on herbal medicine treatment, presence/absence of diabetes mellitus, and smoking status) and olfactory test factors (response/no response and onset latency and duration in the IVO test, and detection and recognition scores on the T&;T olfactory test) to predict the olfactory improvement period (defined respectively as the time from PIOD onset or olfactory testing to the first self-report of olfaction improvement) was analyzed by univariate and multivariate regression.

Results: Of the 187 PIOD patients, the prognostic ability of demographic/clinical factors was analyzed in 65. None predicted the olfactory improvement period. Of the 65 patients, 20 did not respond in the IVO test. In the remaining 45 patients, onset latency (but not the other olfactory test factors) was a significant prognosticator of olfactory improvement period (R²=0.24, p?=?0.003).     

Monitoring tumor recurrence with nasopharyngeal swab and latent membrane protein-1 and epstein-barr nuclear antigen-1 gene detection in treated patients with nasopharyngeal carcinoma

OBJECTIVES: Epstein-Barr virus (EBV) is closely related to nasopharyngeal carcinoma (NPC). Detection of EBV genomic DNA in a nasopharyngeal swab specimen may indicate the presence of NPC, and the EBV genomic DNA is only detected in patients with NPC and not in other head and neck cancers. This study aims to prove that detection of EBV genomic DNA by means of the latent membrane protein (LMP)-1 gene and the Epstein-Barr nuclear antigen (EBNA)-1 gene in the nasopharynx in NPC patients after radiation therapy indicates local recurrence of NPC. STUDY DESIGN: Prospective. METHODS: Nasopharyngeal swab with polymerase chain reaction (PCR)-based LMP-1 and EBNA-1 gene detection was used to monitor local recurrence in 84 NPC patients who completed radiation therapy. RESULTS: Of the 12 patients demonstrating positive LMP-1 and EBNA-1 gene, 11 had local recurrence, and 10 of them had early rT1 mucosal recurrence. Subsequent salvage nasopharyngectomy controlled local disease in nine. Only one local recurrence in the skull base failed to show LMP-1 gene initially. Detection of LMP-1 gene and later verification with EBNA-1 gene from nasopharyngeal swabs in NPC patients after radiation therapy predicted local recurrence with a sensitivity of 91.7% and a specificity of 98.6%. CONCLUSIONS: Nasopharyngeal swab with LMP-1 and EBNA-1 gene detection is a useful and reliable method to monitor local recurrence in NPC patients. It helps to detect recurrence early and may improve local control and enhance survival.     

Immunohistochemical absence of CD21 membrane receptor in nasopharyngeal carcinoma cells infected by Epstein-Barr virus in Spanish patients

OBJECTIVES/HYPOTHESIS: The aim of this study was to analyze the relevance of the CD21 membrane receptor in nasopharyngeal carcinoma (NPC). CD21 is implicated in the introduction of the Epstein-Barr virus (EBV) genome into epithelial cells and B lymphocytes. STUDY DESIGN: Immunohistochemical analysis of CD21 in NPC. METHODS: Paraffin-embedded samples of NPC of different histological types with demonstrated presence of EBV were analyzed for CD21 expression using immunohistochemistry. RESULTS: We detected EBV by non-isotopic in situ hybridization (NISH) and nested polymerase chain reaction (PCR) in 100% of samples, regardless of histological type, supporting the previous view that all the types of NPC are variants of an EBV-associated malignancy. CD21 was not detected in NPC, and this absence was a typical feature in our data group. CONCLUSIONS: The loss of the CD21 membrane receptor could be one of the immunophenotypical changes of the neoplastic cells that occur in the evolution of the NPC malignancy.     

嗅觉功能障碍患者鼻内三叉神经功能的评估

目的探讨嗅觉障碍患者鼻内三叉神经功能的改变。方法 303例受试者中健康人100名,嗅觉功能障碍患者203例,分别采用T&T嗅觉计定量检查法(T&T)、嗅觉事件相关电位(olfactory event-related potentials,oERPs)和三叉神经事件相关电位(trigeminal event-related potentials,tERPs)进行嗅觉和三叉神经功能检测。结果 T&T识别域结果表明嗅觉功能障碍患者跟健康人比较差异有显著性意义(P<0.05)。oERPs和tERPs结果显示嗅觉功能障碍患者跟健康人比较N1、P2波潜伏期延长,差异有显著性意义(P<0.05)。结论嗅觉功能障碍患者多伴有三叉神经敏感性的下降,青年患者下降尤为显著,其下降程度与性别关系不大。研究证实两种化学感受系统之间存在联系,联合检测可有助于临床的诊断和治疗。     

Treatment of posttraumatic olfactory dysfunction with corticosteroids and olfactory training

Abstract

Background: Few have investigated long-term effect of treatment of posttraumatic olfactory dysfunction (OD).

Aims/objectives: To explore if sequential treatment with corticosteroids and olfactory training (OT) improved smell in patients with OD after moderate and severe traumatic brain injury (TBI).

Material and methods: Twenty-two patients with persistent OD, mean 62 months after trauma, completed an open uncontrolled intervention study of treatment for 10 d with oral corticosteroids and thereafter for 3 months with OT twice daily. Olfaction was assessed by Sniffin’ Sticks. They were tested at four-time points, with the last assessment 12 months after baseline measurements.

Results: Mean age at trauma was 45 (SD 14) years. Mean threshold, discrimination and identification (TDI) score at baseline was 14.4 (SD 7.3) and increased to mean 20.8 (SD 7.4) after 1 year (minimum ?3.0; maximum 19.5, p value <.001). Analysed separately, each TDI component increased significantly after 1 year. Half of the patients (11/22) experienced a clinically significant improvement of ≥6.0 TDI points. Improvement was not associated with any sociodemographic or trauma-related characteristics or with olfactory function at baseline.

Conclusions and significance: Treatment with corticosteroids and OT was promising in persistent OD after TBI and should be further studied.     

A clinical study of olfactory dysfunction in patients with Mikulicz's disease

Objective

Mikulicz's disease (MD) is differentiated from Sjögren's syndrome as an immunoglobulin G4 (IgG4) systemic disease. MD patients often report olfactory dysfunction (OD). To analyze cases of OD associated with MD, we studied clinicopathological and serological findings of MD patients.

Methods

A total of 44 MD patients (17 males and 27 females) were examined for OD. We evaluated clinicopathological and serological findings of these patients by dividing them into OD (+) and OD (−) groups.

Results

The mean IgG4 concentration (SD) in such cases was 950.5 (797.5) mg/dl. Of the 44 patients, 20 (45%) had OD even though no abnormalities, such as obstructive and inflammatory disease, were detected in their nasal cavities and sinuses. The two groups did not show significant differences in background characteristics, such as age, sex, IgG4 concentration, presence or absence of allergic rhinitis, and presence or absence of extrasalivary gland lesions. We found abundant IgG4-positive plasmacytes in the nasal mucosa specimens of the OD (+) group but not in that of the OD (−) group.

Conclusions

Nasal mucosa in the MD patients with OD was infiltrated with IgG4-positive plasmacytes. We concluded that OD may be associated with infiltration by IgG4-positive cells.