Local and systemic administration of corticosteroids in the treatment of olfactory loss

BACKGROUND: The aim of this study was to evaluate the benefit of patients with olfactory dysfunction from local (group A) or systemic (group B) administration of corticosteroids. METHODS: This unblinded study was conducted at a smell and taste outpatient clinic of an institutional referral center. Patients with olfactory loss after infections of the upper respiratory tract, patients with apparent sinonasal disease, and patients suffering from "idiopathic" smell loss were included. Effects of mometasone nasal spray, administered for 1-3 months, were studied in 37 patients. In addition, effects of oral prednisolone were analyzed in 55 patients who received decreasing doses over 21 days, starting with a dose of 40 mg. Olfactory function before and after treatment was measured. RESULTS: Although odor identification scores tended to increase (p = 0.05), mometasone nasal spray did not significantly improve olfactory function, when looking at the entire group of patients or when analyzing the three diagnostic categories separately. In contrast, after systemic administration of corticosteroids, improvement of olfactory function was seen over all diagnostic categories (p < 0.001). Interestingly, olfactory function also improved in patients diagnosed with olfactory loss after upper respiratory tract infection (p = 0.05) and in patients initially diagnosed with "idiopathic," olfactory dysfunction (p = 0.008). CONCLUSION: In many patients, local application of corticosteroids appears to have little or no positive effect on olfactory dysfunction, especially when considering long-term changes. Duration of disease, the patient's age/sex, or the presence of parosmia does not appear to predict the response to therapy with corticosteroids.     

Post-tonsillectomy taste disorders

Gustatory dysfunction is an uncommon complication following tonsillectomy with a potential impact on the quality of life. This retrospective study was undertaken to evaluate the incidence of post-tonsillectomy dysgeusia and its relationship to wound healing and pain. A retrospective chart review of 100 patients who had undergone tonsillectomy between June and December 2008 at a single tertiary care institution was performed. Clinical examination included evaluation of the patient’s history and psychophysical testing with cottons soaked with chininsulfate (0.075%; 0.2%), glucose (2%; 10%), citric acid (0.5%; 7.5%) and sodium chloride (0.5%; 2.5%) before, as well as 4 days to 3 months following tonsillectomy at a tertiary care hospital. Anatomical peculiarities, intubation problems, operation time, methods to achieve hemostasis were extracted from the charts. Healing was scored by the physician and pain was scored by the patient. Subjective taste dysfunction was registered in 29 patients 4 days after surgery. In all patients this dysgeusia regressed within weeks. Measured taste function showed lateralized and transient changes. No investigated factor such as pain, operating time, anatomical particularities, wound healing or haemostatic technique were associated with the occurrence of dysgeusia. Transient taste perception changes seem to be relatively frequent after tonsillectomy. Although our results indicate no correlation of even transiently altered taste perception and any of the investigated parameters, this further confirms the clinical impression that gustatory symptoms can occur even after uneventful tonsillectomy. Informed consent should include post-tonsillectomy gustatory dysfunction.     

Taste function in elderly patients with unilateral middle ear disease

OBJECTIVE: It is generally said that taste function deteriorates naturally with age. Taste function after middle ear surgery in elderly patients has not been clarified. MATERIAL AND METHODS: The taste function of the chorda tympani nerve on the normal and diseased sides was examined before and after middle ear surgery using electrogustometry in 79 patients aged>60 years, and the findings were compared with those in 228 young and middle-aged patients. RESULTS: The threshold of electrogustometry on the normal side increased significantly with increasing age (p<0.0001). The rate of thresholds that were off the scale was highest in the>70 years age group. The preoperative threshold on the diseased side increased significantly with increasing age in patients with chronic otitis media (p=0.0029) and cholesteatoma (p<0.0001). In patients with chronic otitis media, the postoperative threshold of the>60 years age group tended to be higher than that of the<60 years age group. CONCLUSIONS: These findings suggest that the taste function of the chorda tympani nerve deteriorated on the diseased side as much as on the normal side in elderly patients. Therefore, in most cases, we do not have to pay as much attention to the chorda tymapani nerve when performing surgery in elderly patients compared to young and middle-aged patients.     

Effects of cochlear implantation on gustatory function

OBJECTIVES: Because of the anatomic position of the chorda tympani in the tympanic cavity, the nerve is at risk during cochlear implantation. The aim of this study was to assess changes in taste sensitivity and in self-ratings of gustatory function after surgery. METHODS: Twenty-four patients (mean age, 54 years) who underwent cochlear implantation were investigated. Taste function was tested with a validated test for regional quantitative assessment of sweet, sour, salty, and bitter tastes on each side of the tongue before and 4 days after surgery. RESULTS: The mean taste score was 10.0 (SD, 4.0) before and 8.0 (SD, 4.1) after surgery on the side of the tongue ipsilateral to the operated ear (p = .004). However, only 1 patient reported subjective taste loss due to surgery. Taste testing of the side of the tongue contralateral to the operated ear yielded a score of 10.0 (SD, 4.1) before and 10.9 (SD, 4.5) after surgery (p = .037). Self-ratings of gustatory function did not change significantly as a consequence of the procedure. CONCLUSIONS: Our results indicate that cochlear implantation is a relatively safe procedure regarding taste function. Preoperative testing of gustatory function is recommended, at least in those patients who already have undergone operation on the contralateral ear.     

Gustatory function after microlaryngoscopy

CONCLUSION: Quantitative gustatory alterations are rare after microlaryngoscopy (MLS), whereas transient qualitative taste distortions occur more often. Patients undergoing MLS should know that mild but transient qualitative taste disorders may occur. OBJECTIVE: Suspension MLS requires neck extension and tongue compression. Little is known about taste disorders following MLS. To investigate qualitative and quantitative gustatory function after MLS we tested and questioned patients before and several weeks after the MLS. SUBJECTS AND METHODS: This was a prospective controlled study carried out in a tertiary care centre. Forty-three patients participated, 33 of whom underwent MLS and 10 septoplasty. Tongue compression time was recorded during MLS. Patients received taste evaluation before and at 1 and 14 days after the intervention. Patients were asked to indicate subjectively changed taste perceptions. RESULTS: Psychophysical (quantitative) taste results showed no significant differences before and at 1 and 14 days after the intervention (p = 0.60). Tongue compression time (MLS group) had no influence on measured post-MLS taste scores. In the MLS group four patients reported distorted taste perception the day after the MLS, whereas no patient in the septoplasty group did so. In all, four patients distorted taste perception, had disappeared after 14 days.     

Younger patients have a higher rate of recovery of taste function after middle ear surgery

BACKGROUND: Although the chorda tympani nerve (CTN) is frequently damaged during tympanoplasty, little attention has been given to the patients' symptoms and taste function. OBJECTIVE: To investigate patients' symptoms and the functional recovery of taste after surgery using electrogustometry (EGM). DESIGN: Prospective study. PATIENTS: Analysis of 163 ears of 156 patients who underwent middle ear surgery from April 1997 through December 1999. There were 18 ears with noninflammatory diseases, 80 with chronic otitis media, and 65 with cholesteatoma. The patients' taste functions were examined 2 days before surgery and 2 weeks and 6 months after surgery. MAIN OUTCOME MEASURES: The taste disturbance before and after middle ear surgery and the relationship between age and the recovery rate of CTN function. RESULTS: Two weeks after surgery, the mean EGM threshold was elevated in all groups regardless of preservation or section of the CTN. Numbness in the tongue and taste disturbance were more frequently found in patients with preservation of CTN than in those with section of the CTN (P =.008 and P =.001, respectively). In patients with preservation of the CTN, 6 months after surgery, the recovery rate of EGM threshold was 83% in those aged 20 years or younger (P =.008 compared with the 2 older groups), 53% in the those aged 21 to 40 years, and 44% in those aged 41 to 60 years. CONCLUSION: Age is an important factor for recovery of taste function after middle ear surgery, which is useful information when explaining complications to patients.     

Taste disorders and recovery of the taste function after middle ear surgery

BACKGROUND: The incidence and the scale of recovery of the taste function after middle ear surgery is usually determined by the use of anamnestic data and electrogustometry. METHODS: Taste tests (regional chemical taste test, electrogustometry and subjective evaluation) were performed preoperatively, 2 to 3 weeks and 6 to 9 months after middle ear surgery. These results were evaluated by taking the scale of chorda tympani nerve (CTN) manipulation into consideration. Three groups were chosen: group 1: no or small CTN manipulation, n = 54; group 2: strong CTN manipulation, n = 14; group 3: severed CTN, n = 50. PATIENTS: In a prospective study 118 patients were examined after middle ear surgery in the ENT-Department of the University of Rostock between 2001 and 2002. 61 females and 57 males, age from 7 - 81 years, were included. RESULTS: Complaints were observed in all three groups, mainly in groups 2 and 3. These included taste disorders, taste phenomenon and numbness of the tongue. Using regional chemical taste tests, the taste loss of group 3 could be proven for those patients with complaints in 64 % and for those patients without complaints in 27 %. The electrogustometry is more sensitive than chemical taste test. All patients had pathological thresholds after chorda cutting (78 % no thresholds; 22 % elevated thresholds). 68 out of 118 patients (58 %) had a second follow-up after 6 to 9 months after middle ear surgery. The complaints are declining in all groups. In groups 2 and 3 a recovery of taste function could be observed. Even if the number of patients with severed chorda, who suffer from taste disorders, diminishes, a recovery of the taste function could only be observed in 30 %. CONCLUSIONS: The scale of chorda manipulation is important for the recovery of the taste function after middle ear surgery. The CTN should be preserved intraoperatively, especially when an operation of the contralateral ear is planned as well.     

Vestibular and taste disorders after bilateral cochlear implantation

The objective of this study was to investigate the occurrence of vestibular receptor deficiency and taste disorders after bilateral cochlear implantation in postlingually deafened patients and to find out whether the risk for these complications is higher for the second implantation. In a retrospective cohort study, we examined 20 patients (11–58 years, mean age 41.5 years), implanted sequentially between 2000 and 2007 (mean period between cochlear implantation 32.9 ± 25 months). Pre- and postoperative vestibular testing was performed by subjective rating [Dizziness Handicap Inventory (DHI)], caloric irrigation [vestibuloocular reflex (VOR)] and by vestibular-evoked myogenic potential (VEMP) recordings for saccular function. The sense of taste was evaluated pre- and postoperatively by a questionnaire and testing (sour/sweet/bitter/salty bilaterally on the tongue). DHI evaluation showed a moderate not significant mean increase by 2.7 ± 7.7 SD points after the first and a significant increase by 9.4 ± 16.6 SD points after the second implantation. Ipsilateral VEMP responses disappeared in three ears (27.3%) after the first and in two ears (18.2%) after the second operation. VOR disappeared only once (5.9%) after the first implantation. One (5%) patient complained of a persisting disturbance of taste in the questionnaire after unilateral and 3 (15%) after bilateral implantation. Specific testing showed in one case (5%) a unilateral taste disorder after ipsilateral cochlear implantation. Our data show that there is a higher risk for subjective vertigo after the second implantation. The occurrence of unilateral and/or bilateral vestibular dysfunction and the potential risk of taste disorder should be included in the risk counseling before bilateral cochlear implantation to increase patients’ and medicolegal safety in the decision-making process.     

Olfactory and gustatory dysfunctions of COVID‐19 patients in China: A multicenter study

IntroductionWith the spread of the epidemic worldwide, an increasing number of doctors abroad have observed the following atypical symptoms of coronavirus disease 2019 (COVID‐19): olfactory or taste disorders. Therefore, clarifying the incidence and clinical characteristics of olfactory and taste disorders in Chinese COVID‐19 patients is of great significance and urgency.Materials and MethodsA retrospective study was conducted, which included 229 severe acute respiratory syndrome coronavirus 2 confirmed patients, through face‐to‐face interviews and telephone follow‐up. Following the completion of questionnaires, the patients participating in the study, were categorized according to the degree of olfactory and taste disorders experienced, and the proportion of each clinical type of patient with olfactory and taste disorders and the time when symptoms appeared were recorded.ResultsAmong the 229 patients, 31 (13.54%) had olfactory dysfunction, and 44 (19.21%) had gustatory dysfunction. For the patients with olfactory dysfunction, 6 (19.35%) developed severe disease and became critically ill. Olfactory dysfunction appeared before the other symptoms in 21.43% of cases. The proportion of females with olfactory and gustatory dysfunction was higher than that of males (P < 0.001).ConclusionsThe incidence of olfactory and gustatory dysfunction was much lower than that reported abroad; the prognosis of patients with olfactory dysfunction is relatively favorable; olfactory and gustatory dysfunction can be used as a sign for early screening; females are more prone to olfactory and gustatory dysfunction.     

Objective assessment of terbinafine-induced taste loss

OBJECTIVES: Terbinafine (Lamisil), a widely prescribed oral antifungal agent, reportedly induces taste loss in 0.6% to 2.8% of those taking the drug. However, many so-called taste problems reflect olfactory problems, and the sole empirical study published on this topic, based on whole-mouth testing of a single subject, found no terbinafine-related deficit. In this study, we quantitatively assessed, using well-validated taste and smell tests, chemosensory function in six patients complaining of taste disturbance after terbinafine treatment and compared their test scores to those of six age-, race-, and sex-matched normal controls. METHODS: Taste function was measured using a 96-trial regional test that assesses sweet, sour, bitter, and salty taste perception within the anterior (cranial nerve [CN] VII) and posterior (CN IX) lingual taste bud fields. Smell function was bilaterally evaluated using the 40-item University of Pennsylvania Smell Identification Test. RESULTS: Taste function for sweet-, sour-, and bitter-tasting stimuli was significantly depressed in both the anterior and posterior lingual regions. For sodium chloride, the decrements were confined to the posterior region. Olfactory function was within normal limits. CONCLUSION: These findings 1) support anecdotal case reports of taste loss after terbinafine use, 2) demonstrate that all four major taste qualities are affected, and 3) suggest that olfactory dysfunction is not involved. Because self-report markedly underestimates chemosensory deficits, more extensive quantitative testing of patients receiving terbinafine will likely reveal a much higher prevalence of terbinafine-induced taste loss than currently reported. Since being older than 65 years of age and having a low body mass index are reportedly risk factors for terbinafine-induced taste loss, physicians should be particularly on the alert for elderly persons taking this medication who may become depressed or alter their food intake in response to decreased taste sensation.     

Evaluation of Greater Petrosal Nerve Function in Patients with Acute Peripheral Facial Paralysis: Comparison of Soft Palate Electrogustometry and Schirmer's Tear Test

We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM.     

Evaluation of greater petrosal nerve function in patients with acute peripheral facial paralysis: comparison of soft palate electrogustometry and Schirmer's tear test

We tested sensory and secretomotor function of the greater petrosal nerve (GPN) by means of electrogustometry (EGM) of the soft palate and Schirmer's tear test in 115 patients (59 males, 56 females) with acute peripheral facial paralysis. Facial paralysis was caused by Bell's palsy in 78 cases, Ramsay Hunt syndrome in 27 cases and zoster sine herpetic lesions in 10. All patients had dysfunction of the stapedial nerve. An electrogustometer was used to test taste (GPN sensory function), and elevation of the threshold by > 6 dB on the affected side was considered abnormal. Schirmer's test was used to evaluate lacrimal (GPN secretomotor) function, which was considered abnormal when tear secretion on the affected side was < 50% of secretion on the non-affected side. Of the 78 patients with Bell's palsy, 28.2% had altered taste on the soft palate (sensory dysfunction) and 10.3% had lacrimal dysfunction, indicating that EGM of the soft palate is more sensitive than Schirmer's test for identifying dysfunction of the GPN in patients with facial paralysis due to Bell's palsy. Of the total of 115 patients, 32 (28%) had taste dysfunction and 9 (28.1%) of these 32 patients also had lacrimal dysfunction. This finding indicates that facial paralysis has different effects on the sensory and secretory nerve fibers of the GPN. The results of Schirmer's test were more closely related to the severity of, and prognosis for, facial paralysis than the results of EGM.     

Taste function after stapes surgery

Objective

A manipulation of chorda tympani nerve (CTN) is frequently necessary during the surgical therapy of stapedial ankylosis. The aim of this study was to re-assess the taste function before and after stapes surgery in patients with unilateral stapes ankylosis.

Methods

Eighteen patients (14 female and 4 male) with unilateral stapedial ankylosis were included. Taste and olfactory function were measured preoperatively, 3 days and 3 months after surgery by questionnaire, chemical taste test, electrogustometry, and Sniffin'Sticks. The patients who reported deterioration in taste and revealed pathological taste test results were re-investigated 8–12 months after surgery. Postoperatively 11 patients were treated intravenously for 3 days for inner ear protection with 1 g of cortisone. The gustatory and olfactory results were compared with age and sex specific normative data.

Results

A significant transient decrease of gustatory measurement values was found on the ipsilateral two thirds of the anterior tongue. 12 out of 17 patients whose CTN was slightly manipulated during stapes surgery reported tongue sensations, such as numbness or gustatory blindness of the ipsilateral tongue side. The measures of chemical taste test significantly decrease in lateralized taste test on the ipsilateral side and in whole mouth testing. There was no significant increase of the EGM measures at the ipslateral tongue. In 11 of 12 patients with symptoms, complaints recovered within one year after surgery completely. The factor “cortisone” did not have a significant effect on the taste test results after surgery.

Conclusion

In conclusion, even after minor CTN manipulation the rate of postoperative taste disorders or tongue symptoms after stapes surgery is high. The symptoms appear to be transient. Therefore CTN should be preserved in stapes surgery after mild trauma of the CTN. Transient taste alteration should be mentioned prior to stapes surgery.     

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...     

Evaluation of smell and taste in patients with Wegener’s granulomatosis

Although a reduced olfactory/gustatory function affects patients in all parts of life, this problem has not received much attention in Wegener’s granulomatosis (WG). The aim of this study was to assess the smell/taste function of WG patients. Demographic data of 16 WG patients (9 males, 7 females) were obtained. They all subjectively assessed their taste/smell function on visual analogue scale. Olfactory/gustatory functions of the patients were tested with ‘Sniffin’ Sticks and ‘Taste’ strips, respectively. The results were then compared with those from sex and age-matched control group (n = 16) and normative data. WG patients subjectively assessed their olfactory (p = 0.03) and gustatory (p = 0.02) function to be lower than control group. All the olfactory scores (odour identification, odour discrimination and threshold) in both genders were significantly below the scores in the control group. WG patients were hyposmic. For taste (total taste score, as well as scores for the qualities sweet, sour, salty and bitter), WG patients did not significantly differ from controls and were normogeusic. However, the gustatory scores showed the tendency of reduction as compared to the control group. In conclusion, WG patients truly suffer from olfactory/taste dysfunction, but this is worse with olfaction. It is, therefore, imperative that physicians should make their patients to be aware of these sensory dysfunctions and educate them on methods to cope with it for better quality of life.     

Secretory Function of the Salivary Gland in Patients with Taste Disorders or Xerostomia: Correlation with Zinc Deficiency

A notable proportion of patients with taste disorders complain of xerostomia and when zinc is prescribed the xerostomia is often improved in conjunction with the taste disorder. To study the relationship between taste disorders, zinc deficiency and xerostomia, we measured salivary gland function and zinc levels in 93 patients with hypogeusia and/or xerostomia and 60 patients with unilateral acute peripheral facial palsy who served as controls. We then prescribed zinc for patients with low serum zinc levels and evaluated xerostomia and taste sensation after 6 months of this treatment. The salivary gland secretory ratio (SGSR), determined by dynamic salivary 99mTc scintigraphy, was found to be an objective measure of salivary gland function and was reduced in patients with xerostomia. Patients with salivary gland dysfunction also had abnormal morphology of the papillae of the tongue. No significant relation was found between the severity of taste disorders and SGSR values, but low SGSR values were found in patients with zinc deficiency. Patients with taste disorders and/or xerostomia who were treated with zinc had relief of symptoms at 6 months, indicating that both taste disorders and xerostomia are among the symptoms of zinc deficiency.     

Secretory function of the salivary gland in patients with taste disorders or xerostomia: correlation with zinc deficiency

A notable proportion of patients with taste disorders complain of xerostomia and when zinc is prescribed the xerostomia is often improved in conjunction with the taste disorder. To study the relationship between taste disorders, zinc deficiency and xerostomia, we measured salivary gland function and zinc levels in 93 patients with hypogeusia and/or xerostomia and 60 patients with unilateral acute peripheral facial palsy who served as controls. We then prescribed zinc for patients with low serum zinc levels and evaluated xerostomia and taste sensation after 6 months of this treatment. The salivary gland secretory ratio (SGSR), determined by dynamic salivary 99mTc scintigraphy, was found to be an objective measure of salivary gland function and was reduced in patients with xerostomia. Patients with salivary gland dysfunction also had abnormal morphology of the papillae of the tongue. No significant relation was found between the severity of taste disorders and SGSR values, but low SGSR values were found in patients with zinc deficiency. Patients with taste disorders and/or xerostomia who were treated with zinc had relief of symptoms at 6 months, indicating that both taste disorders and xerostomia are among the symptoms of zinc deficiency.     

A ChemoSensory questionnaire for patients treated for cancer of the head and neck

OBJECTIVES: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ). DESIGN: Cross sectional survey for questionnaire development and testing. METHODS: Literature, expert opinion, and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed, and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire (HRQOL) to a sample of patients. After item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. RESULTS: Two hundred six patients were included in the study. The final survey instrument consisted of eight items, four on smell and four on taste. Cronbach's alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated. CONCLUSIONS: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and is brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance.     

Subjective improvement of olfactory function after endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: The purpose of this study was to determine the effect of functional endoscopic sinus surgery (FESS) on subjective olfactory dysfunction in patients with chronic rhinosinusitis.Materials and methods Prospective collection of data on consecutive patients undergoing FESS after failing prolonged medical therapy for chronic rhinosinusitis at a tertiary institution. Patients were asked to grade their olfactory dysfunction from 0 to 10, with 0 representing normal function and 10 complete anosmia. In addition, data such as computed tomography scores, presence or absence of nasal polyps, and the presence or absence of asthma were recorded and analyzed. Patients were followed up to 1 year after surgery. RESULTS: Data were collected on 178 patients who had sinus surgery over a 2-year period. The average olfactory dysfunction score before surgery was 4.9. This improved to 0.9 at 1 year after surgery (P =.00). Higher computed tomography scores as per Lund and MacKay correlated with higher olfactory dysfunction scores (r = 0.62, P <.01) and greater improvement after surgery (r = 0.82, P <.01). Asthmatics and patients with polyps had higher subjective olfactory dysfunction scores than nonasthmatics and patients without polyps (6.8 and 7.2 v 4.4 and 4.1, respectively). All groups had subjective improvement at 1 year (2.3 and 1.5 v 0.6 and 0.7, respectively; P =.00). CONCLUSION: Patients with subjective olfactory dysfunction despite appropriate medical management for rhinosinusitis benefit from FESS.     

Gustatory function in chronic inflammatory middle ear diseases

HYPOTHESIS: Changes of gustatory function after ear surgery have been studied extensively. However, little is known on the influence of repeated/chronic inflammation within the middle ear on taste. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: Forty-six patients suffering from either cholesteatoma (n = 25) or chronic otitis media mesotympanalis (n = 21) received quantitative gustatory tests. None of these patients had been operated on before these investigations. RESULTS: Side by side comparison showed a significantly lower taste function on the anterior two thirds of the tongue ipsilateral to the site of inflammation, regardless of the diagnosis. Further analyses exhibited a trend toward greater impairment in relation to the severity of the inflammatory process. CONCLUSION: These data are proof that taste function changes in relation to chronic middle ear diseases. It further shows that many of these alterations go unnoticed by the patients.