Olfactory and gustatory disturbances caused by digitalism: a case report

It is known that an overdose of digoxin causes visual disturbance, but the effect on the senses of smell and taste is not known. A case of olfactory and gustatory disturbance caused by digitalism is reported. In a 62-year-old male patient suffering from chronic digitalism, the serum digoxin level rose to 6.0 ng/ml. The patient was diagnosed not only with visual disturbance but also hyposmia and hypogeusia. The patient recovered from visual and chemosensory disturbances after the serum digoxin concentration returned to normal. Because the similarity of intracellular signal transduction between photoreceptor cells and olfactory and/or taste receptor cells is known, it is suspected that the influence of digoxin to chemosensory organs was caused by intermediation of sodium–potassium–adenosine triphosphatase (Na–K–ATPase) of the chemosensory receptor cells.     

Taste disturbance after tonsillectomy and laryngomicrosurgery

OBJECTIVE: To investigate the incidence of taste disturbance after tonsillectomy and laryngomicrosurgery. STUDY DESIGN: A prospective study. METHODS: Thirty-five consecutive patients underwent tonsillectomy with electric coagulator at Kanebo Memorial Hospital from September 2002 to May 2004. Another 35 consecutive patients underwent laryngomicrosurgery in a routine way during the same period. Both procedures were performed by two experienced doctors. The postoperative taste function was evaluated with questionnaire, electrogustometry (EGM), and serum levels of Zn, Cu and Fe. RESULTS: After tonsillectomy, 3/35 patients (8.6%) complained of taste disturbance, due to the pressure on the tongue in two, and Zn deficiency after lack of intake in one. All three patients recovered taste within 1.5 months. None of our patients had taste disturbance due to surgical insult of the lingual branch of the glossopharyngeal nerve. After laryngomicrosurgery, only one patient (2.9%) complained of taste disturbance with elevation of the EGM threshold that resulted from the pressure on the tongue. In addition, abnormal sensation in the tongue occurred in 9 cases (25.7%) after tonsillectomy and in 2 cases (5.7%) after laryngomicrosurgery, and feeling of thirst occurred in 12 cases (34.3%) and in 8 cases (22.9%), respectively. CONCLUSION: Taste disturbance occurs in few cases when experienced surgeons perform tonsillectomy or laryngomicrosurgery. However, it is recommended to inform the patients of the potential postoperative complications such as taste disturbance and abnormal sensation of the tongue.     

变应性鼻炎中嗅觉障碍的研究进展

单纯变应性鼻炎导致的嗅觉障碍不仅是机械阻塞的结果，鼻粘膜嗜酸粒细胞炎症可能是更主要的原因。变应性鼻炎合并鼻窦炎和鼻息肉者，其嗅觉障碍的原因可能为机械阻塞加炎症。通过综述国内外相关文献，以期对炎症因素在变应性鼻炎嗅觉障碍发病机制中的作用以及变应性鼻炎的诊断和治疗原则作一阐述和初步探讨。     

药物治疗慢性鼻-鼻窦炎嗅觉障碍的疗效观察

目的 观察药物治疗慢性鼻-鼻窦炎嗅觉障碍的疗效。方法 对本院2006年1月～2008年8月26例慢性鼻-鼻窦炎（不伴鼻息肉）嗅觉障碍患者进行回顾性分析。减充血剂、抗炎、抗感染、黏液促排药物治疗20例,在此基础上给予全身激素及营养神经治疗5例,全身激素、营养神经及抗病毒治疗1例。治疗前后行嗅觉测试、鼻窦CT和鼻内镜检查。结果 本组26患者中24例治愈,治愈率92.00％,平均治疗时间25.64d。结论 以嗅觉障碍为主诉的慢性鼻-鼻窦炎,根据病因,选择正确的治疗方案,可获满意治疗效果。     

突发性聋与铁代谢障碍疾病关系的临床调查

对１９７９年７月至１９９６年６月的突发性聋发病情况进行前瞻性研究与回顾性分析，探讨突聋与铁代谢障碍疾病的关系，前瞻性研究的对象分为铁代谢障碍疾病组２１８例，血液病组２１５例和正常对照组４８５０例；回顾性分析为１７年间资料完整的４２９例突聋患者史的代谢障碍疾病及其他血液病的发病情况。结果表明，铁代谢障碍疾病组的突聋调整年发病率显著高于血液病组以及正常对照组，４２９例突聋患者的无贫血缺铁，缺铁性人同血     

A pilot study of quantitative aspiration in patients with symptoms of obstructive sleep apnea: comparison to a historic control group

OBJECTIVE: It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal aspiration. STUDY DESIGN: A prospective study in which patients with symptoms of OSA were compared with a historic group of normal controls by using the same methodology. METHODS: The study was offered to patients with symptoms of OSA undergoing a sleep study. The radiotracer Technicium was infused through a plastic tube placed in the nasopharynx after the patient achieved stage II sleep. A chest radionuclide scan determined the amount of material aspirated. The Wilcoxon-rank sum test was used to compare the mean amount aspirated between the experimental and historic control groups. RESULTS: Fourteen patients successfully completed the study. One normal volunteer in our study aspirated a quantity similar to the historic normal control group. The amount of aspirated material in the study group ranged from 0.152 to 3.648 mL, with a mean of 1.24 mL +/- 0.905 (SD). When compared with the historic normal control group, the patients with symptoms of OSA aspirated significantly more radio-tracer (P <.01). There was a lack of association between respiratory disturbance index and amount aspirated. CONCLUSIONS: The results suggest there is an apparent risk of increased pharyngeal aspiration in patients with symptoms of OSA.     

Paranasal sinus mucoceles with visual disturbance

Objective

Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease.

Methods

We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients.

Results

Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery.

Conclusions

These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.     

Examination and classification of human olfactory mucosa in patients with clinical olfactory disturbances

Summary To determine objectively the degree of olfactory disturbance, we biopsied the olfactory mucosa from patients who complained of anosmia. The olfactory disturbances in this study were caused by choanal atresia, chronic sinusitis, viral inflammation, and head trauma, as well as by congenital and idiopathic anosmia. The biopsy specimens were examined by light microscopy and the degree of mucosal degeneration present was classified according to five grades. The clinical courses of the patients studied paralleled the changes found in the olfactory mucosa.     

Infraorbital nerve recovery after minimally dislocated facial fractures

There is evidence that rigid fixation of zygomaticomaxillary suture enhances the recovery of the infraorbital nerve compared with other means of surgical treatments. There is, however, no agreement as to whether any surgery decreases the number of sensory disturbance in cases with little or no dislocation, or whether infraorbital numbness alone should be considered an indication for surgery. An operation may even increase the edema and hemorrhage around the nerve. This retrospective study was carried out among patients with infraorbital hypesthesia but little or not at all dislocated midfacial fractures. Two special types of trauma patients were selected; those with a blow-out fracture but an intact infraorbital rim (BO) and those with a zygomaticomaxillary complex fracture (ZMC). A questionnaire was sent to the patients (n = 226) 2.2 years (mean) after the accident. There were 128 responses (BO n = 41, ZMC n = 87). Of these, 27 BO and 29 ZMC patients had been treated by observation. An orbital exploration had been carried out in 14 BO patients, and 58 ZMC patients had received malar bone elevation without rigid fixation. At the end of the follow-up period nontreated patients had fewer symptoms than those who had had surgery. This was clearer in the ZCM group (symptom free 69% vs. 52%) than in the BO group (69% vs. 50%). The differences between surgically and nontreated BO or ZMC patients, however, were statistically nonsignificant. According to our findings, exploration of the orbital floor or an attempted elevation of a minimally or nondislocated fracture of the ZMC does not enhance the recovery of the infraorbital nerve. On the contrary, the procedure may itself increase the morbidity and sensory dysfunction. Further studies are needed to determine whether the results could be improved by selective decompression of the infraorbital nerve and a rigid fixation. Received: 22 December 1999 / Accepted: 30 May 2000     

The prevalence of psychological disturbance in neuro-otology outpatients

This study assesses the prevalence of psychological disturbance among a consecutive series of 120 neuro-otology outpatients, using a structured interview conducted by a clinical psychologist. 42% of all patients were found to be in need of, and were offered, psychological help (27% of those with hearing loss, 45% of those with tinnitus and 64% of those with dizziness). 86% of those offered psychological help accepted it. Current psychological distress was associated with the number of symptoms complained of and past psychiatric history. Patients completed the General Health Questionnaire which was found to have a sensitivity rate of 82% and a specificity rate of 87% in this setting. Physicians were also asked to rate patients' psychological state; close agreement was found between these ratings and those of a psychologist. The contribution of psychological assessment of neuro-otology patients is discussed.     

Correlation between anthropometric measurements of the oropharyngeal area and severity of apnea in patients with snoring and obstructive sleep apnea

The aim of this study was to investigate the relationship between severity of apnea and anthropometric oropharyngeal measurements in patients with snoring and obstructive sleep apnea. A total of 22 patients complaining of snoring and apneic spell during sleep were evaluated by polysomnographic and anthropometric measurements of the oropharyngeal area. The horizontal width of the uvula at the mid-point and the length of the uvula were measured using a T-shaped ruler. The distance between the anterior pillars, posterior pillars and retromolar raphes were also measured. The correlation between these anthropometric measurements and polysomnographic parameters including the respiratory disturbance index (RDI) and the lowest arterial O₂ saturation level (lowest SaO₂) of the patients were analyzed. Of the anthropometric measurements, the horizontal width of the uvula showed a significant correlation with RDI and lowest SaO₂. The results of the present study indicate that patients with broader uvula may have severer sleep apnea and that anthropometric oropharyngeal measurements may give additional information to polysomnographic findings for selecting surgical candidates.     

The effect of vestibular rehabilitation on sleep disturbance in patients with chronic dizziness

Conclusions: Improvement in sleep, emotional distress, and health-related quality-of-life (QoL) accompanied the improvement in dizziness symptoms after vestibular rehabilitation. Persistent sleep disturbance could prevent improvements in self-perceived handicap due to chronic dizziness and anxiety.

Objective: The present study investigated prospectively the effects of intervention for dizziness (vestibular rehabilitation) on sleep disturbance, and the relationship between improvements in dizziness symptoms and improvements in sleep disturbance after the intervention.

Methods: The participants of this study were 127 chronic dizziness inpatients with comorbid sleep disturbance (Pittsburgh sleep quality index [PSQI-J] global score ≥6). Participants completed the Dizziness Handicap Inventory (DHI, three sub-scales: Physical, Emotional, and Functional), PSQI-J, Hospital Anxiety and Depression Scale (HADS), and SF-8 (health-related QoL), and underwent gravity center fluctuation measurement before (time 1) and 1 month after (time 2) an in-hospital rehabilitation program.

Results: All measured variables were significantly improved at time 2, compared to time 1. At time 2, 80.31% of patients still reported sleep disturbance. Analysis of covariance showed that chronic dizziness patients with sleep disturbance at time 2 had significantly higher DHI total, DHI-physical, and HADS-anxiety scores at time 2 than patients without sleep disturbance at time 2, after adjusting for these scores at time 1.     

声门闭合不良4种发声方式频率与正常人对比分析

目的 :了解声门闭合不良 4种发声方式 (最低音、舒适音、真声最高音和假声最高音 )和不同发音持续最大时间 (最大声时 )的频率变化参数。方法 :用 2 0 3 1型频谱分析仪检测 15 0例功能性声门闭合不良患者 4种发声方式的频率 ,并与正常男女各 3 0例作对比。结果 :从整体看 ,男女最低音的频率 ,闭合不良者明显高于正常人 ,假声最高音的频率则前者明显低于正常人 ;按最大声时不同与正常人比 ,总的趋势是随着最大声时延长 ,最低音和舒适音的频率下降 ,真声和假声最高音的频率上升 ,且有的组间对比差异显著。结论 :声门闭合不良患者发低音和高音的功能同时下降 ;其低音与高音功能随最大声时的延长而增强     

Sphenoid marsupialization for chronic sphenoidal sinusitis

OBJECTIVES: To review experience with sphenoid marsupialization and describe the technique using new instrumentation. STUDY DESIGN: Retrospective review of five cases of chronic sphenoid sinusitis that were resistant to standard medical and surgical methods, which were treated by sphenoid marsupialization. METHODS: Charts were reviewed and patients were interviewed regarding postoperative resolution of symptoms. RESULTS: Five cases of recalcitrant sphenoid sinusitis were reviewed. All patients had headache before surgery, and two had visual disturbance. In follow-up ranging from 1 to 87 months, all were free of symptoms related to the sphenoid sinus. CONCLUSIONS: Marsupialization is an effective method of exteriorizing a chronically infected sphenoid sinus. The use of functional endoscopic sinus surgery instruments and the TAC attachment of the Midas Rex drill make this surgery possible.     

A Case of Cronkhite-Canada Syndrome Whose Major Complaint,Taste Disturbance,Was Improved by Zinc Therapy

A patient whose major complaint was taste disturbance and who was diagnosed as having Cronkhite-Canada syndrome was prescribed zinc sulfate. Improvement in taste disturbance was noted after 3 weeks of treatment, followed by gradual improvement in skin and gastrointestinal symptoms. Cronkhite-Canada syndrome can be considered a zinc-deficiency disorder caused by gastrointestinal polyposis.     

A case of Cronkhite-Canada syndrome whose major complaint,taste disturbance,was improved by zinc therapy

A patient whose major complaint was taste disturbance and who was diagnosed as having Cronkhite-Canada syndrome was prescribed zinc sulfate. Improvement in taste disturbance was noted after 3 weeks of treatment, followed by gradual improvement in skin and gastrointestinal symptoms. Cronkhite-Canada syndrome can be considered a zinc-deficiency disorder caused by gastrointestinal polyposis.     

Clinical study of flavor disturbance

OBJECTIVE: We have observed that, in cases of smell loss, patients often complain of taste loss as well even though they actually have normal gustatory acuity according to gustatory tests; we have defined such symptoms as "flavor disturbance". The clinical features of flavor disturbance are reported in this paper. MATERIAL AND METHODS: A total of 297 patients (99 males, 198 females; mean age 55.5 years) were treated for olfactory disturbance at the hospital of Hyogo College of Medicine between July 1995 and August 2001. Sixty-six out of 297 patients (22.5%) also experienced taste disturbance, and 49 of these 66 cases were evaluated by means of smell and taste tests. These 49 patients who complained of taste and smell loss were classified into two groups according to the results of their smell and taste tests. Patients who only complained of olfactory disturbance were also reviewed. RESULTS: There was no relationship between the severity of olfactory disturbance and the degree of flavor disturbance. The incidence of flavor disturbance was high in patients with sudden olfactory disturbance after upper respiratory tract infection or head trauma and low in those with slowly progressive olfactory disturbance. The symptoms of flavor disturbance improved regardless of whether smell was improved or not. CONCLUSIONS: The patients with flavor disturbance tended to misrecognize that they had taste loss because of sudden smell loss, and there were more of these cases than we expected. When patients with smell and taste loss are treated, flavor disturbance should also be considered.     

Pathohistologie des Ductus und Saccus endolymphaticus beim Innenohrhydrops

Summary The morphological substrate of Menière's disease is the endolymphatic hydrops. That can be idiopathic or secondary as a sequence of a labyrinthine disease of another cause. It is possible to coordinate function loss of the sensory end-organs and pathohistological findings, but not all failures are light-microscopically explainable. The reason for the hydrops is certainly a disturbance in the endolymph physiology. For the pathogenesis are important, besides the biochemistry of the inner ear-fluids, problems of the membranes and pathological changes on ductus and saccus endolymphaticus and perimacular areals and plana semilunata. The perilymphatic space, documentated on the example of the secondary hydrops, is certainly not only passively enrolled in the procedure. All observations bring the initation and periodicity of attacks to another point of view. A complete solution hat not been possible so far, especially in the case of the etiology in idiopathic hydrops

Mit Unterstützung des Fonds für wissenschaftliche Forschung in Österreich     

Head shaking nystagmus]

The method of head shaking test and the clinical significance of head shaking nystagmus were studied. A series of 300 patients suffering from dizziness and disturbance of equilibrium and a group of 60 normal persons were investigated. There was no head shaking nystagmus in normal persons. The incidences of head shaking nystagmus were exceedingly higher than those of other methods of nystagmus provocation. The elicited nystagmus was considered as a form of pathologic sign of central lesions if it was of vertical and oblique type. The head shaking test for detection of latent imbalance of vestibular function as well as for the examination of the patients with dizziness and disturbance of equilibrium was stressed.