Characteristics of olfactory disorders in relation to major causes of olfactory loss

OBJECTIVE: To investigate the consequences of olfactory loss and explore specific questions related to the effect of duration of olfactory loss, degree of olfactory sensitivity, and cause of the olfactory loss. PATIENTS: A total of 278 consecutive patients with hyposmia or anosmia were examined. RESULTS: Causes of olfactory loss were categorized as follows: trauma (17%), upper respiratory tract infection (URI) (39%), sinonasal disease (21%), congenital anosmia (3%), idiopathic causes (18%), or other causes (3%). Our data suggest that (1) recovery rate was higher in URI olfactory loss than in olfactory loss from other causes; (2) likelihood of recovery seemed to decrease with increased duration of olfactory loss; and (3) the elderly are more prone to URI olfactory loss than younger patients. Regarding changes in quality of life (QoL), we found that (1) in most patients olfactory loss caused food-related problems; (2) loss in QoL did not change with duration of olfactory loss; (3) younger patients had more complaints than older ones, and women had more complaints than men; (4) complaint scores were higher in hyposmic patients than in anosmic patients; and (5) self-rated depression did not relate to measured olfactory function. CONCLUSIONS: Among many complaints of olfactory loss, the predominant ones were food related. This loss in QoL seemed to be of greater importance in younger than in older people, and women seem to be affected more strongly than men.     

嗅觉训练治疗嗅觉障碍的临床观察

目的初步探讨复杂香味进行嗅觉训练对外伤或上呼吸道感染引起的嗅觉障碍的疗效。方法2016年12月~2018年3月于中国医科大学附属第一医院门诊收治的外伤及上呼吸道感染后嗅觉障碍患者36例,其中男12例,女24例;年龄20~80岁,平均年龄（47.61±16.68）岁,病程3~60个月,平均病程（13.58±13.51）个月。分别按病因分为上呼吸道感染组（19例）和外伤组（17例）,按嗅觉下降程度分为嗅觉下降组（18例）和嗅觉丧失组（18例）。均采用患者自行购买的4种味道明显不同的香水进行嗅觉训练,治疗前后进行嗅觉综合VAS评分,并分别对香味、臭味进行嗅觉评分。用Fisher确切概率法进行统计学分析。结果所有患者均完成治疗方案,总有效率为55.56%（20/36）。嗅觉下降组有效率77.78%（14/18）,嗅觉丧失组有效率33.33%（6/18）,经比较差异具有统计学意义（P<0.05）。上呼吸道感染后嗅觉障碍组有效率73.68%（14/19）,外伤后嗅觉障碍组有效率35.29%（6/17）,经比较差异具有统计学意义（P<0.05）。治疗有效患者中50.00%（10/20）对香味感知的恢复明显优于臭味,经比较差异具有统计学意义（P<0.05）。结论本研究所采用的嗅觉训练方案具有简便易行、灵活度高、患者负担轻、患者依从度高的特点,对嗅觉障碍患者有一定的疗效,其中对有残余嗅觉的患者疗效更显著,上呼吸道感染引起的嗅觉障碍比外伤后的嗅觉障碍更易于恢复。另外,嗅觉训练通常采用香味嗅剂,因而有重要警示作用的臭味嗅觉恢复明显落后于香味,应该受到重视。     

A re-evaluation of the classification of olfactory epithelia in patients with olfactory disorders

Summary We have previously demonstrated that human olfactory epithelia can be classified into five grades according to the degree of degeneration present in patients with various kinds of olfactory disorders. In practice, however, the occurrence of additional types of cell changes in other kinds of olfactory disorders and findings with immunohistochemical techniques have led us to re-evaluate our previous classification. In the present study, changes in olfactory epithelia from ten patients with various kinds of olfactory disorders are discussed and a revised classification is proposed. Microvillar and differentiating cells were also evaluated in the epithelium studied. Correspondence to: M. Yamagishi     

嗅觉障碍与慢性鼻-鼻窦炎患者鼻腔鼻窦形态的相关性研究

目的:观察伴有嗅觉障碍的慢性鼻-鼻窦炎患者鼻腔鼻窦形态及其影像学表现,探讨嗅觉障碍与鼻腔鼻窦形态和影像改变的相关性。方法:对176例慢性鼻-鼻窦炎患者测试嗅觉功能,同时行鼻窦CT和鼻内镜检查,进行Lund-Mackey鼻窦CT评分及Kennedy鼻内镜评分,并观察嗅裂区阻塞情况,对检查及评分结果进行统计学分析。结果:①30例患者嗅觉正常(17.1%),109例患者有不同程度的嗅觉减退(61.9%),37例患者嗅觉丧失(21%);②Lund-Mackey鼻窦CT评分与嗅觉障碍的程度存在正相关(P<0.01);③Kennedy鼻内镜评分的变化与嗅觉障碍程度正相关(P<0.05)。结论:①嗅觉功能障碍与慢性鼻-鼻窦炎相关;②Lund-Mackey鼻窦CT评分系统对于嗅觉障碍的初步判断有一定临床意义;③Kennedy鼻内镜评分系统更侧重于评价鼻腔总体形态的改变。     

Active olfactory training for the treatment of smelling disorders

Olfactory function appears to be influenced by repeated odor stimulation. We conducted a nonrandomized, nonblinded, retrospective study of the impact of an 8-month period of olfactory training in patients with olfactory dysfunction. Our study population was made up of 46 adults-14 men and 32 women (mean age: 59.17 ± 13.25 yr)-with olfactory dysfunction of different etiologies (sinonasal: n = 15; post-upper-respiratory-tract infection [URTI]: n = 16; post-traumatic: n = 7; and idiopathic: n = 8). All patients had been previously treated without success with systemic or topical corticosteroids. For their training, patients exposed themselves to four different odors twice a day. Olfactory function was evaluated at baseline and again at 4 and 8 months, and results were quantified in the form of each patient's TDI (threshold, discrimination, and identification) score. Of the 46 patients, 28 had undergone olfactory training only, while the remaining 18 had received topical corticosteroids in addition to training. At study's end, the mean overall TDI score in the entire group increased by 4.09 points over baseline--a statistically significant increase (p = 0.01); this increase was mainly attributable to improvement in the identification component of the TDI, which increased by 2.51 points (p = 0.02). Among the 18 patients who received a topical corticosteroid in addition to training, the mean TDI increased by 6.83 points (p = 0.001), primarily because of improvements in the discrimination and identification components. The 28 patients who underwent olfactory training alone experienced a mean increase in the identification component of only 2.20 points (p = 0.14) after 8 months. Olfactory function in the post-URTI patients increased significantly at 4 months. We conclude that olfactory discrimination and identification can be enhanced by the addition of a topical corticosteroid to a program of defined, daily, short-term exposure to olfactory training.     

糖皮质激素治疗嗅觉障碍的效果评价

嗅觉功能与人们的生活密切相关.嗅觉障碍会导致患者识别、辨别气味能力降低,食欲下降,情绪低落,甚至会导致其获取危险信息(如食物变质,煤气泄漏等)的能力丧失.嗅觉障碍由多种病冈引起,多个嗅觉味觉研究中心的研究结果显示,上呼吸道感染、鼻和鼻窦疾病以及头部外伤是引起嗅觉障碍最常见的病因[1-2].     

Special characteristics of expert assessment of olfactory and taste disorders]

BACKGROUND: The number of medical expert opinions dealing with smell and taste disorders has continuously increased in recent years. However, an overview of the specific problems and results of those expert opinions has not been published until now. INDIVIDUALS AND METHODS: Olfaction was assessed by multiple subjective tests in 145 individuals with chemosensory dysfunction caused by trauma or occupational and environmental exposures. Additionally, a gustatory test, nasal endoscopy, anterior rhinomanometry, and radiography of the paranasal sinuses were performed. Malignering was diagnosed on a trial of multiple symptoms. Retronasal olfaction was tested using the Güttich gustatory olfaction test. RESULTS: Most of the medical expert opinions have been ordered by professional associations (42%) and insurance companies (28%). Compensation for olfactory dysfunction was claimed after trauma (64%), occupational exposure (23%) rhinosurgical procedures (8%), and laryngectomy (5%). Anosmia or hyposmia was claimed by 66% and 24% of all individuals, respectively. According to the results of the chemosensory tests, 41% of patients suffered from anosmia and 40% had hyposmia. Malignering was registered in 14%. CONCLUSIONS: The study shows that the "characteristic case" is a male in the late fourties, complaining of anosmia initially noticed after an occipital or frontobasal head trauma. The assessment of olfactory deficits related to toxic or chemical occupational exposure is difficult when a latency between the occupational exposure and the onset of chemosensory dysfunction is present. Moreover, interactions between the occupational exposure and nicotine or alcohol abuse must be taken into consideration. Claims for medical liability arose in 3% of the study group after septoplasty and sinus surgery.     

以嗅觉障碍为主要症状的慢性鼻-鼻窦炎临床分析

目的:分析以嗅觉障碍为主要症状的慢性鼻-鼻窦炎患者的临床特征.方法:28例仅有嗅觉障碍患者,影像学检查证实为慢性鼻-鼻窦炎;其中16例(32侧)进行布地奈德混悬剂鼻腔雾化治疗.所有患者均进行治疗前后主观嗅觉识别阈和嗅觉事件相关电位检查.结果:①病程≤12个月和>12个月患者主观嗅觉识别阈差异无统计学意义(P＞0.05),筛窦、上颌窦炎症改变高于蝶窦和额窦(P＜0.01).②治疗后16例(32侧)患者的主观嗅觉识别阈和嗅觉事件相关电位引出率均有显著提高(均P＜0.01),12例(24侧)病程≤12个月的患者治疗后主观嗅觉识别阈恢复情况好于4例(8侧)病程>12个月的患者(P＜0.01).结论:①临床存在仅有嗅觉障碍的慢性鼻-鼻窦炎患者;②布地奈德混悬剂鼻腔雾化治疗可以明显改善慢性鼻-鼻窦炎患者的嗅觉功能.     

Clinical availability of a self-administered odor questionnaire for patients with olfactory disorders

Objective

This study demonstrated statistical correlations between a novel self-administered odor questionnaire (SAOQ) and other olfaction tests in patients with olfactory disorders, and the usefulness of this questionnaire was discussed.

Materials and methods

Between December 2004 and November 2009 (5 years), the SAOQ was completed by 405 healthy people without any nasal diseases (Group A) and 539 patients with an olfactory disorder (Group B) at the Department of Otolaryngology, Hyogo College of Medicine. This was a prospective study. The SAOQ proposed by the Japan Rhinology Society is a self-administered survey consisting of 20 smell-related items: “steamed rice, miso, seaweed, soy sauce, baked bread, butter, curry, garlic, orange, strawberry, green tea, coffee, chocolate, household gas, garbage, timber, stercus, sweat, flower, and perfume”. The normal reference range of scores (%) of the SAOQ was calculated in Group A. To determine whether the results of the SAOQ were correlated with those of visual analogue scale (VAS) and T&T olfactometer, pre- and post-treatment results of the SAOQ and olfaction tests were analyzed.

Results

The questionnaire response rates were 99.5% (403/405 people) in Group A and 95.9% (517/539 patients) in Group B. The statistically normal reference level of the SAOQ was determined as more than 70%. In Group B, the mean pre-treatment SAOQ score (20.4%), VAS score (16.5%), and T&T recognition threshold (5.0) significantly improved to values of 46.7%, 41.1%, and 4.1 after treatments, respectively (n = 249). Both pre- and post-treatment SAOQ scores (ΔQ) had statistically significant relationships with those of VAS and T&T (n = 249).

Conclusion

The utility of the SAOQ as an easy method of estimating olfaction was suggested.