感觉神经性失嗅的磁共振成像评估

失嗅分为传导性、感觉神经性以及混合性。由于鼻腔鼻窦的病变影响气流到达嗅区导致的传导性失嗅临床最为常见，但其病因、诊断比较明确，治疗以及预后较好。感觉神经性失嗅一直是临床研究的难点。磁共振成像（MRI）用于嗅觉系统检查早期用于Kallmann综合征检查，而且技术比较成熟。我们对先天性失嗅、外伤后失嗅以及感冒后失嗅、特发性失嗅的病人行嗅路MRI检查，以探讨MRI对感觉神经性失嗅的评估价值。     

孤立性蝶窦良性病变诊断和经鼻内镜下治疗

目的 探讨孤立性蝶窦良性疾病的诊断和治疗.方法 对24例孤立性蝶窦痰病患者其临床表现及治疗经过进行分析,均行鼻内镜下蝶窦手术.结果 24例中囊肿6例,真菌性蝶窦炎18例.全部患者经CT或MRI检查及术后病理检查确诊.经鼻内镜下行蝶窦开放清理术,24例术后所有症状先后缓解或消失.结论 孤立性蝶窦良性病变易误诊、漏诊.诊断本病有赖于CT和MRI检查,鼻内镜手术是治疗本病的首选术式.     

鼻内镜下孤立性蝶窦良性疾病的诊治

目的 提高对孤立性蝶窦良性疾病症状、体征的认识和首诊准确率。方法 分析32例孤立性蝶窦良性疾病的临床表现和手术方法与途径及病人总的治疗与恢复情况。结果 经鼻内镜蝶窦开放术，治愈27例，其中17例手术后症状立即消失，10例术后3-5d症状消失;好转5例，仅感轻微头痛和嗅觉失灵，鼻内镜见窦口黏膜肿胀。术后1个月复诊窦口开放率为93.75%（30/32），所有病例均随访6-48个月无病变及症状复发，CT/MRI复查未见窦腔病变。未再次手术。结论 孤立性蝶窦良性疾病经CT或MRI等高清晰度的影像学检查加之以鼻内镜检查可明确诊断，且鼻内镜下经蝶筛隐窝入路手术具有视野清晰、安全有效的优点。     

孤立性蝶窦病变诊治的回顾性分析

目的探讨孤立性蝶窦疾病的临床特征、诊断及合理的治疗方法。方法回顾性分析我科2003~2008年19例孤立性蝶窦病变患者的临床资料并文献复习。结果19例患者术前均经CT、MRI及鼻内镜确诊。术后病理慢性蝶窦炎10例,蝶窦囊肿2例,真菌性蝶窦炎7例。19例全部治愈。结论CT及MRI检查和鼻内镜的应用,为蝶窦病变诊断提供有力依据,经鼻窦内镜微创手术具有径路安全,视野清楚,痛苦小,疗效肯定,术后不易复发等优点。     

鼻内镜下治疗孤立性蝶窦病变30例临床体会

目的总结鼻内镜下治疗孤立性蝶窦病变临床体会。方法回顾性分析30例鼻内镜下治疗孤立性蝶窦病变患者的手术方法及治疗效果。结果 30例患者术前均经CT或MRI检查及鼻内镜检查,8例病理报告可见大量真菌菌丝,未侵及黏膜基底层;炎症6例;黏膜囊肿6例;黏液囊肿4例;脓囊肿1例;骨瘤1例;软骨瘤1例;内翻性乳头状瘤1例;高分化鳞状细胞癌1例;嗅母细胞瘤1例。30例均临床治愈,无并发症。结论鼻内镜下行保留中鼻甲经嗅沟径路进行蝶窦开放术治疗孤立性蝶窦病变,安全、有效、并发症少,是治疗孤立性蝶窦疾病的首选术式。     

鼻内镜下孤立性蝶窦后鼻孔息肉诊治探讨

目的:探讨孤立性蝶窦后鼻孔息肉的诊断及鼻内窥镜下手术方法,提高诊治水平.方法:收治孤立性蝶窦后鼻孔息肉患者3例,回顾性分析临床资料.结果:3例术前均行鼻窦CT及鼻内镜检查;明确诊断后在鼻内镜下手术,查清根蒂起源,开放窦口,彻底咬除息肉根蒂.3例经随访6个月,蝶窦黏膜光滑,无复发,均治愈.结论:鼻窦CT及术前鼻内镜检查是确定后鼻孔息肉根蒂起源的主要方法;鼻内镜下彻底钳除蝶窦口周及窦内息肉根蒂是蝶窦后鼻孔息肉手术治疗的重点,是防止术后复发的关键.     

鼻内镜下鼻腔径路处理孤立性蝶窦病变

蝶窦是4个鼻窦位置最深的一个鼻窦,居于头颅的中央,周围毗邻重要器官.且蝶窦病变的症状无特异性,因此临床上容易被忽视和漏诊,在过去相当长的时间里,人们对蝶窦病变的诊断和治疗缺乏足够的认识,特别是孤立性蝶窦病变的文献报导更少.近年来,随CT及MRI等影像学检查的广泛应用和鼻内镜技术的普及,临床对于本病的确诊率和治疗效果有了显著提高.我院在2004年2月～2009年12月共收治孤立性蝶窦病变患者18例.均由CT确诊,并经鼻内镜手术治愈.现报告如下.     

鼻内镜下孤立性蝶窦良性疾病的诊治

目的提高对孤立性蝶窦良性疾病症状、体征的认识和首诊准确率。方法分析32例孤立性蝶窦良性疾病的临床表现和鼻内镜手术32例的手术。结果经鼻内镜蝶窦开放术,治愈27例,其中17例手术后症状立即消失,10例术后3～5d症状缓解;好转5例其中3例仅感轻微头痛和嗅觉失灵,鼻内镜见窦口黏膜肿胀。CT/MRI复查未见窦腔病变。术后1个月复诊窦口开放率为93.75%(30/32),随访6～48个月无病变及症状复发,未再次手术。结论孤立性蝶窦良性疾病经CT或MRI等高清晰度的影像学检查加之以鼻内镜检查均可明确诊断,且经鼻内镜手术对其治愈有显著的优越性。     

鼻内窥镜在真菌性鼻窦炎治疗中的应用

目的 探讨鼻窦真菌的病因、诊断及合理的手术方式.方法 总结分析31例经病理诊断为鼻窦真菌患者的病史、临床表现、鼻窦 CT、鼻腔内病变的特点和鼻内镜手术后的疗效.结果 31例经鼻内镜手术患者治愈28例,好转3例,无复发. 结论 鼻窦真菌并非少见,鼻窦CT和鼻内窥镜检查是诊断的主要依据,最终确诊还需病理学检查,鼻内窥镜下病灶清除术、及充分引流是治疗此病首选术式.     

孤立性蝶窦病变22例的诊治体会

目的 探讨孤立性蝶窦病变的临床诊断与鼻内镜微创手术.方法 孤立性蝾窦病变患者22例,在鼻内镜下采用Stryker电动吸切器扩大蝶窦自然口或直接开放蝶窦前壁处理蝶窦病变.结果 术后病理证实,蝶窦炎10例,蝶窦真菌病6例,蝶窦囊肿5例,蝶窦息肉1例.22例均治愈,无脑脊液漏、术中大出血及视神经损伤等并发症的发生,随访6个月以上,未见病变复发.结论 对不明原因头痛头昏、眼部症状及抽吸性血痰者应尽早行鼻窦CT扫描或MRI检查,以期早期确诊.鼻内镜下上鼻道径路配合切割吸引器使用行蝶窦开放术是治疗孤立性蝶窦病变最直接、安全并有效的微创手术方法.     

嗅觉正常与失嗅者嗅觉事件相关功能磁共振成像的观察

目的 应用事件相关功能磁共振成像技术初步研究人嗅觉脑活化区.方法 受试者15人,均右利手,其中健康年轻志愿者10人,完全失嗅患者5例.受试者行耳鼻咽喉科常规体格检查以及T&T主观嗅觉测试.功能磁共振采用事件相关设计,以醋酸异戊酯为刺激剂,通过呼吸同步式嗅觉刺激器释放刺激,刺激间隔60 s,刺激10次.功能磁共振成像扫描采用梯度回波平面回波成像序列.SPM2处理图像数据.结果 嗅觉正常受试者能得到气味刺激脑功能活化区,完全失嗅患者无脑活化区.嗅觉正常受试者得到的脑活化区位于:梨状皮质、眶额回、杏仁体、扣带回、额回、颞回、基底核、丘脑和岛回.右侧脑活化部位明显多于左侧,右侧总活化像素为314,左侧为57.结论 嗅觉事件相关功能磁共振是能直接反映嗅皮质活化的客观嗅功能测试,具有临床应用价值,同时对于揭示嗅觉中枢处理有重要意义.     

醋酸异戊酯刺激相关嗅觉诱发电位对先天性嗅觉失患者嗅觉功能的评价

目的 通过先天性嗅觉缺失患者事件相关嗅觉电位（ＯＥＰ）及与临床嗅觉功能检查的研究,进一步探讨ＯＥＰ的起源。方法对９例先天性缺失患者及９例性别年龄匹配的正常人进行了嗅觉功能的评价,包括ＯＥＰ测定、标准的嗅觉识别评分和对３种气味的嗅觉阈值检查;纯嗅觉刺激乙醇（ＰＥＡ）、刺激嗅神经同时中等程度刺激三叉神经的醋酸异戊酯（ＩＡＡ）和强烈刺激三叉神经的氯乙酚（ＣＡＰ）。结果 嗅觉识别评分两组之间差异有非常显著     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection （URI）. Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials （OERPs） recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrophysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.     

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection

Background Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). Methods We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. Results An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. Conclusions We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrephysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.