病毒感染后嗅觉障碍和慢性鼻窦炎伴嗅觉障碍患者的焦虑抑郁状态及影响因素分析

目的　观察病毒感染后嗅觉障碍（postviral olfactory dysfunction,PVOD）患者和慢性鼻窦炎（CRS）伴嗅觉障碍患者的情绪障碍状况,比较这两种疾病导致的嗅觉障碍引起的患者情绪障碍是否有差异及相关影响因素。方法　自2020年11月～2021年8月在中日友好医院耳鼻咽喉头颈外科,对门诊的PVOD患者（n=20）和住院的CRS伴嗅觉障碍患者（n=43）进行研究。收集患者的年龄、性别、病程、发病方式等人口学和临床资料,采用鼻腔鼻窦结局测试-22（sino-nasal outcome test-22,SNOT-22）、T&T嗅觉功能测试、Zung焦虑自评量表（self-rating anxiety scale,SAS）和Zung抑郁自评量表（self-rating depression scale,SDS）分别评估患者的鼻部症状、嗅觉功能、焦虑和抑郁状态。结果　PVOD患者的平均SNOT-22评分、嗅觉察觉阈及嗅觉识别阈分值均低于CRS伴嗅觉障碍患者（17.64±6.42 vs 30.42±12.08、1.58±3.42 vs 3.40±3.52和3.58±3.07 vs 2.16±3.51）（P 均<0.05）,但PVOD患者焦虑抑郁状态的百分比、SAS评分和SDS评分均高于CRS伴嗅觉障碍患者（45% vs 14%、49.83±6.59 vs 43.97±4.50、52.21±7.83 vs 46.40±9.50）（P 均<0.05）。PVOD和CRS伴嗅觉障碍患者出现轻度焦虑的百分比分别为45.0%和11.63%,轻度抑郁分别 为20%和11.63%,中度抑郁百分比分别为20%和2.33%,焦虑且抑郁分别为30%和2.33%。PVOD患者中多数患者病程＜3个月（75%）、多为突然发病（85%）、鼻腔通气情况多为良好（85%）,而CRS伴嗅觉障碍患者中多数患者病程＞24个月（65.1%）、发病方式多为缓慢发病（76.7%）、鼻腔通气情况多数为差（69.8%）;PVOD患者SNOT-22评分与SDS评分呈正相关（P <0.05）,与SAS评分无显著相关性,CRS伴嗅觉障碍患者SNOT-22评分与SAS、SDS评分均呈正相关（P <0.05）,两种疾病与T&T评分、性别、发病方式及鼻部通气情况均无显著相关性。将PVOD和CRS伴嗅觉障碍患者（n=63）汇集在一起进行Logistic多元回归分析发现嗅觉障碍病程与SAS和SDS评分均呈负相关（P <0.05）;SNOT-22评分与SAS和SDS评分均呈正相关（P <0.01）;年龄与SAS评分呈正相关（P <0.05）,与SDS无显著相关性。结论　相较于CRS伴嗅觉障碍患者,PVOD患者SAS、SDS评分以及 出现焦虑抑郁状态百分比更高,病程、年龄和SNOT-22评分可能会影响嗅觉障碍患者的焦虑抑郁状态。     

SARS-CoV-2感染后嗅觉功能障碍治疗的研究进展

嗅觉功能障碍(olfactory dysfunction, OD)被认为是新型冠状病毒肺炎的主要症状之一。目前,COVID-19相关的OD的发病机制尚不明确,对其患者暂无特异性治疗手段。论文通过回顾近年来OD的相关文献,结合目前COVID-19及COVID-19相关的OD的治疗方法,从安全咨询、嗅觉训练、药物治疗、针灸、中医药、日本汉方药等方面对相关治疗方案进行总结和比较,探讨其在临床应用和开发新的治疗方法方面的挑战,以期为临床治疗COVID-19相关的OD提供参考和帮助。     

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...     

2019冠状病毒疾病相关嗅觉障碍

2019冠状病毒疾病(COVID-19)的致病病毒为新型冠状病毒SARS-CoV-2,其主要临床表现为发热、干咳、乏力等上呼吸道感染症状,严重者可快速进展为急性呼吸窘迫综合征、脓毒症休克、难以纠正代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等.多国流行病学研究调查表明嗅觉障碍是COVID-19的临床症状之一,甚至是部分...     

嗅觉障碍和嗅觉功能检查

嗅觉是一个很重要的感觉 ,但与视觉、听觉相比其研究显著滞后。主要表现在对嗅觉的中枢解剖通路、嗅觉机制、嗅觉障碍机制和治疗了解甚少 ,缺乏准确行嗅觉功能定性和定量检查的客观方法。另外 ,嗅觉功能有Ⅴ、Ⅸ、Ⅹ脑神经的参与 ,还受心理因素的影响 ,增加了嗅觉功能研究的难度。嗅觉在人类生命活动中起着非常重要的作用 ,其不仅有报警作用 ,还和生活质量密切相关 ,而且一些疾病的早期表现为嗅觉的改变。 2 0世纪 70年代美国国家神经和交流障碍与中风咨询委员会估计有 2 0 0万美国人有味觉或嗅觉障碍。晚近统计 ,国家地球协会和Monell化学…     

新型冠状病毒肺炎患者的嗅觉障碍[综述]

新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）是由严重急性呼吸综合征相关冠状病毒2（severe acute respiratory syndrome coronavirus 2,SARS-CoV-2）引起的疾病。该疾病可能导致从轻度到严重的急性呼吸系统综合征。COVID-19的临床表现包括发热、干咳、乏力、咳痰、气短、咽喉痛、头痛等。伴随着COVID-19的大流行,世界各地的耳鼻咽喉科医师报道相当数量的COVID-19轻症或无症状患者出现嗅觉功能障碍。撰写本文的目的是回顾现有的文献和整理分析文献中COVID-19患者嗅觉减退的症状特点,并分析潜在机制和应对措施。对出现不明原因嗅觉减退的患者予以重视,以指导临床医师的实践。     

2019新型冠状病毒变异株奥密克戎感染后嗅觉、味觉和听觉障碍的发病率和预后：一项基于网络的调查

目的 了解2019新型冠状病毒变异株奥密克戎（Omicron）感染后嗅觉、味觉及听觉障碍发病率及预后。方法 基于线上问卷的横断面研究,采用视觉模拟量表（VAS）评价嗅觉、味觉及听觉功能。结果 （1）共获得869份有效调查问卷,Omicron感染后耳鼻咽喉科相关症状总体发生率达96.8%,嗅觉、味觉及听觉障碍发生率分别为44.4%、44.2%和10.7%。（2）全体受调查者感染前后嗅觉、味觉、听觉障碍VAS评分,及出现嗅觉、味觉及听觉障碍的受调查者感染前后相应VAS评分均具有统计学差异（P<0.001）。（3）嗅觉、味觉及听觉障碍持续的中位时间分别为5 d、4 d和3 d。结论 Omicron感染后嗅觉、味觉、听觉障碍发生率高,多数可快速自发改善,对于症状长期存在者,耳鼻咽喉科医师需积极干预。     

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...     

上呼吸道感染后嗅觉障碍预后因素分析

目的:分析上呼吸道感染后嗅觉障碍(PVOD)患者主客观嗅觉功能测试结果,评估预后因素,为临床诊疗提供依据.方法:回顾性分析就诊于首都医科大学附属北京安贞医院门诊的PVOD患者,给予嗅觉训练治疗4个月,对患者治疗前后进行Sniffin'Sticks嗅觉测试,根据嗅觉功能改善情况分为嗅觉功能改善组和嗅觉功能无改善组,分析患...     

阻塞性睡眠呼吸暂停综合征患者发生嗅觉功能障碍的影响因素分析

目的 分析阻塞性睡眠呼吸暂停综合症患者发生嗅觉功能障碍的影响因素.方法 回顾性分析2017年1月～2019年6月因OSAS到我院治疗的168例患者临床资料,根据TDI评分法,将嗅觉功能减退、嗅觉功能丧失纳入嗅觉功能障碍,即≤28为障碍组,其他为正常组,采用多因素logistic回归分析OSAS患者发生嗅觉功能障碍的影响...     

突发性聋患者焦虑、抑郁与病情阶段的关系及影响因素分析

目的 探讨突发性聋患者焦虑、抑郁与病情阶段的关系,并分析焦虑及抑郁发生的影响因素。 方法 于2016年1月至2017年1月纳入急性期突发性聋患者45例(急性期组)、慢性期突发性聋患者71例(慢性期组)、健康志愿者30例(对照组),进行问卷调查。应用汉密尔顿焦虑(HAMA)及抑郁(HAMD)量表测评并对比各组焦虑及抑郁发生情况。统计患者一般资料、发病及治疗相关资料,通过回归树分析测评患者发生焦虑、抑郁的影响因素。 结果 急性期组HAMA、HAMD得分及焦虑、抑郁发生率明显高于慢性期组和健康对照组(与慢性期组对比,Z=-9.100,P<0.001;Z=-9.091,P<0.001; χ2=31.209,P<0.001; χ2=35.845,P<0.001;与健康对照组对比,Z=-7.336,P<0.001; Z=-7.324,P<0.001; χ2=21.674,P<0.001; χ2=23.148,P<0.001);慢性期组HAMA、HAMD得分及焦虑、抑郁发生率与健康对照组对比,差异无统计学意义(Z=-1.018,P=0.308; Z=-0.042,P=0.967;P=0.671;P=0.722)。发生焦虑或抑郁患者中,急性期患者占比更高(χ2=31.209,P<0.001; χ2=35.845,P<0.001),耳聋轻度、耳鸣无或轻度患者占比更低(χ2=12.650,P<0.001; χ2=18.629,P<0.001),发生抑郁患者中,男性患者占比更低(χ2=4.424,P=0.035),差异有统计学意义。疾病阶段、就诊时耳聋程度是患者发生焦虑及抑郁的主要影响因素。慢性期组中无效患者发生焦虑或抑郁患者占比更高,差异有统计学意义(Z=-2.445,P=0.014; Z=-2.815,P=0.005)。 结论 急性期突发性聋患者焦虑及抑郁发生率较高;疾病阶段、就诊时耳聋程度是患者发生焦虑及抑郁的主要影响因素;慢性期组患者疗效越好,焦虑及抑郁风险越低。     

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.     

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.     

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。     

鼻窦CT评分在评估慢性鼻-鼻窦炎嗅觉障碍中的应用

目的探讨分析鼻窦CT评分在慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者嗅觉功能评估的价值。方法回顾性分析92 例确诊为CRS患者的临床资料,其中嗜酸性粒细胞性慢性鼻-鼻窦炎（eosinophi chronic rhinosinu sitis,ECRS）组患者28 例,非嗜酸性粒细胞性慢性鼻-鼻窦炎（non eosinophi chronic rhinosinu sitis,nECRS）组患者64 例。排除鼻部手术史和其他可能影响嗅觉功能的因素,进行病史采集、嗅觉功能检测和鼻窦CT评分,采用χ2和t检验比较两组间患者临床资料;采用Mann Whitney U检验比较两组鼻窦CT评分;采用Spearman相关分析对鼻窦CT评分和嗅觉功能进行相关性分析;采用ROC曲线分析鼻窦CT评分在嗅觉障碍中的预测评估价值。 结果ECRS组双侧炎症(26/28),筛窦上额窦总和差,（EM 差）值3.32±2.25;nECRS组双侧炎症(48/64),EM差值1.81±2.33,两组患者比较差异均具有统计学意义(P<0.05)。在CT评分方面,CRS患者的EM 差值与嗅觉功能相关性更强(r=0.634),具有更高的预测评估价值,其曲线下面积为0.827。当EM差截断值取2.5时,诊断嗅觉障碍的敏感度为76.9%,特异度为79.2%。结论与其他鼻窦CT评分相比,筛窦上颌窦总和差值对于CRS患者嗅觉障碍有更好的预测诊断价值。     

Risk factors for olfactory dysfunction in chronic rhinosinusitis

Objective

Although risk factors for olfactory dysfunction in patients with chronic rhinosinusitis (CRS) have been examined, most studies did not distinguish between classified eosinophilic chronic rhinosinusitis (ECRS) and noneosinophilic chronic rhinosinusitis (NECRS). The incidence of eosinophilic disease in Japan differs from that in the West. Thus, when olfaction in CRS is investigated, ECRS and NECRS should be examined separately. In the present study, we examined the clinical characteristics associated with olfactory dysfunction in Japanese patients with ECRS and NECRS enrolled in a large multicenter, prospective cohort study.

Methods

Olfactory examination results, demographic data, clinical factors, and comorbidity data were analyzed for 418 patients with CRS at 3 tertiary care centers. We used T&T olfactometry, intravenous olfactory test (the Alinamin test) and Likert scale to assess subjects’ olfactory function. Data were analyzed with univariate and multivariate analyses.

Results

Olfactory dysfunction was more severe and more prevalent in ECRS than in NECRS. We found that olfactory cleft polyps (odds ratio [OR], 3.24), ethmoid opacification (OR, 2.64), asthma (OR, 2.29), current smoking (OR, 1.74) and age ≥50 years (OR, 1.66) were associated with olfactory dysfunction in CRS. Ethmoid opacification (OR, 3.09) and olfactory cleft polyps (OR, 3.05) were associated with olfactory dysfunction in NECRS. Olfactory cleft polyps (OR, 3.98), current smoking (OR, 2.67), IgE ≥400 IU/ml (OR, 2.65), ethmoid opacification (OR, 2.51), and asthma (OR, 2.34) were associated with olfactory dysfunction in ECRS.

Conclusions

Olfactory dysfunction was more severe and prevalent in ECRS than in NECRS. Physician should pay attention to these clinical findings to diagnose olfactory dysfunction, especially in ECRS, and should provide appropriate explanation, guidance, and care. In addition, smokers should be advised to stop smoking to help prevent olfactory dysfunction.     

Olfactory bulb volume and olfactory function after radiotherapy in patients with nasopharyngeal cancer

Objective

Radiotherapy is the primary method of treatment for nasopharyngeal cancer (NPC) and many side effects were reported in patients receiving radiation to this area. This study was conducted to evaluate the long-term effects of radiotherapy following NPC on olfactory bulb (OB) volume and olfactory function.

Methods

Twenty-four patients with NPC who received radiotherapy at least 12 months ago were recruited. Fourteen healthy subjects with similar demographical characteristics were recruited as the healthy control group. All volunteers were subjected to a nasoendoscopical examination, and abnormalities that could potentially cause olfactory dysfunction were the exclusion criteria from the study. An experienced radiologist segmented the MRI coronal, axial and sagittal slices manually for three-dimensional OB volume measurement in a blinded manner. Olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, and average score (0: worst, 7: best) was calculated as the total CCCRC olfactory score.

Results

The mean CCCRC score was 5.5 ± 1.1 for the nasopharyngeal cancer patients, whereas the mean score of healthy control group was 6.4 ± 0.4. There was a significant difference in the olfactory scores (p = 0.003). The mean OB volume in the NPC group was 46.7 ± 12.1 mm³. Among the patients with NPC, the cisplatin receiving group had a mean OB volume of 47.2 mm³, whereas the cisplatin + docetaxel receiving group had a mean OB volume of 46.5 mm³, and they were similar. The MRI measurement of the healthy control group was 58.6 ± 13.8 mm³. The OB volumes of the healthy control group were significantly higher (p < 0.05).

Conclusion

Radiotherapy following nasopharyngeal cancer results in a diminished OB volume and deteriorated olfactory function. Chemosensory olfactory dysfunction might be a contributing factor to lack of appetite, cancer cachexia and consequent lowered quality of life in NPC patients.     

焦虑、抑郁与声带息肉发病的相互关系

目的探讨焦虑、抑郁等情绪异常与声带息肉发病的关系。方法40例声带息肉患者为实验组,40例无嗓音病史患者为对照组,均采用医用焦虑抑郁量表评估患者心理状况,比较分析其组间差异。结果在实验组患者,HADS-D分平均（6．35±3．90）,〉7分者15例,显著高于对照组（P=0．022）;HADS-A分平均（4．20±2．39）,〉7分者14例,显著高于对照组（P=0．006）。结论抑郁、焦虑状态与声带息肉的发生可能存在相关性。