Olfactory function assessed with orthonasal and retronasal testing, olfactory bulb volume, and chemosensory event-related potentials

OBJECTIVE: To investigate whether differences in olfactory function between healthy individuals and patients with olfactory loss could be detected by various diagnostic tests. DESIGN: Psychophysical testing of orthonasal and retronasal olfactory functions, magnetic resonance imaging of olfactory bulb (OB) volume, and chemosensory event-related potential (ERP) measurement performed between January 1, 2005, and October 31, 2005. SETTING: Academic tertiary referral medical center. PATIENTS: Eleven healthy individuals with normal olfactory function (NL) and 11 patients with nasal polyposis (NP), 11 with posttraumatic olfactory loss (PT), and 11 with postinfectious olfactory loss (PI) were included in this study. MAIN OUTCOME MEASURES: Orthonasal and retronasal olfactory test results, magnetic resonance imaging-based OB volume, and ERPs to both olfactory and intranasal trigeminal stimulation. RESULTS: Orthonasal and retronasal testing revealed that NL individuals had higher scores than patients with NP, PT, or PI. Retronasal scores were higher in NP patients compared with PT and PI patients. The OB volumes were higher in NL individuals compared with NP, PT, and PI patients. The OB volumes in PT patients were significantly lower than those from NP and PI patients. Olfactory ERPs were different between NL individuals and NP, PT, and PI patients, and trigeminal ERPs were significantly different when comparing NL individuals with NP patients. For the entire cohort, a significant correlation was found between orthonasal testing and OB volume, between retronasal testing and OB volume, and between both orthonasal and retronasal testing and olfactory ERP amplitudes. Olfactory ERPs were recorded in the 11 NL individuals and in 3 NP, 3 PT, and 4 PI patients, defined as responders. Orthonasal and retronasal test scores, OB volume, and olfactory ERPs were significantly larger in responders compared with nonresponders. CONCLUSIONS: Significant differences in various tests that evaluate olfactory function were detectable in a cohort of NL individuals and NP, PT, and PI patients. This finding suggests that these diagnostic tools provide information in terms of the clinical assessment of olfactory function. Future studies will investigate their combined use in terms of the prognosis of olfactory function in patients with olfactory loss.     

Hazardous events associated with impaired olfactory function

OBJECTIVE: To evaluate the risk of olfactory-related hazardous events in patients with impaired olfactory function. DESIGN: Retrospective cohort study. SETTING: A university-based clinic for smell and taste disorders. PATIENTS: A total of 445 patients who underwent olfactory testing between 1983 and 2001. INTERVENTIONS: Patient interview, olfactory testing. MAIN OUTCOME MEASURES: (1) Frequency of olfactory-related hazardous events including cooking incidents (ie, burning pots or pans), undetected fires, undetected gas leaks, and ingestion of spoiled foods or toxic substances; (2) level of olfactory function (anosmia; severe, moderate, or mild hyposmia; or normosmia) as determined by olfactory testing. RESULTS: Olfactory testing revealed that 76% of patients had some degree of impairment; 30% had complete anosmia. Thirty-seven percent of patients with olfactory impairment but only 19% of patients without impairment experienced at least 1 olfactory-related hazardous event. Of the hazardous events reported by impaired patients, cooking-related incidents were most common, representing 45%, with ingestion of spoiled food (25%), inability to detect a gas leak (23%), and inability to smell a fire (7%) reported less frequently. There was a significant correlation between frequency of hazardous events and degree of olfactory impairment (Cochran-Armitage trend test, P<.001): at least 1 hazardous event was reported by 45.2% of patients with anosmia, 34.1% with severe hyposmia, 32.8% with moderate hyposmia, 24.2% with mild hyposmia, and 19.0% of patients with with normal olfaction by testing. CONCLUSION: Patients with impaired olfactory function are more likely to experience olfactory-related hazardous events than those with normal olfactory function.     

Flavor education and training in olfactory dysfunction: a pilot study

European Archives of Oto-Rhino-Laryngology - Olfactory training is recommended in olfactory dysfunction (OD) showing promising results. OD patients frequently ask for training modifications in the...     

Possible role of nano-sized particles in chronic tonsillitis and tonsillar carcinoma: a pilot study

This study aimed to evaluate the palatine tonsils of patients with chronic tonsillitis and spinocellular carcinoma to determine the presence of nano-sized particles. Tonsil samples from adult patients with chronic tonsillitis and spinocellular carcinoma of the palatine tonsil were dried and analyzed using a scanning electron microscope with the X-ray microprobe of an energy-dispersive spectroscope. Demographic data and smoking histories were obtained. The principal metals found in almost all tissues analyzed were iron, chromium, nickel, aluminum, zinc, and copper. No significant difference in elemental composition was found between the group of patients with chronic tonsillitis and the group with spinocellular carcinoma of the palatine tonsil. Likewise, no significant difference was found between the group of smokers and the group of nonsmokers. The presence of various micro- and nano-sized metallic particles in human tonsils was confirmed. These particles may potentially cause an inflammatory response as well as neoplastic changes in human palatine tonsils similar to those occurring in the lungs. Further and more detailed studies addressing this issue, including studies designed to determine the chemical form of the metals detected, studies devoted to quantitative analysis, biokinetics, and to the degradation and elimination of nanoparticles are needed for a more detailed prediction of the relation between the diagnosis and the presence of specific metal nanoparticles in tonsillar tissue.     

Olfactory function in patients with ischemic stroke: a pilot study

The aim of this pilot study was to investigate olfactory function in unselected, cooperative patients with ischemic stroke and to gain information about olfactory perception in patients with distinct stroke localizations. Three ischemic stroke patients underwent olfactory testing using the Sniffin’ Sticks test and olfactory event-related potentials recording. All stroke patients were found to be normosmic or only slightly hyposmic when using a psychophysical testing device with age-adjusted norms. No responses or longer latencies on the affected side were found, however, when recording evoked potentials. This seems to argue for the idea that on the affected side it is often possible to document the objective lesion although the subjective perception of the patient appears normal.     

Assessment of olfactory function after septoplasty: a longitudinal study

AIM: Aim of the study was to evaluate septoplasty-related changes of lateralised olfactory function during both early and late postoperative periods in comparison to the preoperative situation. MATERIAL/METHODS: Lateralised olfactory function was assessed in 30 patients using the "Sniffin' Sticks" test battery. Measurements were performed preoperatively, and 4 and 9 months postoperatively. RESULTS: Prior to septal surgery measurements revealed significantly higher odor thresholds for the obstructed nostril compared to contralateral thresholds. No such observations were made for suprathreshold measures. Postoperatively, a significant decline of odor discrimination was found in comparison to the preoperative situation. However, there was no significant change of odor thresholds and odor identification function during the 9-month postoperative follow up. On an individual basis, one of the initially normosmic patients became hyposmic following surgery. CONCLUSIONS: The present data indicate that odor thresholds, but not suprathreshold olfactory function, are related to nasal obstruction resulting from septal deviation. In contrast, postoperative changes were only seen for odor discrimination. Apart from psychological explanations of this finding, it may be hypothesized that these observations result from changes in intranasal airflow following surgery.     

Vestibular function in migraine-related dizziness: a pilot study

Migraine-related dizziness (MRD) refers to a disorder in which vestibular symptoms are an integral part of migraine symptomatology. The purpose of this study was to better define the pathophysiology of MRD, which is incompletely understood and to generate hypotheses regarding MRD by assessing the semicircular canal-ocular reflex, the otolith-ocular reflex, visual-vestibular interaction, vestibulo-spinal function, and visually induced postural sway. Subjects included five subjects with MRD, five subjects with migraine without dizziness, and five headache-free controls. Subjects with migraine were tested interictally. Results indicated that the mean gain of the semicircular canal-ocular reflex during both sinusoidal and constant velocity rotation was reduced in subjects with MRD. No changes were noted in the dynamics of the semicircular canal-ocular reflex. The otolith-ocular reflex, assessed with constant velocity OVAR, indicated that subjects with MRD showed a larger modulation component. No group differences were found in the bias component during constant velocity OVAR, nor in semicircular canal-otolith interaction or visual-vestibular interaction. Computerized dynamic posturography indicated that subjects with MRD demonstrated a surface-dependent pattern. Postural sway during optic flow indicated that subjects with MRD swayed more than the other subjects. We hypothesize that competing processes of serotonergic excitation and inhibition alter central vestibular pathways differently for semicircular canal vs. otolithic responses and for vestibulo-ocular vs. vestibulo-spinal pathways.     

Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy

OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.     

Bipolar radiofrequency-induced thermotherapy of turbinate hypertrophy: pilot study and 20 months' follow-up

OBJECTIVES/HYPOTHESIS: The present report is a pilot clinical study about a new bipolar ablation technique for the treatment of turbinate hypertrophy, which offers an alternative to conventional methods. STUDY DESIGN: Prospective, clinical. METHODS: From August 1999 to March 2000, a new bipolar radiofrequency system with acoustic feedback control was submucosally applied for the treatment of 38 patients with nasal airway obstruction of vasomotor (n = 31) or allergic (n = 7) genesis. The therapy was made ambulatory with surface anesthesia. Data were collected by questionnaire and rhinomanometry preoperatively and 2 and 20 months postoperatively. RESULTS: Nearly all patients reported an improvement of their nasal breathing, with 68% of them reporting a full and 29% a partial recovery. No significant differences were reported with regard to the response of the allergic versus the vasomotor rhinitis. On average, a definite benefit was observed after 2 weeks. Side effects, such as bleeding, synechia, or atrophic changes of the mucosa, which would have to be treated, were not observed. CONCLUSION: The new bipolar radiofrequency thermotherapy presents an efficient option for the treatment of turbinate hypertrophy, which meets the requirements for an outpatient treatment.     

鼻咽癌患者放疗后嗅觉功能及嗅球体积和嗅沟深度的研究

目的　探讨放疗对鼻咽癌患者嗅觉功能以及嗅球体积和嗅沟深度的影响。方法　选取鼻咽癌放疗结束后1年以上的患者（测试组）及无嗅觉减退的健康受试者（对照组）各20例,采用TT嗅觉测试法检查所有受试者的嗅觉功能,并行嗅球体积、嗅沟深度MRI检查。结果  测试组TT嗅觉测试法嗅觉功能评分大于对照组,测试组 平均嗅球体积明显小于对照组。测试组与对照组平均嗅沟深度比较无差异。测试组嗅觉识别阈与嗅球体积呈负相关性（r =-0.641,P <0.05）,与嗅沟深度无关（r =-0.175,P >0.05）。结论　鼻咽癌放疗后嗅觉减退患者,嗅球体积减少,嗅沟深度不变;嗅觉功能与嗅球体积具有相关性,与嗅沟深度无关。     

Screening of olfactory function using the Biolfa olfactory test: investigations in patients with dysosmia

OBJECTIVE: To present a statistical evaluation of a new olfactory test, Biolfa. MATERIAL AND METHODS: The olfactory test was carried out in individuals with normal olfactory function (n=67; 31 males; mean age 27.4 years) and in patients with mild, moderate or severe hyposmia (n=155; 61 males; mean age 54.6 years). The main diagnoses of the hyposmic patients were upper respiratory tract infection (32%), nasal polyposis (24%), head trauma (8%), idiopathic (8%), old age (5%) and chronic rhinitis (5%). In the first part of the test, olfactory thresholds were measured for three different substances (eugenol, aldehyde C14 and phenyl ethyl alcohol). The second part comprised an odor identification test for determining olfactory function for a large panel of common odors of Southern European countries. RESULTS: Mean olfactory thresholds were determined for subjects with normal olfaction and hyposmic patients; there was a statistically significant relationship between olfactory thresholds and degree of olfaction (mild to moderate hyposmia versus severe hyposmia). For the odor identification test, a global score was determined to allow the differentiation of normosmic subjects from patients with mild, moderate or severe hyposmia. The principles of decision theory (i.e. analysis of the receiver operating characteristic curve) were applied to the problem of evaluating the ability of Biolfa to distinguish subnormal subjects from hyposmic subjects. CONCLUSION: This study provides a basis for the routine clinical use of Biolfa.     

Treatment of tinnitus with gabapentin: a pilot study.

OBJECTIVE: To evaluate the effectiveness of gabapentin (Neurontin) improve the disease-specific quality of life in patients with moderate tinnitus. STUDY DESIGN: Randomized, double blind, placebo-controlled clinical trial. SETTING: Single-center academic outpatient otolaryngology practice. INTERVENTION: Gabapentin 1800 mg daily versus placebo. MAIN OUTCOME MEASURES: The study design is a randomized, double blind placebo controlled single site trial conducted in an academic medical center. Inclusion criteria included patients between ages 18 and 70 with a complaint of nonpulsatile, subjective tinnitus, bilateral or unilateral, greater than 3 months in duration. The primary outcome measure is the Tinnitus Handicap Inventory; secondary measures include the Profile of Mood States (POMS) rating scale, subjective tinnitus severity. The null hypothesis addressed in this study is that the drug would not result in significant alleviation of the symptom of tinnitus. RESULTS: Seventy-six patients completed the trial; of these 52 received the drug. No significant differences were found between the two groups after 5 weeks of treatment with gabapentin. CONCLUSION: There is insufficient evidence to support the effectiveness of gabapentin in the treatment of tinnitus.     

Managing disturbing snoring with palatal implants: a pilot study

OBJECTIVE: To evaluate the safety and efficacy of polyethylene terephthalate implants in the soft palate to modify disturbing snoring. DESIGN: Interventional study, before-after trial. SETTING: Referral center, institutional practice, hospitalized care. PATIENTS: Twelve consecutive patients with disturbing snoring and an apnea-hypopnea index less than 15 per hour and a body mass index of 30 or less were recruited. One patient with no adverse effects was lost to follow-up. Extrusion of implants occurred in 2 patients. Complete data in 9 patients were available for analysis. INTERVENTION: Polyethylene terephthalate implants were inserted in the soft palate. MAIN OUTCOME MEASURES: Safety of the procedure and evaluation of the loudness of snoring by bed partners using a visual analog scale. RESULTS: There were no complications of infection or bleeding. Extrusion of implants occurred in 2 patients with no clinical sequelae. The mean (SD) loudness of snoring at baseline, as assessed by bed partners using a visual analog scale of 0 to 100, was 79 (17.2). This significantly decreased to 48 (20.4) at 3 months (Wilcoxon signed rank test, P =.008). Daytime sleepiness as measured with the Epworth Sleepiness Scale also decreased from an average score of 8.9 at baseline to 5.7 at 3 months (P =.007). There were no significant changes in the apnea-hypopnea index and body mass index from baseline to 3 months' follow-up. CONCLUSIONS: Polyethylene terephthalate implants in the soft palate are safe. Snoring decreased significantly at 3 months after surgery. Polyethylene terephthalate implants in the soft palate should be further explored as a treatment for snoring.     

Adenovirus-mediated gene transfer in olfactory epithelium and olfactory bulb: a long-term study

OBJECTIVES: We sought to study the spatiotemporal gene expression mediated by adenoviral vector in the olfactory pathways. METHODS: The replication-defective adenoviral vector AxCALacZ, which encodes the enzyme Escherichia coli beta-galactosidase, was applied to mouse olfactory epithelium by intranasal instillation. RESULTS: The LacZ gene product, beta-galactosidase, was expressed not only in the olfactory receptor neurons and their axons, but also in the olfactory bulbs. The first evidence of anterograde labeling was observed at postinfection day (PID) 2. At PID 3, beta-galactosidase was strongly expressed in olfactory nerve axons, as well as their terminal glomeruli, in the olfactory bulbs. beta-Galactosidase expression persisted up to PID 90, and there was a significant decrease in the number of labeled neurons at PID 30. CONCLUSIONS: These results suggest possible long-term effects of adenovirus-mediated gene transfer on the olfactory neurons, as well as the olfactory bulbs.     

The impacts of adenotonsillar hypertrophy on periodontal health in children: A prospective controlled pilot study

Objectives

To evaluate the impacts of obstructive adenotonsillar disease on periodontal health and to assess the efficacy of adenotonsillectomy in the prevention of chronic periodontitis in children.

Methods

This prospective and controlled clinical study was conducted between August 2012 and February 2013 with 35 pediatric patients who had permanent anterior dentition. The study group included twenty patients (n = 20) who had complaints of chronic mouth breathing and snoring and were diagnosed with obstructive adenotonsillar disease. These patients underwent adenoidectomy with or without tonsillectomy. We performed periodontal examinations to assess the periodontal health status in these children before and two months after surgery. The periodontal measures included plaque index (PI), pocket depth (PD) and gingival index scores (GI). Subsequently, these periodontal measures were compared with healthy control group who had no adenotonsillar disease (n = 15).

Results

Among the study group six patients underwent adenoidectomy and 14 patients underwent adenoidectomy combined with either tonsillectomy or tonsillotomy. The preoperative PI, PD and GI scores of the study group were 1.27 ± 0.39, 1.34 ± 0.31 and 0.97 ± 0.37 respectively. These scores were significantly higher compared to the control group (p < 0.001). These periodontal index scores were significantly improved after surgery (p = 0.008 for PI and p < 0.001 for both PD and GI). In addition, we found no difference in postoperative values of PD and GI between the study group and control group.

Conclusion

We concluded that obstructive adenotonsillar disease adversely affects periodontal health in children and surgical management of obstruction improves the clinical findings. However, more comprehensive research is required to elucidate the association between adenotonsillar hypertrophy and periodontal disease.     

Screening of olfactory function with a four-minute odor identification test: reliability, normative data, and investigations in patients with olfactory loss

The study aimed to create a screening test on the basis of the odor identification test as used in the "Sniffin' Sticks" olfactory test kit. It should appeal to the practitioner in terms of 1) time required for testing, 2) reliability, 3) separation of "normal" from "abnormal," and 4) the fact that it allows lateralized screening. Experiments should provide a normative database (number of subjects > 1,000), establish test-retest reliability (n > 100), and compare results from patients with olfactory loss (n > 200). The correlation between results on 2 repetitive tests was .78. The test differentiated anosmics, hyposmics, and normosmics (p < .001). None of the 112 anosmics reached a score higher than 8; the 90th percentile was at a score of 6. When only 6 odors were used for calculating scores, for anosmics the 95th percentile was at a score of 4. These data provide a basis for the screening of patients by means of "Sniffin' Sticks."