Olfactory dysfunction and its measurement in the clinic

The sense of smell is largely taken for granted by laypersons and medical professionals alike. Indeed, its role in determining the flavor of foods and beverages, as well as in warning of, or protecting against, environmental hazards, often goes unrecognized. This is exemplified, in part, by the fact that most patients presenting to medical clinics with “taste” problems are typically subjected to complex brain imaging and gastroenterological tests without the sense of smell even being tested or considered as a basis of the problem. Aside from frank deficiencies in sweet, sour, bitter, salty and savory (umami) sensations, “taste” disorders most commonly reflect inadequate stimulation of the olfactory receptors via the retronasal route; i.e., from volatiles passing to the receptors from the oral cavity through the nasal pharynx. This article describes the two most common procedures for measuring the sense of smell in the clinic and provides examples of the application of these tests to diseases and other disorders frequently associated with smell loss. Basic issues related to olfactory testing and evaluation are addressed. It is pointed out that smell loss, particularly in later life, can be a harbinger for not only a range of neurodegenerative diseases, but can be a prognostic indicator of early mortality.     

黏蛋白基因MUC2在慢性鼻-鼻窦炎筛窦黏膜中的表达

目的：定量检测慢性鼻-鼻窦炎（CRS）筛窦黏膜中黏蛋白基因MUC2的表达,探讨其在CRS黏液过量分泌中的意义。方法：采用荧光定量RT-PCR检测32例CRS患者（CRS组）和8例正常筛窦黏膜患者（正常对照组）中MUC2 mRNA的表达。结果：MUC2 mRNA在CRS组中的表达[（10．55±3．31）×10^10拷贝／g]较正常对照组[（1．40±0．44）×10^10拷贝／g]增高,两组间差异有统计学意义（P〈0．01）。结论：MUC2 mRNA在CRS筛窦黏膜中表达上调,可能是CRS黏液过度分泌的重要因素之一。     

Cofactors and comorbidities in patients with aspirin/NSAID hypersensitivity

Hypersensitivity reactions to aspirin and other NSAIDs occur in individuals genetically predisposed and exhibit different clinical manifestations, especially respiratory, cutaneous, and generalised. Five different phenotypes define distinct clinical pictures: aspirin-exacerbated respiratory disease, aspirin/NSAID cutaneous disease, NSAID-induced urticaria, angio-oedema and anaphylaxis, single NSAID reactions, and delayed reactions. They are observed more frequently in middle-aged women, and in atopic individuals. While ASA/NSAID hypersensitivity shares comorbidities with asthma, chronic rhinosinusitis, nasal polyposis, chronic urticaria and angio-oedema, ASA and other NSAIDs can also be cofactors for other clinically relevant conditions, especially food-dependent exercise-induced anaphylaxis, angio-oedema induced by angiotensin-converting enzyme inhibitors, and oral mite anaphylaxis. Awareness on these relationships is required for the correct diagnosis, classification, and treatment of affected patients.     

Increased CD69 expression on activated eosinophils in eosinophilic chronic rhinosinusitis correlates with clinical findings

BackgroundEosinophilic chronic rhinosinusitis (ECRS) is a subtype of chronic rhinosinusitis associated with asthma. CD69 is an important marker of activation for eosinophils. But, whether a correlation exist between the CD69 expression on eosinophils and clinical findings is unclear.MethodsWe performed quantitative PCR and/or flow cytometry using tissue and purified eosinophils from the blood and nasal polyps of 12 patients with ECRS and from 8 patients without ECRS (controls). We assessed clinical findings including nasal polyp (NP) scores, sinus CT findings, and pulmonary function test results, and examined their possible association with the CD69 expression. We also performed CD69 cross-linking experiments in mouse eosinophils to investigate the functional role of CD69.ResultsLevels of cytokine mRNAs (IL-4, -5, -10, and -13) were significantly higher in purified NP eosinophils and tissues from patients with ECRS than the levels of those in controls. The expressions of major basic protein (MBP), eosinophilic cationic protein (ECP), eosinophilic-derived neurotoxin (EDN), eosinophil peroxidase (EPX) in cytotoxic granules, and CD69 mRNA were significantly higher in purified eosinophils from NPs than in those from blood. We also found a correlation between expression of CD69 and clinical findings. Moreover, we found EPX release from mouse eosinophils following CD69 cross-linking.ConclusionsThese data suggest that increased CD69 expression by eosinophils is not only a biomarker for nasal obstruction and pulmonary dysfunction, but also a potential therapeutic target for patients with ECRS and asthma.     

Janus looks both ways: How do the upper and lower airways interact?

Our understanding of the relationship between the upper and lower airways has greatly increased as a consequence of epidemiologic and pharmacologic studies. A consistent body of scientific evidence supports the concept that rhinitis, rhinosinusitis and asthma may be the expression of a common inflammatory process, which manifests at different sites of the respiratory tract, at different times. This paradigm states that allergic reactions may begin at the local mucosa, but tend to propagate along the airway. Central to the allergic diathesis is the eosinophil and its interaction with the airway epithelium. The implications of the interplay between upper and lower airway are not only academic, but also important for diagnostic and therapeutic reasons. Furthermore, there is significant overlap in symptomatology and pathophysiology for childhood sleep disordered breathing (SDB) and asthma. Recent evidence supports an association between these two conditions, but causality has not been demonstrated. Regardless, it is important to recognize the overlap and evaluate for the other condition when one is present. In children with poorly controlled asthma, the presence of SDB may significantly contribute to asthma morbidity and, as such, should be actively excluded. On the other hand, clinical evaluation for asthma should be considered in children with SDB.Future robust longitudinal research is needed to explore the association between upper and lower airway diseases using objective measures in children.     

表观遗传学在慢性鼻窦炎伴鼻息肉发病机制中的作用

慢性鼻窦炎伴鼻息肉其确切的发病机制尚未完全明确。表观遗传学(Epigenetics)主要指基于非基因序列改变所致基因表达水平的变化,包括DNA甲基化、组蛋白修饰和非编码RNA调控等。就相关基因的表观遗传学修饰及其引起的相应细胞因子和蛋白质等的表达改变在CRS发病机制中的作用作一综述,从全新的角度认识CRS,为明确其发病过程、探究治疗方法提供新的方向。     

南京城区儿童慢性鼻-鼻窦炎流行病学调查

目的：了解南京城区儿童慢性鼻-鼻窦炎流行病学特征。方法：2004年3月至9月，用“南京市儿童呼吸道疾病问卷调查表”对随机选择南京市7所小学三年级学生（9～10岁）进行问卷调查。根据诊断标准对问卷中有相关症状者，由专科医师进行集中检查予以确诊，将结果进行统计学处理。结果：共计发放问卷调查表l087份，回收989份，应答率9l％，有效答卷942份。南京市9至10岁儿童慢性鼻-鼻窦炎现患率为8．8％（83／942），其中男9．1％（44／484），女8．5％（39／458），男、女发病率无统计学差异（x^2=0．097，P〉0．05）。症状中鼻塞占29．0％（273／942），流鼻涕占31．5％（297／942），头痛头昏占18．2％（171／942）。83例慢性鼻-鼻窦炎患儿中，有鼻塞者54例（65．1％）；流涕者55例（66．3％）；头痛者36例（43．4％）。儿童慢性鼻-鼻窦炎对睡眠状态、性格、记忆的影响等差异有显著性统计学意义（P均=0．000）。结论：慢性鼻-鼻窦炎是儿童的常见病，其发生率为8．8％，对儿童相关的生活质量有一定影响。     

鼻内镜鼻窦手术后迁延性鼻窦炎的细菌学研究

目的：探讨慢性鼻窦炎鼻内镜鼻窦手术（ESS）后迁延不愈者鼻窦分泌物的细菌学特征。方法：对143例慢性鼻窦炎患者行ESS,术中取筛寞分泌物做细菌培养和药物敏感试验（术前组）,术后随访6个月以上,对其中未达治愈标准的49例在鼻内镜下取筛窦分泌物做细菌培养和药物敏感试验（术后组）,2组结果进行比较分析。结果：术前组检出细菌153株,术后组检出细菌65株,2组均以G^＋球菌为主,其差异无统计学意义;术后组G^-杆菌检出率显著高于术前组;而厌氧菌检出率显著低于术前组;对常用抗生素耐药的菌株比例在术后组显著高于术前组。结论：细菌感染是慢性鼻窦炎术后迁延不愈的原因之一,其致病菌仍以G^＋球菌为主,但G^-杆菌的感染较术前增多,而厌氧菌的感染较术前减少;术后致病菌的耐药性增加。因此,对鼻内镜鼻窦手术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上。     

儿童鼻窦炎的临床诊疗进展

儿童鼻窦发育和免疫能力均不够成熟,鼻窦炎临床特征和转归与成人患者差异显著,且与其他气道病变如变应性鼻炎、腺样体肥大及分泌性中耳炎及扁桃体炎、支气管哮喘等之间存在密切联系,容易出现眶内及颅内并发症,需要引起重视。论文主要讨论儿童慢性鼻窦炎的发病机制、诊断及诊疗进展,重点对药物治疗和手术治疗进行阐述,希冀对耳鼻喉科医生诊疗此类儿童疾病提供参考。