Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia

Abstract Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.

Changes in olfaction & quality of life following standard medical therapy in patients with intermittent & persistent allergic rhinitis

Background & objectives: Allergic rhinitis (AR) is an inflammatory disease prevalent worldwide which can affect both olfaction and quality of life (QoL). The objective of the present study was to assess olfaction and QoL changes in patients with AR before and after medical therapy. Methods: Adult participants (>18 yr) with AR were recruited for this study. These patients prospectively underwent olfaction testing using the modified Connecticut Chemosensory Clinical Research Centre Test and QoL assessment using Rhinoconjunctivitis QoL Questionnaire (RQLQ) before and after standard medical therapy with topical steroids and/antihistaminics. Results: Of the 150 patients recruited, 72 per cent had intermittent AR. The symptom of hyposmia was present in 34 patients (22.7%) and was more prevalent in patients with moderate-to-severe type of AR (P<0.001). However, olfaction testing revealed hyposmia/anosmia in 44 patients (29.3%). Mean composite olfaction scores were significantly higher in patients with mild AR compared to moderate/ severe AR (P=0.026). The pre-therapy mean composite olfaction score in the 34 patients with olfaction disturbances was 3.1 standard deviation (±1.06 SD). Following therapy, the mean composite olfaction score rose to 4.3 (±1.34 SD) and this change was found to be significant (P<0.001). Mean pre-therapy RQLQ scores were 2.87 (0.06-5.33) overall. Significant improvement was also found in RQLQ scores following therapy (P<0.001). Mean RQLQ scores were significantly lower in those with moderate-to- severe AR (P<0.001) as well as those with intermittent AR (P=0.004). Nine patients had persistently high RQLQ scores after medical therapy. Interpretation & conclusions: Both olfaction and QoL showed significant improvement after medical therapy in Indian adults with AR. In those patients who do not improve, other causes must be sought for the persistent symptoms.

A Case Series of Olfactory Dysfunction in Imported COVID-19 Patients: A 12-Month Follow-Up Study / 生物医学与环境科学（英文）

Objective@#The scientific community knows little about the long-term influence of coronavirus disease 2019 (COVID-19) on olfactory dysfunction (OD). With the COVID-19 pandemic ongoing worldwide, the risk of imported cases remains high. In China, it is necessary to understand OD in imported cases.@*Methods@#A prospective follow-up design was adopted. A total of 11 self-reported patients with COVID-19 and OD from Xi'an No. 8 Hospital were followed between August 19, 2021, and December 12, 2021. Demographics, clinical characteristics, laboratory and radiological findings, and treatment outcomes were analyzed at admission. We surveyed the patients via telephone for recurrence and sequelae at the 1-, 6-, and 12-month follow-up.@*Results@#Eleven patients with OD were enrolled; of these, 54.5% (6/11) had hyposmia and 45.5% (5/11) had anosmia. 63.6% (7/11) reported OD before or on the day of admission as their initial symptom; of these, 42.9% (3/7) described OD as the only symptom. All patients in the study received combined treatment with traditional Chinese medicine and Western medicine, and 72.7% (8/11) had partially or fully recovered at discharge. In terms of OD recovery at the 12-month follow-up, 45.5% (5/11) reported at least one sequela, 81.8% (9/11) had recovered completely, 18.2% (2/11) had recovered partially, and there were no recurrent cases.@*Conclusions@#Our data revealed that OD frequently presented as the initial or even the only symptom among imported cases. Most OD improvements occurred in the first 2 weeks after onset, and patients with COVID-19 and OD had favorable treatment outcomes during long-term follow-up. A better understanding of the pathogenesis and appropriate treatment of OD is needed to guide clinicians in the care of these patients.

Rehabilitación olfatoria en pacientes laringectomizados: maniobra de inducción del flujo aéreo nasal / Olfactory rehabilitation in laryngectomized patients: nasal airflow inducing maneuver

Resumen Introducción: La laringectomía total (LT) tiene como secuela la perdida de la voz, pero otra consecuencia no estudiada es la pérdida del olfato. Objetivo: Demostrar que la "maniobra de inducción del flujo aéreo nasal" (MIFAN) rehabilita el olfato en pacientes con LT. Material y Método: Estudio cuasiexperimental antes-después en pacientes laringectomizados por cáncer de laringe del Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau (HBLT) de Santiago de Chile. Evaluación a través de encuesta, examen físico, nasofibroscopía y test olfatométrico. Pacientes con alteración del olfato por transmisión serán enrolados y se enseñará la MIFAN. Resultados: Se estudiaron 12 pacientes: 10 hombres, 2 mujeres. Edad promedio 66,3 años, todos autovalentes. 66,6% presentó anosmia y 33,3% hiposmia. Todos lograron realizar la maniobra. Posrehabilitación el 100% presentó presencia de olfato valorada por olfatometría. Población intervenida similar a otras series en cuanto a sexo y edad. La erigmofonación facilita la rehabilitación con MIFAN. La rehabilitación del olfato se logró en todos y paralelamente mejoró el sentido del gusto. Conclusión: La MIFAN es una técnica sencilla, barata y asequible para lograr rehabilitar el sentido del olfato en pacientes laringectomizados.

Abstract Introduction: Total laryngectomy (TL) has as a consequence the loss of voice, but another not studied consequence is the loss of smell. Aim: To demonstrate that the "nasal airflow inducing maneuver" (NAIM) rehabilitates smell in patients with TL. Material and Method: A quasi-experimental before-after study in laryngectomized patients for laryngeal cancer from the Otorhinolaryngology Service (ENT) of the Barros Luco Trudeau Hospital (BLTH) at Santiago, Chile. Evaluation through survey, physical examination, nasofibroscopy and olfactory test. Patients with transmission impairment of smell were enrolled and NAIM was performed. Results: 12 patients were studied: 10 men, 2 women. Average age 66.3 years. All self-supporting. 66.6% presented anosmia and 33.3% hyposmia. They all managed to perform the maneuver. Post-rehabilitation, 100% presented the presence of smell assessed by olfactometry. Intervened population similar to other series in terms of sex and age. Esophageal speech facilitates NAIM rehabilitation. Rehabilitation of smell was achieved in all of them and in parallel, the sense of taste improved. Conclusion: NAIM is a simple, cheap and affordable technique to rehabilitate the sense of smell in laryngectomized patients.

Possible effects of low testosterone levels on olfactory function in males / Possíveis efeitos dos baixos níveis de testosterona na função olfativa em homens

Abstract Introduction: Functions attributed to androgens have increased, ranging from the role in hypothalamic-pituitary-gonadal axis and reproductive behaviors to modulation of cognition, mood and some other functions. Sex differences and changes in circulating sex hormones affect human sensory function. In the literature, authors reported this kind of influence for olfaction predominantly in females. Objective: To investigate the effects of low testosterone levels on olfactory functions in males, in this prospective clinical study. Methods: Male patients diagnosed with prostate cancer were included. Thirty-nine patients with prostate cancer whose testosterone levels were lower than 50 ng/dL due to castration, were the study group. Thirty-one patients with prostate cancer who were not castrated with testosterone levels higher than 50 ng/dL were selected as the control group. Acoustic rhinometry and peak nasal inspiratory flow tests were performed for all participants; and for evaluation of olfactory function, both groups completed the Connecticut chemosensory clinical research center olfactory test. Results: The mean ages of the patients and controls were 69.6 ± 7.2 (57-89) and 66.3 ± 5.8 (50-78) years, respectively (= 0.039). There was a significant difference between groups in terms of testosterone levels (p < 0.0001). The multivariate logistic regression revealed testosterone level as the only predictive factor determining the difference between the groups. In terms of olfactory parameters, all scores were lower in the emasculated group (butanol threshold test p = 0.019, identification p = 0.059, and Connecticut center score p = 0.029) There was a significant correlation between testosterone levels and olfactory parameters (p = 0.023; p = 0.025 for identification and Connecticut center scores, respectively). Conclusion: Low testosterone levels in males have negative effects on olfactory functions. Further molecular research is required to understand the connection between testosterone and olfaction.

Resumo Introdução: As funções atribuídas aos andrógenos aumentaram, variam desde o papel no eixo hipotálamo-hipófise-gonadal e comportamentos reprodutivos até a modulação da cognição, humor e outras funções. As diferenças entre os sexos e as mudanças nos hormônios sexuais circulantes afetam a função sensorial humana. Na literatura, os autores relataram esse tipo de influência para o olfato, principalmente no sexo feminino. Objetivo: Investigar os efeitos dos baixos níveis de testosterona nas funções olfativas em homens, neste estudo clínico prospectivo. Método: Pacientes do sexo masculino com diagnóstico de câncer de próstata foram incluídos no estudo. Compreenderam o grupo de estudo 39 pacientes com câncer de próstata cujos níveis de testosterona eram inferiores a 50 ng/dL devido à castração. Foram determinados como grupo controle 31 pacientes com câncer de próstata que não foram emasculados, com níveis de testosterona superiores a 50 ng/dL. Testes de rinometria acústica e pico de fluxo inspiratório nasal foram feitos para todos os participantes; e para avaliação da função olfativa, ambos os grupos concluíram o teste olfativo do Connecticut chemosensory clinical research center. Resultados: A média da idade dos pacientes e controles foi de 69,6 ± 7,2 (57 ± 89) e 66,3 ± 5,8 (50 ± 78) anos, respectivamente (= 0,039). Houve uma diferença significante entre os grupos em relação a níveis de testosterona (p < 0,0001). A regressão logística multivariada revelou o nível de testosterona como o único fator preditivo que determinou a diferença entre os grupos. Em termos de parâmetros olfativos, todos os escores foram menores no grupo castrado (teste do limiar de butanol p = 0,019, identificação p = 0,059 e escore do Connecticut center p = 0,029). Houve uma correlação significante entre o nível de testosterona e os parâmetros olfativos (p = 0,023; p = 0,025 para identificação e escore do Connecticut center, respectivamente). Conclusão: Baixos níveis de testosterona em homens têm efeito negativo na função olfativa. Mais pesquisas moleculares são necessárias para entender a conexão entre testosterona e olfação.

Meningioma como causa poco común de hiposmia. A propósito de un caso

Resumen La afectación del sentido del olfato puede pasar desapercibida en gran parte de los pacientes, siendo únicamente valorada cuando la alteración es importante. Sin embargo, la hiposmia es un síntoma asociado a numerosas patologías, de menor a mayor gravedad. Este sentido está relacionado con nuestros recuerdos y puede alertarnos de potenciales amenazas. Como médicos especialistas en Otorrinolaringología debemos estar alerta ante determinados síntomas que orienten a posible etiología central. Presentamos el caso de una mujer de 39 años que acudió al Servicio de Otorrinolaringología del Hospital General Universitario Morales Meseguer derivada por hiposmia de un año de evolución con cervicalgia y cefalea occipital progresiva, sin otra sintomatología asociada. La exploración otorrinolaringológica resultó normal. Debido a la persistencia sintomática se solicitó una tomografía computarizada de senos paranasales con hallazgos de masa intracraneal extraaxial compatible con meningioma de fosa craneal anterior.

Abstract The affectation of smell can go unnoticed in a great part of the patients, being only valued when the alteration is important. However, this sense is related to our memories and can alert us to potential threats. As otolaryngologists we must be alert to certain symptoms that may lead to a possible central aetiology. We present the case of a 39-year-old woman who went to the otolaryngology service at Morales Meseguer General University Hospital due to one-year evolution of hyposmia with cervicalgia and progressive occipital headache, with no other symptoms associated. The otolaryngology examination was anodyne. In view of symptomatic persistence, a paranasal sinus computed tomography scan was requested with findings of extra-axial intracranial mass compatible with anterior cranial fossa meningioma.

Narcolepsy: the impact of aging, hypocretin deficiency, and years of formal education in olfactory function and abdominal obesity / Narcolepsia: o impacto da idade, deficiência de hipocretina e anos de estudo na função olfatória e na obesidade central

ABSTRACT Background: Narcolepsy is a disease resulting from the loss of hypocretin-producing cells or other dysfunctions of the hypocretinergic system. In addition to sleep disorders, affected patients may experience increased weight gain, olfactory changes, and poorer quality of life. Methods: This study aimed to investigate the relationship between narcolepsy and weight gain, years of study, sleep parameters, and olfactory dysfunction in patients with narcolepsy type 1 and narcolepsy type 2. Anthropometric, olfactory, socioeducational, and excessive daytime sleepiness evaluations were performed in 77 patients. Results: Greater weight gain and abdominal obesity were observed in patients with type 1 narcolepsy. Patients with higher education level had lower scores of daytime sleepiness, higher scores on the olfactory function test, and lower rates of abdominal obesity. Discussion: Patients with narcolepsy type 1 showed an increased body weight and abdominal obesity when compared to narcolepsy type 2. The patients with a higher schooling level showed a reduction of the daytime sleepiness scores, lower rates of abdominal obesity, and better scores on the olfactory function test. Conclusion: Among all the patients with narcolepsy, the data indicated that aging and hypocretin deficiency are associated with abdominal obesity, while years of study is the variable that mostly influences olfaction function.

RESUMO Antecedentes: A narcolepsia é resultante da perda de células produtoras de hipocretina ou da disfunção do sistema hipocretinérgico. Além dos distúrbios do sono característicos da doença, os pacientes afetados podem apresentar também aumento de peso, alterações olfatórias e pior qualidade de vida. Métodos: O objetivo do estudo é investigar a relação entre a narcolepsia e o ganho de peso, anos de estudo, parâmetros do sono e a disfunção olfatória em pacientes com narcolepsia tipo 1 e narcolepsia tipo 2. Foram realizadas avaliações antropométricas, do olfato, sociais, educacionais e da sonolência excessiva diurna nos 77 indivíduos participantes da pesquisa. Resultados: Foram observados, nos pacientes com narcolepsia tipo 1, maior ganho de peso e maior frequência de obesidade central. Pacientes com ensino superior apresentaram escores mais baixos de sonolência excessiva diurna, escores mais altos no teste de função olfatória e menores taxas de obesidade central. Discussão: Pacientes com narcolepsia tipo 1 apresentaram maior ganho de peso e obesidade central quando comparados aos com narcolepsia tipo 2. Os pacientes com maior escolaridade apresentaram menores escores de sonolência diurna, de obesidade central e melhores escores no teste da função olfatória. Conclusão: Nos indivíduos com narcolepsia tipo 1 e tipo 2, os dados indicaram que o envelhecimento e a deficiência de hipocretina estão associados à obesidade central, enquanto anos de estudo é a variável que mais influencia na função olfatória.

Transtornos del olfato y el gusto, de las bases a la práctica clínica / Smell and Taste Disorders. From the Basics to the Clinical Practice

Resumen Alrededor de una cuarta parte de la población de adultos de más de 40 años presenta algún trastorno del olfato. Las alteraciones primarias del gusto son menos frecuentes y suelen atribuirse a un problema del olfato concomitante. Ambos tienen un fuerte impacto en la calidad de vida de las personas que lo padecen, generando depresión, aislamiento y sensación de vulnerabilidad. El grado de disfunción del olfato y el gusto han sido utilizados como predictor de mortalidad y pronóstico en ciertas enfermedades. Las etiologías son diversas e incluyen desde problemas nasosinusales hasta enfermedades neurodegenerativas. Existen diversas pruebas, fáciles de aplicar y almacenar, que permiten al clínico medir de manera objetiva el grado de disfunción de estos sistemas. El propósito de este artículo de revisión es mostrar al médico de cualquier área, la importancia de explorar estos sistemas y cómo realizarlo. También se discuten las distintas opciones de tratamiento y rehabilitación.

Abstract It is estimated that around 25% of adults over 40 years have some form of smell disorder. The primary taste disfunctions are less frequent and they are usually caused by some olfactory alteration. They both have an important impact on the quality of life of people who suffer from them, predisposing to depression, isolation and vulnerability. The degree of smell and taste dysfunction have been used as mortality predictor and prognosis in certain diseases. The etiologies go from sinonasal causes to neurodegenerative diseases. There are multiple identification tests that let us objectively know the magnitude of these disorders. The objective of these article is to show the healthcare personnel the importance of these senses, how to explore their alterations, how to approach them and their possible management and rehabilitation.

Anosmia/Hyposmia is a Good Predictor of Coronavirus Disease 2019 (COVID-19) Infection: A Meta-Analysis

Abstract Introduction The number of positive cases and deaths from the coronavirus disease 2019 (COVID-19) is still increasing. The early detection of the disease is very important. Olfactory dysfunction has been reported as the main symptom in part of the patients. Objective To analyze the potential usefulness of anosmia or hyposmia in the detection of the COVID-19 infection. Data Synthesis We systematically searched the PubMed Central database using specific keywords related to our aims until July 31st, 2020. All articles published on COVID-19 and anosmia or hyposmia were retrieved. A statistical analysis was performed using the Review Manager (RevMan, Cochrane, London, UK) software, version 5.4. A total of 10 studies involving 21,638 patients were included in the present analysis. The meta-analysis showed that anosmia or hyposmia is significantly associated with positive COVID-19 infections (risk ratio [RR]: 4.56; 95 % confidence interval [95 %CI]: 3.32-6.24; p < 0.00001; I2 = 78 %, random-effects modeling). Conclusion The presence of anosmia or hyposmia is a good predictor of positive COVID-19 infections. Patients with onset of anosmia or hyposmia should take the test or undergo screening for the possibility of COVID-19 infection.

The close relationship between sudden loss of smell and COVID-19 / A estreita relação entre perda súbita de olfato e COVID-19

Abstract Introduction: The real number of COVID-19 cases may be underestimated since several countries have difficulty offering laboratory tests for all the population. Therefore, finding a symptom with a high predictive value would help in diagnostic and isolation strategies. Objective: To correlate the sudden loss of the sense of smell in the context of the COVID-19 pandemic with results of diagnostic tests for COVID-19. Methods: This is a cross-sectional observational study. An online questionnaire was digitally addressed to 725 outpatients in Brazil who reported partial or total sudden loss of the sense of smell from March to April 2020. Results: Total or partial sudden loss of the sense of smell showed high positive predictive value for COVID-19 diagnosis, during the COVID-19 pandemic in Brazil (88.8%). There were no differences between groups tested positive and negative in regard to demographic and clinical characteristics such as presence of allergy, rhinitis, neither to olfactory recovery time. Conclusion: The identification of sudden loss of the sense of smell during COVID-19 pandemic may serve as a sentinel symptom and may be a warning to establish measures to prevent the transmission of the disease.

Resumo Introdução: O número real de casos Covid-19 pode estar subestimado, pois vários países têm dificuldade em oferecer exames laboratoriais para toda a população. Portanto, encontrar um sintoma com alto valor preditivo ajudaria nas estratégias de diagnóstico e isolamento. Objetivo: Correlacionar a perda súbita do olfato no contexto da pandemia da Covid-19 com os resultados dos testes de diagnóstico da Covid-19. Método: Trata-se de um estudo observacional transversal. Um questionário on-line foi enviado digitalmente a 725 voluntários que apresentaram perda súbita parcial ou total do sentido de olfato de março a abril de 2020 no Brasil. Resultados: A perda súbita total ou parcial do sentido do olfato apresentou alto valor preditivo positivo para o diagnóstico de Covid-19, durante a pandemia de Covid-19 no Brasil (88,8%). Não houve diferenças entre os grupos positivos e negativos em relação às características demográficas e clínicas, como presença de alergia, rinite e tempo de recuperação olfativa. Conclusão: A identificação de perda súbita do olfato durante a pandemia de Covid-19 pode servir como sintoma sentinela e pode ser um alerta para estabelecer medidas para impedir a transmissão da doença.

Entrenamiento olfatorio: revisión de literatura / Olfactory training: review of literature

RESUMEN La disfunción olfatoria es una patología frecuente que trae consigo una disminución importante en la calidad de vida de los pacientes y que incluso conlleva una mortalidad aumentada respecto a la población general. Sin embargo, es una condición subdiagnosticada, ya sea por desconocimiento de los profesionales o por falta de un método diagnóstico adecuado. A la fecha no existe un tratamiento efectivo para estos pacientes y generalmente se les deja sin tratar. Una alternativa para este gran problema es el entrenamiento olfatorio, tratamiento propuesto recientemente con resultados promisorios.

ABSTRACT Olfactory dysfunction is a frequent pathology associated with an important decrease in the quality of life of patients and an increased mortality respect to the general population. However, it is an underdiagnosed condition, either due to lack of knowledge of the professionals or due to the lack of an adequate diagnostic method. To date there is no effective treatment for these patients and they are usually left untreated. An alternative to this problem is olfactory training, a treatment recently proposed with promising results.

Diagnóstico en la patología del olfato: revisión de la literatura / Diagnosis in smell pathology: literature review

La patología del olfato es una afección común en la población, principalmente en adultos mayores, que puede alterar de manera significativa la calidad de vida del paciente, pudiendo ser la manifestación inicial de enfermedades neurológicas como la enfermedad de Parkinson. A pesar de su relevancia, el sentido del olfato continúa siendo poco estudiado en clínica, no obstante la existencia de métodos simples validados para su evaluación. En este articulo realizamos una revisión y análisis de la literatura actual sobre el estudio clínico del olfato, con el objetivo de establecer las herramientas diagnósticas disponibles en la práctica clínica para su estudio.

Olfactory diseases are common to find in the population, mainly in older people, and it can affect significantly life quality. It can also be the first manifestation of neurological diseases, such as Parkinson disease. Despite its relevance, the sense of smell is still not studied although there are simple and validated methods available in the clinical practice. In this article, we make a review and analysis of the actual literature related to smell studies, so that we can establish available diagnosis tools in the clinical practice.

Clinical Features Indicating Nigrostriatal Dopaminergic Degeneration in Drug-Induced Parkinsonism

OBJECTIVE: Patients with drug-induced parkinsonism (DIP) may have nigrostriatal dopaminergic degeneration. We studied the clinical features that may indicate nigrostriatal dopaminergic degeneration in patients with DIP. METHODS: Forty-one DIP patients were classified into normal and abnormal [¹⁸F] FP-CIT scan groups. Differences in 32 clinical features and drug withdrawal effects were studied. RESULTS: Twenty-eight patients had normal (Group I) and 13 patients had abnormal (Group II) scans. Eight patients of Group I, but none of Group II, had taken calcium channel blockers (p = 0.040). Three patients of Group I and six of Group II had hyposmia (p = 0.018). After drug withdrawal, Group I showed greater improvement in Unified Parkinson's Disease Rating Scale total motor scores and subscores for bradykinesia and tremors than Group II. Only hyposmia was an independent factor associated with abnormal scans, but it had suboptimal sensitivity. CONCLUSION: None of the clinical features were practical indicators of nigrostriatal dopaminergic degeneration in patients with DIP.

Application of smell identification test in Parkinson's disease in China / 中华神经科杂志

Objective To evaluate the olfactory functions in patients with Parkinson's disease (PD) with a smell identification test developed for the Chinese population and to examine possible factors contributing to PD patients' olfactory performance.Methods Fifty-five patients with idiopathic and nondementia PD and 55 demographically matched healthy controls (HC) were recruited and their olfactory identification tested using the Chinese Smell Identification Test developed by the Institute of Psychology at Chinese Academy of Sciences.Results Olfactory identification score was significantly lower (t =-6.827,P＜0.01) in the PD group (19.3 ±5.4) as compared with the HC group (26.5 ±5.7).Of all PD patients,63.6％ scored over 1 SD below the age norm.In particular,of those with Hoehn-Yahr ratings between 2 to 3,77.8％ scored over 1 SD below the age norm.Receiver operating characteristic (ROC) curve analysis indicated that a cut-off score of 22.5 on the Chinese Smell Identification Test distinguished between PD patients and HC with a sensitivity of 74.6％ and specificity of 70.9％.Within the PD group,age,education,Hoehn-Yahr rating and Mini-Mental State Examination score were not found to correlate with olfactory performance (all P ＞ 0.05).Conclusion PD patients in China show significant impairment of olfactory identification,which is effectively captured by the Chinese Smell Identification Test.

Analysis of Characteristics and Steroid Effects in Olfactory Dysfunction Patients

BACKGROUND AND OBJECTIVES: Olfactory dysfunction is a common sensory disorder, but there are currently no standard diagnostics or therapeutic methods. We analyzed the effects of systemic steroid therapy in patients with olfactory dysfunction. MATERIALS AND METHOD: We analyzed patients who visited our ENT department with olfactory dysfunction for 3 years. We reviewed their charts and classified the patients according to age, sex, etiology of olfactory dysfunction, degrees of olfactory dysfunction and the effect of systemic steroid therapy. RESULTS: The mean age was 44.3 years old and there were 50 males and 55 females; 55 patients had inflammatory disease and 50 patients had non-inflammatory disease. The distribution of degrees of olfactory disorder according to cause was not significantly different (p=0.120). In 105 patients, 20% experienced improvements after systemic steroid therapy, and the response of systemic steroid therapy was better among patients with inflammatory causes. In cases of inflammatory disease, there was a larger amount of severe hyposmia patients, and their response to systemic steroid therapy was significant (p=0.015). Patients with mild and moderate hyposmia were more responsive to systemic steroid therapy than patients with severe hyposmia (p=0.382). CONCLUSION: In cases of hyposmia due to inflammatory disease, systemic steroid therapy with proper operative management may increase therapeutic effects.

Non-motor signs in Parkinson’s disease: a review / Sinais não motores na doença de Parkinson: uma revisão

During the past decade the view of Parkinson’s disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem process with diverse non-motor signs (NMS). In addition to been extremely common, these NMS play a major role in undermining functionality and quality of life. On the other hand, NMS are under recognized by physicians and neglected by patients. Here, we review the most common NMS in PD, including cognitive, psychiatric, sleep, metabolic, and sensory disturbances, discuss the current knowledge from biological, epidemiological, clinical, and prognostic standpoints, highlighting the need for early recognition and management.

No decorrer da última década, a visão da doença de Parkinson (DP) como um distúrbio de movimento puro mudou significativamente, sendo atualmente reconhecida como um processo multisistêmico com diversos sinais não motores (SNM). Além de serem extremamente comuns, estes SNM têm um impacto muito significativo na limitacão funcional e da qualidade de vida na DP. Por outro lado, os SNM são mal reconhecidos pelos clínicos e negligenciados pelos pacientes. Nessa revisão os SNM mais comuns na DP foram detalhados, incluindo distúrbios cognitivos, psiquiátricos, do sono, metabólicos, e sensitivos; e discutindo o conhecimento atual sob o ponto de vista biológico, epidemiólogico, clínico e prognóstico, destacando a necessidade de reconhecimento e abordagem terapêutica precoces.

The Effect of Stellate Ganglion Block on the Treatment of Sensorineural Olfactory Disorder Following Upper Respiratory Tract Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although systemic steroid is widely used, there is no established standard treatment for patients with sensorineural olfactory disorder. The aim of this study was to prospectively investigate the effect of stellate ganglion block (SGB) in patients with sensorineural olfactory disorders unresponsive to systemic steroids. SUBJECTS AND METHOD: Twenty patients with anosmia or hyposmia following upper respiratory tract infection (URI) that was unresponsive to systemic steroid treatments were included in this study from February 2009 through December 2009. Nine patients were treated with SGB (the treatment group) and compared with the 11 untreated patients (the control group). Except for SGB, both groups were treated the same otherwise (with topical steroids, vitamins, peripheral vasodilators) during the treatment period. We evaluated the olfactory function using Korean Version of Sniffin' Sticks test II (KVSS II) and the subjective symptom questionnaire (SSQ). RESULTS: The KVSS II scores improved significantly only in the treatment group, showing a significant difference between the two groups, whreas the SSQ scores were improved in both groups and did not show significant differences. KVSS II and SSQ scores showed a significant correlation. CONCLUSION: These results suggest that SGB may be effective in the treatment for patients with sensorineural olfactory disorder following URI unresponsiveness to systemic steroid treatments.

A cross-sectional study on olfactory function among young adult smokers

Objective: To determine the olfactory function and/or dysfunction of young adults who are cigarette smokers using a locally validated smell identification test. Design: Cross-sectional study Setting:Tertiary hospital in Metro Manila Patients: The volunteer study group was composed of 60 male and 21 female students and] employees of a tertiary hospital and its affiliated medical school (both in Quezon City). All subjects were young adults within the age range of 20-35 years with a mean age of 27.58 years (+/- 4.33). All the subjects were currently smoking cigarettes with no medical history of recent viral infection, nasal/sinus surgery, nasal/brain tumors, head trauma, radiotherapy, chronic rhinitides in exacerbation ortracheostomy. Olfactory function of each subject was evaluated using the Sto. Tomas Smell Identification Test (ST-SIT) which is a locally-validated test. Results: Majority of the subjects fell within the 24-27 age group with a mean age of 27.58 years (+/- 4.33). Males outnumbered females 74.1 percent as against 25.9 percent. An inverse relation between pack years and ST-SIT score was present indicating that there could be a dose-related effect off cigarette smoking on olfactory function. Among the 81 subjects, 15 (18.5 percent) turned out to be anosmic, 46 (56.7 percent) were hyposmic I and 20 (24.6 percent) had normal olfactory function. A mean ST-SIT score was computed at 81.183 (+/- 12.58), indicating that majority of the subjects had olfactory dysfunction, meaning they were hyposmic. Conclusion: Smoking cigarettes has become part of the lifestyle of a lot of people in spite of its hazards to health. In the present study, a majority of supposedly healthy young adults who currently smoked cigarettes were proven to suffer from olfactory impairment based on the scores of a locally-validated smell identification test. An inverse relation between ST-SIT scores and pack years was also noted which may indicate a dose-related effect of smoking on olfactory function. (Author)

Development of KVSS Test (Korean Version of Sniffin' Sticks Test) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a society develops, olfactory disturbance increases with the increased industrial disaster, traffic accidents, upper respiratory tract infection, chronic sinusitis and allergic rhinitis from air pollution, Parkinson's disease and Alzheimer's disease from aging process. Nevertheless, there is no practical clinical test of olfactory function in Korea. Authors decided to develop the "Korean olfactory test" using the odorants which are familiar to Koreans. MATERIALS AND METHODS: KVSS Test (Korean Version of Sniffin' Sticks Test) is composed of KVSS Test I (screening test) and KVSS Test II (comprehensive test). KVSS Test I was performed on 120 controls with normosmia, 39 patients with hyposmia, and 24 patients with anosmia. KVSS Test II was performed on 117 controls with normosmia, 29 patients with hyposmia, and 22 patients with anosmia. The subjects ranged in ages from 20 to 69 years. RESULTS: In KVSS Test I, the range of scores (smell test) was 5.36-7.34 in normosmia, 3.41-6.73 in hyposmia, and 1.14-3.16 in anosmia. In KVSS Test II, the range of T.D.I. score (the sum of olfactory threshold score, odor discrimination score, and odor identification score) was 25.98-35.48 in normosmia, 17.01-30.63 in hyposmia, and 7.32-14.06 in anosmia (p<0.001). CONCLUSION: It is concluded that KVSS Test I and II are suitable for the routine clinical assessment of olfactory performance in Koreans.

Changes of the Olfactory Epithelium in Artificially Induced Hypothyroid Rats

BACKGROUND AND OBJECTIVES: This study was performed to investigate, through immunohistochemical analysis, the thyroid hormone's effect on the olfactory receptor neurons of adult rats. MATERIALS AND METHODS: Hypothyroidism was induced by adding reversible goitrogen propylthiouracil (PTU) to the rats' drinking water (30 mg/kg weight). Sprague-Dawly rats aged nine to ten weeks were divided into three groups : control, six weeks or PTU therapy, and 12 weeks of PTU therapy. Light microscopic investigation of the olfactory mucosa was conducted with an immunohistochemical stain to observe for proliferating cell nuclear antigen (PCNA) and protein genepeptide (PGP) 9.5. RESULTS: The rats in the experimental groups gained less weight compared with normal rats of the same age. Light microscopic examination revealed no statistically significant differences in the thicknesses of the olfactory epithelium and the numbers of cells among the three groups in H-E stains, but the ratio of PCNA(+) supporting cells decreased significantly with longer durations of PTU treatment. As PTU therapy continued, immunoreactivities to PGP 9.5 in olfactory receptor cells decreased remarkably. After 12 weeks of PTU treatment, no immunoreactivity was observed in the olfactory receptor cells. CONCLUSION: These results indicate that the thyroid hormone is essential for maturation of the olfactory receptor neuron.