OLFATO: forma más antigua de comunicación y sentido preciso que el otorrinolaringólogo debe conocer a profundidad / SMELL: oldest form of communication and precise sense that the otolaryngologist must know in depth

Introducción: el papel clave del olfato, antiguo sistema sensorial, es proporcionar información sobre las sustancias químicas en el medio ambiente. El olfato desempeña un papel en la detección de compuestos peligrosos, el mantenimiento de la nutrición, el comportamiento interpersonal, la salud neurológica y la sensación de placer, entre otras funciones. En consecuencia, la disfunción olfativa puede conducir a un riesgo de lesiones, desnutrición, aislamiento social y una mala calidad de vida. Materiales y métodos: se realizó una exploración bibliográfica y se identificaron artículos de acuerdo con los criterios de inclusión y exclusión definidos y se tomaron aquellos con calidad en la evidencia. Discusión: el sistema olfativo humano tiene diferencias anatómicas, fisiológicas y genéticas considerables con respecto al de otros mamíferos. Conclusiones: las destrezas olfativas varían con factores como la edad, el sexo, la etapa de desarrollo, ciertas enfermedades otorrinolaringológicas y enfermedades generales.

Introduction: The key role of the ancient olfactory sensory system is to provide information about chemicals in the environment. Smell plays a role in the detection of dangerous compounds, the maintenance of nutrition, interpersonal behavior, neurological health, and the sensation of pleasure, among other functions. Consequently, olfactory dysfunction can lead to a risk of injury, malnutrition, social isolation, and a poor quality of life. Materials and methods: A bibliographical exploration was carried out and articles were identified according to the inclusion and exclusion criteria defined and those with quality evidence were taken. Discussion: The human olfactory system has considerable anatomical, physiological, and genetic differences from that of other mammals. Conclusions: Olfactory skills vary with factors such as age, sex, stage of development, certain ear, nose and throat diseases and general diseases.

Validation of the Connecticut olfactory test (CCCRC) adapted to Brazil / Validação do teste de olfato de Connecticut (CCCRC) adaptado para o Brasil

Abstract Introduction Olfactory changes are quite common in the population, causing a significant impact on the quality of life. Documentation of the olfactory function is essential for the diagnosis, treatment and follow-up of patients with inflammatory diseases of the upper airways, neurodegenerative diseases or viral infections. Among the different existing smell tests, the CCCRC is an inexpensive test, easy to apply, but it has not yet been evaluated on a large scale in the Brazilian population. Objective To validate the CCCRC smell test, after adaptation for the Brazilian population, evaluating the performance of healthy volunteers and the stability of the test in retests. Methods In this study, we carried out a cultural adaptation of the CCCRC test to Brazil. To validate and determine the normality scores, we applied the test to 334 healthy volunteers, aged >18 years of age. The retest was also carried out in up to four weeks on 34 additional volunteers to assess validity of the results. Results When evaluating the participants' performance, normosmia and mild hyposmia values were obtained in more than 95% of them. Women (58.4%) showed better accuracy than men (41.6%): p < 0.02, and individuals over 60 years of age showed worse performance (median: 6; 75th percentile: 6.5; 25th percentile). The test and retest of the 34 volunteers demonstrated that there was agreement (ICC, intraclass correlation coefficient) considered good in the left nostril (ICC = 0.65) and excellent in the right nostril (ICC = 0.77) in the combined score. Conclusion The CCCRC test adapted to Brazil showed normal values, similar to the originally-described test and validations in other countries, with a high reproducibility rate. Considering the highly favorable cost-benefit ratio, the adapted CCCRC is a very useful tool for measuring olfactory function in the Brazilian population.

Resumo Introdução Alterações olfativas são bastante comuns na população, causam significativo impacto na qualidade de vida. A documentação da função olfatória é fundamental para o diagnóstico, tratamento e seguimento de pacientes que cursam com doenças inflamatórias das vias aéreas superiores, neurodegenerativas ou infecções virais. Entre os diferentes testes de olfato existentes, o teste do Connecticut Chemosensory Clinical Research Center (CCCRC) é barato, de fácil aplicação, mas que ainda não foi avaliado em grande escala para a população brasileira. Objetivo Validar o teste de olfato CCCRC com adaptação para a população brasileira, avaliar o desempenho de voluntários saudáveis e a estabilidade do teste em retestes. Método Neste estudo fizemos adaptação cultural do teste CCCRC para o Brasil. Para validação e determinação dos escores de normalidade, aplicamos o teste em 334 voluntários saudáveis, com mais de 18 anos. O reteste foi ainda feito em até quatro semanas em 34 voluntários adicionais para avaliar concordância dos resultados. Resultados Avaliando o desempenho dos participantes, valores de normosmia e hiposmia leve foram obtidos em mais de 95% deles. Mulheres (58,4%) apresentaram melhor acurácia em relação aos homens (41,6%), p< 0,02; e indivíduos acima dos 60 anos apresentaram pior desempenho (mediana: 6; percentil 75: 6,5; percentil 25: 5). O teste e reteste dos 34 voluntários demonstrou que houve concordância (coeficiente de correlação intraclasse, CCI) considerada boa em narina esquerda (CCI = 0,65) e excelente em narina direita (CCI = 0,77) no escore combinado. Conclusão O teste CCCRC adaptado para o Brasil apresentou valores de normalidade semelhantes ao teste originalmente descrito e a validações em outros países, com alta taxa de reprodutibilidade. Considerando a relação custo-benefício altamente favorável, o CCCRC adaptado é uma ferramenta muito útil para mensuração da função olfatória na população brasileira.

Olfactory nerve: from ugly duckling to swan / Nervo olfatório: de patinho feio a cisne

ABSTRACT Background: The olfactory nerve has never been the shining star of neurological examination. Quite the contrary, examining the first cranial nerve is often an overlooked step. As cases of anosmia secondary to COVID-19 infection continue to rise, the 2020 pandemic has shed new light on this much-forgotten nerve, its value as an aid to diagnosis of several diseases and its central role in our daily lives. Objective: We aimed to emphasize how essential and simple clinical examination of the olfactory system can be by highlighting practical techniques and clinical tips for its assessment. We also share pearls and pitfalls in localization and differential diagnosis, which may prove valuable to busy clinicians. Methods: A broad review of the literature was conducted by searching PubMed, Cochrane and Google Scholar for articles and books containing topics regarding examination of the olfactory nerve and its anatomy, physiology and pathology. No particular inclusion or exclusion criteria were used. Results: Forty different works were found, between books and articles, from which 20 were selected after careful analysis. Conclusions: Despite the tragedy and adversity that followed the COVID-19 pandemic, its legacy has taught us a crystal-clear lesson: olfaction should no longer be neglected in clinical practice.

RESUMO Antecedentes: O nervo olfatório nunca foi a estrela do exame neurológico. Pelo contrário, o exame desse nervo craniano é um passo frequentemente ignorado. No entanto, o aumento exponencial de casos de anosmia secundária a COVID-19 o colocou sob os holofotes, tanto em relação á sua função para o ser humano em sociedade, como seu papel no auxílio do diagnóstico de diversas patologias. Objetivos: Enfatizar quão importante é examinar o nervo olfatório e compreender as desordens do seu sistema. Ressaltamos pérolas clínicas e erros comuns no exame deste nervo, além dicas que possam auxiliar no diagnóstico de uma série de doenças neurológicas e sistêmicas. Métodos: Uma ampla revisão da literatura foi conduzida por meio de busca no PubMed, Cochrane e Google Acadêmico por artigos e livros relacionados aos tópicos do exame físico, fisiologia, anatomia e patologia do nervo olfatório. Não foram utilizados critérios específicos de inclusão ou exclusão. Resultados: Foram encontrados 40 artigos itens relacionados na língua inglesa, dentre os quais livros e artigos, tendo sido analisados e selecionados um a um até o total de 20 referências. Conclusões: Apesar da tragédia e adversidade trazidas pela pandemia de COVID-19, uma lição clara permanece: o olfato não deve mais ser negligenciado na prática clínica.

Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia?

SUMMARY OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.

Inalação da fumaça do tabaco provoca alterações histopatológicas no nervo olfatório de ratas / Inhalation of tobacco smoke causes histopathological changes in the olfactory nerve of rats

Introdução: o tabagismo é uma das principais causas evitáveis de mortes no mundo representando um problema de saúde pública. Objetivo: investigar a relação da exposição passiva à fumaça principal do cigarro e as possíveis alterações histomorfométricas das células gliais, arteríolas e da matriz extracelular do nervo olfatório de ratas. Metodologia: trata-se de um estudo experimental, analítico e quantitativo. Vinte ratas randomizadas divididas em dois grupos, controle e tabaco, foram expostas à inalação da fumaça principal do cigarro por 60 dias utilizando dispositivo validado na literatura. Resultados: a exposição à inalação da fumaça principal do cigarro resultou em alterações significativas no grupo tabaco, tais como, elevação nos níveis de cotinina no plasma sanguíneo, aumento na espessura da parede dos vasos sanguíneos, aumento na porcentagem do colágeno total do tecido, diminuição no número total de astrócitos e aumento no número total de micróglias. Conclusão: a exposição à fumaça principal do cigarro resulta em alterações histomorfométricas que poderiam causar alterações funcionais no nervo olfatório como perda sensorial olfativa. Os achados constatados são fortes o suficiente para servir como alerta a toda a população e às autoridades de saúde, no que se refere às leis antifumo, principalmente em ambientes fechados.

Introduction: smoking is one of the main preventable causes of death in the world and represents a worldwide public health problem. Objective: to investigate the relationship of second hand tobacco smoke and possible histomorphometric changes of glial cells, arterioles and extracellular matrix of the olfactory nerve in rats. Methodology: experimental, analytical and quantitative study, twenty wistar animals randomized into two control and tobacco groups, were exposed to inhalation of main cigarette smoke for 60 days using a device validated in the literature. Results: exposure to inhalation of main cigarette smoke resulted in changes in the tobacco group, such as increased levels of cotinine in the blood plasma, increased thickness of the blood vessel wall, increased percentage of total tissue collagen, decreased in the total number of astrocytes and increase in the total number of microglia. Conclusion: exposure to main cigarette smoke results in histomorphometric changes that can cause changes in the olfactory nerve such as sensory olfactory loss. Our findings are strong enough to serve as a warning to the entire population and to health authorities in relation to smokefree laws especially in closed environments.

Nervios olfatorio, trigémino, facial, glosofaríngeo y vago: vínculos con sars-cov-2 y prospectivas neurosemiológicas / Olfactory, trigeminal, facial, glossopharyngeal and vagus nerves: links with sars-cov-2 and neurosemiological prospects

Se presenta una breve revisión los nervios olfatorio, trigémino, facial, glosofaríngeo y vago, el primero funcionalmente relacionado con la inervación quimiosensitiva olfativa en la mucosa nasal, los siguientes para el registro de dolor endocraneal y para la mucosa orofaríngea, a efectos de transducción sensitiva gustativa. Estos nervios se vinculan con los síntomas en pacientes positivos para Covid-19, que manifiestan como dolor de cabeza, disosmia, anosmia, disgeusia, ageusia entre otras características neurosemiológicas. Se concluye que estas características semiológicas se puedan deber a mecanismos neurotrópicos y transinápticos por lo que se debe realizar un examen neurológico más riguroso sobre síntomas y signos de pacientes con Covid-19.

A brief review of olfactory, facial, glossopharyngeal and vagus nerves is presented, the first one functionally related to odoriferous chemosensory innervation in the nasal mucosa, the following four cranial nerves to endocranial headache and oropharyngeal mucosa for purposes of gustatory sensory transduction. These nerves are associated with symptoms in Covid-19 positive patients, which dysosmia, anosmia, dysgeusia, ageusia manifestation, among other neurosemiological characteristics. It is concluded that these semiological characteristics may be due to neurotropic and transynaptic mechanisms, therefore a more rigorous neurological examination should be performed on symptoms and signs of Covid-19 patients.

Neurological manifestations of COVID-19: systemic review article / Монголын Анагаах Ухаан

Background@#Acute respiratory viral infection caused by human new coronavirus that was reported in last December of 2019, is becoming the most serious issue worldwide. During human coronavirus infection, upper and lower respiratory symptoms are common. However, other systemic symptoms, especially neurological signs were reported previously. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Purpose: to analyze information of neurological manifestations related to COVID-19 disease and possible way of affection of nervous system by SARS-CoV-2 virus.@*Material and Methods@#We searched Medline, PubMed, Central and Google Scholar, Web of Science for related published articles and case reports, using keywords such as “COVID-19”, “Coronavirus”, “pandemic”, “SARS-CoV-2”, “Neurological manifestations”; “Complications”; “Clinical characteristics”. There were found and considered few articles of clinical characteristics and case series reports related to COVID-19 with neurological manifestations and complications, also articles of SARS-CoV-2 virus affection to nervous system.@*Results@#Neurological manifestations including headache, dizziness, myalgia, confusion, and hyposmia were observed during COVID-19 in 6-36.4% cases. A few cases with COVID-19 showed more severe symptoms such as stroke, polyneuropathy, encephalopathy, myelitis and acute necrotizing encephalitis. SARS-CoV-2 viral infection pathway may be two different ways, namely, a) binding ACE-2 receptor on capillary endothelium and causing inflammation where then can cross blood-brain barrier and to emerge brain tissue damage; b) entering via nasal epithelium where the bipolar cells locate, from there directs to central nervous system to cause neuronal injury through olfactory bulb. </br> Conclusion: neurological manifestations are relatively common in COVID-19, however, there is lack of evidence-based study. There may have two possible pathways of SARS-CoV-2 to affect nervous system, but is required necessary further elaborately study

Nervus terminalis and nerves to the vomeronasal organ: a study using human fetal specimens / 대한해부학회지

The human nervus terminalis (terminal nerve) and the nerves to the vomeronasal organ (VNON) are both associated with the olfactory nerves and are of major interest to embryologists. However, there is still limited knowledge on their topographical anatomy in the nasal septum and on the number and distribution of ganglion cells along and near the cribriform plate of the ethmoid bone. We observed serial or semiserial sections of 30 fetuses at 7–18 weeks (crown rump length [CRL], 25–160 mm). Calretinin and S100 protein staining demonstrated not only the terminal nerve along the anterior edge of the perpendicular lamina of the ethmoid, but also the VNON along the posterior edge of the lamina. The terminal nerve was composed of 1–2 nerve bundles that passed through the anterior end of the cribriform plate, whereas the VNON consisted of 2–3 bundles behind the olfactory nerves. The terminal nerve ran along and crossed the posterior side of the nasal branch of the anterior ethmoidal nerve. Multiple clusters of small ganglion cells were found on the lateral surfaces of the ethmoid's crista galli, which are likely the origin of both the terminal nerve and VNON. The ganglions along the crista galli were ball-like and 15–20 µm in diameter and, ranged from 40–153 in unilateral number according to our counting at 21-µm-interval except for one specimen (480 neurons; CRL, 137 mm). An effect of nerve degeneration with increasing age seemed to be masked by a remarkable individual difference.

Modified primary culture method of mouse olfactory sensory neurons and its identification / 重庆医学

Objective To establish a convenient method for primary culture of olfactory sensory neurons(OSNs).Methods The C57BL/6 mouse embryos olfactory mucosa in the mouse with gestation of 15? 20 d was collected.Then the OSNs primary culture was conducted by adopting the routine and modified separation procedure.The cellular morphology was observed on 1,3,5,7,9 d after plating by using inverted microscope.The OSNs specific β-tubulin Ⅲ antigen and olfactory marker protein(OMP) in the cultured cells were identified by using the routine immunofluorescence method.Results According to modified experimental process,partial survival cells demonstrated the morphology of typical bipolar neuron,the cells on 5 d were verified as OSNs by β-tubulin Ⅲ and OMP immunofluorescence labeling.By adopting the common process,the fibrocytes began to grow on day 3 and gradually covered the culture dish.Conclusion This research successfully establishes a relatively simple and convenient method for primary culture of OSNs.

Olfactory Dysfunction in Nasal Bone Fracture

BACKGROUND: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. METHODS: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I–IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. RESULTS: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. CONCLUSION: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

Subfrontal Schwannoma Extended Broadly to Nasal Cavity Treated by Gamma Knife Radiosurgery Following Surgical Excision: A Case Report

Subfrontal schwannomas are rarely reported. They are usually found only in the subfrontal area, but some extend to the nasal cavity. In these cases, prevention of postoperative cerebrospinal fluid (CSF) leakage through thinned or eroded anterior skull base is important. A 51-year-old female with anosmia and mild nausea was diagnosed as subfrontal extraaxial mass with nasal cavity extension. This mass was initially thought to be an olfactory groove meningioma. We performed a bifrontal craniotomy for surgical excision. We did not totally remove the tumor, as we wanted to prevent a skull base defect. The histopathological diagnosis was a schwannoma. There was no postoperative complication such as CSF leakage. The residual tumor was treated with gamma knife radiosurgery. The nasal cavity mass has not grown as of five years after radiosurgery.

Las estrías olfatorias del ser humano y propuesta de inclusión en la terminologia anatomica de estría olfatoria intermedia / Olfactory stria in the human being and proposal for inclusion in terminologia anatomica of olfactory intermediate stria

Las estrías olfatorias del ser humano son dos divisiones del tracto olfatorio, tradicionalmente identificadas como medial y lateral, reconocibles a nivel del trígono olfatorio y asociadas con la corteza piriforme. El objetivo del presente trabajo fue estudiar tomando como referentes treinta y seis nervios olfatorios de cerebros frescos, la presencia de más de dos estrías olfatorias y verificar si hay estría olfatoria intermedia. Se concluye que las estrías olfatorias son variables en número de dos a tres y que se debe incluirse en la Terminologia Anatomica el término estría intermedia.

The human olfactory stria are two divisions of the olfactory tract, traditionally identified as medial and lateral olfactory stria, recognizable at the level of the olfactory trigone, and associated with the piriform cortex. The aim of this work was to study taking as reference thirty six fresh brain's olfactory nerves, the presence of more than two olfactory stria and check for intermediate olfactory stria. It is concluded that the olfactory stria are variable in number from two to three and this should be included in the Terminologia Anatomica as the term stria intermedia.

Isolated Schwannoma of the Olfactory Groove: A Case Report

Introduction Schwannoma of the olfactory groove is an extremely rare tumor that can share a differential diagnosis with meningioma or neuroblastoma. Objectives The authors present a case of giant schwannoma involving the anterior cranial fossa and ethmoid sinuses. Case Report The patient presented with a 30-month history of left nasal obstruction, anosmia, and sporadic ipsilateral bleeding. Computed tomography of the paranasal sinuses revealed expansive lesion on the left nasal cavity extending to nasopharynx up to ethmoid and sphenoid sinuses bilaterally with intraorbital and parasellar extension to the skull base. Magnetic resonance imaging scan confirmed the expansive tumor without dural penetration. Biopsy revealed no evidence of malignancy and probable neural cell. Bifrontal craniotomy was performed combined with lateral rhinotomy (Weber-Ferguson approach), and the lesion was totally removed. The tumor measured 8.0 4.3 3.7 cm and microscopically appeared as a schwannoma composed of interwoven bundles of elongated cells (Antoni A regions)mixed with less cellular regions (Antoni B). Immunohistochemical study stained intensively for vimentin and S-100. Conclusion Schwannomas of the olfactory groove are extremely rare, and the findings of origin of this tumor is still uncertain but recent studies point most probably to the meningeal branches of trigeminal nerve or anterior ethmoidal nerves. .

Main causes and diagnostic evaluation in patients with primary complaint of olfactory disturbances / Principais causas e avaliação diagnóstica em pacientes com queixa primária de distúrbio olfatório

INTRODUCTION: Establishing a diagnosis in patients with olfactory disturbances has always been challenging for physicians.One reason for this is the rarity of some of the diseases that affect this sense, such as Kallmann's syndrome and post-viral olfactory loss. OBJECTIVE: To identify the major causes of olfactory disturbances and to describe the diagnostic evaluation in outpatients attended to at an ambulatory clinic specialized in olfaction disorders. METHODS: A retrospective analysis was performed in outpatients with primary olfactory complaint attended to between June 1, 2011 and September 30, 2013 in a center specialized in olfactory disorders. Patient history, nasofibroscopy, and the University of Pennsylvania Smell Identification Test (UPSIT) comprised the examination. RESULTS: Sixty-two patients were evaluated. The major causes were chronic rhinosinusitis (31%); rhinitis, primarily the allergic type (19%); post-viral olfactory loss (13%); and post-traumatic loss (8%). UPSIT scores were statistically different among different etiologies (p = 0.01). CONCLUSIONS: The major diagnoses that should be part of the physician assessment when a patient complains of olfactory disturbance are chronic rhinosinusitis with and without polyps, allergic rhinitis, post-viral olfactory loss, and post-traumatic loss. .

INTRODUÇÃO: Estabelecer um diagnóstico em pacientes com distúrbios olfatórios foi sempre um desafio aos médicos. Uma das razões para isso é a raridade de algumas doenças que afetam esse sentido como a Síndrome de Kallmann e a perda olfatória pós-viral. OBJETIVO: Identificar as principais causas das doenças olfatórias e descrever sua condução diagnóstica em um ambulatório direcionado a esses distúrbios. MÉTODO: Análise retrospectiva de pacientes ambulatoriais com queixa olfatória primária atendida entre 1º de junho de 2011 e 30 de setembro de 2013 em centro especializado. História clínica, nasofibroscopia e o Teste de Identificação do Olfato da Universidade da Pensilvânia (UPSIT) compuseram a avaliação. Sempre que necessário, foram solicitadas tomografia de seios paranasais e ressonância magnética de crânio. RESULTADOS: Sessenta e dois pacientes foram avaliados. As causas mais comuns encontradas foram respectivamente: rinossinusite crônica (31%), rinites (19%), principalmente a rinite alérgica, perda olfatória pós-viral (13%) e pós-traumática (8%). As pontuações no UPSIT foram estatisticamente diferentes entre as cinco principais causas (p = 0,01). CONCLUSÕES: Os principais diagnósticos que devem fazer parte na investigação médica diante de um paciente com queixa olfatória são: rinossinusite crônica com e sem polipose nasal, rinite alérgica, perda olfatória pós-viral e pós-traumática. .

Diagnosis and treatment of esthesioneuroblastoma / 国际肿瘤学杂志

Esthesioneuroblastoma is one of the most uncommon nasal malignancies which is characterized by low incidence and high misdiagnosis rate.The only prognosis factor is the metastasis on lymph node of neck.Its clinical symptoms are associated with tumor infiltrating extent.Pathological diagnosis is the “gold standard” on esthesioneuroblastoma,and the Kadish staging based on the image is the most important staging standard.The traditional operation therapy mode has been replaced by the combined method of operation and radiotherapy,with the adjunctive therapy of chemotherapy.

Lesões olfatórias pós-traumáticas / Post traumatic olfactory lesions

OBJETIVO: Documentar a incidência de lesões traumáticas do nervo olfatório, assim como a etiologia traumática; correlacionar as lesões do nervo olfatório com achados radiológicos (lesões cranianas e intracranianas) e estudar lesões múltiplas de nervos cranianos. MÉTODOS: Vinte e quatro pacientes admitidos no Serviço de Emergência da Santa Casa de Misericórdia de São Paulo com lesão traumática do nervo olfatório foram incluídos. Os pacientes foram divididos em três grupos, de acordo com o escore da escala de coma de Glasgow (ECG): trauma leve (ECG de 13 a 15), moderado (ECG de 9 a 12) e grave (ECG de 3 a 8), assim como em diferentes graus de lesão do olfatório, como hiposmia, anosmia e parosmia, distribuição quanto a gênero, presença de fraturas, lesões intracranianas, fístulas liquóricas e mecanismo de trauma. RESULTADOS: Dos 24 casos, 15 lesões ocorreram em conjunto com outros nervos cranianos e em nove casos houve lesão exclusiva do nervo olfatório. O atropelamento foi a causa mais comum de lesão do nervo olfatório de forma isolada, assim como nas lesões de múltiplos nervos. Hematomas extradurais foram as lesões intracranianas mais frequentes e a ausência de fraturas predominou nos indivíduos estudados. CONCLUSÃO: Neuropatia traumática do olfatório deve ser pesquisada na admissão do paciente (quando possível), sobretudo quando houver evidência de traumas frontais ou occipitais.

OBJECTIVE: To register the incidence of the traumatic lesions to the cranial nerves and its etiology; to correlate the lesions to the radiological ndings (cranial and intracranial) and study multiple cranial nerve lesions. METHODS: Fifty-four patients admitted to the Emergency Service of Santa Casa de Misericórdia de São Paulo Hospital have been studied and lesions to the different cranial nerves were described. All patients were submitted do radiographic exams, computed tomography, and, when necessary, magnetic resonance imaging. The patients were divided into 3 groups according to the Glasgow Coma Scale (GCS) in: mild trauma (GCS: 13 to 15), moderate (GCS: 9 to 12) and severe (GCS: 3 to 8). RESULTS: Posttraumatic single nerve lesion was more frequent seen on olfactory, facial and oculomotor nerves.Running over was the main cause of these lesions (single nerve and multiple nerves). Contusions and extradural hematomas were the most frequent intracranial lesions. CONCLUSION: Traumatic cranial neuropathy occurs frequently and must be searched on the patient admission, because it can surgical decompression may necessary, such as decompression of the optic or facial nerves.

A new cultural adaptation of the University of Pennsylvania Smell Identification Test

OBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test.

Expression and function of aquaporin-4 in olfactory system of mice / 第二军医大学学报

Objective To investigate the expression and function of aquaporin-4(AQP4) in the olfactory system of mice. Methods The differences of AQP4 expression in olfaction system between wild-type and AQP4-null mice were studied by immunoblotting and immunofluorescence methods. The differences of mouse olfactory functions in the two groups were examined by two olfactory behavioral assays: the busied food pellet test and olfaction maze test, and the odorant-stimulated electroolfactogram (EOG) recording. Results The results of immunoblotting and immunofluorescence showed no AQP4 expression in the olfactory system in AQP4-null mice. Immunofluorescence result also indicated that AQP4 was mainly distributed in the membrane of support cells, duct cells of Bowmann's gland, basal cells of olfactory epithelium, membrane of Bowmann's gland epithelial cells, olfactory sheath cells surrounding the olfactory bundles, and the membrane of cells in the olfactory bundle layer and glomeruler layer. The results of olfactory behavioral assay were significantly different between the two groups at all time points tested in both the olfaction maze test and the buried food pellet test (P<0.05). It was showed that the EOGs under different pressures of saturated trimethylamine had a similar shape in both groups, and the amplitude of EOGs increased with the increase of pressure. While under the same pressure, the EOG amplitude of AQP4-null mice was significantly lower than that of wild-type mice(P<0.05). Conclusion AQP4 is widely distributed in the olfactory system of mice, including the olfactory mucosa, olfactory nerve, and olfactory bulb, which can protect the olfactory neural bundle and facilitate neural signal transfer.

Anosmia congênita associada à hipospádia: relato de caso / Congenital anosmia associated with hypospadia: a case report

Introdução: A incidência de distúrbios olfatórios nos Estados Unidos da América é de cerca de 200 mil pacientes por ano, sendo as doenças sinusais as causas mais comuns. A anosmia congênita é rara e pode ocorrer como parte de uma síndrome ou como anosmia isolada. O objetivo deste trabalho é relatar um caso raro de anosmia congênita associada à hipospádia. Descrição do caso: Paciente masculino com 20 anos de idade e quadro de anosmia congênita, apresentando gustação e sensibilidade olfatória para odores irritantes preservadas. Refere hipospádia operada aos 13 anos de idade. Negava antecedentes familiares de anosmia. Apresentava exame otorrinolaringológico e nasofibroscopia sem alterações. Ao exame neurológico constatou-se anosmia pelo Cross Culture Smell Test. Ao exame geniturinário, apresentava orifício fistuloso em face ventral de terço médio do pênis, testículos tópicos e de tamanho normal, e desenvolvimento normal dos caracteres sexuais secundários. Observou-se, na tomografia computadorizada dos seios paranasais, presença de concha média bolhosa à esquerda. A ressonância magnética apresentava-se dentro dos padrões de normalidade. Uma análise hormonal foi realizada, cujos resultados foram: hormônio luteinizante de 5,02 mUI/mL, Hormônio folículo-estimulante de 0,8 mUI/mL e testosterona total de 887 ng/dL. Discussão: O relato deste caso é importante pela existência de apenas dois casos relatados na literatura de anosmia congênita associada à hipospádia. O relato de um novo caso e da associação da anosmia com outras anormalidades, como a hipospádia, pode auxiliar na aquisição de novos conhecimentos sobre o assunto e a despertar interesse na descoberta de algum fator etiológico comum às duas anormalidades.

Introduction: The incidence of olfactory disorders in the United States is approximately 200,000 patients per year. Sinus diseases are the most common causes. The congenital anosmia is rare and may occur as part of a syndrome or isolated. The purpose of this paper is to report a case of congenital anosmia associated with hypospadia. Case report: Male, 20 years old, reporting congenital anosmia. The taste and olfactory perception for irritant odors were preserved. He was submitted to hypospadia repair surgery at the age of 13 years old. Family history of anosmia was negative. Otolaryngologyc exam and nasofibroscopy were normal. In the neurologic exam, anosmia was determined by Cross Culture Smell Test. Genitourinary exam showed: fistular orificium in ventral face of medium third section of penis, topic and normal size testicles and full development of secondary sexual characters. On computed tomography of paranasal sinuses, a concha bullosa was observed on the left. The magnetic resonance was normal. Hormonal tests: LH 5.02 mUI/mL, FSH 0.8 mUI/mL and total testosterone 887 ng/dL. Discussion: This case report is important because there are only two cases reported in the literature about congenital anosmia associated with hypospadia. The report of a new case and the association of anosmia with others abnormalities such as hypospadia may lead to additional knowledge about the subject and may raise interest on the discovery of common etiological factors of these abnormalities (anosmia and hypospadia).

Olfactory Schwannoma: Case Report

Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-year-old woman whose chief complaints were anosmia and frontal headache for 2 years. The gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed an extra-axial mass from ethmoid sinus to right frontal base region near the midline, with solid enhancement in lower portion and multicystic formation in upper portion. The tumor was totally resected via basal subfrontal approach. At operation, the tumor had cystic portion with marginal calcification and the anterior skull base was destructed by the tumor. The olfactory bulb was involved, and the tumor capsule did not contain neoplastic cells. The histopathological diagnosis was schwannoma. We report a rare case of anterior cranial fossa schwannoma with literature review.