Parosmia is Associated with Relevant Olfactory Recovery After Olfactory Training.

OBJECTIVE/HYPOTHESIS: This study aims to determine the association between parosmia and clinically relevant recovery of olfactory function in patients with post-infectious olfactory dysfunction (PIOD) receiving olfactory training. STUDY DESIGN: Retrospective cohort study. METHODS: This was a retrospective cohort study of patients with PIOD that received olfactory training. Adult patients with the major complaint of quantitative smell loss were recruited and treated at several ENT clinics in German between 2008 and 2018. The outcome was based on the association between smell-loss related factors (including parosmia and phantosmia) and clinically relevant changes in overall and subdimension olfactory function of threshold, discrimination, and identification using binary logistic regression analysis. RESULTS: A total of 153 participants with PIOD were included. Clinically relevant improvements in overall olfactory function were more likely in those that had lower baseline olfactory function. Relevant improvements in discrimination function were more likely in those that had lower baseline olfactory function and those that had parosmia at the initial visit. Similarly, relevant improvements in odor identification were more likely in those that had a lower baseline olfactory function and in those who had parosmia at the first visit. Clinically significant improvements in odor threshold were more likely in those who were older in age. CONCLUSIONS: This study demonstrated that the presence of parosmia is associated with clinically relevant recovery in olfactory discrimination and identification function in patients with PIOD receiving olfactory training. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:618-623, 2021.

Game-specific abilities in elite youth football players: validity and sensitivity to change of subjective coach ratings compared to objectively-assessed data.

BACKGROUND: Little is known on the accuracy of coaches' ratings of game-specific physical abilities in elite youth football players. The present study on elite youth football players aims to assess whether: 1) the coaches' subjective assessment of the level of performance of each athlete within the team is in accordance with objectively collected data; and 2) the coaches rate changes in the athletes' performance level accurately or not. METHODS: Data on jumping ability, sprinting speed, change of direction and strength were collected in seven age groups at a football youth academy (N.=150). The diagnostic battery was repeated after seven months (N.=138). Before the second session, the head coaches completed Likert-scaled closed questions on: 1) the importance of running speed and reactive strength components and their relevance to the individual game performance of each of their athletes; 2) the level of performance of their athletes; 3) the change between the first and second performance testing results. Validity and sensitivity of change of their ratings in comparison to the performance data were calculated using analyses of interrelationship. RESULTS: The data of the head coaches showed a low to medium effect size in the agreement with the performance data (Cohen's W=0.33-0.71). The evaluation of the change in level of performance was poorer (Cohen's W=0.04-0.2; not statistically significant). CONCLUSIONS: Our results underline that functional/physical testing twice during a season may be crucial for displaying performance levels of elite youth football players. Simple self-reported ratings by the coach may be valid in recent performance level assessment but not for performance changes.

Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience.

BACKGROUND AND STUDY AIMS: Endoscopic full-thickness resection (EFTR) in the lower gastrointestinal tract may be a valuable therapeutic and diagnostic approach for a variety of indications. Although feasibility of EFTR has been demonstrated, there is a lack of safe and effective endoscopic devices for routine use. The aim of this study was to investigate the efficacy and safety of a novel over-the-scope device for colorectal EFTR. PATIENTS AND METHODS: Between July 2012 and July 2014, 25 patients underwent EFTR at two tertiary referral centers. All resections were performed using the full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Data were collected retrospectively. RESULTS: Indications for EFTR were: recurrent or incompletely resected adenoma with nonlifting sign (n = 11), untreated adenoma and nonlifting sign (n = 2), adenoma involving the appendix (n = 5), flat adenoma in a patient with coagulopathy (n = 1), diagnostic re-resection after incomplete resection of a T1 carcinoma (n = 2), adenoma involving a diverticulum (n = 1), submucosal tumor (n = 2), and diagnostic resection in a patient with suspected Hirschsprung's disease (n = 1). In one patient, the lesion could not be reached because of a sigmoid stenosis. In the other patients, resection of the lesion was macroscopically complete and en bloc in 20/24 patients (83.3 %). The mean diameter of the resection specimen was 24 mm (range 12 - 40 mm). The R0 resection rate was 75.0 % (18/24), and full-thickness resection was histologically confirmed in 87.5 %. No perforations or major bleeding were observed during or after resection. Two patients developed postpolypectomy syndrome, which was managed with antibiotic therapy. CONCLUSIONS: Full-thickness resection in the lower gastrointestinal tract with the novel FTRD was feasible and effective. Prospective studies are needed to further evaluate the device and technique.

Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series.

BACKGROUND AND STUDY AIMS: Over-the-scope clips (OTSCs; Ovesco Endoscopy, Tübingen, Germany) are extensively used for treatment of gastrointestinal perforations, leakages, fistulas, and bleeding. In this report, a new method of removing OTSCs using a prototype bipolar cutting device is described. PATIENTS AND METHODS: A total of 11 patients underwent endoscopic removal of an OTSC. The OTSC was cut at two opposing sites by a prototype device (DC ClipCutter; Ovesco Endoscopy). The remaining clip fragments were extracted using a standard forceps. RESULTS: Mean procedure time was 47 minutes (range 35 - 75 minutes). Cutting of the OTSC at two opposing sites was successful in all cases (100 %). Complete retrieval of all clip fragments was possible in 10 patients (91 %). The overall success rate for cutting and complete removal of the clip was 91 %. No major complications were observed. CONCLUSIONS: Removal of OTSCs with the prototype device was feasible and effective. The device may be valuable for OTSC removal in emergency as well as elective indications.

Do the blinds smell better?

If people lose a sense organ, there is thought to be an increase in the remaining sensory functions. Previous studies showed ambiguous results on this topic. In a prospective matched pair case-control study on 46 blind and 46 normal-sighted subjects, the olfactory performance was examined using the Sniffin' Sticks Test [threshold-discrimination-identification (TDI) test], determining the olfactory threshold, the identification and the discrimination performance. There was no significant difference between the groups. Neither the overall olfactory performance (TDI score) nor any of its subtests did correlate with the vision or with the duration of blindness. The study could not detect any superior smell abilities of blind subjects as compared to sighted subjects.

Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study.

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate the effects of olfactory training (OT) on olfactory function in patients with persistent postinfectious olfactory dysfunction (PIOD). STUDY DESIGN: Randomized, single-blind, controlled, multicenter crossover study. METHODS: Twelve tertiary university medical centers participated. Investigations were performed at three visits (baseline, after 18 weeks, and after 36 weeks), including only subjects with PIOD of <24-months duration. At each visit, participants received detailed assessment of olfactory function. Seventy subjects trained with high concentrations of four odors for 18 weeks; the other half (n = 74) trained with low concentrations of odors. For the following 18 weeks this regimen was switched. RESULTS: After 18 weeks, olfactory function improved in the high-training group in 18 of 70 participants (26%), whereas only 11/74 improved in the low-training group (15%). In subjects with a duration of olfactory dysfunction of <12 months, olfactory function improved in 15/24 participants (63%) of the high-training group and in 6/31 participants (19%) of the low-training group (P = .03). CONCLUSIONS: OT improves PIOD, and the use of odors at higher concentrations is beneficial to improvement. OT is a safe procedure and appears to be particularly useful in patients who start OT within 12 months after the onset of the disorder. OT is the first successful therapy regime in patients with PIOD. LEVEL OF EVIDENCE: 1b.

Durability of stochastic antireflective structures--analyses on damage thresholds and adsorbate elimination.

We fabricated stochastic antireflective structures (ARS) and analyzed their stability against high power laser irradiation and high temperature annealing. For 8 ps pulse duration and 1030 nm wavelength we experimentally determined their laser induced damage threshold to 4.9 (±0.3) J/cm(2), which is nearly as high as bulk fused silica with 5.6 (±0.3) J/cm(2). A commercial layer stack reached 2.0 (±0.2) J/cm(2). An annealing process removed adsorbed organics, as shown by XPS measurements, and significantly increased the transmission of the ARS. Because of their monolithic build the ARS endure such high temperature treatments. For more sensitive samples an UV irradiation proved to be capable. It decreased the absorbed light and reinforced the transmission.

A time-saving method for recording chemosensory event-related potentials.

The objective of this study was to reduce the recording duration of chemosensory event-related potentials (CSERP) and thereby to make the method more suitable for routine clinical use. Measurements were performed in the Department of Otorhinolaryngology of the university hospital of Cologne. Two protocols with different sequences [inter-stimulus intervals (ISI)-standard sequence: 30 s; PRS-15: pseudo-randomized sequence, mean ISI of 15 s] were applied to 40 volunteers to record CSERPs. To compare CSERP recordings under optimal and adverse test conditions, 20 younger/normosmic adults and 20 older/hyposmic participants were included in this study. Olfactory function was gauged using the "Sniffin'Sticks" test. For CSERP recordings, phenylethyl alcohol, hydrogen sulfide and carbon dioxide were used for olfactory or trigeminal stimulation, respectively. Both ISI protocols allowed recording CSERPs under optimal and adverse test conditions and distinguishing both groups by latencies (p ≤ 0.015). The time requirement for the recording of CSERPs with the PRS-15 sequence was less than 30 min. The pseudo-randomized sequence allowed the recording of diagnostically conclusive CSERPs in both groups and saved approximately 40% of the measuring time. This seems to be especially useful in cases where a yes/no answer (e.g., medical reports, exclusion of anosmia) is required. Shortening the time requirement significantly allows applying CSERPs to larger populations of patients with olfactory impairment.

Pro-inflammatory effects of ochratoxin A on nasal epithelial cells.

Eosinophilic chronic rhinosinusitis (ECRS) largely consists of allergic fungal sinusitis, non-allergic fungal rhinosinusitis, aspirin-exacerbated ECRS, and superantigen-induced ECRS. The pathophysiology of ECRS is not completely understood, in particular, the role of mycotoxins remains unknown. The aim of this study was to evaluate the effects of one of the most widespread mycotoxin, ochratoxin A (OTA), on the release of pro-inflammatory cytokines such as interleukin-(IL)-6 and the CXC-chemokine IL-8 from nasal epithelial cell cultures (NEC) of subjects with and without ECRS. NEC (ECRS group: n = 16; controls: n = 7) were stimulated with OTA for 24 h. Protein concentrations of IL-6 and IL-8 levels were measured in NEC supernatants by ELISA prior and 24 h after addition of OTA. Baseline levels in the supernatants of NEC were 183.3 pg/ml for IL-6 and 384.6 pg/ml for IL-8. Stimulation with OTA induced a significant increase of IL-6 (p < 0.001) and IL-8 (p < 0.001) in both NEC of controls and ECRS, respectively. There were no significant differences between controls and ECRS. This is the first study evaluating the effects of a mycotoxin on epithelial airway cells. Our data show that the ubiquitous mycotoxin OTA has a strong pro-inflammatory effect on NEC resulting in the release of IL-6 and IL-8. Mycotoxins may promote inflammation in nasal mucosa.

The learning curve of sialendoscopy with modular sialendoscopes: a single surgeon's experience.

OBJECTIVE: To assess the learning curve of sialendoscopy with modular endoscopes based on operative parameters and a postoperative performance rating. DESIGN: Prospective study, case series. SETTING: Tertiary referral hospital. PATIENTS: The study included 50 consecutive patients who underwent sialendoscopy by a single surgeon (J.C.L.) between September 2007 and March 2009 at University Hospital of Cologne, Cologne, Germany. The patients were chronologically arranged into 5 groups of 10 patients. INTERVENTIONS: Diagnostic and interventional sialendoscopy using local anesthesia. MAIN OUTCOME MEASURES: Operative parameters and postoperative performance ratings. RESULTS: The average operative time was 39 minutes, with a ratio of diagnostic to interventional sialendoscopy of 62%:38%. There was a significant improvement in the average operative time (P < .001) and in the average performance rating (P = .007) after the first 10 patients and again after the first 30 patients (P = .003 and P = .01, respectively). A continuous decrease in operation time was measurable up to the last patients. Performance ratings reached a level of excellence within the last group of patients. CONCLUSIONS: The performance of sialendoscopy improves with time and experience. With endoscopes of a modular design, the surgeons have a remarkable learning curve. The surgeons' learning curve in this study required 30 cases to reach satisfactory operation times and performance ratings. Both parameters showed continuous improvement and a leveling off after 50 cases.

Effects of traditional Chinese acupuncture in post-viral olfactory dysfunction.

OBJECTIVE: To date, recovery of olfactory function after viral infection of the upper airway cannot be achieved reliably with pharmacotherapy. The aim of this study was to evaluate the effects of traditional Chinese acupuncture (TCA) on olfactory function in patients with persistent post-viral olfactory dysfunction (PVOD). STUDY DESIGN: Historical cohort study. SETTING: University Medical Center, Department of Otorhinolaryngology. SUBJECTS AND METHODS: A total of 15 patients presenting to the outpatient clinic with PVOD were treated by TCA in 10 weekly, 30-minute sessions. Subjective olfactometry was performed with the Sniffin' Sticks test set. Treatment success was defined as an increase in Sniffin' Sticks test scores of at least six points. The effects of TCA, obtained with the chi(2) test, were compared with those of matched pairs suffering from PVOD who had been treated with vitamin B complex over 12 weeks. RESULTS: Eight patients treated with TCA had improved olfactory function compared with two treated with vitamin B complex. chi(2) test revealed a significantly better outcome in olfactory function in patients undergoing acupuncture compared with patients receiving vitamin B complex (P = 0.02). CONCLUSION: TCA possibly offers a new therapeutic regimen for post-viral dysosmia. More research in a larger case series is needed before a clearer picture will emerge.

Impact of recurrent head trauma on olfactory function in boxers: a matched pairs analysis.

Recently, interest in the health of boxers has been raised by a petition of the British Medical Association to restrict boxing. However, scientific data on permanent damage are rare and typical localisations of injuries were yet to be defined. The aim of this study was to determine whether there are changes in the sense of smell in people undergoing recurrent head traumas. The hypothesis to be tested was if boxers had a reduced olfactory function. We used a matched pairs analysis design. Fifty healthy, male athletes underwent subjective olfactometry using Sniffin'Sticks testing (including threshold, discrimination and identification, TDI). Nasal endoscopy was performed and a thorough, questionnaire-based history was obtained. These data were correlated with normative data from healthy subjects. Statistical analysis was based on matched pairs analysis by t-tests, i.e. boxers and healthy (non-boxing) subjects. Boxers showed a mean TDI score of 32.5 compared to 35.1 of non-boxing controls (p=0.003). The olfactory threshold (p<0.001) and odour identification (p<0.05) were significantly decreased in boxers; whereas odour discrimination was unaffected. Performance of odour identification showed a correlation with cushioning of the gloves (p<0.05), and thus seems a protective measure regarding the sense of smell. Boxing seems to affect olfactory function, particularly by reducing the olfactory threshold. Furthermore, cushioning of the gloves can be protective and should be increased to safeguard sportsmen from physical damage. Boxing can serve as a model for central regeneration after trauma.

Effects of short inter-stimulus intervals on olfactory and trigeminal event-related potentials.

CONCLUSION: Chemosensory event-related potentials (CSERPs) were identified in all measurements using the 20 s and the 10 s inter-stimulus interval (ISI) protocol, reducing the recording time to 75% or 57% compared with the standard protocol. A possible explanation for the rising CSERP amplitudes by shortening the ISI in CO(2) stimulation is due to a phenomenon known as trigeminal sensitization during repeated stimulation. OBJECTIVES: CSERPs are influenced by the ISI. The aim of this study was to evaluate the changes in CSERPs by decreasing the ISI from 30 s to 20 s or 10 s, respectively. SUBJECTS AND METHODS: Ten normosmic healthy subjects participated this study. Phenyl ethyl alcohol (PEA), hydrogen sulphide (H(2)S) and carbon dioxide (CO(2)) were used in CSERP measurements with different ISI protocols (30 s (standard), 20 s and 10 s). Amplitudes and latencies of ISI protocols were submitted to ANOVA for repeated measurements and t tests for paired samples. RESULTS: The amplitudes of CSERPs with PEA and H(2)S stimuli were decreasing with shortening the ISI significantly. In contrast, the highest amplitudes of trigeminal CSERPs were recorded with the 10 s ISI protocol with CO(2). The ANOVA revealed a significantly different effect of shortening the ISI on CSERPs on the right and the left side.

Long-term results of surgical treatment for recurrent respiratory papillomatosis.

CONCLUSIONS: The presented results add further support to the observation that laser microsurgery is the preferential surgical treatment for recurrent respiratory papillomatosis (RRP). A meticulous follow-up for early recognition of local recurrence and malignant transformation is recommended. OBJECTIVES: Endoscopic microsurgery continues to be the treatment of choice for RRP. The aim of this study was to evaluate the outcome of patients treated surgically. We focused on demographic data, recurrence rates, and treatment-related complications. PATIENTS AND METHODS: The charts of 194 patients treated at our institution between 1963 and 1993 were analyzed retrospectively. RESULTS: In all, 64 patients (33%) underwent a total of 137 operations using the CO2 laser; 130 patients (67%) underwent a total of 565 microlaryngeal operations by surgery with cold instruments. Five percent of the patients treated with conventional microlaryngeal surgery and none of the patients treated with laser surgery required tracheostomy (p<0.05). Postoperative glottic webs and scar formations were found in 6% of all patients after laser surgery and 20% after conventional surgery (p<0.05). The different methods of treatment did not affect the rate of recurrence (p=0.61) Malignant transformation or secondary airway carcinoma were observed in 4% of all patients.

[Idiopathic rhinitis]. / Idiopathische Rhinitis.

Idiopathic Rhinitis (IR) is a term for a group of nasal diseases of unknown aetiology. Formerly, these diseases were called vasomotor rhinitis, but because there is no indication of a disorder in the vasomotor system, this term has been abandoned. Other terms, like non-infectious non-allergic rhinitis and non-allergic non-infectious perennial rhinitis are purely descriptive. Potential pathomechanisms in IR could be 1) neural dysfunction/dysregulation; 2) immunological inflammatory responses; and 3) changes of the permeability of the mucosa, leading to increase entrance of potential harmful substances. Idiopathic Rhinitis is a diagnosis by exclusion, meaning that a number of more or less defined nasal conditions as a cause of rhinitis have been excluded - not only allergic rhinitis. Although a considerable progress was made in the standardization of provocation tests or biomarkers in nasal secretions, there are today no specific test available to confirm the diagnosis rhinitis in many non allergic conditions. An evidence-based review of treatment outcomes shows topical sprays of steroids, antihistamines to be of benefit in idiopathic rhinitis. Furthermore, nasal saline solution is effective in many patients with IR. Multiple surgical procedures have been suggested for IR, but should be reserved for patients who fail medical therapy.

Proinflammatory effects of Staphylococcus aureus exotoxin B on nasal epithelial cells.

OBJECTIVE: The aim of this study was to evaluate the effects of Staphylococcus aureus exotoxin B (SE-B) on proinflammatory cytokine/chemokine releases in primary nasal epithelial cell cultures (NECC) of subjects with and without chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: NECC (CRS: n = 14; CONTROLS: n = 11) were stimulated with SE-B. Protein concentrations of interleukin-(IL)-1beta, IL-6, and IL-8 levels were measured in NECC supernatants by ELISA before (T0) and after 24 hr stimulation with SE-B (T1). RESULTS: T0: supernatants of the NECC of CRS patients contained significant lower levels of IL-8 (2.1 ng/ml) compared to CONTROLS (IL-8: 6.2 ng/ml; P < 0.01). T1: SE-B induced a significant increase of IL-6 in NECC (P < 0.001). IL-1beta was not detectable. CONCLUSIONS: This is the first study evaluating the effects of exotoxins on NECC. SE-B showed proinflammatory effects on NECC. SIGNIFICANCE: Our data suggest that resident NECC are involved in immunological responses to Staphylococcus aureus toxins, supplementing the so-called "superantigen hypothesis" in CRS.

Comparison of a centered 32P source wire system with a noncentered 90Sr/Y brachytherapy system for intracoronary beta-radiation following PCI of diffuse in-stent restenosis.

BACKGROUND: We investigated the potential impact of differences in effective radiation dose between the centered Guidant 32P source wire system and the noncentered Novoste 90Sr/Y BetaCath system on clinical and angiographic outcomes of intracoronary brachytherapy for the prevention of in-stent restenosis. METHODS: From 10/00 to 05/04, a total of 400 patients underwent percutaneous coronary intervention (PCI) with brachytherapy for diffuse in-stent restenosis at our institution. Following balloon dilatation, patient Group A (n=200) was treated with the centered 32P Galileo source wire system, patient Group B (n=200) was treated with the noncentered 90Sr/Y BetaCath radiation system. In Group A, the prescribed dose of 20 Gy was applied in 1-mm depth of the vessel wall. In Group B, the prescribed dose of 18.4 Gy was applied for visual reference vessel sizes >2.7 and <3.35 mm, 23 Gy for >3.36 and <4.00 mm, and 25.3 Gy for >4.00 mm, each calculated at a distance of 2 mm from the center line of the radiation source. Patients received aspirin and clopidogrel over 12 months. Primary endpoint was target lesion revascularization (TLR) at 6 months. Secondary endpoints were the binary restenosis rate and major adverse cardiac event (MACE) at 30 days and 6 months. RESULTS: At 30 days, one patient of each group underwent PCI at a nontarget lesion (0.5%). At 6 months, MACEs were equally distributed in both groups. Target lesion revascularization at 6 months was 5.9% in Group A and 9.2% in Group B (P=.08). Binary angiographic restenosis rate at 6 months was 5.5% in Group A and 11.2% in Group B (P=.014). CONCLUSION: Intracoronary beta-radiation using the centered 32P source wire system yielded a significant reduction of recurrence rate compared to the noncentered 90S/Y BetaCath system after PCI of diffuse in-stent restenosis. There was a nonsignificant trend toward reduction of TLR among patients treated with the centered 32P source wire system.

Nasal colonization with Staphylococcus aureus is not associated with the severity of symptoms or the extent of the disease in chronic rhinosinusitis.

OBJECTIVES: There is an increasing knowledge that the severity of perennial allergic rhinitis is associated with nasal carriage of Staphylococcus aureus (S. aureus). The aim of this study was to evaluate the rate of bacterial colonization with S. aureus in the nose of subjects with and without chronic rhinosinusitis (CRS) and to correlate these findings with the severity of symptoms and the extent of the disease. STUDY DESIGN AND SETTING: Open, prospective controlled trial. METHODS: 190 subjects with CRS and 42 subjects with septal deviation without sinusitis (control subjects) were included in this study. Swabs were taken endoscopically from the middle meatus and bacteria were cultured and identified. Airway symptoms were assessed by subjects in standardized questionnaires and frequencies of respiratory tract infections were noted. The rhinosinusitis extent was graded by CT scan assessment. Analysis of variance, chi-square test, and Pearson's correlation test were applied for statistical analyses. RESULTS: The S. aureus carriage rate was 25.5% in CRS and 31.4% in control subjects. Further facultative pathogens were cultured in 20.6% of subjects with CRS and in 8.5% of controls. 73.8% of S. aureus were ampicillin-resistant, multiresistant strains were cultured in 5.8%. Most airway symptoms and the frequencies of respiratory tract infections were significantly higher in the CRS group compared with control subjects. In post hoc comparison between the subgroups with and without S. aureus colonization, no significant differences were found between the extent of rhinosinusitis and the severity of airway symptoms. CONCLUSIONS: Facultative pathogens were detected in more than 40% of CRS patients without acute respiratory tract infections. In contrast to the findings in atopic dermatitis and perennial allergic rhinitis, the colonization rate with S. aureus is not increased and S. aureus carriage is not a risk factor for the severity or the extent of rhinosinusitis.