Impact of olfactory impairment on quality of life and disability.

OBJECTIVE: To determine whether olfactory loss affects patients' quality of life or level of disability. DESIGN: Retrospective survey using questionnaire data and clinic database review. SETTING: Two university medical center smell and taste clinics. PATIENTS: A total of 1407 patients were tested for smell and taste disturbances from 1984 through 1998. Surveys were mailed to 1093 patients who had abnormal test scores; 420 (38.4%) returned completed surveys. Patients were grouped by self-rated ability to smell as "impaired" (those reporting persisting deficits) or "improved" (those reporting no smell problem when surveyed). MAIN OUTCOME MEASURES: Response frequencies were compared between the 2 groups for questions regarding ability to perform common activities of daily living and quality-of-life issues. RESULTS: Mean (+/-SD) number of activities of daily living affected by olfactory loss was 4.70 +/- 3.56 for the impaired group and 0.61 +/- 1.58 for the improved group (P < .001). Among specific activities, the most common cited impairments were ability to detect spoiled food (impaired vs improved groups, 75% vs 12%; P < .001), gas leaks (61% vs 8%; P < .001), or smoke (50% vs 1%; P < .001); eating (53% vs 12%; P < .001); and cooking (49% vs 12%; P < .001). Differences in quality-of-life issues were reported primarily in the areas of safety and eating. Overall satisfaction with life was reported by 87% of the improved group but only 50% of the impaired group (P < .001). CONCLUSIONS: Patients reporting persistent olfactory impairment after previously documented olfactory loss indicate a higher level of disability and lower quality of life than those with perceived resolution of olfactory compromise.

Microscopic detection of occult malignancy in the adult tonsil.

Microscopic evaluation of all adult tonsillar specimens has been considered essential despite the low incidence of unsuspected pathologic conditions. We evaluate whether routine histologic examination of clinically benign adult tonsillar specimens is indicated. We retrospectively reviewed pathology results from all tonsillectomies performed on patients ages 18 years or older at our institution from 1989 through 1996. Three groups were created on the basis of indications for tonsillectomy: (1) routine tonsillectomies for benign disease, (2) asymmetric tonsils, and (3) search for unknown primary lesions. Demographic data and pathologic findings in each group were analyzed. In 1280 tonsillectomies performed for benign disease there were no malignancies (0%) and 32 cases (2.50%) with clinically unsuspected benign pathologic conditions. In 31 cases of tonsillar asymmetry, two cases with malignant lymphoma (6.5%) and three cases with benign pathology (9.7%) were identified. In nine patients with squamous cell carcinoma metastatic to the neck, two occult primary lesions were identified in the ipsilateral tonsil. Our results suggest that histologic evaluation of adult tonsils removed for benign disease may be clinically unnecessary. The elimination of microscopic examination of tonsils removed from patients whose clinical presentation is entirely consistent with benign disease poses minimal risk of missing clinically significant pathologic conditions. Substantial costs for negative examinations may be avoided.

Efferent-mediated protection from acoustic overexposure: relation to slow effects of olivocochlear stimulation.

1. The present study attempts to resolve discrepancies in the reported role of olivocochlear (OC) efferent activation in protecting the inner ear from acoustic overstimulation: in previous studies, activating the OC system in guinea pigs reduced the threshold shift caused by 1 min monaural exposure to a 10-kHz tone; whereas unilateral OC activation in cats had no effect on threshold shifts following binaural exposure to a 10 min 6-kHz tone. 2. In this study, anesthetized and curarized guinea pigs were exposed either monaurally or binaurally to tones of different duration (1-5 min), frequency (6 to 10 kHz) and intensity (105-118 dB SPL). For each exposure condition, threshold shifts were compared among ears with different levels of OC activation: in some cases, the OC bundle (OCB) was electrically stimulated during (and/or before) the acoustic overexposure; in others, the OCB was cut before the exposure; in control cases, the OCB was neither cut nor electrically stimulated. 3. Electrical stimulation of the OCB delivered simultaneously with acoustic overstimulation produced significant reductions in threshold shift only for acoustic exposures at higher frequencies (8 and 10 kHz) and shorter durations (1 and 2 min). The protective effects on 1-min exposures could be extinguished by prior stimulation of the OCB, i.e., if the OC stimulation was turned on 4 min before the acoustic overexposure.(ABSTRACT TRUNCATED AT 250 WORDS)