Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial.

BACKGROUND: Endoscopic endonasal approaches pose the potential risk of olfactory loss. Loss of olfaction and potentially taste can be permanent and greatly affect patients' quality of life. Treatments for olfactory loss have had limited success. Omega-3 supplementation may be a therapeutic option with its effect on wound healing and nerve regeneration. OBJECTIVE: To evaluate the impact on olfaction in patients treated with omega-3 supplementation following endoscopic skull base tumor resection. METHODS: In this multi-institutional, prospective, randomized controlled trial, 110 patients with sellar or parasellar tumors undergoing endoscopic resection were randomized to nasal saline irrigations or nasal saline irrigations plus omega-3 supplementation. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and at 6 wk, 3 mo, and 6 mo postoperatively. RESULTS: Eighty-seven patients completed all 6 mo of follow-up (41 control arm, 46 omega-3 arm). At 6 wk postoperatively, 25% of patients in both groups experienced a clinically significant loss in olfaction. At 3 and 6 mo, patients receiving omega-3 demonstrated significantly less persistent olfactory loss compared to patients without supplementation (P = .02 and P = .01, respectively). After controlling for multiple confounding variables, omega-3 supplementation was found to be protective against olfactory loss (odds ratio [OR] 0.05, 95% CI 0.003-0.81, P = .03). Tumor functionality was a significant independent predictor for olfactory loss (OR 32.7, 95% CI 1.15-929.5, P = .04). CONCLUSION: Omega-3 supplementation appears to be protective for the olfactory system during the healing period in patients who undergo endoscopic resection of sellar and parasellar masses.

Assessing asthma in the otolaryngologist's office.

PURPOSE OF REVIEW: To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. RECENT FINDINGS: Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. SUMMARY: Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control.

Polypoid changes of the middle turbinate as an indicator of atopic disease.

BACKGROUND: High levels of local immunoglobulin E (IgE) have been demonstrated in nasal polypoid tissue; however, an association between nasal polyps and allergy has not been proven. The authors have observed that polypoid edema isolated to the leading edge of the middle turbinate (MT) is highly associated with allergic rhinitis. The objective of this study was to determine if there is an association between isolated MT polyps and inhalant allergy. METHODS: A single institution prospective study was performed. Twenty-five consecutive patients found to have isolated MT polyps on endoscopic exam were recruited. Nasal and allergy symptoms were documented on the intake form. Allergy testing was recommended to all patients. RESULTS: Of the 25 patients found to have isolated MT polypoid edema documented on endoscopic exam, 16 patients underwent skin or in vitro allergy testing. All of the patients tested positive for inhalant allergy. CONCLUSION: This small series provides strong evidence to support an association between isolated MT polypoid edema and allergy. We recommend allergy testing in all patients with isolated MT polyps or polypoid edema.