Patterns of non-conductive olfactory disorders in eastern Austria: a study of 120 patients from the Department of Otorhinolaryngology at the University of Vienna.

BACKGROUND: About 1% of the population suffer from disorders of the chemosensory system. In the United States at least two million people have problems related to smell and taste. The sense of smell enables the individual to determine the flavour of food and beverages and is most important as a sophisticated warning system. For the present investigation, we collected data on the age pattern and causes of olfactory disorders in eastern Austria. METHODS: 120 patients with non-conductive olfactory disorders were examined over a 9-month period starting from July 1998 at the outpatient clinic of the Ear Nose and Throat Department of the University of Vienna. Data concerning the underlying population taken from the 1998 population census in Vienna were used for comparison, in order to gain a more representative estimation of the distribution of these disorders. The diagnosis was based on thorough history taking, physical examination, CT scan, and olfactory testing for sensitivity by means of so-called "sniffin' sticks". RESULTS: The patients' ages ranged from 16 to 86 years (mean, 54.5 years; 74 females, 46 males). Those older than 50 years seem to have a higher risk of developing olfactory disorders. Only 15 of the female patients were pre-menopausal. Olfactory disorders were most frequently caused by viral infections in the upper respiratory tract (n = 51). Fifteen patients reported head trauma as a cause of olfactory loss, and 45 causes were idiopathic. Most of those in whom the olfactory disorder had been in existence for less than 3 months were anosmic (84%), very few were hyposmic (16% of a total of 19 patients). In contrast, 38% (of a total of 29 patients) in whom the disease had been in existence for 3 and 6 months were hyposmic. Parosmia was reported in 16 cases. Most parosmias appeared after viral infection (56%). Eight of the 120 patients reported dysgeusia. CONCLUSIONS: The present study is a first step towards an assessment of olfactory disorders in Austria. We found similar causes of non-conductive olfactory disorders as have been reported in the literature for other countries, namely upper respiratory infection leading to postviral olfactory disorders, and head trauma. With increasing age women seem to suffer more often from chemosensory dysfunction than men, which may be related to hormonal factors.

The role of fibroblasts from oropharyngeal mucosa in producing proinflammatory and mitogenic cytokines without prior stimulation.

Cytokine production by fibroblasts is not only important for immunological and inflammatory reactions in the epidermis and mucosa, but also for growth and differentiation of epithelial cells. To characterize the role of fibroblasts in the oropharyngeal mucosa, the expression of a panel of cytokines and cytokine receptors by fibroblasts isolated from normal human oropharyngeal mucosa was investigated by enzyme-linked immunosorbent assay (ELISA), reverse transcribed polymerase chain reaction (RT-PCR) and flow cytometry (FACS). Oropharyngeal fibroblasts produced the proinflammatory cytokines interleukin 1 alpha (IL-1 alpha), IL-6 and IL-8 without addition of phorbol-12-myristate-13-acetate (PMA) or biological response modifiers, suggesting an active involvement of these cells in host defence mechanisms. Keratinocyte growth factor (KGF), a growth factor for epithelial cells, and the angiogenetic fibroblast growth factors acidic and basic FGF (aFGF, bFGF) were also synthesized. Expression of receptors for IL-1, IL-4, IL-6, platelet-derived growth factor (PDGF) and epidermal growth factor (EGF) was found. These results indicate that oral fibroblasts are capable of producing a number of cytokines without the need for additional stimuli and emphasize their active regulatory role in the maintenance of the oral mucosa.

Different KGF expression in squamous cell carcinomas of the head and neck and in normal mucosa.

Fibroblast growth factors (FGFs) are major factors mediating epithelial-mesenchymal interactions in the epidermis and mucosa. In this study the expression of the FGFs keratinocyte growth factor (KGF), acidic FGF (aFGF) and basic FGF (bFGF) was examined in tumour tissue specimens from 14 patients with advanced-stage squamous cell carcinoma of the head and neck (SCCHN) and 3 SCC cell lines by reverse-transcribed polymerase chain reaction (RT-PCR) and immunohistochemistry. None of the SCC cell lines was positive for KGF mRNA, whereas all cell lines were highly positive for aFGF and bFGF. In SCCHN tissue samples the level of KGF mRNA expression was significantly lower than in normal mucosa. Tumour stroma and the submucosal areas of normal mucosa stained intensely with anti-KGF antibody in immunohistochemical slides, whereas tumour cell nests were negative. Exposure of SCC cells to KGF thus differs from normal mucosa both quantitatively and regarding spatial distribution. This fact and the overexpression of aFGF and bFGF by tumour cells potentially promote tumour growth, invasion and metastasis. Since these growth factors and their receptors are well characterized, these observations could lead to new therapeutic strategies in SCCHN, for instance by blocking their receptors or antisense targeting.

Variant petrotympanic fissure as possible cause of an otologic complication during TMJ arthroscopy. A case report.

In this reported case, a variant petrotympanic fissure--opening at the height of the orifice of the Eustachian tube into the hypotympanon--was identified by high resolution computed tomography (CT) as the possible cause of a tympanic membrane perforation. Inner ear function was preserved by an otosclerotic stapes which prevented destruction of the labyrinth. The perforation was closed by a myringoplasty and was to be followed by a stapedectomy after six months to restore normal hearing. Surgeons performing temporomandibular joint arthroscopy should be aware that in a small percentage of patients a variant anatomy of the tympanic plate exists and, therefore, great care must be exercised in the manipulation of instruments near this structure. A preoperative high resolution CT with thin slices of the temporal bone might allow identification of these high risk patients.

Substance P in the auditory hair cells in the guinea pig.

Previous immunohistochemical and electrophysiological studies on various neurotransmitters revealed the tachykinin substance P (SP) as a neuromodulator in the auditory system of mammals. This study was performed in order to determine the immunohistochemical expression and distribution pattern of SP in the organ of Corti, especially in the inner (IHC) and outer hair cell (OHC) region of the guinea pig. We examined the immunoreactivity of SP of surface preparations by means of a fluorescence and a laser scanning microscope. The electrophysiological action of SP, N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) were recorded at the subsynaptic afferent region of the IHCs using micro-iontophoretic techniques. The SP-like immunostaining could be detected at the basal and apical pole of the IHCs with a gradient distribution pattern from the basal to the apical turn. Furthermore, we could demonstrate SP-like immunoreactivity in OHCs with different occurrence in turns as well as in rows. Electrical activity was induced by applying SP, NMDA and AMPA perisynaptically to the IHCs. The selective SP antagonist spantide (D-Arg1, D-Trp7,9, Leu11-substance P) specifically blocked the SP-induced activity but without altering the activity of NMDA and AMPA. In contrast, specific NMDA or AMPA antagonists reversibly blocked either the NMDA- or AMPA-induced responses without affecting the SP-induced activity. These immunohistochemical and electrophysiological results confirm that SP may represent a neuromodulator function at the synapses of the IHCs in the guinea pig.

Immunohistochemical and electrophysiological demonstration of substance P in human vestibular ganglion cells.

This study was performed in order to determine the immunohistochemical expression and distribution pattern as well as the electrophysiological actions of substance P in human vestibular ganglion cells. Substance P-like immunostaining was mainly found in the cytoplasm of small vestibular ganglion cells. In contrast, nerve fibers were not labeled. Using intracellular recording techniques, substance P produced a slow depolarization of membrane potentials accompanied by an increase in membrane resistance. Furthermore, an enhanced firing response to depolarization occurred.