Brain waves spectral analysis of human responses to odorous and non-odorous substances: a preliminary study.

OBJECTIVE: The aim of this study was to identify the potential electrophysiological biomarkers of human responses by comparing the electroencephalogram brain wave changes towards lavender versus normal saline in a healthy human population. METHOD: This study included a total of 44 participants without subjective olfactory disturbances. Lavender and normal saline were used as the olfactory stimulant and control. Electroencephalogram was recorded and power spectra were analysed by the spectral analysis for each alpha, beta, delta, theta and gamma bandwidth frequency upon exposure to lavender and normal saline independently. RESULTS: The oscillatory brain activities in response to the olfactory stimulant indicated that the lavender smell decreased the beta activity in the left frontal (F7 electrode) and central region (C3 electrode) with a reduction in the gamma activity in the right parietal region (P4 electrode) (p < 0.05). CONCLUSION: Olfactory stimulants result in changes of electrical brain activities in different brain regions, as evidenced by the topographical brain map and spectra analysis of each brain wave.

Smell Outcome and Seropositivity Titre in Post-COVID-19 Patients.

INTRODUCTION: The aims of the study were to perform an olfactory assessment on patients active and post-COVID-19 using the culturally adapted Malaysian version Sniffin' Sticks identification smell test (mSS-SIT), to evaluate the patient olfactory outcome using a Malay short version of the Questionnaire of Olfactory Disorders-Negative Statements (msQOD-NS), as well as to evaluate seropositive titre (IgG) response using automated serology method. METHODS: Score for mSS-SIT was performed during the hospitalization, when patients had tested positive for SARS-CoV-2 (during COVID-19), and repeated after they had tested negative (after COVID-19). Also, each patient completed msQOD-NS and serology SARS-CoV-2 antibodies blood test was evaluated. RESULTS: During COVID-19, 2 of our patients were anosmia (6.5%), 22 (70.9%) were hyposmia, and 7 (22.6%) were normosmia. We repeated mSS-SIT on these same patients after COVID-19, and none of these subjects were hyposmia or anosmia, as they achieved a score >12. All our patients had scored 21 using msQOD-NS, meaning no impact on quality of life as they had regained their normal olfactory function. In this study also, we obtained no correlation between smell test and seropositivity titre COVID-19, and antibody levels gradually decreased over time till 6 months and remained stable up to 12 months. CONCLUSION: From this study, we know full recovery of the sense of smell can be expected post-COVID-19 infection and COVID-19 antibody persists in the body up to 12 months of infection.

Rare Extranodal Manifestation of Rosai-Dorfman Disease Presenting as Nasal Obstruction and its Management.

Rosai-Dorfman disease (RDD) is a rare and benign lymphoproliferative disorder that commonly presents as painless, bilateral neck swelling. Extranodal presentations are considered rare, but the most common extranodal locations involved include skin, subcutaneous followed by nasal/paranasal sinuses. Although it is a benign condition, it may be mistaken as a malignant lesion and requires a biopsy for diagnostic confirmation. In this study, we report a rare case of RDD with bilateral neck node and nasal/paranasal sinus involvement which initially presented with bilateral nasal obstruction. And, we reviewed the management in this unusual case and discussed the helpful role imaging studies play in the further workup and subsequent follow-up to treatment response.

Solitary Fibrous Tumour: A Rare Differential Diagnosis of Unilateral Nasal Mass.

Solitary fibrous tumors of the nasal cavity and paranasal sinuses are rarely encountered in clinical practice. These are unusual mesenchymal tumours initially described as primary spindle-cell neoplasms. Such tumours may manifest in pleural and extrapleural sites such as the liver, parapharyngeal space, sublingual and parotid glands, and thyroid but are seldom described in the nose and paranasal sinus region. Erosion of adjacent structures may occur, but the tumour itself does not metastasise. A young patient presented with a progressive unilateral nasal mass. The initial nasal biopsy reported it as a benign inflammatory nasal polyp. Imaging revealed a large, locally expansile mass within the right nasal cavity displacing the nasal septum. The patient underwent excision of the tumour and the diagnosis of solitary fibrous tumour was confirmed by immunohistochemistry staining. This case is intended to highlight the diagnosis and management of this rare tumour.

Diagnostic Value and Clinical Application of Nasal Fractional Exhaled Nitric Oxide in Subjects with Allergic Rhinitis.

PURPOSE: Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients. METHODS: The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment. RESULTS: One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (p < 0.001). Both the subjective (VAS and NOSE), both (p < 0.01) and objective (nasal FeNO, p < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve. CONCLUSION: Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR.

Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly.

Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.

A Rare Case of a Nasopharyngeal Pleomorphic Adenoma Mimicking a Nasopharyngeal Carcinoma.

Pleomorphic adenoma is the most common benign pathology of the major salivary gland but rare in the minor salivary gland, especially in the nasopharynx, with only a few cases reported in the literature. A 76-year-old lady presented with bilateral nasal blockage for one year secondary to a nasopharyngeal mass. Histopathological examination reported it to be nasopharyngeal carcinoma, but the mass persisted after a course of chemotherapy combined with radiotherapy. Upon repeat biopsy, the mass was found to be a pleomorphic adenoma. The patient underwent nasopharyngectomy without complications and no evidence of recurrence after 18 months of follow-up.

Reflux Finding Score Using HD Video Chromoendoscopy: A Diagnostic Adjunct in Suspected Laryngopharyngeal Reflux?

OBJECTIVE: To explore the use of real-time virtual chromoendoscopy (i-scan) in characterizing the mucosal changes present in subjects with suspected laryngopharyngeal reflux (LPR) and to compare the inter-rater and intra-rater agreement of Reflux Finding Scores (RFS) from both laryngologists and general otolaryngologists (ORL) observing exams using both white light endoscopy (WLE) and i-scan. METHODS: This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH). Two laryngologists and two general otolaryngologists evaluated the anonymized videos independently using RFS. Dx-pH results were interpreted using the pH graph, report and RYAN score. Subjects were then designated into one of three groups: no reflux, acid reflux and alkaline reflux. RESULTS: For the symptomatic group, no mucosal irregularities or early mucosal lesions were observed except in one subject who had granulation tissue. The mean RFS using WLE and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and 7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement among all four raters were good to excellent and similar for both WLE and i-scan (ICC of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more specifically showed 39 subjects had "acid reflux" and 8 had "alkaline reflux". Sixteen subjects demonstrated a positive RYAN score but showed none were significantly correlated with their RFS. CONCLUSIONS: This study reports the first utilization of real-time video chromoendoscopy with i-scan technology through high-definition flexible endoscopes to attempt to characterize laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists and laryngologists were equally capable of reliably calculating the RFS using both WLE and i-scan, however no significant improvement in agreement or change in RFS was found when i-scan technology was employed. LEVEL OF EVIDENCE: Level 2.

Malaysian Version of the Sniffin' Sticks Identification Smell Test: Cutoff Points of Hyposmia.

INTRODUCTION: Cultural backgrounds can influence the smell test because of the unfamiliarity of different populations with a number of odorants. The study aims to determine the cutoff points for hyposmia using the cultural adaptation of the Malaysian version of the Sniffin' Sticks identification smell test among different age groups. METHODS: In this cross-sectional study, healthy participants were recruited from a hospital, senior citizen homes, and schools from 2019 until 2021. Participants were divided into 5 different age groups (A: children, B: adolescents, C: young adults, D: middle-aged adults, and E: older adults) and underwent the identification smell test. Scores below the 10th percentile in these age groups were used to determine the cutoff points for hyposmia. RESULTS: The cutoff points for the smell identification scores for hyposmia at the 10th percentile in children, adolescents, and adults (young, middle-aged, and older) were less than 6, 9, and 11, respectively. Pairwise comparisons were made using the Bonferroni post hoc test, with p < 0.001. Scores showed a significant difference between males (mean [SD]: 11.43 [2.42]) and females (12.01 [1.98]); p = 0.005. CONCLUSION: Our study found that the cutoff points of the identification smell test for hyposmia were lower than those of other studies. It is important to use these cutoff points in our population to establish the correct integrity of olfaction function in the clinic setting and in future research.

Intractable Sneezing Unfolding a Hideous Truth.

Intractable sneezing is a diagnosis of exclusion and is mostly psychogenic. We reported a case of an 11-year-old girl who presented with uncontrollable bouts of sneezing for three weeks, which did not respond to conventional treatment. She was eventually diagnosed to have psychogenic intractable sneezing, which was triggered by an unfortunate family circumstance. She improved with psychotherapy and was discharged well. Literature review on intractable sneezing showed that patients were predominately female teenagers and mostly recovered after psychotherapy. Multidisciplinary team effort especially with a child psychiatrist is important for the treatment and follow-up of these patients. Imaging should also be routinely performed as some had underlying organic causes that presented as intractable sneezing.

Recurrent Nasal Septal Hematoma and Abscess: A Rare Manifestation of Leukemia.

Nasal septal abscess and hematoma are rare clinical entities. To the best of our knowledge, there have only been 2 cases of nasal septal abscess associated with haematological malignancy reported in the literature. Herein, we present a unique case of recurrent spontaneous nasal septal hematoma and abscess in a patient prior to and after the diagnosis of acute myelogenous leukemia. Its rarity in immunocompromised population, clinical presentation, treatment and complications are further discussed.

Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report.

Mild to severe epistaxis is common in pregnancy and often results from increased vascularity of the nasal mucosa and hormonal changes. Symptoms may occur in the absence of an obvious local cause or any systemic disorder; however, thorough otolaryngological (i.e., "ENT") evaluation is always warranted. Pyogenic granuloma or lobular capillary haemangioma is a benign fibrovascular proliferative tumour that is commonly found on the face, fingers, lips, and nasal mucosa. Pregnancy-induced pyogenic granuloma is not an uncommon entity and may result in torrential epistaxis if untreated. Managing a case of severe epistaxis during pregnancy usually requires multidisciplinary management. The authors present a case of severe epistaxis in pregnancy that necessitated examination of the nasal cavity under general anaesthesia. Intraoperative findings showed a bluish-red mass occupying the patient's right maxillary sinus. Bleeding was arrested and complete haemostasis was achieved. The nasal pyogenic granuloma completely resolved in the post-partum period.