Fast Screening of Olfactory Function Using the Q-Sticks Test.

OBJECTIVES: Classical, longer olfactory tests are associated with difficulties in everyday practice. The aim of this study was to investigate the clinical utility of the Q-Sticks test within the context of a multicenter study. METHODS: A total of 333 subjects, aged between 12 and 88 years, completed a 3-item Q-Sticks test and a longer Sniffin' Sticks identification test. We analyzed the sensitivity and specificity of the test results for different cutoffs for anosmia and hyposmia. RESULTS: Our study showed that the test can be used on subjects aged 12 years and older, regardless of their sex. The data indicated a test sensitivity and specificity of 91.8 and 92%, respectively, with a score of 2 taken as a cutoff for olfactory dysfunction. Conversely, normal olfactory function can be declared with high probability with a score of 3 in the Q-Sticks test. CONCLUSION: We reconfirmed that the Q-Sticks test is a good screening tool for everyday medical practice and in laboratory settings, although it has to be kept in mind that the test can produce false-negative results at a score of 3. The test was relatively sensitive to anosmia and differences between normosmic and hyposmic/anosmic patients.

Isolation, culture optimization and functional characterization of stem cell neurospheres from mouse neonatal olfactory bulb and epithelium.

The olfactory epithelium contains basal cells with stem cell characteristics, which have the capacity to differentiate throughout life into olfactory receptor neurons (ORNs). Here we investigate the in vitro characteristics of stem cells taken from the olfactory bulb (OB) and the olfactory epithelium (OE) of neonatal TIS21 knock-in mice. The major aim of the study was the generation of olfactory neurospheres (ONS) derived from OB and OE of neonatal mice as a tool to further analyze the elementary processes of ORN development. Our data showed that the presence of epidermal growth factor (EGF) and fibroblast growth factor (FGF) leads to a significant increase in number of ONS derived from OB but not from OE. The differentiation of ONSs led to the formation of different neuronal cell types, in particular to bipolar-shaped cells as well as putative pyramidal-neurons, astrocytes and oligodendrocytes. Immunohistochemical staining confirmed the presence of astrocytes and neurons in both types of ONSs. In order to investigate the functionality of the neurons we performed calcium imaging and patch-clamp experiments. Calcium imaging experiments revealed that the application of high potassium concentration provokes calcium transients. No excitable properties, neither sodium currents nor action potentials, were observed for the bipolar-shaped cells derived from OB and OE neurospheres, which means that these types of cells morphologically defined as putative neuronal cells, were not physiologically active. Interestingly, patch-clamp recordings performed in the pyramidal-shaped cells of OB neurospheres showed sodium and potassium currents as well as action potentials. Our study will help to establish further models in the field of olfactology.

Tumor site and disease stage as predictors of quality of life in head and neck cancer: a prospective study on patients treated with surgery or combined therapy with surgery and radiotherapy or radiochemotherapy.

In this prospective study, we compared the short-term quality of life (QOL) of two subgroups of head and neck cancers: oropharyngeal and laryngeal cancers. Patients treated with curative surgery, were asked to participate in the study using the EORTC QLQ-C30 and H&N35 questionnaires to examine QOL. The oropharynx group consisted of 32 (48 %) patients, while the larynx group consisted of 35 (52 %) patients. All patients were treated with either curative surgery alone or curative surgery combined with adjuvant radiotherapy or radiochemotherapy. The questionnaires were handed out pre- and post-therapy (10 months). At baseline, an impaired overall QOL (=EORTC QLQ-C30 global score) with a value of 53.4 for the whole patient collective was found; the overall QOL after 10 months improved (60.2, p < 0.05). Between the two patient groups, there was no difference in the global score after 10 months. The oropharynx patients described more problems with fatigue and oral cavity associated. The main symptoms in the larynx group were loss of sensual function and coughing. The present investigation revealed that the general post-therapy QOL in two subgroups of head and neck cancer reached a satisfying level.

Audiometric Results of Open Cavity Tympanomastoidectomy in Advanced Attic Cholesteatoma.

In this retrospective study, we evaluated the audiometric results after using the retrograde mastoidectomy technique with open mastoid cavity for the removal of extended attic cholesteatomas. The described technique was used for cholesteatoma removal in 168 adult patients with an average follow-up time of 12 months. Due to cholesteatoma extension far into the mastoid, the disease was eradicated by the canal wall down (CWD) technique with the creation of an open mastoid cavity. Primary surgery was carried out in 47% of ears, with the remaining 53% representing revision surgery. In all cases, a classical CWD with an open mastoid cavity and partial obliteration with cartilage was created. A dry ear was achieved in 94% of cases. A postoperative air-bone gap ≤ 20 dB was achieved in 42.9% of the operated ears. 9.3% (n = 15) of the operated ears showed a postoperative air-bone gap > 30 dB. Important factors leading to significantly better hearing restoration were an intact malleus, the use of alloplastic titanium prostheses and primary surgery. Although most cholesteatomas nowadays can be eradicated with the canal wall up technique, in far advanced cholesteatomas, the CWD technique can be applied with acceptable postoperative hearing results.

Suture of the mucosa after the endoscopic LASER mucomyotomy of Zenker's diverticulum.

The treatment of choice of Zenker's diverticulum is the rigid endoscopic mucomyotomy. At our ENT department, we usually perform an endoscopic mucosal suture after the myotomy. We diagnosed 49 patients and treated 39 patients between 2003 and 2013 due to a Zenker's diverticulum. We used the classification of Brombart to determine the size of the diverticulum. Surgery was performed as an endoscopic LASER mucomyotomy with mucosal sutures or as an open approach with diverticulectomy and myotomy. Patients were phoned to ask for their complaints postoperatively. The symptoms were classified using a visual scale from 0 (no complaint) until 10 (same or more complaints than before the surgery). The distribution of the diverticulum's size was: 6 patients Brombart I, 11 patients Brombart II, 14 patients Brombart III and 18 patients Brombart IV. 10 patients did not undergo surgery. With 33 patients, we performed an endoscopic operation and 6 patients underwent an open approach. The scale of postoperative complaints was the following: 20 patients (0/10), 12 patients (1/10 or 2/10), 3 patients (3/10), 1 patient (6/10) and 1 patient (10/10). None of the patients suffered from severe complications such as mediastinitis. In 85% of the cases, an endoscopic approach could be performed. Postoperatively, 94% of the patients did not have any or just mild complaints. The risk of severe complications or recurrence of the diverticulum is low. The mucosal suture might reduce the risk of infections.

Predictive value of disease severity on self-reported rating and quantitative measures of olfactory function outcomes after primary endoscopic sinus surgery. A prospective study.

BACKGROUND: This prospective study investigates the influence of primary Endoscopic Sinus Surgery (ESS) in patients with chronic rhinosinusitis (CRS) on olfactory function and on the patients' quality of life. We assess the role of preoperative disease severity measured by computed tomography (CT) scan in predicting outcome. METHODOLOGY: Adults undergoing ESS were examined preoperatively (n=92) and five months postoperatively. Coronal CT scans were evaluated referencing the Lund Mackay (LM) system. On the basis of the LM score, the collective was divided into two groups. We performed the olfactory test "Sniffin' Sticks" and handed out the specific health-related quality of life questionnaire SNOT-20. RESULTS: We could demonstrate that olfactory function of patients with strong opacification on CT scans improved by an average of 2.49 points more than olfactory function of patients with less severe disease. In terms of the self-reported rating of smell, the degree of amelioration differed significantly. Both groups showed an improvement in quality of life irrespective of severity of disease. CONCLUSION: Mean olfactory function of patients with a high degree of disease in CT scan improved more than that of patients with less opacification on CT scan. Patient's subjective perception of smell impairment was in line with these findings.

Astringency is a trigeminal sensation that involves the activation of G protein-coupled signaling by phenolic compounds.

Astringency is an everyday sensory experience best described as a dry mouthfeel typically elicited by phenol-rich alimentary products like tea and wine. The neural correlates and cellular mechanisms of astringency perception are still not well understood. We explored taste and astringency perception in human subjects to study the contribution of the taste as well as of the trigeminal sensory system to astringency perception. Subjects with either a lesion or lidocaine anesthesia of the Chorda tympani taste nerve showed no impairment of astringency perception. Only anesthesia of both the lingual taste and trigeminal innervation by inferior alveolar nerve block led to a loss of astringency perception. In an in vitro model of trigeminal ganglion neurons of mice, we studied the cellular mechanisms of astringency perception. Primary mouse trigeminal ganglion neurons showed robust responses to 8 out of 19 monomeric phenolic astringent compounds and 8 polymeric red wine polyphenols in Ca(2+) imaging experiments. The activating substances shared one or several galloyl moieties, whereas substances lacking the moiety did not or only weakly stimulate responses. The responses depended on Ca(2+) influx and voltage-gated Ca(2+) channels, but not on transient receptor potential channels. Responses to the phenolic compound epigallocatechin gallate as well as to a polymeric red wine polyphenol were inhibited by the Gαs inactivator suramin, the adenylate cyclase inhibitor SQ, and the cyclic nucleotide-gated channel inhibitor l-cis-diltiazem and displayed sensitivity to blockers of Ca(2+)-activated Cl(-) channels.

Upper airway obstructions and chronic otitis media: a clinical study.

PURPOSE: To investigate if pathologies causing upper airway obstructions are correlated with chronic otitis media. MATERIALS AND METHODS: One hundred fourteen patients with chronic otitis media and 114 healthy controls were enrolled in this study. Nasal septal deviation, Friedman and Mallampati scores were assessed for upper airway obstructions. Chronic suppurative otitis media was classified into tubotypmanic (n=80) and atticoantral (n=34) subtypes. Number of patients with septal deviation with a convexity to the same side as the affected ear in each CSOM subgroup was compared with chi-square test. The mean Mallampati and Friedman scores in tubotympanic disease group, atticoantral disease group and healthy controls were compared using Kruskal-Wallis test. RESULTS: Septal deviation occurred more frequently on the same side of ear pathology in patients with tubotympanic chronic suppurative otitis media (p=0.0005). Such a difference was not observed between the controls and patients with atticoantral chronic suppurative otitis media (p=0.718). No significant difference was noted between patients and controls in terms of Mallampati and Friedman scores (p=0.602 and p=0.836, respectively). Subtypes of chronic suppurative otitis media were not different from each other in terms of Mallampati and Friedman scores either (p=0.718 and p=0.708). CONCLUSION: Our results indicate that septal deviations may commonly occur on the same side with chronic otitis media. Therefore, septal deviations must be carefully investigated during the preoperative assessment of patients with CSOM. Elucidation of any possible causal relationship calls for further trials in larger series.

Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique.

In this retrospective study, we analyzed the functional results after using the retrograde mastoidectomy technique for cholesteatoma removal in an adult patient population. The described technique was used at a tertiary referral center for cholesteatoma removal in 218 adult patients, representing 242 operated ears, with an average follow-up time of 20.3 months. With the retrograde mastoidectomy technique, the cholesteatoma is removed posteriorly through the canal wall, from the epitympanic region toward the mastoid, with the option to reconstruct the posterior bony canal wall or create an open mastoid cavity, depending on the size of the defect. Primary surgery was carried out in 58.7 % ears, with the remaining 41.3 % representing revision surgery. In 151 cases, the posterior canal wall was reconstructed, and in 91 cases a classical CWD with an open mastoid cavity was created. In the majority of the cases (n = 213, 88.0 %), a primary hearing restoration was performed. There were 18 recurrences (12.7 %) in primary cases and 22 recurrences (22 %) in revision surgeries. Ninety percent of the recurrences (36 of 40 cases) occurred within 5 years. A postoperative air-bone gap of less than 20 dB was achieved in 61.6 % of the operated ears. Ears with a reconstructed posterior canal wall had significantly better hearing results than those cases in which a CWD procedure was used (air-bone gap of 17.6 versus 22.5 dB, p < 0.05). The retrograde mastoidectomy technique for cholesteatoma removal resulted in satisfying hearing results in the majority of the cases, with a recurrence rate comparable to the current literature.

Diseases of the middle ear in childhood.

Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.

Predictors of listening capabilities and patient satisfaction after stapes surgery in otosclerosis.

OBJECTIVE: To study objective or subjective preoperative factors predicting improvement in listening capabilities and patient satisfaction after stapes surgery in otosclerosis. STUDY DESIGN: Prospective, multicenter study. SETTING: Two tertiary referral centers. PATIENTS: Fifty-four consecutive adult patients with otosclerosis. INTERVENTIONS: Stapedotomy, stapedectomy. MAIN OUTCOME MEASURES: Pure tone and speech audiometry and questionnaires were assessed preoperatively and repeated 6 months postoperatively. The questionnaires consisted of a visual analogue scale (VAS, 0-10) to score the overall quality of life, and the Operation Benefit Profile to assess the listening capability in various circumstances. Stereophony, defined by the Belfast rule of thumb, was used to divide the patients in 3 categories having unilateral, symmetric bilateral, or asymmetric bilateral hearing loss. RESULTS: Six patients were considered early failures of surgery, and 8 patients were lost to follow-up. In the remaining 40 patients (43 ears), all audiometric parameters improved significantly. The postoperative air-bone gap was less than 10 dB in 70%. The postoperative average air conduction threshold was less than 30 dB in 49%. The postoperative quality of life was excellent (VAS, ≥9) in 45% and did not correlate with any preoperative parameter. Preoperative and postoperative overall listening capabilities correlated slightly (Spearman r, 0.47). The postoperative VAS correlated with all postoperative audiometric parameters and the Operation Benefit Profile. CONCLUSION: Uncomplicated stapes surgery itself is the only predictor of improvement in listening capabilities and patient satisfaction 6 months after stapes surgery in otosclerosis.

The role of p21 and p53 proteins in congenital cholesteatoma.

OBJECTIVE: Immunoexpression analysis of p53 and p21 in congenital cholesteatoma with assessing their exact localization in cholesteatoma layers and the level of expression. P53 and p21 are apoptosis-related molecules that regulate cell cycle. These markers have been not completely evaluated in congenital cholesteatoma, and the role of apoptosis in congenital cholesteatoma is also not completely understood. METHODS: Congenital cholesteatoma samples, a study group (n = 13) and normal auditory meatal skin, a control group (n = 12) from patients who underwent surgery for cholesteatoma were included in the study. Acquired cholesteatoma samples were used as a comparable group (n = 12). Tissue sections were investigated with the immunohistochemistry technique based on binding of biotinylated secondary antibody with the enzyme-labeled streptavidin with using appropriate primary antibodies. Cells with immunoexpression of analyzed antigens: p53 and p21 were defined as antigen positive. In each section, cells were counted, and the percentage of positive cells was determined. The level of significance was set at p < 0.05. RESULTS: The mean percentage of p21-positive was statistically significant higher in congenital cholesteatoma than in the control group (p < 0.05). There was no meaningful difference between congenital and acquired cholesteatoma with respect to p21 expression. There was significant difference between congenital and acquired cholesteatoma regarding p53. CONCLUSION: Up-regulation of p21 protein is expected to play a significant role in CC development. Apoptosis is an important process in the pathogenesis of congenital cholesteatoma. It seems reasonable to perform studies on apoptosis in congenital cholesteatoma in the prospective way taking into consideration more specimens.

Management of maxillary sinus inverted papilloma via transnasal endoscopic anterior and medial maxillectomy.

OBJECTIVE: To introduce and evaluate the effectiveness and safety of transnasal endoscopic anterior and medial maxillectomy (TEAMM) in the treatment of Krouse stage III inverted papilloma (IP) originating from the maxillary sinus. METHODS: A retrospective chart review was performed for 33 patients with Krouse stage III IP undergoing TEAMM in our hospital between 2003 and 2008. RESULTS: Tumors were completely resected through TEAMM. Sixteen cases had type I TEAMM, during which the nasolacrimal duct was preserved; 17 had type II TEAMM, during which the nasolacrimal duct was resected. The inferior turbinate was partially preserved in 26 cases. Patients were followed for a mean of 40.4 months. Recurrence developed in 2 patients, dry nose syndrome in 5 patients, and epiphora in 1 patient. Squamous cell carcinoma occurred in 1 patient. CONCLUSIONS: TEAMM is an effective and safe technique in the management of Krouse stage III IP and provides good exposure of operative cavities during follow-up.

European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base.

Tumours affecting the nose, paranasal sinuses and adjacent skull base are fortunately rare. However, they pose significant problems of management due their late presentation and juxtaposition to important anatomical structures such eye and brain. The increasing application of endonasal endoscopic techniques to their excision offers potentially similar scales of resection but with reduced morbidity. The present document is intended to be a state-of-the art review for any specialist with an interest in this area 1. to update their knowledge of neoplasia affecting the nose, paranasal sinuses and adjacent skull base; 2. to provide an evidence-based review of the diagnostic methods; 3. to provide an evidence-based review of endoscopic techniques in the context of other available treatments; 4. to propose algorithms for the management of the disease; 5. to propose guidance for outcome measurements for research and encourage prospective collection of data. The importance of a multidisciplinary approach, adherence to oncologic principles with intent to cure and need for long-term follow-up is emphasised.