Odor and chemesthesis from brief exposures to TXIB.

UNLABELLED: An experiment explored ability of subjects to detect vapors of the plasticizer TXIB (2,2,4-trimethyl-1,3-pentanediol diisobutyrate) and ethanol via olfaction and via ocular and nasal chemesthesis, i.e. chemically stimulated feel. Testing, tailored to the sensitivity of each subject, produced psychometric functions for individuals. Olfactory detection of TXIB began at concentrations below 1 ppb (v/v), with 50% correct detection at 1.2 ppb. (Comparable detection for ethanol occurred almost two orders of magnitude higher.) Chemesthetic detection of TXIB began at about 500 ppb, with 50% correct detection at 2.1 ppm for the eye and 4.6 ppm for the nose, both close to saturated vapor concentration. (Comparable detection for ethanol occurred essentially three orders of magnitude higher.) Suggestions that TXIB plays a role in generation of irritative symptoms at concentrations in the range of parts-per-billion need to reckon with a conservatively estimated 200-fold gap between the levels putatively 'responsible' for the symptoms and those even minimally detectable via chemesthesis. Neither the variable of exposure duration nor that of mixing offers a likely explanation. Inclusion of ethanol in the study allowed comparisons pertinent to issues of variability in human chemoreception. An interpretation of the psychometric functions for individuals across materials and perceptual continua led to the conclusion that use of concentration as the metric of detection in olfaction inflates individual differences. PRACTICAL IMPLICATIONS: This study indicated that the plasticizer TXIB could contribute odor at concentrations in the range of parts-per-billion, but could hardly contribute sensory irritation per se, as alleged in reports of some field studies where TXIB has existed amongst many other organic compounds.

Differential gene expression in the T-helper lymphocytes of obstructive sleep apnea patients treated with nasal continuous positive airway pressure (nCPAP).

Obstructive sleep apnea (OSA) is a disease with significant morbidity, increased risk of accidents attributed to daytime somnolence, and has been associated with cardiovascular complications. The treatment of choice for OSA is nasal continuous positive airway pressure (nCPAP). Some OSA patients, however, are unable to benefit from this therapy as they find nCPAP intolerable due to the related nasal inflammation. It is hypothesized that nCPAP may cause nasal inflammation in these patients by inducing changes in the expression of genes that encode interleukins (IL-3, IL-4, IL-6, IL-8, IL-13) or adhesion molecules (i.e., ICAM-1) in T-helper lymphocytes. An understanding of the underlying inflammatory mechanism could lead to specific interventions that render nCPAP therapy tolerable for these individuals.

Orbital response indicates nasal pungency: analysis of biomechanical strain on the skin.

Stimulation of the human nasal passage with pungent vapor elicits motor responses in a zone around the eye. This investigation addressed whether quantification of such responses, particularly activity of the orbicularis oculi muscle, could yield a sensitive index of nasal pungency. We placed an array of small, high-contrast targets just beneath the lower eyelid and videotaped their movement to capture deformation of the skin atop the orbicularis oculi during 3 s stimulation with pungent concentrations of ethyl acetate. Eleven subjects participated. Analysis of the movements served to determine mechanical strain, which yielded a single index that we termed 'maximum strain'. This increased with concentration of the vapor and with time during and just after stimulation. Comparison with psychophysical data showed that the strain became evident at concentrations just detectable as pungent. Maximum strain measured on the skin shows promise as an objective index of pungency.

[Olfaction dysfunction]. / Disfunción del olfato.

OBJECTIVE: To report of results obtained with the systematized boarding (physiopathology, diagnosis and treatment) to dysfunction of the smell that can affect the patient's life in significant form. MATERIAL AND METHOD: 58 patients were evaluated that went to the clinic with alterations in the olfaction or the pleasure, or both. The protocol includes a guided questionnaire, tests of identification of scent and threshold olfactory, rhinomanometry, nasal histogram, I simple study radiological of the roads breathing superiors and paranasals sinus, besides computer axial tomography and endoscopy. RESULTS: The most frequent cause in the olfactory dysfunction was the due mechanical obstruction to inflammatory processes, as chronic sinusitis and nasal polyposis, which obstruct the olfactory niche like complication; of the 58 patients, 48% belonged to this group. This inflammatory illness was divided, in turn, in allergy pure 25%, infectious 21% and pattern mixed 54%. The olfactory tests showed hyponia severe. In the general analysis the rest of the olfactory dysfunction was classified as postviral in 20%, posttraumatic in 12.1%, a group miscellaneous 8.6%, caused by toxins 6-9%, being a group of idiopathic cause in 3.4%.

Disfunción del olfato / Disfunction of the sense of smell

Objetivo: reportar los resultados obtenidos con el abordaje sistematizado (fisiopatológico, de diagnóstico y tratamiento) de la disfunción del olfato que puede afectar la vida del paciente en forma significativa. Material y método: se evaluaron 58 pacientes que acudieron a la clínica con alteraciones en la olfación o el gusto, o ambos. El protocolo incluye un cuestionario orientado, pruebas de identificación de olores y umbral olfatorio, rinomanometría, histograma nasal, estudio radiológico simple de las vías respiratorias superiores y senos paranasales, además de tomografía axial computada y endoscopia. Resultados: la causa más frecuente de la disfunción olfatoria fue la obstrucción mecánica debida a procesos inflamatorios, como sinusitis crónica y poliposis nasal, las cuales obstruyen el nicho olfatorio como complicación; de los 58 pacientes, 48 por ciento pertenecieron a este grupo. Esta enfermedad inflamatoria se dividió, a su vez, en alergia pura 25 por ciento, infecciosa 21 por ciento y patrón mixto 54 por ciento. Las pruebas olfatorias mostraron hiposmia severa. En el análisis general el resto de la disfunción olfatoria se clasificó como postviral en 20 por ciento, postraumática en 12.1 por ciento, un grupo misceláneo 8.6 por ciento, provocada por toxinas 6-9 por ciento, quedando un grupo de causa idiopática en 3.4 por ciento.

Subjective and objective assessments in patients with seasonal allergic rhinitis: effects of therapy with mometasone furoate nasal spray.

BACKGROUND: Efficacy of topical nasal steroid therapy for allergic rhinitis is usually evaluated by patient and clinician assessments of subjective symptom changes in diaries and at clinical interviews. OBJECTIVE: We sought to complement the subjective measures with objective measures of nasal cytology, biochemistry, and function. METHODS: In this double-blind, randomized study patients with seasonal allergic rhinitis (SAR) 12 years of age or older received 200 microg mometasone furoate nasal spray (n = 80) or placebo spray (n = 41) once daily for 2 weeks. Subjective assessments by clinician and patient comprised symptom/sign scores and overall therapeutic response evaluations. Objective measures included nasal cytology, nasal biochemistry, nasal airway resistance (NAR), mucociliary clearance, and olfactory functions. RESULTS: Mometasone furoate produced a significantly greater decrease than placebo in subjective measures of SAR for total symptom score (-46% vs -30%, p < 0.05), total nasal score (-47% vs -30%, p < 0.024), individual nasal symptom scores, and overall therapeutic response. The objective measures of eosinophil, basophil, and neutrophil counts and mucociliary clearance were significantly better in mometasone furoate- than in placebo-treated patients. Similarly, within-treatment statistically significant improvements were produced by mometasone furoate but not by placebo sprays for levels of eosinophilic cationic protein, tryptase and albumin, NAR, and odor identification. Significant positive correlations were found between NAR and nasal stuffiness and between eosinophils, basophils, and neutrophils and both eosinophilic cationic protein and albumin. CONCLUSION: Subjective measures of SAR were significantly improved in the mometasone furoate group by comparison with placebo-treated patients. Objective assessments supported the subjective findings because within-treatment measures were frequently significantly improved after mometasone furoate treatment but not after placebo treatment.

Prevalence and assessment of qualitative olfactory dysfunction in different age groups.

The prevalence of parosmia and phantosmia among 363 chemosensory and nasal/sinus patients was studied, as was the accuracy with which our clinical questionnaire could assess these dysfunctions. We then investigated whether patients with parosmia or phantosmia, matched for odor intensity, perform poorer on odor identification than do patients with no dysosmia. More than 40% of the study group evidenced either parosmia (18.7%) and/or phantosmia (25.6%), a finding that suggests that more attention should be paid by the medical practitioner in addressing qualitative olfactory dysfunction. Furthermore, it appears that assessment of these dysfunctions may aid in differential diagnosis, and that questionnaires can be used with reasonable validity irrespective of the patient's age. Finally, the results imply that parosmia may be reflected in a discrepancy between odor identification and detection.

Smell impairment. Can it be reversed?

Patients who have lost the sense of smell usually come to a doctor on their own, reporting loss of the sense of taste. Inflammation (often due to allergy), viral infection, and head trauma are common causes of olfactory disturbance. History taking may provide clues to these and other problems (eg, toxin exposure, congenital dysosmia). Workup should not begin until a standardized test has been given that established impairment of the sense of smell. The only truly reversible cause is inflammation, which is confirmed when smell returns after a course of corticosteroid. Sinus computed tomography is necessary to view the olfactory cleft; lack of obstruction indicates that smell impairment is nonreversible. Patients deserve an explanation for their disorder and a prognosis. If restoration of their sense of smell is unlikely, patients should be cautioned to take steps to ensure safety in regard to such dangers as gas leaks, smoke, and spoiled foods.

Histamine levels and nasal cytology in children with chronic otitis media and rhinitis.

OBJECTIVE: Nasal and middle ear diseases are frequent health problems for young children. In some of these patients, allergic reactions may be contributing factors. The objective of this study was to determine whether the histamine level in nasal mucosal scrapings may be used as a marker for this subset of children. METHODS: A total of 50 children, aged 2 through 7 years, was categorized into five groups of ten subjects as: normal, allergic rhinitis, nonallergic rhinitis, allergic with otitis media and nonallergic with otitis media by history, physical examination, allergy skin testing, nasal cytology, and tympanometry. Nasal mucosal scrapings were obtained using the Rhino-probe technique. Eosinophils, basophilic cells, neutrophils, and bacteria in nasal cytograms were quantified. Histamine levels were measured by radioimmunoassay, the values normalized to the total protein content assayed by enzyme-linked immunoassay, and expressed in pcg/micrograms of total protein. RESULTS: The mean histamine level for each group was: normal = 0.20, allergic rhinitis = 10.14, nonallergic rhinitis = 0.13, allergic with otitis media = 5.34, nonallergic with otitis media = 0.24 pcg/micrograms of total protein. Mean levels of histamine were statistically significantly higher in the allergic groups than in the nonallergic and normal groups (P < .05). Allergic groups had significantly more eosinophils and basophilic cells in the nasal cytograms than the nonallergic groups. By contrast, the cytograms of children with nonallergic rhinitis and nonallergic otitis had significantly more neutrophils than the normal and allergic groups. CONCLUSION: We conclude that measuring histamine in nasal mucosal scrapings could be useful in the evaluation of young children with rhinitis and otitis and in determining which patients may have allergic disease.

Oronasal reconstruction with local mucoperiosteal and free latissimus dorsi flaps.

We describe the use of maxillary sinus mucoperiosteum as a pedicled flap to reconstruct the floor of the nose following resection of cancer involving the palate, buccal mucosa, and mandible. Complete inferior turbinectomy allows access to the roof of the maxillary sinus to harvest the mucoperiosteum as a vascularized flap pedicled under the remaining middle turbinate. A free latissimus dorsi myocutaneous flap suspended from the floor of the orbit and nasal septum is then used to obliterate the maxillary sinus, reconstruct the palate, and support the floor of the nose. A reconstruction employing this combination of flaps is presented, including postoperative endoscopic intranasal photography and magnetic resonance imaging. Despite the elevated level of the floor of the nose and the absence of the inferior turbinates, rhinomanometry performed 3 months postoperatively demonstrates adequate nasal airflow with normal responses to nasal decongestants.

The rhinologic evaluation of Alzheimer's disease.

Olfactory dysfunction is currently not listed among the NINCDS-ADRDA clinical criteria for the diagnosis of Alzheimer's disease. There is a large amount of psychophysical and neuropathologic evidence to suggest that patients with Alzheimer's type dementia have olfactory system abnormalities. The rhinologic status of this group has not been characterized. The authors examined 21 Alzheimer's patients and 21 age-matched controls to determine whether 1. the Alzheimer's group, in fact, had a diminished sense of smell, and whether 2. rhinologic factors were responsible for this nasal dysfunction. The findings support a neurologically mediated phenomenon as the cause for significant impairment in olfactory function in patients with probable Alzheimer's disease.

Rapid detection of respiratory syncytial virus in nasopharyngeal specimens obtained with the rhinoprobe scraper.

We compared the Rhinoprobe scraping technique for collection of superficial nasal mucosa epithelial cells and rapid detection of respiratory syncytial virus by immunofluorescence with paired, swab-collected specimens for virus culture from 1,257 infants and children with acute respiratory infections. Compared with viral culture as the reference test, the sensitivity, specificity, and accuracy of the immunofluorescence test were 83.6, 93.6, and 91.3%, respectively. We found the Rhinoprobe method safe, easy to use, and helpful in obtaining large quantities of epithelial cells for detection of respiratory syncytial virus and other respiratory viruses.

Peroxidase-antiperoxidase assay for rapid detection of respiratory syncytial virus in nasal epithelial specimens from infants and children.

A peroxidase-antiperoxidase (PAP) assay for the rapid detection of respiratory syncytial virus was compared with the indirect immunofluorescence method and with viral culture. Nasal epithelial specimens from 147 infants and children with acute respiratory infections were obtained and evaluated for the presence of respiratory syncytial virus antigens. Sensitivity, specificity, and accuracy by PAP were 91.7, 84.8, and 87.1%, respectively, and 87.0, 88.5, and 88.0%, respectively, by immunofluorescence compared with viral culture. The PAP assay was found to be as accurate as the indirect immunofluorescence method and more convenient to perform, since the color reaction and cell morphology were more easily observable by light microscopy. A new specimen collection method is reported; gentle scraping of the superficial nasal mucosa by the Rhino-probe method provided sufficient numbers of epithelial cells to perform multiple assays.

Evaluation and treatment of smell dysfunction.

We gave 63 patients with symptoms of smell dysfunction a full evaluation by age-adjusted olfactory threshold and odor identification testing, rhinomanometry, nasal cytology, nasal endoscopy, computed tomographic (CT) scan and a trial of medical treatment. CT scans were valuable for identifying ethmoid sinus disease and nasal endoscopy for inspecting olfactory epithelium. A trial of prednisone served as a diagnostic modality to identify correctable causes of smell dysfunction. Given that there are 2 million people in the United States with a smell dysfunction, that the average physician knows little about its diagnosis and treatment and that the psychosocial impact to an afflicted person is great, we urge a greater awareness of smell dysfunction, its diagnosis and its treatment.

Normal nasal cytology in infancy.

Nasal cytology in the first year of life has rarely been utilized diagnostically because of an early report that nasal eosinophilia is a common finding in normal young infants. Using an improved sampling technique with a flexible nasal probe, we obtained nasal mucosal specimens for histologic examination from 22 healthy infants and five infants with upper respiratory tract infections. None of the healthy infants had nasal eosinophilia and no adverse effects were noted during the sampling procedure. We concluded that the present sampling technique is as safe and effective in infants as in children and adults and that the majority of healthy young infants do not have nasal eosinophilia.

Surgery for nasal obstruction--evaluation by rhinomanometry.

Nasal obstruction is predominantly a subjective patient complaint. The physical examination of the nose for nasal obstruction is a subjective evaluation as well. While the history and physical examination are reasonable diagnostic indicators, an objective means of evaluation is needed. Rhinomanometry measures nasal obstruction objectively and reliably. Thirty-six patients with nasal obstruction were evaluated by rhinomanometry before and after nasal surgery. The results are reported here. Rhinomanometry confirms the effectiveness of intranasal surgery. Using rhinomanometry, various techniques of intranasal surgery are evaluated, and several interesting observations are made.

Distribution of specific ventilation in cystic fibrosis.

Continuous distributions of specific tidal ventilation were recovered from nitrogen washouts in 29 patients with cystic fibrosis and 22 normal subjects along with other pulmonary parameters to assess the utility of the recovered distribution in describing the progress of the disease. Normal subjects showed predominantly unimodal distributions of a pattern showing a small amount of ventilation going to units with high specific ventilation. Multimodal distributions were the rule in the cystic population with only subjects with normal pulmonary function having unimodal distribution.