Topical upper airway anaesthesia with lidocaine increases airway resistance by impairing glottic function.

OBJECTIVE: To assess if two different forms of upper airway topical anaesthesia induce similar changes in airway flow resistance (Rrs). DESIGN: Serial measurements of Rrs before and after topical anaesthesia with acqueous or paste lidocaine. SETTING: Lung function test laboratory. PARTICIPANTS: 9 normal men with documented normal lung function tests. INTERVENTIONS: 2 different session of topical upper airway anaesthesia with 100 mg of liquid 5% lidocaine and 100 mg of 2% lidocaine paste, respectively. MEASUREMENTS AND RESULTS: Rrs was measured by the random noise forced oscillation technique. Fiberoptic upper airway examination was performed in two subjects. Rrs increased on average by 81% after lidocaine spray and by 68% after lidocaine paste (p < 0.005, respectively) with no difference in the magnitude of Rrs increase between the two modes of anaesthesia studied. This increase lasted 13 +/- 3 min (spray) and 12 +/- 3 min (paste), respectively (p = ns). Fiberoptic examination of the two most responders showed inspiratory laryngeal collapse. CONCLUSIONS: Topical upper airway anaesthesia transiently increases Rrs with no specific effects regarding the drug presentation. Laryngeal dysfunction may be one mechanisms involved in Rrs increase following upper airway topical anaesthesia. Such findings may explain some poor respiratory tolerance reported during endoscopy.

Smell dysfunction and related factors in diabetic patients.

OBJECTIVE: To analyze smell function in diabetic patients and healthy control subjects, with reference to individual characteristics and major complications of the disease. RESEARCH DESIGN AND METHODS: A cross-sectional study of smell recognition in 68 diabetic patients and 30 control subjects without known cause of smell impairment was conducted. Smell was studied using a kit of flavors that patients were asked to recognize, leading to a smell recognition score ranging from 0 (no recognition) to 20 (perfect recognition). Demographic and clinical data, and the electrogustometric threshold were recorded in both groups. Metabolic control and degenerative complications were studied in diabetic patients. RESULTS: The SRS was significantly lower in diabetic patients than in control subjects (12.4 +/- 0.5 vs. 15.1 +/- 0.5, P < 0.001). By use of univariate and multivariate analyses, this difference could not be explained by individual factors such as age, sex, body mass index, blood pressure, or tobacco or alcohol consumption but was related to diabetes. SRS correlated with EGT (r = 0.70, P < 0.001). In the diabetic group, SRS was associated with age (r = 0.29, P < 0.05), duration of diabetes (r = 0.27, P < 0.05), microalbuminuria (12.2 +/- 0.8 vs. 14.4 +/- 0.9, P < 0.05), peripheral neuropathy (10.3 +/- 1.0 vs. 14.1 +/- 0.9, P < 0.01), and EGT (r = 0.39; P < 0.001). By use of multivariate analysis, the strongest association was found with EGT (R2 = 0.15). CONCLUSIONS: These results suggest that smell recognition is impaired in patients with diabetes mellitus. Smell dysfunction is associated with age and degenerative complications of diabetes, suggesting a degenerative mechanism related to diabetes.

[Value of hyperbaric oxygen therapy in the treatment of malignant otitis externa. Apropos of a case]. / Intérêt de l'oxygénothérapie hyperbare dans le traitement de l'otite externe maligne. A propos d'un cas.

The authors report the case of a 75 years old insulin dependent diabetic man presenting a malignant otitis externa with facial nerve paralysis. Despite prolonged, adequate parenteral antibiotic therapy, the patient's clinical status did not improve. The addition of hyperbaric oxygen as a complementary treatment was followed by the regression of clinical signs and the resolution of infection. Based upon a review of the literature, the authors discuss the indications for this therapy and the problems involved in defining the criteria of cure in malignant otitis externa.

Early detection of diabetic patients at risk of developing degenerative complications using electric gustometry: a five-year follow-up study.

OBJECTIVES: Taste impairment has been reported during the course of diabetes. Although a degenerative mechanism has been suspected, the natural history of taste disorders in diabetes remains unknown. The purpose of this study was to describe the five-year evolution of electric gustometry in diabetic patients compared to healthy control subjects and with reference to degenerative complications of the disease. METHODS: Electrogustometry was studied initially and after 5 years in 73 diabetic out patients and 25 control subjects. None of them had any known cause of taste impairment other than diabetes. Diabetic patients and control subjects did not differ for demographic data and confounding factors. RESULTS: After five years, the electrogustometric threshold (EGT) significantly increased (51 +/- 6 vs 95 +/- 11 microA; p < 0.001), whereas slight changes occurred in control subjects (23 +/- 4 vs 25 +/- 5 microA; NS). Frequency of electric hypogeusia (EGT > or = 100 microA) increased from 11 to 46% in diabetic patients (p < 0.001), but did not vary in control subjects (4%). EGT was not strongly associated with individual factors such as blood pressure, tobacco and alcohol consumption, but correlated with age (p < 0.001). In the diabetic group, higher EGT were observed in patients treated with insulin (p < 0.001). EGT and its changes were associated with degenerative complication (p < 0.001), but neither with metabolic control, nor with duration of diabetes. Using multivariate analyses, the strongest associations were found with peripheral neuropathy and microalbuminuria (28 to 45% of variance explained; p < 0.001). The predictive value of initial hypogeusia on neuropathy at follow-up was 88% for a positive test and 63% for a negative one. CONCLUSIONS: These results suggest that the taste nerves transduction function is impaired during the course of diabetes. This impairment is associated with an increased occurrence of degenerative complications, leading to suspect a similar pathophysiological mechanism. Electric gustometry could be an interesting test for early screening for diabetes complications.