Intranasal sodium citrate solution improves olfaction in post-viral hyposmia.

BACKGROUND: Calcium plays an integral role in olfactory signal transduction, including feedback inhibition. Sodium citrate acts as a calcium sequestrant and when applied intranasally, reduces free calcium available for feedback inhibition, which should theoretically improve olfaction. We aimed to investigate the utility of intranasal sodium citrate in improving the olfactory function of hyposmic patients, by performing this prospective placebo controlled, single-blind trial. METHODOLOGY: Monorhinal olfactory testing for odour identification and threshold was performed in hyposmic patients using Sniffin Sticks, before and after treatment. Treatment consisted of one-off sodium citrate solution application to the olfactory cleft. Sodium chloride solution was applied to the contralateral olfactory cleft, which therefore acted as placebo control. Patients were blinded to the side of sodium citrate application, and side of treatment was randomized between patients. RESULTS: 57 patients participated, aged 22-79. Causes of hyposmia included: post-viral (7); posttraumatic (10); sinonasal disease (30) and idiopathic (10). Compared with placebo, there was significant improvement in the identification scores of participants with post-viral hyposmia, following sodium citrate treatment. No significant change in olfactory function occurred for either identification or threshold in any other aetiological subgroup. CONCLUSIONS: Intranasal sodium citrate may be of benefit to patients with post-viral hyposmia.

Treatment of smell loss with systemic methylprednisolone.

BACKGROUND AND AIM: Olfactory dysfunction is a common complaint in a large number of people. As the aetiologies of olfactory dysfunction vary greatly so do the treatment approaches. The aim of this retrospective study was to evaluate treatment with systemic corticosteroids, particularly focusing on its effectiveness on the different olfactory dysfunction aetiologies. Although a prospective randomized control trail is preferred for such an investigation, using the current approach, we were able to test a very large patient population. MATERIAL AND METHODS: A total of 425 patients with olfactory dysfunction were treated with systemic corticosteroids for 14 days. Olfactory performance was measured using the `Sniffin` Sticks` battery before and after the treatment. RESULTS: The treatment with systemic corticosteroids significantly increased the performance on the TDI score and on each of the three subtests; threshold, discrimination and identification. In 26.6% of the patients improvement of more than six points of the TDI score was observed. The treatment proved to be more effective in patients with sinunasal olfactory dysfunction, where this percentage increased to 36.7, compared to other aetiologies. In addition, the increase in olfactory function was negatively correlated with the TDI score before the treatment. CONCLUSION: This study confirms the effectiveness of systemic corticosteroids on olfactory dysfunction in a large patient population. Specifically, the results show that treatment is: (a) more effective in patients with sinunasal than in patients with idiopathic olfactory dysfunction, (b) most effective in patients with sinunasal disease with nasal polyps, and (c), at best, effective in half of the patients. The current study may provide help in counselling patients.

Validation study of the "Sniffin' Sticks" olfactory test in a British population: a preliminary communication.

OBJECTIVE: The 'Sniffin' Sticks' olfactory test contains pen-like odour dispensing devices which are used to assess olfactory threshold, discrimination and identification. Odour identification is strongly dependent on familiarity with the odours and has an important cultural component which has limited the usefulness of other validated tests. The 'Sniffin' Sticks' test was developed in Germany and is validated in other countries but not in the UK. This study aims to validate the applicability of 'Sniffin' Sticks' in a local population. DESIGN: Prospective controlled study. SETTING: Rhinology or olfactory disorder clinic. PARTICIPANTS: About 82 subjects, 33 healthy volunteers with a reported normal sense of smell, and 49 patients with an impaired sense of smell presenting either at a rhinology or an olfactory disorder clinic. Each subject's olfactory function was assessed using the 'Sniffin' Sticks' test with a maximum score of 48. MAIN OUTCOME MEASURES: Threshold, discrimination and identification scores along with the combined olfactory score. RESULTS: The mean age of the subjects tested was 46.7 years; 46 female and 36 male. In the patient group 36 were hyposmic and 13 anosmic. In the healthy volunteers group all subjects were normosmic. In the control group the mean combined olfactory score was 34.5 (±2.5). The mean combined score in the patients group was 20.8 (±7.4). Odour threshold scores were 3.7(±2.8) for patients (hyposmics and anomics) and 8.3(±1.8) for controls. In the identification test the controls mean score was 13.6 (±1.2) for while the patients' mean score was 8.6 (±3.5). CONCLUSIONS: In our sample of the local population the combined olfactory and odour identification scores for healthy volunteers and patients with olfactory disorders are comparable with the normative data published on large samples of European populations. However, modification of a few of the distracters is recommended for British patients based on our findings.

Endoscopic dacryocystorhinostomy in functional lacrimal obstruction.

INTRODUCTION: We performed endoscopic dacryocystorhinostomy in cases diagnosed with both anatomical and functional lacrimal obstruction, and here report results for the latter cases. METHODS: Sixty-eight endoscopic dacryocystorhinostomies were performed for functional obstruction on 44 patients. The indication for surgery was epiphora in 66 patients and recurrent dacryocystitis in two. The minimum follow up was six months. RESULTS: There was complete cure in 44 (65 per cent) patients, partial cure in nine (13 per cent) and no improvement in 15 (22 per cent). Revision surgery was performed in five of the 15 cases with no improvement, after which there was an overall complete cure in 47 patients (69 per cent), partial cure in 10 (15 per cent) and no improvement in 11 (16 per cent). DISCUSSION: Endoscopic dacryocystorhinostomy is indicated in cases of epiphora with a diagnosis of functional lacrimal obstruction. Currently available investigations cannot reliably distinguish partial anatomical obstruction from pump failure.

Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review.

OBJECTIVE: To determine whether routine biopsy of the lacrimal sac wall at dacryocystorhinostomy (DCR) is indicated. METHODS: A prospective study and literature review. In 193 consecutive endoscopic DCRs performed on 164 patients (108 females and 56 males) part of the medial wall of the lacrimal sac was sent for histological examination. The mean age of the patients was 64 years with a range of 2.5-89 years. Previous reported series were reviewed. RESULTS: Of the 193 specimens, 44 (23%) showed normal histology, 146 (76%) showed varying degrees of non-specific chronic inflammation, and three (1.2%) showed specific pathology. Of the three specimens that showed specific pathology two showed sarcoidosis and one showed transitional cell papilloma. The two specimens with sarcoidosis were obtained from one patient who underwent bilateral surgery. In this and the six previous reported series only seven of 1294 specimens (0.5%) showed specific pathology, which was definitely not suspected preoperatively or intraoperatively, and only one of these (0.08%) was found to be malignant (a lymphoma). CONCLUSIONS: Biopsy of the lacrimal sac wall at DCR is not indicated routinely and is only indicated if there is a reason to suspect pathology other than chronic inflammation preoperatively or intraoperatively.

Saddle nose deformity in a patient with Crohn's disease.

Crohn's disease is a chronic idiopathic inflammatory disease of the bowel, and in most cases it involves the small bowel and colon. Extraintestinal manifestations occur frequently and multiple organ systems may be affected. In contrast, nasal manifestations are extremely rare and only a few cases have been reported to date. Saddle nose deformity in a patient with Crohn's disease has not been reported in the English literature. We report a case of such a deformity and the current literature on nasal manifestations in Crohn's is reviewed. The normal diagnostic and therapeutic features are also discussed.