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.

A cross sectional analysis of a case-control study about quality of life in CRS in the UK; a comparison between CRS subtypes

BACKGROUND

The Sinonasal Outcome Test (SNOT-22) has been used as a patient reported outcome measure to grade symptom severity before and after treatment for chronic rhinosinusitis (CRS).

METHODOLOGY

This analysis uses data from the CRS Epidemiology Study (CRES). The overarching aim of CRES was to determine factors that influence the onset and severity of CRS. A study-specific questionnaire including SNOT-22 was distributed to patients with CRS attending ENT clinics across 30 centres in the United Kingdom. The aim of this analysis was to compare SNOT-22 scores between those with different types of CRS to determine any differences present in the total score or the subdomains and to assess whether any differences varied according to gender.

RESULTS

There were a total of 1249 CRS participants in the following subgroups: CRS without nasal polyps (CRSsNPs) (n=553), CRS with nasal polyps (CRSwNPs) (n=651), allergic fungal rhinosinusitis (AFRS) (n=45). Since there were differing gender ratios in each subgroup, males and females were analysed separately. The mean and standard deviation for SNOT-22 was: males CRSsNP 41.1 (21.0), CRSwNP 41.7 (20.5); females CRSsNP 49.6 (19.7), CRSwNP 49.5 (22.9). In the nasal domain, those with CRSwNP scored more highly than those with CRSsNP; for males 18.1 (8.1) vs. 15.9 (7.9); for females 19.6 (8.0) vs 16.7 (7.5).

CONCLUSIONS

Patients with CRSwNPs report higher symptom scores in the nasal domain of SNOT-22 than those with CRSsNPs with women in both subgroups reporting higher total scores than men.

The impact of commissioning for rhinosinusitis in England

OBJECTIVES

To assess the compliance of clinical commissioning groups (CCGs) in England with the ENT-UK rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCGs.

DESIGN

Audit of compliance of English CCGs with the ENT-UK rhinosinusitis commissioning guide.

SETTING

CCGs in England

PARTICIPANTS

A total of 58 of the 221 CCGs in England were included and chosen because they were the first CCGs authorised by NHS England, or alternately, the CCGs forecasted to have a deficit in their first year of operation. Their websites were reviewed; when information was not easily accessible, a freedom of information request was submitted to the relevant CCG.

MAIN OUTCOME MEASURES

Compliance with commissioning guidelines for rhinosinusitis.

RESULTS

Thirteen percent of CCGs had restrictive referral criteria in place, largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanning within primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice.

CONCLUSIONS

Restricting access to surgery may contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and is open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.

A negative ion source test facility

Progress is being made in the development of an Ion Source Test Facility (ISTF) by D-Pace Inc. in collaboration with Buckley Systems Ltd. in Auckland, NZ. The first phase of the ISTF is to be commissioned in October 2015 with the second phase being commissioned in March 2016. The facility will primarily be used for the development and the commercialization of ion sources. It will also be used to characterize and further develop various D-Pace Inc. beam diagnostic devices.

Dural infantile hemangioma masquerading as a skull vault lesion

We describe a case of intracranial dural IH initially diagnosed as a primary skull vault lesion hemangioma due to associated focal hyperostosis. Histopathologic examination of the dural component confirmed IH. The case is discussed in the context of IH within the neural axis.

The Leicester semi-automated olfactory threshold test--a psychophysical olfactory test for the 21st century

OBJECTIVE

Develop a useful and cost-effective olfactometer for routine clinical use by providing a standardised threshold test for patients with olfactory disorders presenting in the ENT clinic.

METHOD OF STUDY

A prospective study of olfactory thresholds in 48 healthy volunteers on 2 consecutive occasions, undergoing quantitative testing with an olfactometer. Further studies of 10 subjects performing 20 tests and 100 subjects performing a single test were performed. An olfactometer was designed to deliver a semi-automated threshold test for an odour. It contains 8 logarithmic dilutions of an odour along with a control valve operated by software from a laptop computer. Common potential variables for olfactory threshold testing were considered including peak inspiratory flow rate. The odours used were phenethyl alcohol (PEA) and eucalyptol (EUC). Subjects were asked to perform 2 tests within 1 month of each other and the mean threshold score for each was calculated to derive a test-retest score.

MAIN RESULTS

Consistent olfactory thresholds for PEA were achieved with a mean concentration of 10-4. Test-retest reliability score (r(x)) for the olfactometer was r(x) = 0.78 (95% CI 0.67 to 0.89).

PRINCIPAL CONCLUSIONS

The Leicester Olfactometer provides a simple and cost-effective method of reliably assessing olfactory thresholds in the outpatient clinic.

Methicillin resistant Staphylococcus aureus: is it a problem for nasal surgery?

Methicillin resistant Staphylococcus aureus (MRSA) is becoming ever more prevalent in the UK, and the proportion of MRSA to methicillin sensitive Staphylococcus aureus (MSSA) seems to be increasing. New strains of MRSA are ever developing resistance to antibiotic treatment, increasing morbidity and mortality of infection. Staphylococcus aureus is part of the normal flora of the nose, and MRSA colonizes the nose in infection. However, nasal surgery is rarely complicated by staphylococcal infections, and MRSA infection following nasal surgery is rare. The authors present a literature review of MRSA infection, its relation to the nasal cavity, and infection following nasal surgery.

The effect of temperature, humidity and peak inspiratory nasal flow on olfactory thresholds

Temperature, humidity and nasal peak inspiratory flow rate (PIFR) are potential variables in the quantitative measurement of olfactory thresholds in the clinic. To date, these variables have not been properly evaluated with respect to olfactory perception, and therefore the aim of this study was to determine their effect on the thresholds. These variables were measured on 10 occasions in 10 subjects over a 10-week period. The results obtained were then subjected to statistical analysis using a linear mixed-effect model. This demonstrated that olfactory thresholds are sufficiently independent of room temperature, peak humidity and nasal PIFR in a routine outpatient clinic environment in normal subjects, with no evidence of any statistically significant influence by these variables.

Identification of a Candida albicans ferrichrome transporter and its characterization by expression in Saccharomyces cerevisiae

Saccharomyces cerevisiae can accumulate iron through the uptake of siderophore-iron. Siderophore-iron uptake can occur through the reduction of the complex and the subsequent uptake of iron by the high affinity iron transporter Fet3p/Ftr1p. Alternatively, specific siderophore transporters can take up the siderophore-iron complex. The pathogenic fungus Candida albicans can also take up siderophore-iron. Here we identify a C. albicans siderophore transporter, CaArn1p, and characterize its activity. CaARN1 is transcriptionally regulated in response to iron. Through expression studies in S. cerevisiae strains lacking endogenous siderophore transporters, we demonstrate that CaArn1p specifically mediates the uptake of ferrichrome-iron. Iron-ferrichrome and gallium-ferrichrome, but not desferri-ferrichrome, could competitively inhibit the uptake of iron from ferrichrome. Uptake of siderophore-iron resulting from expression of CaARN1 under the control of the MET25-promoter in S. cerevisiae was independent of the iron status of the cells and of Aft1p, the iron-sensing transcription factor. These studies demonstrate that the expression of CaArn1p is both necessary and sufficient for the nonreductive uptake of ferrichrome-iron and suggests that the transporter may be the only required component of the siderophore uptake system that is regulated by iron and Aft1p.

Central venous catheter-related septicaemia in paediatric cancer patients

A prospective study of septicaemia, with special reference to central venous catheter (CVC)-related septicaemia, was performed over a nine-month period in paediatric cancer patients undergoing anti-neoplastic therapy. A total of 142 patients with 153 CVCs were included in the study. Seventy-two episodes of septicaemia were detected in 66 patients; overall, 46% of patients developed one or more episodes of septicaemia. Thirty-nine (54%) of these episodes occurring in 34 patients were CVC-related. Twenty-one (29%) of the episodes occurring in twenty patients were probably unrelated to CVCs and 12 (17%) episodes in 12 patients were of uncertain source. A total of 22932 CVC days were studied. The rate of CVC-related septicaemia was 1.7 episodes/1000 catheter days. Gram-positive organisms were commonest, causing 34 (87%) episodes of CVC-related septicaemia. Twenty-five (71%) of 35 evaluable episodes were successfully treated with antibiotics without CVC removal. Two patients died, CVC related sepsis probably contributing to death, and one patient suffered prolonged morbidity associated with CVC sepsis. Gram-negative organisms were the commonest cause of CVC-unrelated septicaemia, being implicated in 13 (62%) episodes.