Capsaicin provocation using two different inhalation devices

BACKGROUND

Sensory hyperreactivity (SHR) has been suggested as one explanation for chemically induced airway symptoms; it can be diagnosed with a capsaicin inhalation test. Previous capsaicin inhalation studies of SHR have used a Pari Boy device. This model of inhalator device has become outdated, hence it is necessary to abandon it in favour of a new device. The aim of this study was to transfer the capsaicin inhalation test using the Pari Boy device to a corresponding model using the Maxin MA3 device.

METHODS

Twenty-one patients with SHR and 44 healthy controls visited the clinic twice and underwent a randomised protocol. The participants were provoked with saline and capsaicin using one of two devices, Pari Boy and Maxin MA3. Eight patients also underwent two additional capsaicin provocations with Maxin MA3. A new series of capsaicin concentrations was chosen for Maxin MA3. The results from each device were analysed, the agreement between the two devices and the repeatability of the Maxin MA3 were evaluated.

RESULTS

Among all participants, the mean number of coughs with the Pari Boy was 5.5 (95% CI: 2.7; 8.2) after inhalation of 0.4 micromol/L capsaicin and 20.0 (95% CI: 14.1; 25.9) after 2.0 micromol/L. With the Maxin MA3, the mean number of coughs was 3.6 (95% CI: 1.3; 4.0) after 0.06 micromol/L capsaicin, and 17.8 (95% CI: 12.0; 23.6) after 0.3 micromol/L. The Maxin MA3 showed good repeatability and the agreement between the devices with the capsaicin concentrations chosen for each device was considered to be good.

Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

A suggested explanation for airway symptoms induced by chemicals and scents is sensory hyperreactivity (SHR) of airway mucosal nerves. Patients with SHR have increased cough sensitivity to inhaled capsaicin, mediated by transient receptor potential (TRP) ion channels. In animal experiments, some TRP receptors are potentiated by ethanol, which is why in this study, the aim was to evaluate whether a pre-inhalation of ethanol could influence the capsaicin cough response in patients with SHR. Fifteen patients with SHR and 15 healthy controls were provoked on three occasions with two concentrations of inhaled capsaicin. Before each capsaicin provocation, a pre-inhalation of saline or one of two concentrations of ethanol was given in a double-blind, randomized fashion. The participants reacted in a dose-dependent way with cough on the capsaicin inhalations. Among the patients, but not in the control group, pre-inhalation of ethanol increased the cough response dose-dependently. The results suggest that the pathophysiology of SHR is related to airway mucosal TRP receptors in the sensory nerves. In scented products, the combination of ethanol as a solvent and perfume may augment an airway reaction in sensitive individuals.

Prevalence and risk factors for chemical sensitivity and sensory hyperreactivity in teenagers

The prevalence of chemical sensitivity (CS) and sensory hyperreactivity (SHR) was assessed in a teenage population. Among a random sample of 401 teenagers, 326 (81.3%) answered questionnaires assessing sensitivity to chemicals and noise, anxiety and depression. A subgroup of 85 teenagers conducted a capsaicin inhalation test. The estimated prevalence was 15.6% for general self-reported CS, 3.7% for CS with affective and behavioral consequences, about 1% for SHR. Sensitivity variables were positively intercorrelated. Risk factors for general CS were noise sensitivity (OR: 2.1), probable anxiety (OR: 2.5) and female sex (OR: 2.0). CS problems seem to be present also in teenagers, although less so than in adults. Furthermore, CS seems to be related to other environmental sensitivities.

A prospective study of allergy development in 158 children and 128 adults with new extensive exposure to furred animals

BACKGROUND

There is still controversy over whether exposure to furred animals increases or decreases the risk of developing sensitization and allergic symptoms to such animals, and there is a need for further knowledge on this subject.

OBJECTIVE

The aim of this study was to follow allergy development in relation to new extensive exposure to furred animals in adults and children.

METHODS

A total of 286 individuals, 128 parents and 158 children, were recruited from 68 families who intended to buy a dog or a cat, or where one child of the family intended to start riding a horse. Subjects were examined before the new allergen exposure and once a year thereafter for 5 years, in all at six occasions, and they also completed questionnaires covering allergy symptoms. Serum IgE antibodies to cat, dog and horse were determined each year, and fur allergens from beds and living rooms were analysed.

RESULTS

Two-hundred and fifty-six study subjects remained for evaluation, 37 of whom showed signs of allergic sensitization at the start of the study. Four children (11%) in this pre-sensitized group developed IgE antibodies to their new animal and six (16%) to another animal. Among the 219 participants who were not sensitized when entering the study, one male adult (0.4%) developed a sensitization to his new animal, and nobody developed sensitization to other animals. Pre-sensitized individuals had significantly more allergic symptoms at the study start, but the symptom scores did not change over time.

CONCLUSIONS

When the first year of a human's life has passed, we have no strong evidence to recommend avoidance of a domestic animal in order to prevent new allergy development, even if there are known allergies in the family or if the individual is sensitized and has allergic symptoms to another allergen. Five years exposure to new fur allergens does not seem to influence sensitization to these animals in either sensitized or non-sensitized children and adults.

Excessive obesity is related to daily symptoms of nasal blockage: the Skövde population-based study

This study has as its focus on obesity as a factor of importance for nasal blockage. A random sample of 1.900 adults stratified according to age and gender were recruited from the general population. The study included a structured interview about symptoms of nasal blockage and asthma, and a clinical examination with nasal endoscopy. Smoking habits were evaluated by a questionnaire on current and previous smoking. A response rate of 73% was achieved. There was a statistically significant relationship between subjectively experienced daily nasal blockage and registered heavy overweight, but no relationship was found between nasal blockage and age, gender, diabetes or asthma. The odds ratio (OR) for individuals with excessive obesity to have daily symptoms of nasal blockage was 3.7 [95% CI 1.6-7.6]. In patients with nasal blockage, obesity as a cause should be taken into consideration.

Voice change in seasonal allergic rhinitis

Voice problems are seldom reported in pollen allergy, although the allergic reaction involves the entire airways. The objective of this study was to investigate voice dysfunction during the pollen season in patients with allergic rhinitis. Thirty patients with verified birch pollen allergy and 30 controls were investigated twice, during the pollen season and outside the pollen season. Both times they scored respiratory and voice symptoms, the latter with the validated questionnaire Voice Handicap Index (VHI), and performed standardized voice recordings. These recordings were analyzed in a controlled manner by a professional voice therapist. During the allergy season, patients reported more respiratory and voice symptoms compared with controls. Those with blinded scored voice dysfunction scored their voice quality during springtime as 31 mm (95% confidence interval [CI] 20-42 mm), compared with 13 mm (95% CI 6-21 mm for participants without voice dysfunction (P<0.01). Furthermore, the group with experienced voice dysfunction scored significantly higher on the VHI in the functional and physical domains and in the total VHI score. Although voice problems during the pollen season are rarely discussed, in allergic rhinitis the larynx may also be involved. These findings support that some patients experience voice change, an experience which can be objectively confirmed.

Prevalence of parosmia: the Skövde population-based studies

AIM

Parosmia can be defined as a qualitative odor distortion. Despite the consequences of this condition for quality of life, the scientific literature lacks information about the prevalence of parosmia in the general population, which was the objective of the present study.

METHODS

Random samples of 1,900 adult and 401 teenage inhabitants, stratified for age and gender, were drawn from the municipal population register of Skövde, Sweden. In total, 1,713 individuals (74% of the samples) agreed to participate, of which 1,387 (73%) were adults and 326 (81%) were teenagers. They responded to a question about parosmia by means of either a structured interview (adults) or a questionnaire (teenagers).

RESULTS

The overall prevalence of parosmia was 3.9% (4.0% in adults and 3.4% in teenagers), which was stable across gender, but differed somewhat between age groups, with highest prevalence in the age group 20-29 years.

CONCLUSIONS

The rather high overall prevalence, 3.9%, does indeed suggest that parosmia deserves attention when attempting to better understand olfactory dysfunction in clinical settings and in the general population of both adults and teenagers.

Clinical experience with patients with olfactory complaints, and their quality of life

CONCLUSION

A special consulting team for patients with olfactory disorders would be able to verify, describe, and explain the characteristics of the disorders, also in cases where a patient experiences a disorder, but has a normal sense of smell.

OBJECTIVES

The general purpose of this paper was to present our experience with patients seeking medical attention for olfactory disorders, and to describe how quantitative and qualitative olfactory disorders are diagnosed, what the etiologies are, and how quality of life is compromised in patients with olfactory disorders.

SUBJECTS AND METHODS

This investigation was performed prospectively over a 10-year period by one physician responsible for the consulting team for patients with olfactory disorders. Based on a standardized clinical examination, a structured interview, and assessment of olfactory function, its aim was to diagnose quantitative and qualitative disorders in 303 consecutive patients. Health-related quality of life was assessed with the Nottingham Health Profile (NHP) in about one-third of patients.

RESULTS

In the majority of patients, a reduced sense of smell was found after testing. Often, but not always, this was combined with qualitative disorders. Dominating etiologies were infections, nasal polyposis, head trauma, and aging. Patients complaining of olfactory disorders experience a significantly reduced quality of life regarding the impact of their health problem on paid employment, household work, and social and family life.

Substance and tongue-region specific loss in basic taste-quality identification in elderly adults

Physiological anorexia, decreased dietary variation, and weight loss associated with poor health are common conditions in the elderly population, with changes in chemosensory perception as important contributing causes. The present study of age-related taste loss aimed to investigate the question whether this loss is generalised and unspecific, or whether it exhibits differences in relation to certain tastants and/or differences in the topographical distribution of age-related loss. Impregnated "taste strips" with four concentrations of each of the tastants sucrose, NaCl, quinine-hydrochloride, and citric acid were applied on the tip, midlateral and posteromedial tongue regions to be identified as either sweet, salty, bitter, or sour by 30 young and 26 elderly adults. The results showed more pronounced age-related loss in identification for citric acid and quinine-hydrochloride than for sucrose and NaCl at both the tip and midlateral regions, but not at the posteromedial region where both age groups performed close to chance level. These findings may have implications for food preferences, and thus, the diets of elderly people.

Role of the upper airways in patients with chronic cough

PURPOSE OF THE REVIEW

Chronic cough can be caused by a number of factors, including infections, rhinosinusitis, asthma and environmental stimuli. This paper reviews recent findings and opinions regarding the role played by the upper airways in chronic cough.

RECENT FINDINGS

Chronic cough has a significant impact on quality of life, which is more pronounced in women. In Western countries, the reported occurrence of rhinosinusitis in patient groups with chronic cough ranges from 8% to 81%. Allergic rhinitis is a risk factor for later development of asthma. In children, bronchiectasis is combined with upper airway abnormalities in the majority of cases. Increased expression of the capsaicin receptor subtype named 'transient receptor potential vanilloid-1', which correlates with capsaicin cough response, has been identified in patients with chronic cough. Patients with airway chemical sensitivity and chronic cough as one symptom have augmented capsaicin cough sensitivity that is related to changed levels of nerve growth factor in nasal lavage.

SUMMARY

Involvement of the upper airways in chronic cough has been confirmed in several studies. However, there are considerable differences between different health centres in the occurrence of rhinosinusitis as a cause of chronic cough. In patients with chronic cough of various causes, a neurochemical alteration in both the upper and the lower airways appears to have taken place, followed by increased cough sensitivity.

Relationship Between Self-Reported Odor Intolerance and Sensitivity to Inhaled Capsaicin

STUDY OBJECTIVES

The aim of this study was to investigate the relationship between the behavioral consequences of self-reported odor sensitivity with the chemical sensitivity scale for sensory hyperreactivity (CSS-SHR) and cough sensitivity to inhaled capsaicin. We also wanted to estimate the prevalence of airway sensory hyperreactivity (SHR), which was defined as a positive CSS-SHR score in combination with a positive capsaicin inhalation test result.

DESIGN

A general population-based study with randomly selected individuals after stratification for age and gender.

SETTING

Skövde Central Hospital, Departments of Lung Medicine and Otorhinolaryngology, Sweden.

PARTICIPANTS

A total of 693 randomly selected individuals from a population-based study in which 595 persons (86%) responded to the CSS-SHR questionnaire.

INTERVENTIONS

The individuals were divided into four groups with different odor sensitivity according to their CSS-SHR score. Of these, 137 individuals were randomly recruited for the capsaicin inhalation test. Capsaicin inhalation was performed with concentrations of 0.4 and 2.0 mumol/L in a randomized order. The number of coughs were registered and counted for 10 min from the start of each inhalation.

MEASUREMENTS AND RESULTS

Of the 137 individuals who were recruited for the capsaicin inhalation test, 103 (75%) participated. Sixteen individuals had increased cough sensitivity and fulfilled the criteria for a positive capsaicin inhalation test result. Of the individuals with a positive capsaicin inhalation test result, > 80% also had a positive CSS-SHR score. Only 5% of the individuals with a negative CSS-SHR score had a positive capsaicin inhalation test result. The order of inhaled capsaicin concentration was found to influence the results. The prevalence of SHR with the definition given above was estimated to be 6.3% in this general population.

CONCLUSIONS

A high CSS-SHR score was found to be directly related to the sensitivity for inhaled capsaicin, which made it possible to relate subjective data to objective findings.

Prevalence of upper and lower airway symptoms: the Skövde population-based study

CONCLUSION

This study was able to present representative data from Sweden as a whole and illuminates the epidemiological background of symptoms of the upper and lower airways. Current regular smokers, compared with non-smokers, had more problems with nasal blockage, cough and asthma. The relationship between the upper and lower airways was confirmed as regards airway symptoms.

BACKGROUND

Epidemiology of common respiratory symptoms is basic information in health care. This study has focused on the prevalence of upper and lower airway symptoms.

PATIENTS AND METHODS

A random sample of 1900 age- and gender-stratified adults was recruited from a general population for this study, which included a structured interview about symptoms of nasal secretions and blockage, cough and asthma, and a clinical examination with nasal endoscopy, and peak nasal-inspiratory flow (PNIF). Smoking habits were evaluated by a questionnaire for current and previous smoking.

RESULTS

A response rate of 73% was achieved. The prevalence of various symptoms varied between age strata and gender. There was a statistically significant relationship between subjectively experienced nasal blockage and objectively observed nasal congestion. PNIF was negatively related to age and height and was increased in male gender. Smoking was most common among females and related to nasal blockage, cough and asthma, but not to nasal secretions. Significant relationships between the upper and lower airways were found.

Do topical nasal decongestants affect polyps?

CONCLUSIONS

The hypothesis that decongestants reduce the size of nasal polyps could not be verified. Decongestion is therefore recommended prior to nasal endoscopy, especially in polyp diagnosis, as it does not artificially change the size of the polyps.

OBJECTIVE

The role of nasal decongestants in nasal stuffiness is well established and their action is well known. Decongestants are also used prior to nasal endoscopy to achieve a better view of the nasal cavity in order to diagnose polyps. The question is whether this decongestion invalidates the estimation of polyp size in clinical and scientific practice. The aim of this study was to evaluate possible effects of topical decongestants on polyp extension in patients with nasal polyposis.

MATERIAL AND METHODS

The effect of the decongestants nafazoline and epinephrine on nasal polyp size was assessed by means of a double-blind, placebo-controlled randomized study. A sensitive endoscopic scoring system, lateral imaging, was used to assess the size and extension of the nasal polyps.

RESULTS

No significant effect of decongestion on polyp size could be found for either treatment.

Two-year follow-up with acoustic rhinometry in children

BACKGROUND

This is an explorative study of growth-related nasal geometry in healthy children.

METHODS

A total of 88 girls and boys between the ages of 4 and 16 years were followed over a period of 2 years by acoustic rhinometry. The registrations were correlated to height at each occasion.

RESULTS

Although both the minimal cross-sectional area and the nasal volume increased in all age groups over 7 years, large individual variations in nasal geometry led to a weak relationship with growth.

CONCLUSION

In the undecongested nasal cavity in children, correlation of nasal geometry makes sense for height but not for age.

Prevalence and risk factors for self-reported odour intolerance: the Skövde population-based study

OBJECTIVES

The present study was performed to determine the prevalence of odour intolerance in adults with respect to both self-reported general intolerance and affective and behavioural consequences. Furthermore, we aimed to relate odour intolerance to explanatory variables and risk factors.

METHOD

This is a cross-sectional, population-based epidemiological study. A random sample of 1900 inhabitants from the age of 20, stratified for age and gender, were recruited. Subjects were invited for clinical examinations that included questions about general odour intolerance, respiratory symptoms and smoking habits, as well as a smell identification test. The chemical sensitivity scale for sensory hyperreactivity (CSS-SHR) was used to quantify affective and behavioural consequences.

RESULTS

In total 1387 volunteers (73% of the sample) were investigated. The overall prevalence of self-reported general odour intolerance was 33% (95% confidence interval (CI): 30-36%), with problems mainly from the upper respiratory tract. The prevalence of affective and behavioural consequences of odour intolerance (CSS-SHR score > or =43) was 19% (95% CI: 15-22%). The risk for the latter condition was increased in women compared with men (odds ratio = 2.3: 95% CI: 1.5-3.6), but no increased risk was found related to current smoking or impaired sense of smell.

CONCLUSION

This study demonstrates that intolerance to odours is a widespread problem in society, and that it is about twice as common in women than in men.

Changes in levels of nerve growth factor in nasal secretions after capsaicin inhalation in patients with airway symptoms from scents and chemicals

Patients complaining of upper and lower airway symptoms caused by scents and chemicals have previously been shown to have increased cough sensitivity to inhaled capsaicin, but the precise mechanisms behind this reaction are unknown. Hypothesizing that a neurochemical alteration related to sensory hyperreactivity (SHR) of the airway mucosa occurs, we measured levels of nerve growth factor (NGF) in nasal lavage fluid (NAL) before and after capsaicin inhalation provocations and related the capsaicin cough sensitivity to the NGF levels. Thirteen patients with SHR and 14 control subjects were provoked with capsaicin inhalation at three different doses. We measured NGF in NAL before and after provocation and recorded cough and capsaicin-induced symptoms. All subjects demonstrated a dose-dependent cough response to capsaicin inhalation, with a more pronounced effect in patients than in controls. Basal levels of NGF were significantly lower in the patient group than in the control subjects (p < 0.01). After capsaicin provocation, the patients showed a significant increase in NGF (p < 0.01), which was related to capsaicin cough sensitivity. The findings demonstrate that, in patients with airway symptoms induced by scents and chemicals, SHR is real and measurable, demonstrating a pathophysiology in the airways of these patients compared to healthy subjects.

Chemosensory perception and event-related potentials in self-reported chemical hypersensitivity

Anormal chemosensory perception has been identified as a possible mechanism underlying odor intolerance, but research in this domain has yet been rather limited. The main objective of the present study was to investigate total perceived intensity, unpleasantness, sensory irritation, and cortical activity assessed with chemosensory event-related potentials (ERPs) for three concentrations of pyridine ranging from predominantly olfactory to trigeminal in activation. Results from 19 individuals with self-reported chemical hypersensitivity and 19 controls with self-reported normal chemical sensitivity show that the hypersensitive group, compared to controls, rated the pyridine stimuli to be more intense and unpleasant, and that these group differences increased with pyridine concentration. Sensory irritation was also the perceptual dimension found to correlate strongest with score on the chemical sensitivity scale. However, no group differences were found in ERP amplitudes or latencies. These findings suggest that self-reported chemical hypersensitivity (1) can be associated with anormal chemosensory perception, (2) may be more closely related to trigeminal function than to olfaction, and (3) has a neural basis at a higher cortical level than that captured by chemosensory ERPs.

Prevalence of self-reported poor odor detection sensitivity: the Skövde population-based study

OBJECTIVE

To enable adequate planning of ENT healthcare it is important to know the prevalence of olfactory dysfunction in the general population. Whether an individual will actually seek medical attention for olfactory dysfunction is likely to depend predominantly on his/her self-evaluation of the sense of smell. This motivated an investigation of the prevalences of self-reported poorer- and better-than-normal odor detection sensitivity in the general population.

MATERIAL AND METHODS

A random sample of 1900 adult inhabitants, stratified for age and gender, was drawn from the municipal population register of Skövde, Sweden. Subjects were asked to attend a structured interview concerning their self-evaluation of their odor detection sensitivity.

RESULTS

In total, 1387 volunteers (73% of the sample) were investigated. The overall prevalences of self-reported poorer- and better-than normal odor detection sensitivity were 15.3% and 17.4%, respectively. The prevalence of poorer sensitivity was found to increase with age, and the prevalence of better sensitivity was lower in men than women.

CONCLUSIONS

Considering the fairly high participation rate in this study and the fact that the population of Skövde is representative of the general Swedish population, the obtained prevalences can be considered representative of the general Swedish adult population.

Relationship of airway symptoms from chemicals to capsaicin cough sensitivity in atopic subjects

BACKGROUND

It is well known that some patients with allergy complain of airway symptoms from chemicals (ASCs) and strong odours. However, the importance of such information for the treatment of allergic disease is not known. Such symptoms in non-allergic patients have previously been shown to be related to increased sensory nerve reactivity, which is expressed as increased cough sensitivity to inhaled capsaicin.

OBJECTIVE

The aim of this study was to examine ASC in atopic patients and relate it to cough reaction to capsaicin inhalation.

MATERIALS AND METHODS

Fifty-seven consecutively chosen, skin prick-positive patients with symptoms of the upper and/or lower airways completed a questionnaire concerning ASC. The patients were then divided into two groups, those with and those without such symptoms. Both groups were provoked with inhaled capsaicin in three increments and compared with 73 healthy control subjects.

RESULTS

Out of 57 atopic patients, 34 reported ASC agents and 23 did not. The patients with ASC were older (P<0.01) and coughed significantly more on capsaicin provocation (P<0.001), but did not differ from them with respect to the allergic disease or its treatment or to smoking habits. Patients with atopy but without ASC did not differ from healthy controls with regard to sensitivity to capsaicin inhalation. The scored degree of ASC was directly related to the number of coughs during the capsaicin provocation.

CONCLUSION

ASC in atopic patients are related to increased airway sensory nerve reactivity. There is still no explanation for this in certain patients with atopy, but age may be a confounding factor.

Prevalence of Olfactory Dysfunction: The Sk??vde Population-Based Study

OBJECTIVES/HYPOTHESIS

Patients with olfactory dysfunction appear repeatedly in ear, nose, and throat practices, but the prevalence of such problems in the general adult population is not known. Therefore, the objectives were to investigate the prevalence of olfactory dysfunction in an adult Swedish population and to relate dysfunction to age, gender, diabetes mellitus, nasal polyps, and smoking habits.

STUDY DESIGN

Cross-sectional, population-based epidemiological study.

METHODS

A random sample of 1900 adult inhabitants, who were stratified for age and gender, was drawn from the municipal population register of Skövde, Sweden. Subjects were called to clinical visits that included questions about olfaction, diabetes, and smoking habits. Examination was performed with a smell identification test and nasal endoscopy.

RESULTS

In all, 1387 volunteers (73% of the sample) were investigated. The overall prevalence of olfactory dysfunction was 19.1%, composed of 13.3% with hyposmia and 5.8% with anosmia. A logistic regression analysis showed a significant relationship between impaired olfaction and aging, male gender, and nasal polyps, but not diabetes or smoking. In an analysis of a group composed entirely of individuals with anosmia, diabetes mellitus and nasal polyps were found to be risk factors, and gender and smoking were not.

CONCLUSION

The sample size of the population-based study was adequate, with a good fit to the entire population, which suggests that it was representative for the Swedish population. Prevalence data for various types of olfactory dysfunction could be given with reasonable precision, and suggested risk factors analyzed. The lack of a statistically significant relationship between olfactory dysfunction and smoking may be controversial.

A short Chemical Sensitivity Scale for assessment of airway sensory hyperreactivity

OBJECTIVES

A short version of the 21-item Chemical Sensitivity Scale (CSS), called the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), was developed and evaluated for the quantifying of self-reported affective reactions to and behavioral disruptions in daily activities by odorous/pungent substances among patients with sensory hyperreactivity (SHR) for clinical and epidemiological studies.

METHODS

Twenty-two patients with clinically diagnosed SHR and 124 control participants responded to the CSS and to additional questions about chemical sensitivity for the evaluation of the CSS-SHR.

RESULTS

Eleven of the 21 items of the CSS were selected, on statistical grounds, to constitute the CSS-SHR, which was found to generate approximately normal distributions, have good test-retest reliability (r(xy)=0.87), satisfying internal consistency (r(alpha)=0.76-0.84) and predictive and concurrent validity, and to be uni-dimensional. The metric properties of the CSS-SHR were, despite its few items, comparable with those of the CSS. A proposed diagnostic cut-off score for SHR demonstrated a high correct classification rate (92%) for the CSS-SHR.

CONCLUSIONS

The favorable metric properties of the CSS-SHR and its sensitivity/specificity suggests that it is useful for clinical diagnosis and epidemiological study of sensory hyperreactivity in combination with other diagnostic tools.

Clinical relevance of nasal polyps in individuals recruited from a general population-based study

OBJECTIVE

To compare the clinical presentations of individuals with nasal polyps detected by endoscopy in a general population sample with those of patients with nasal polyp disease seeking medical attention.

MATERIAL AND METHODS

A total of 38 individuals with nasal polyps from a population-based sample were compared with 38 matched controls and a third group consisting of 44 patients who presented to an outpatient clinic with symptoms and diagnosed nasal polyps Upper and lower airway symptoms were registered. Polyp size, peak nasal inspiratory flow (PNIF), olfactory function and health-related quality of life were measured.

RESULTS

Compared with the individuals with nasal polyps in the population sample, patients actively seeking medical care for nasal polyposis experienced more symptoms of nasal blockage and an impaired sense of smell, and had more extensive polyps and reduced PNIF. There were equal frequencies of asthma symptoms in these two groups. Compared with the controls, the individuals with nasal polyps in the population sample had a greater frequency of asthma symptoms and aspirin intolerance and also experienced an impaired sense of smell.

CONCLUSION

Nasal polyps alone, as seen occasionally, are indicative of airway disease involving the upper and lower respiratory tracts.

Prevalence of nasal polyps in adults: the Skövde population-based study

Patients with nasal polyps present repeatedly in otorhinolaryngology practices, but the prevalence of nasal polyps in the general population is not known. Our objective was to investigate the prevalence of nasal polyps in an adult Swedish population in relation to age, gender, asthma, and aspirin intolerance. A random sample of 1,900 inhabitants over the age of 20 years, stratified for age and gender, was drawn from the municipal population register in Skövde, Sweden, in December 2000. The subjects were called to clinical visits that included questions about rhinitis, asthma, and aspirin intolerance and examination by nasal endoscopy. In total, 1,387 volunteers (73% of the sample) were investigated. The sample size was adequate, with a good fit to the whole population. The prevalence of nasal polyps was 2.7% (95% confidence interval, 1.9-3.5), and polyps were more frequent in men (2.2 to 1), the elderly (5% at > or = 60 years of age), and asthmatics. Subjective symptoms of aspirin intolerance were not found to correlate with polyps. Nasal polyps were more common in adults than was stated by the a priori estimate. The Skövde population-based study is considered representative for the Swedish population.

Prevalence of nasal septal perforation: the Skövde population-based study

BACKGROUND

Patients with nasal septal perforation appear from time to time in Ear, Nose, and Throat (ENT) practices, but the prevalence in a general population is not known.

OBJECTIVE

The objective was to investigate the prevalence of nasal septal perforation in an adult Swedish population, and to relate septal perforation to possible risk factors, such as age, gender, diabetes mellitus, nasal polyps, and smoking.

METHODS

A random sample of 1,900 inhabitants over the age of 20, stratified for age and gender, was drawn from the municipal population register in Skövde, Sweden, in December 2000. Subjects were called to clinical visits that included questions about diabetes and smoking habits. Nasal endoscopy was performed and, when a perforation was observed, the size was measured.

RESULTS

In total, 1,387 volunteers (73% of the sample) were investigated. The sample size was adequate, with a good fit to the whole population. The prevalence of nasal septal perforation was 0.9% [95% CI 0.5-1.6%]. Nasal polyps was a possible risk factor, odds ratio of 11.5 [95% CI 3.0-43.5], but not age, gender, diabetes, or smoking.

CONCLUSION

The prevalence of nasal septal perforation was found to be less than 1% in an adult population.

A Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire: evaluation of questions about olfaction

OBJECTIVE

A Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire (MCSTQ-Sc) was evaluated with respect to comprehension and test-retest reliability for responses to questions about olfactory dysfunction (abnormal sensitivity, parosmia and phantosmia) and related questions about medical history and consequences of olfactory dysfunction.

MATERIAL AND METHODS

Comprehension was evaluated in a first study in 20 patients with chief complaints of olfactory dysfunction by comparing questionnaire- and interview-based responses. Test-retest reliability was evaluated in a second study in 30 other patients with olfactory complaints.

RESULTS

Data from the two studies suggest that the vast majority of the questions evaluated from the MCSTQ-Sc are comprehensible and generate responses with very good reliability. Distinct exceptions were poor agreement between the questionnaire- and interview-based responses for questions about the number of cigarettes smoked and the pleasantness and typical episode length of phantosmia; the test-retest reliability regarding the nostril side of phantosmia also showed poor agreement. The results suggest the importance of probing these areas further in the clinical interview.

CONCLUSION

The findings imply that, with a few caveats, the MCSTQ-Sc is a useful tool for the clinical assessment of olfactory dysfunction and its consequences.