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Imbs S, Deyrail B, Nguyen DT, Hossu G, Blum A, Gondim Teixeira PA, Rumeau C, Jankowski R, Gillet R. Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings? Eur Radiol 2024; 34:5339-5348. [PMID: 38206402 DOI: 10.1007/s00330-023-10564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE(S) To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.
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Affiliation(s)
- Sara Imbs
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
| | - Baptiste Deyrail
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Rumeau
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Roger Jankowski
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France.
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Sicard RM, Frank-Ito DO. Parameter characteristics in intranasal drug delivery: A key to targeting medications to the olfactory airspace. Clin Biomech (Bristol, Avon) 2024; 114:106231. [PMID: 38507865 DOI: 10.1016/j.clinbiomech.2024.106231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The nose is a viable pathway for topical drug delivery to the olfactory cleft for treatment of obstructive smell loss and nose-to-brain drug delivery. This study investigates how variations in nasal vestibule morphology influence intranasal spray drug transport to the olfactory cleft and olfactory roof/bulb regions. METHODS The unilateral nasal vestibule morphology in three healthy subjects with healthy normal nasal anatomy was classified as Elongated (Subject DN001), Notched (Subject DN002), and Standard (Subject DN003). Computational fluid and particle dynamics modelling were used to simulate nasal airflow and drug particle transport to the olfactory cleft and olfactory roof/bulb regions in each subject-specific nasal cavity. To evaluate highest drug depositions in these regions, the particle transport simulations involved extensive parameter combination analyses: 6 inspiratory flow rates mimicking resting to sniffing (10-50 L/min); 5 spray release locations (Top, Bottom, Central, Lateral, and Medial); 5 head positions (Upright, Tilted Forward, Tilted Back, Supine, and Mygind); 3 particle velocities (1, 5, and 10 m/s); 350,000 μm-particles (1-100 μm) and 346,500 nanoparticles (10-990 nm). FINDINGS Particle size groups with highest depositions in olfactory cleft: DN001 left = 28.4% at 11-20 μm, right = 75.3% at 6-10 μm; DN002 left = 16.8% at 1-5 μm, right = 45.3% at 30-40 nm; DN003 left = 29.1% at 21-30 μm, right = 15.9% at 6-10 μm. Highest depositions in olfactory roof/bulb: DN001 left = 6.5% at 11-20 μm, right = 26.4% at 11-20 μm; DN002 left = 3.6% at 1-5 μm, right = 2.6% at 1-5 μm; DN003 left = 2.8% at 21-30 μm, right = 1.7% at 31-40 μm. INTERPRETATION DN001 (Elongated nasal vestibule) had the most deposition in the olfactory regions. Micron-particles size groups generally had better deposition in the olfactory regions.
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Affiliation(s)
- Ryan M Sicard
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis O Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Eliezer M, Hamel AL, Houdart E, Herman P, Housset J, Jourdaine C, Eloit C, Verillaud B, Hautefort C. Loss of smell in patients with COVID-19. Neurology 2020; 95:e3145-e3152. [DOI: 10.1212/wnl.0000000000010806] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo assess the physiopathology of olfactory function loss (OFL) in patients with coronavirus disease 2019 (COVID-19), we evaluated the olfactory clefts (OC) on MRI during the early stage of the disease and 1 month later.MethodsThis was a prospective, monocentric, case-controlled study. Twenty severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)–infected patients with OFL were included and compared to 20 age-matched healthy controls. All infected patients underwent olfactory function assessment and 3T MRI, performed both at the early stage of the disease and at the 1-month follow-up.ResultsAt the early stage, SARS-CoV2–infected patients had a mean olfactory score of 2.8 ± 2.7 (range 0–8), and MRI displayed a complete obstruction of the OC in 19 of 20 patients. Controls had normal olfactory scores and no obstruction of the OC on MRI. At the 1 month follow-up, the olfactory score had improved to 8.3 ± 1.9 (range 4–10) in patients, and only 7 of 20 patients still had an obstruction of the OC. There was a correlation between olfactory score and obstruction of the OC (p = 0.004).ConclusionOFL in SARS-CoV2–infected patients is associated with a reversible obstruction of the OC.
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Liu J, Pinheiro-Neto CD, Zhao J, Chen Z, Wang Y. A novel surgical treatment for long lasting unilateral peripheral parosmia: Olfactory cleft blocking technique. Auris Nasus Larynx 2020; 48:1209-1213. [PMID: 32768312 DOI: 10.1016/j.anl.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/12/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
The treatment of qualitative olfactory disease is challenging. We aimed to treat parosmia using a new minimally invasive surgical technique-the olfactory cleft blocking technique- by preventing odorants from reaching the olfactory epithelium. A novel surgical procedure for blocking the anterior and inferior openings of the olfactory cleft was accomplished in a patient with unilateral persistent peripheral parosmia. The HRCT and endoscopy were performed preoperatively and postoperatively to evaluate the anatomical structure of the olfactory cleft. The T&T olfactometer was used to assess the preoperative and postoperative olfactory function. After surgery, the patient's parosmia disappeared. Endoscopic examination and CT scan showed complete obstruction of the anterior and inferior portions of the olfactory cleft. No recurrence was reported during a 2-year follow-up. No surgical complications were reported except olfactory loss in the operative nostril. For patients with long-term unilateral peripheral olfactory dysfunction, the olfactory cleft blocking technique seems a novel, simple, safe and effective treatment. Further studies are required with a larger number of patients in order to access success rate.
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Affiliation(s)
- Jianfeng Liu
- Department of Otolaryngology, China-Japan Friendship Hospital, Yinghuadong Street, Chaoyang District, Beijing 100029, China.
| | - Carlos D Pinheiro-Neto
- Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Jianhui Zhao
- Department of Otolaryngology, China-Japan Friendship Hospital, Yinghuadong Street, Chaoyang District, Beijing 100029, China
| | - Zhongyan Chen
- Department of Otolaryngology, China-Japan Friendship Hospital, Yinghuadong Street, Chaoyang District, Beijing 100029, China
| | - Yibei Wang
- Department of Otolaryngology, China-Japan Friendship Hospital, Yinghuadong Street, Chaoyang District, Beijing 100029, China
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Gurushekar PR, Isiah R, John S, Sebastian T, Varghese L. Effects of radiotherapy on olfaction and nasal function in head and neck cancer patients. Am J Otolaryngol 2020; 41:102537. [PMID: 32416968 DOI: 10.1016/j.amjoto.2020.102537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Radiotherapy (RT) is a major component of treatment in head and neck malignancies and often the radiation field includes the nasal cavity and olfactory cleft region. We aimed to assess olfaction, mucociliary clearance time and quality of life (QOL) before RT and during the course of radiotherapy. METHODS This prospective, observational, cohort study was conducted over a period of 1 year. The olfactory function, mucociliary clearance and QOL of patients with primary head and neck cancers undergoing radiation therapy as part of treatment were assessed prior to radiotherapy and followed up serially up to 3 months after radiotherapy. A total of 21 patients were enrolled. Assessment was done using noninvasive tests for better compliance and ease of examination. RESULTS Among the 21 patients recruited, 18 completed radiotherapy and 13 were assessed 3 months post radiotherapy. Mean olfactory scores (including olfactory threshold and odor identification), using Connecticut Chemosensory Clinical Research Center (CCCRC) test, deteriorated significantly at the end of radiotherapy (p < 0.001) as compared to scores before irradiation. Subjective assessment of olfaction by Appetite, Hunger and Sensory perception (AHSP) questionnaire did not demonstrate significant impairment in nasal function (p < 0.319) although overall QOL significantly deteriorated (p 0.004). The mucociliary clearance time was prolonged in 72% of the patients at the end of radiotherapy. CONCLUSION Deterioration in olfactory function was found to occur during the course of radiotherapy with gradual improvement after 3 months. However, patients did not notice olfactory dysfunction subjectively. Mucociliary dysfunction persisted even after 3 months following radiation.
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The Effect of Endoscopic Olfactory Cleft Opening on Obstructed Olfactory Cleft Disease. Int J Otolaryngol 2020; 2020:8073726. [PMID: 32292482 PMCID: PMC7149324 DOI: 10.1155/2020/8073726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose This study was conducted to evaluate the effect of endoscopic olfactory cleft (OC) opening on olfaction in patients with obstructed OC disease. Materials and Methods. Patients with obstructed OC disease who underwent endoscopic OC opening for treatment were enrolled. The endoscopic olfactory cleft opening was performed under local anesthesia. Under an endoscopy, the middle and superior turbinates were gently lateralized to open the OC using an elevator. The phenyl ethyl alcohol threshold test was performed to evaluate the olfactory function both before and after surgery. Results An endoscopic OC opening was performed on 42 patients. Amongst them, the etiology of OC obstruction revealed anatomic anomalies in 14 patients, inflammatory process in 14, and anatomic anomalies as well as inflammatory process in 14. The phenyl ethyl alcohol threshold levels improved in 32 (76.2%) of the patients after surgery. The olfactory function was better improved in patients experiencing OC obstructed by inflammatory process than those by anatomic anomalies. Conclusions This study showed that endoscopic OC opening seemed to be effective in treating olfactory dysfunction in patients with obstructed OC disease caused by inflammatory process.
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Wolf A, Liesinger L, Spoerk S, Schittmayer M, Lang-Loidolt D, Birner-Gruenberger R, Tomazic PV. Olfactory cleft proteome does not reflect olfactory performance in patients with idiopathic and postinfectious olfactory disorder: A pilot study. Sci Rep 2018; 8:17554. [PMID: 30510230 PMCID: PMC6277379 DOI: 10.1038/s41598-018-35776-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/09/2018] [Indexed: 01/15/2023] Open
Abstract
Technical advances including liquid chromatography-tandem mass spectrometry and its data analysis enable detailed proteomic analysis of the nasal mucus. Alterations of the nasal mucus proteome may provoke substantial changes of the nasal physiology and have already been associated with rhinologic diseases such as allergic rhinitis. This study was conducted as a pilot study to map the olfactory cleft proteome using current techniques for proteomic analysis. Furthermore, we aimed to investigate proteomic changes as potential biomarkers in patients suffering from idiopathic and postinfectious olfactory disorders compared to healthy controls. Seven patients with idiopathic hyposmia and anosmia, seven patients with postinfectious hyposmia and anosmia and seven healthy controls were included in this study. In total, 1117 different proteins were detected in at least five patients in at least one group. Results of this study did not reveal significant differences regarding the proteomic composition of the olfactory cleft mucus between patients versus healthy controls. Among proteins involved in olfactory perception the G protein family was detected but also found unchanged between groups. Investigation of protein composition by liquid chromatography-tandem mass spectrometry enabled us to perform an in-depth analysis of the olfactory cleft mucus proteome regarding the diversity of different proteins in individual patients. However untargeted proteomics of the olfactory cleft mucus may not be an applicable approach to develop biomarkers for olfactory disorders. Targeted analyses of distinct proteins known to be involved in olfactory perception but not detected by our approach, e.g. odorant binding proteins, may provide more information regarding pathophysiology of olfactory diseases.
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Affiliation(s)
- Axel Wolf
- Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Laura Liesinger
- Gottfried Schatz Research Center, Medical University of Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
- Omics Center Graz, BioTechMed-Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
| | - Stefan Spoerk
- Gottfried Schatz Research Center, Medical University of Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
- Omics Center Graz, BioTechMed-Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
| | - Matthias Schittmayer
- Gottfried Schatz Research Center, Medical University of Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
- Omics Center Graz, BioTechMed-Graz, Stiftingtalstrasse 24, 8010, Graz, Austria
| | - Doris Lang-Loidolt
- Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Ruth Birner-Gruenberger
- Gottfried Schatz Research Center, Medical University of Graz, Stiftingtalstrasse 24, 8010, Graz, Austria.
- Omics Center Graz, BioTechMed-Graz, Stiftingtalstrasse 24, 8010, Graz, Austria.
| | - Peter V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
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Jankowski R, Nguyen DT, Gallet P, Rumeau C. Olfactory cleft dilatation. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:437-441. [PMID: 29934261 DOI: 10.1016/j.anorl.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the turbinate wall of the ethmoid, composed, from anterior to posterior, of the middle, superior and supreme turbinates), in order to get access to the recess hosting the human olfactory mucosa and to the roof of the olfactory cleft (i.e., cribriform plate), with minimal trauma to the mucosa. Olfactory cleft dilatation is indicated for dysosmia secondary to constitutional stenosis of the olfactory clefts due to abnormal development of the ethmoid. Constitutional stenosis of the olfactory clefts should be differentiated from inflammatory obstruction and other diseases of the olfactory clefts, and especially from respiratory epithelial adenomatoid hamartoma, which enlarges the olfactory clefts and must be treated by resection. The technique of olfactory cleft dilatation is illustrated by three surgical cases. There was clear improvement in dysosmia in all three cases, without any complications. The place of constitutional olfactory cleft stenosis needs still to be defined in both diagnosis and treatment of dysosmia.
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Affiliation(s)
- R Jankowski
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France.
| | - D T Nguyen
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
| | - P Gallet
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
| | - C Rumeau
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
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Su K, Zhang W, Shi H, Yin S. Pedunculated cavernous hemangioma originating in the olfactory cleft. EAR, NOSE & THROAT JOURNAL 2016; 93:E29-33. [PMID: 25255356 DOI: 10.1177/014556131409300907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sinonasal cavernous hemangioma is a rare condition that usually affects the lateral wall of the nasal cavity. We report the case of a 77-year-old man who presented with severe epistaxis, nasal congestion, and olfactory dysfunction. Endoscopic examination of the nasal cavity revealed the presence of a red-blue tumor that had almost completely filled the nasopharynx. Preoperatively, it was difficult to distinguish this lesion from a juvenile nasopharyngeal angiofibroma. During endoscopic surgery, the tumor was found to originate in the left olfactory cleft, and it had a long peduncle that contained blood vessels. Postoperative histopathologic examination indicated that the mass was a cavernous hemangioma. To the best of our knowledge, this is the first case of an olfactory cleft cavernous hemangioma and the first case of olfactory cleft disease associated with a cavernous hemangioma to be reported in the English-language literature.
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Affiliation(s)
- Kaiming Su
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
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Hummel T, Landis BN, Hüttenbrink KB. Smell and taste disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc04. [PMID: 22558054 PMCID: PMC3341581 DOI: 10.3205/cto000077] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Smell and taste disorders can markedly affect the quality of life. In recent years we have become much better in the assessment of the ability to smell and taste. In addition, information is now available to say something about the prognosis of individual patients. With regard to therapy there also seems to be low but steady progress. Of special importance for the treatment is the ability of the olfactory epithelium to regenerate.
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Konstantinidis I, Triaridis S, Printza A, Vital V, Ferekidis E, Constantinidis J. Olfactory dysfunction in nasal polyposis: correlation with computed tomography findings. ORL J Otorhinolaryngol Relat Spec 2007; 69:226-32. [PMID: 17409781 DOI: 10.1159/000101543] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 01/24/2007] [Indexed: 12/16/2022]
Abstract
AIMS This study evaluates if a computed tomography (CT) scan is useful to assess the olfactory loss in sinonasal disease, and if a preoperative CT scan has a predictive value for the long-term outcome regarding olfaction. METHODS Thirty-one patients with nasal polyposis were included. Olfactory function was assessed with the 'Sniffin' Sticks' test and subjective perception recorded with a visual analogue scale. CT scans were assessed with the Lund-Mackay system and the Damm nasal segmentation. Patients were retested after endoscopic sinus surgery in a follow-up appointment at least 1 year later. RESULTS Disease in the upper meatus and the posterior portion of the middle meatus strongly affects olfactory function. Lund-Mackay scores were significantly correlated with preoperative olfactory test results. Preoperative subjective ratings had a significant correlation only with present disease in the anterior upper meatus. Postoperative results were significantly decreased. Their relative percentage change was correlated only with the preoperative presence of disease in the anterior upper meatus. No correlation was found between the Lund-Mackay score and the postoperative olfactory results. CONCLUSIONS Olfactory dysfunction in nasal polyposis is strongly related to specific obstructed nasal areas. A CT scan has no predictive value for the long-term surgical outcome regarding olfaction.
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Débat H, Eloit C, Blon F, Sarazin B, Henry C, Huet JC, Trotier D, Pernollet JC. Identification of human olfactory cleft mucus proteins using proteomic analysis. J Proteome Res 2007; 6:1985-96. [PMID: 17381150 DOI: 10.1021/pr0606575] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In humans, the olfactory epithelium is located in two narrow passages, the olfactory clefts, at the upper part of the nasal cavities. The olfactory epithelium is covered by a mucus layer which is essential for the function of the olfactory neurons that are directly connected with the brain through the cribriform plate. This anatomical weakness of the brain protection may be the source of infection. Little is known about the composition of this mucus in humans. Previous proteomic analyses have been performed on washes of the entire nasal cavities and therefore might better correspond to the mucus over the respiratory epithelium than to the mucus covering the olfactory epithelium. In the present study, we sampled the olfactory mucus directly from the clefts of 16 healthy adult volunteers, and 83 proteins were identified in the samples using two-dimensional gel electrophoresis, MALDI-TOF, RPLC, and Edman sequencing. Forty-three proteins were not previously observed either in nasal mucus sampled through washings, saliva, tear, or cerebrospinal fluid. In Accordance with the data in the protein databases, the most abundant proteins are secreted, whereas some others correspond to intracellular proteins covering a large range of functions: anti-inflammatory, antimicrobial, protease inhibition, antioxidant, transport, transcription, transduction, cytoskeletal, regulation, binding, and metabolism of odorant molecules. This study clearly demonstrates the complexity of the mucus covering the human olfactory epithelium, which might comprise potential markers for characterizing pathophysiological states.
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Affiliation(s)
- Hélène Débat
- Biochimie de l'Olfaction et de la Gustation, UMR 1197, Neurobiologie de l'Olfaction et de la Prise Alimentaire, INRA, Jouy-en-Josas, France.
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Trotier D, Bensimon JL, Herman P, Tran Ba Huy P, Døving KB, Eloit C. Inflammatory Obstruction of the Olfactory Clefts and Olfactory Loss in Humans: A New Syndrome? Chem Senses 2007; 32:285-92. [PMID: 17237476 DOI: 10.1093/chemse/bjl057] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The first step in the olfactory perception is the activation by odorants of sensory neurones in the olfactory epithelium. In humans, this sensory epithelium is located at 2 narrow passages, the olfactory clefts, at the upper part of the nasal cavities. Little is known about the physiology of these clefts. We examined, in 34 patients, the impact of obstructed clefts upon detection and postlearning identification of 5 odorants. The location and extension of the obstructions were assessed using endoscopy, CT scans, and MRI. The inflammatory obstruction was usually bilateral, extending anteroposteriorly, and confined to the clefts, with no sign of obstruction or any inflammatory disease in the rest of the nasal cavities and sinuses. When tested with 5 odorants, these patients showed greatly impaired olfaction compared with a group of 73 normosmic subjects. The majority of these 34 patients had sensory deficits equivalent to that found in another group of 41 congenital anosmic patients, where inspection with MRI indicated the lack of olfactory bulbs. This study demonstrates that the olfactory clefts, in human, function as an entity that is different from other regions of the nasal cavity and is the target for local inflammatory events that are apparently not responding to corticoid and antibiotic treatments.
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Affiliation(s)
- Didier Trotier
- Neurobiologie Sensorielle, NOPA, UMR 1197, INRA, Bât. 325, Jouy-en-Josas, France.
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Abstract
PURPOSE OF REVIEW Disorders of the sense of smell can result through hundreds of different processes, but most commonly occur from upper-respiratory-tract infections, trauma, and chronic rhinosinusitis. RECENT DEVELOPMENTS Research in the basic science of olfaction has progressed rapidly with powerful new molecular discoveries; however, our ability to treat these disorders remains limited. In clinical olfaction we are just realizing the broader existence of the sensory dysfunction in our population. We are discovering associations between neurodegenerative disorders and smell function that may allow us to identify these disorders earlier in the disease process. We are also challenging our previous categorization schemes and realizing that many etiologies cross the traditional conductive and neuro-sensory divisions. SUMMARY Currently, aside from the possible therapeutic potential of systemic steroids, we have no effective treatment for the most common causes of olfactory loss. Recent advances in the basic science of olfaction provides us with an opportunity to develop new and novel clinical studies in an attempt at improving the quality of life for many of these patients.
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Affiliation(s)
- Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA.
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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