Cultural determinants of food attitudes in anosmic patients.

The decrease in food enjoyment is a major factor why patients suffer from depression when having anosmia, or total loss of smell. While we have some knowledge about how food preferences and attitudes change with dysosmia, these findings are limited because other factors such as culture are not factored in. It is likely that the culture in which an anosmic patient identifies with will influence how their smell loss impacts their relationship with food. This study examined the current attitudes within the United States and Germany towards foods, focusing on the comparison between anosmic patients (N = 53) and those with a healthy sense of smell (N = 121). A survey was used to collect free responses for liking on a variety of foods (N = 15) that were also rated for their overall liking. Additionally, individuals rated and ranked their liking for sensory attributes in relation to their enjoyment of food. Free responses were classified into categories and subcategories, the frequency of those responses were then compared across groups. The patient population of each culture gave lower importance to aroma and flavor; however, the U.S.A. patient population showed a larger decrease from their healthy counterparts. Furthermore, anosmic patients from the U.S.A. showed less overall liking towards the food stimuli compared to their healthy counterparts, while no such effect observed among the German population. Reasons to enjoy a food were largely explained by the culture, and patients within a culture took on different compensation strategies which we use to explain their effectiveness.

Preoperative quality-of-life measures predict acute postoperative pain in endoscopic sinus surgery.

OBJECTIVES: Recent increases in opioid-related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS). METHODS: Sixty-four consecutive patients undergoing ESS were enrolled. Baseline 22-item SinoNasal Outcomes Test (SNOT-22) and Short-Form 8 (SF-8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT-22/SF-8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables. RESULTS: Day-of-surgery pain scores were significantly correlated with the SF-8 role-physical domain (Rs = 0.32, P = 0.04). Whereas SF-8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF-8 pain score became correlated with self-reported pain (Rs = 0.39, P = 0.02). SNOT-22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF-8 role-physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R2 = 0.359, P < 0.0001). CONCLUSION: Baseline patient-reported global quality-of-life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:1274-1279, 2019.

Postoperative Opioid Use in Sinonasal Surgery.

OBJECTIVE: To survey patients following sinonasal surgery regarding postoperative pain and opioid use. STUDY DESIGN: Patients were surveyed for 4 days following sinus and/or nasal surgery regarding their pain level and use of prescribed opioids. SETTING: Four academic medical centers and 1 private practice institution. SUBJECTS: Consecutive adult patients undergoing sinonasal surgery. RESULTS: A total of 219 subjects met criteria and were included for analysis; 134 patients (61%) took 5 or fewer combination oxycodone (5-mg) and acetaminophen (325-mg) tablets in the first 3 postoperative days, and 196 patients (89.5%) took fewer than 15. Fifty-one patients (23%) consumed no opioid pain medication. Opioid consumption was positively correlated with postoperative pain ( R2 = 0.2, P < .01) but was not correlated with the use of acetaminophen ( R2 = 0.002, P = .48). No significant difference in postoperative pain or opioid consumption was seen with respect to age, sex, specific procedures performed, postoperative steroids, or smoking history. Current smokers reported higher average pain than nonsmokers ( P < .001) and also required more postoperative opioids ( P = .02). CONCLUSIONS: An evidence-based approach to postoperative pain control following sinonasal surgery that reduces the number of unused and potentially diverted opioids is needed. The current study suggests that 15 combination oxycodone (5-mg) and acetaminophen (325-mg) tablets provide sufficient pain control for 90% of patients in the immediate postoperative period following sinonasal surgery, irrespective of the specific procedures performed, use of acetaminophen, or use of systemic steroids. Smoking status may help surgeons predict which patients will require larger opioid prescriptions.

Safety and tolerability of surfactant nasal irrigation.

BACKGROUND: Abnormal mucus composition and bacterial biofilms are thought to contribute to the pathophysiology of rhinosinusitis. Addition of a mucoactive surfactant to saline irrigation solution has been hypothesized to address these factors. We evaluated the safety and tolerability of a reformulated surfactant in a sample of normal subjects. METHODS: A total of 33 volunteers were randomly assigned to receive either surfactant solution or buffered saline at baseline in a controlled crossover study design. Each subject underwent rhinoscopic exam and in-office smell testing via the 40-question smell identification test (SIT). Those with non-normosmic results or active rhinitis symptoms were excluded. Subjects were instructed to irrigate twice daily with the selected solution for 1 week while keeping a daily diary. For week 2, treatment was stopped. During week 3, each group switched to the other treatment. Exam, SIT, and degree of congestion were assessed after each phase. RESULTS: Use of surfactant led to a marginal reduction in mean SIT score of 1.5 points, which was statistically significant (p = 0.012). A clinically meaningful reduction in SIT score, defined as ≥4 points, was observed in 18% (6/33) of subjects after surfactant vs 3% (1/33) after saline (p = 0.046). During the surfactant phase, moderate or severe congestion was reported in 29% (8/28) of subjects completing the diary. In contrast, only 6% (2/32) of subjects reported moderate congestion after the saline phase (p = 0.021). CONCLUSION: In normal volunteers, surfactant nasal irrigation may be associated with tolerability issues due to congestion. A subset may experience reduction in olfactory acuity that appears reversible.

Assessing Body Fat Changes during Moderate Weight Loss with Anthropometry and Bioelectrical Impedance.

BACKGROUND/OBJECTIVES: Monitoring changes in total fat mass and abdominal adiposity are important in understanding the impact of different types of weight loss interventions on health risks. Our objective was to assess the usefulness of anthropometry and bioelectrical impedance analysis (BIA) in predicting fat mass changes during moderate weight loss. SUBJECTS/METHODS: Fat mass changes were assessed in 34 overweight adults (24 females, 10 males) after a 12-week supervised weight loss induced by caloric restriction (-30% of requirement) using BIA and DXA. Agreement between BIA and DXA measurements were assessed by Bland-Altman plots. Linear regression modeling was used to predict body and truncal fat mass from anthropometric measures. RESULTS: Diet intervention resulted in a significant decrease in body weight (- 7.86 ± 2.87 kg), body mass index (BMI - 2.69 ± 0.98 kg/m(2)), total body fat (- 5.22 ± 2.32 kg), truncal fat (- 2.80 ± 1.94 kg) and waist circumference (- 5.52 ± 3.57 cm). BMI and body weight were highly correlated with body fat (0.83 and 0.92 in females and 0.94 and 0.92 in males respectively) and truncal fat (0.75 and 0.87 in females; 0.90 and 0.84 in males respectively) during weight loss. Waist circumference was more correlated with truncal fat in males than females (0.94 vs. 0.85 in females). Compared to DXA, BIA underestimated total body fat changes in males (- 8.8 kg, p<0.001) and overestimated total body fat changes in females (+ 2.1 kg, p< 0.001). CONCLUSIONS: Body mass index, body weight, and waist circumference provide simple and more accurate than BIA estimates of relative changes in total and truncal fat during moderate weight loss in adults.

Validity of a multisensor armband in estimating 24-h energy expenditure in children.

UNLABELLED: Physical activity (PA) and energy expenditure (EE) in children are frequently assessed using portable activity monitors. Algorithms used to predict EE by these monitors are often based on adult populations and may not be accurate for children. PURPOSE: To evaluate the accuracy of the SenseWear Pro Armband (SWA) for assessing EE in African American children during treadmill exercise, sedentary activities, rest, sleep, and total 24-h EE, using indirect room calorimetry (IRC) as a reference standard. METHODS: Participants were healthy African American children (10 boys, 11 girls; age: 11.6 +/- 0.9 yr; weight: 47.3 +/- 13.0 kg; height: 151.6 +/- 8.8 cm; BMI: 20.4 +/- 4.8 kg.m). EE was measured simultaneously using IRC and SWA during a 24-h stay in the IRC. Recorded activities included sedentary behaviors, treadmill exercise, rest periods, and sleep. Results from both methods were matched minute-by-minute and compared by Bland-Altman plot. Multiple linear regression analysis was used to describe the relationship between EE assessed by both methods and children's descriptive characteristics. RESULTS: SWA overestimated EE compared with IRC during all activities and time periods, ranging from 116% during sleep to 143% during rest after treadmill exercise. The SWA-predicted EE was improved by using linear regression modeling. Simple equations for sedentary activities and treadmill exercise were EE [kcal.min] = 0.462EE (SWA) [kcal.min] + 0.015 x body weight [kg], and EE [kcal.min] = 0.637EE (SWA) [kcal.min] + 0.034 x body weight [kg], respectively. The prediction equation for RMR was RMR [kcal.min] = 0.453EE (SWA) [kcal.min] + 0.011 x body weight [kg]. CONCLUSION: EE estimated using SWA was significantly higher than EE measured using IRC in African American children ages 10-14 yr. Bias in individual EE estimated using SWA could be improved by an adjustment for the body weight of a child. The SWA manufacturer should work with researchers on improving existing algorithms for children.