The administration of nasal drops in the "Kaiteki" position allows for delivery of the drug to the olfactory cleft: a pilot study in healthy subjects.

Systemic treatment with corticosteroids shows therapeutic effects, few patients benefit from intranasal topical drug application, probably due to limited access of the drug to the olfactory epithelium. The aim of the present study was to investigate how drops distribute within the nasal cavity when the "Kaiteki" position is performed. Thirteen healthy volunteers participated. Subjects were lying on the side with the head tilted and the chin turned upward. Blue liquid was used to visualize the intranasal distribution of the nasal drops. The investigation was carried out using photo documentation thorough nasal endoscopy; the intranasal distribution of the dye was judged by two independent observers in both a decongested state and a natural state where no decongestants had been used. With regard to the main criterion of this study, using the "Kaiteki" position, nasal drops reached the olfactory cleft in 96 % of the decongested cases and 75 % of the cases who had not been decongested. However, this difference was not statistically different. Because the "Kaiteki" maneuver is not too difficult to perform, it is more likely that topical steroids can be helpful in cases of olfactory loss.

Characteristics of chemosensory disorders--results from a survey.

This survey was undertaken to investigate the nature of chemosensory dysfunction in relation to the underlying cause, severity, and course of the disease and to elucidate their clinical significance. A total of 269 patients (116 men and 149 women) with chemosensory disorders participated in the survey. Approximately 89 % had olfactory loss, either alone or in combination with taste loss and 2 % had gustatory loss alone; 7.4 % had chemosensory distortions. Dysosmia was significantly higher in those on more than four medicines per day (p < 0.02). Most patients (51.6 %) reported sudden onset of symptoms. Self-reported etiologies included: flu/infection (39.4 %), medication intake (13 %), sinusitis (12 %), operation (10.7 %), head-trauma (9.3 %), and not-specified (12.7 %). The most frequent complaint was diminished pleasure from eating followed by a decrease in general quality of life (QoL). Patients with gradual onset of symptoms or long-standing disease complained the least (p < 0.005). Of all etiologies, patients with SND complained the most (p < 0.04). Overall, 18.6 % ate more and 7.3 % ate less, 7.5 % changed their food preferences, and 19 % reported weight gain and 15.8 % weight loss. Haptic feedback was considered more important than visual appeal and acoustic feedback of food. Older patients however valued visual appeal more. When asked directly, 63 % reported having experienced household-mishaps, 58.1 % problems with social communication, 56.8 % reported having changed their sexual behavior and 35.9 % suffered depression. 60.4 % did not cope well with the changes in their lives. Women reported more problems than men, particularly relating to interpersonal communication (64.5 vs. 57.6 %) and mood (47.9 vs. 40.9 %). Women also had more frequent spontaneous recollections of smells (p < 0.02). Chemosensory disorders have a significant impact on QoL. Reduced pleasure from eating is the predominant complaint of patients seeking medical attention. The steeper the onset of symptoms, the worse the ability to cope with changes in daily life. Older patients value the visual appeal, whereas younger patients value the haptic feedback of foods.

Improvement of chronic rhinitis under aspirin.

In a subset of aspirin-tolerant asthmatics, administration of aspirin improves respiratory symptoms. We present a patient with chronic rhinosinusitis with nasal polyps who exhibited relief of nasal obstruction and nasal discharge and improvement in the sense of smell following oral administration of 150 mg of aspirin daily. Improvement in the patency of the nasal passages was documented by nasal endoscopy and magnetic resonance imaging. Improvement of olfactory function was documented by validated psychophysical olfactory testing and by means of olfactory event-related potentials.

Endoscopic dacryocystorhinostomy in patients taking aspirin perioperatively.

PURPOSE: The aim of this study is to report the results of endoscopic dacryocystorhinotomy (EDCR) in patients who did not interrupt their low-dose (75-150 mg daily) aspirin regimen for the procedure. MATERIALS AND METHODS: A case note review was made of all 40 patients taking aspirin who had EDCR at Ipswich Hospital from May 1998 to October 2003. Age, gender, indications for surgery, complications, and outcome were analyzed and the bleeding rate compared to that in patients who were not on aspirin or warfarin who had an EDCR. RESULTS: Of the 51 EDCRs performed in the 40 patients, 47 had complete relief of epiphora. Two of the patients with a persistent watering eye are to have revision surgery, 1 patient was observed (75% improvement), and 1 patient has since died. A total of 33 patients had no postoperative complications; 5 had epistaxis but only 1 of these required a nasal pack; 1 each had minor periorbital bruising, confusion, and facial pain, none of which delayed discharge. None required readmission. Of 257 EDCRs in patients not on aspirin or warfarin, 1.3% had epistaxis resulting in delayed discharged or readmission. CONCLUSIONS: EDCR is a safe and efficacious treatment in patients with distal nasolacrimal obstruction in patients taking aspirin and does not require stopping the aspirin perioperatively.

Endoscopic dacryocystorhinostomy in warfarinized patients.

PURPOSE: To report the results of endoscopic dacryocystorhinotomy (EDCR) in anticoagulated patients who did not interrupt their anticoagulant regimen for the procedure. MATERIALS AND METHODS: A case note review was made of all 9 patients taking warfarin who had EDCR at Ipswich Hospital from May 1998 to October 2003. Age, gender, indications for surgery, complications, and outcome were analyzed, and the results were compared to EDCRs in nonwarfarinized patients. RESULTS: Of the 9 patients, 7 had complete relief of epiphora. Two patients had a persistent watering eye. One of them had blockage of upper, lower, and common canaliculi, and the other was found to have adhesions between the lateral nasal wall and middle turbinate. A total of 6 patients had no postoperative complications; 2 had minor periorbital bruising that did not delay discharge, and only 1 patient had ooze through a Kaltostat nasal pack and was kept in the hospital for 2 days. None required readmission. CONCLUSIONS: EDCR is a safe and efficacious treatment in patients with distal nasolacrimal obstruction in anticoagulated patients and does not require stopping the warfarin perioperatively.