Olfactory loss after head and neck cancer radiation therapy.

BACKGROUND: A reduced sense of smell may be one explanation for why patients with cancer in the ear, nose and throat (ENT) region who are treated with radiation therapy lose weight. The purpose of this study was to investigate whether radiation therapy has a negative effect on olfactory function and, if so, whether this effect is dose-related. METHODOLOGY: Seventy-one patients were tested using odour-detection sensitivity and olfactory identification tests before radiation therapy and 20 months after it. RESULTS: Patients who received radiation close to the olfactory organ showed a reduced sense of smell, in both tests. A multiple regression analysis showed that the radiation dose was related to decline in the olfactory function, while age, sex, chemotherapy and interactions between these variables were not. CONCLUSION: Radiation therapy can damage olfactory cells.

The effect of smoking on physiological decongestion of the nasal mucosa in human.

BACKGROUND: Exercise is known to decongest the nasal mucosa which results in increased nasal patency. In a recent study it was suggested that smoking might influence the effect of exercise on the nasal mucosa. This implies that smoking may cause neurological damage to the normal nasal physiology, which has not previously been shown. The aim of this study was to investigate whether there was a difference in nasal mucosal reaction to exercise between smokers and non-smokers. METHODOLOGY: Forty-two smokers and non-smokers underwent acoustic rhinometry to register nasal geometry before and after cycling on an ergometer cycle. A structured interview was used for questions about smoking habits and airway symptoms. RESULTS: Both smokers and non-smokers had a significant increase in MCA (minimal cross-section area) and total nasal volume after exercise. There was no statistical significant difference between smokers and non-smokers. CONCLUSIONS: Smoking does not seem to affect the normal physiological decongestion of the nasal mucosa after exercise.

On the relation between capsaicin sensitivity and responsiveness to CO2: detection sensitivity and event-related brain potentials.

OBJECTIVE: Sensory hyperreactivity (SHR) with predominantly airway symptoms is a subgroup of chemical intolerance to various environmental substances with pungent/odorous properties. The hallmark of SHR is sensitivity to capsaicin inhalation, resulting in extensive coughing likely to be mediated by a C-fiber hyperreactivity of the airway sensory neurons. However, it is not clear whether capsaicin sensitivity implies a greater sensitivity to chemosomatosensory substances in general. Therefore, the present study tested the hypothesis of an association between capsaicin cough sensitivity and sensitivity to CO(2) with respect to detection sensitivity and electrophysiological brain response. METHODS: A correlational study was employed to investigate the relation between capsaicin cough sensitivity and detection thresholds and chemosomatosensory event-related potentials (ERPs) for CO(2) presented in the nasal cavity in 35 persons varying in capsaicin cough sensitivity. RESULTS: Number of coughs were found to correlate negatively with CO(2) threshold and tended to correlate negatively also with N1 and P2 latencies of the chemosomatosensory ERP for CO(2). No tendencies of correlations were found between number of coughs and latencies for olfactory and auditory ERPs, recorded for comparison, but, unexpectedly, were found between number of coughs and auditory N1 amplitude. CONCLUSIONS: The results imply that capsaicin cough sensitivity, such as in SHR, is related to higher detection sensitivity, and tends to be related to faster cortical processing of other chemosomatosensory substances, at least of CO(2).

Healthcare provider contact for children with symptoms of sleep-disordered breathing: a population survey.

BACKGROUND: Symptoms of sleep-disordered breathing in children, such as frequent snoring, apnoea and choking, may lead to health problems if untreated. The caregiver's level of awareness of these symptoms has been poorly studied. This study aimed to study healthcare provider contact related to sleep-disordered breathing symptoms in a population of children aged 0-11 years. METHODS: A total of 1320 children were randomly selected from a national database that included all children living in Sweden. Caregivers answered a questionnaire about sleep-disordered breathing symptoms during the last month and healthcare provider contact related to these symptoms. RESULTS: A total of 754 answers were received. The prevalence of sleep-disordered breathing symptoms was 4.8 per cent. Of this subgroup, 69 per cent had not been in contact with a healthcare provider regarding their symptoms. CONCLUSION: This study shows that sleep-disordered breathing in children is underestimated and that there is a need to increase caregiver and healthcare provider awareness of sleep-disordered breathing in children.

Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment.

Cardiovascular and pulmonary disease (CVPD) is common in patients with obstructive sleep apnea syndrome (OSAS). This retrospective study addressed the accumulated in-hospital time during 2 years prior to treatment with nasal continuous positive airway pressure (nCPAP) as compared to 2 years after initiating of nCPAP in patients with OSAS and CVPD. A cohort representing all patients (n = 88) receiving nCPAP during the period 1988-1994 at the Skövde Central Hospital, Skövde, Sweden, was studied. Data collection was based on interviews with patients as well as reviews of clinic charts. All hospitalizations and diagnostic codes by any type were thereby successfully gathered for the whole group. Six patients with confounding serious diseases were excluded from the analysis. A CVPD diagnosis (ICD-9, codes 401-435 and 490-496) was found in 54 out of 82 patients (66%), of whom 36 of 58 were nCPAP users (62%) and 18 of 24 were nonusers (75%). In 54 sleep apneics with CVPD, 31 were hospitalized acutely under one or more of these diagnostic codes during the study period of 4 years. The total number of in-hospital days due to CVPD in the nCPAP users (n = 19) before nCPAP prescription was 413 days (median 10, range 3-66) compared to 54 days (median 0, range 0-25) after nCPAP (p < 0.0001). The corresponding values for the nonuser group (n = 12) was 137 days (median 8.5, range 0-42) before and 188 days (median 9.5, range 0-47) after the nCPAP prescription (ns). We conclude that nCPAP treatment reduces the need for acute hospital admission due to CVPD in patients with OSAS. This reduction of concomitant health care consumption should be taken into consideration when assessing the cost-benefit evaluation of nCPAP therapy.

Cytogenetic observations in 13 cystadenolymphomas (Warthin's tumors).

The cytogenetic findings in 13 cultured Warthin's tumors (papillary cystadenoma lymphomatosum) are reported. Only one case showed an abnormal stemline. This was pseudodiploid and characterized by three different reciprocal translocations and one deletion. Small abnormal sidelines, however, were seen in three additional cases. All except one of the 12 tumors with a normal stemline contained variant cells. These showed a variety of numerical and/or structural aberrations. From this study it is obvious that to determine whether or not cytogenetically distinctive subgroups actually exist in cystadenolymphomas (as in pleomorphic adenomas) the number of cases must be greatly amplified.

Perceptual learning in olfaction: professional wine tasters versus controls.

By having professional wine tasters and controls perform olfactory tasks of absolute detection (1-butanol), discrimination (lemon and cloves), and identification (common household odors), the present two experiments studied (a) if perceptual odor learning takes place from odor experience acquired under nonlaboratory conditions, (b) if this learning generalizes to odors for which experience is limited, and (c) if generalized learning can be referred to increased general interest for odors that increases attention to odorous features. The results showed that whereas wine tasters were not better than controls on detection, they were superior to controls on discrimination and identification, the latter due to only a few odors. Ratings of experience with certain odors during professional evaluation suggest that generalized perceptual learning may take place in discrimination but not in identification. Wine tasters did not show more general interest for odorous features than did controls. The nonsuperiority in detection may be explained by the fact wine tasters have no professional experience of a detection task per se, implying that perceptual odor learning does not generalize from the olfactory tasks of discrimination and identification to detection.

Cytogenetical observations in two cases of polymorphous low-grade adenocarcinoma of the salivary glands.

The cytogenetical findings in two cases of cultured salivary polymorphous low-grade adenocarcinoma (PLGA) are reported. The first PLGA was a carcinoma ex pleomorphic adenoma of the parotid gland. This had a pseudodiploid stemline characterized by extensive and complicated structural rearrangements. The chromosomal findings showed many similarities to those in the only previously studied case of PLGA (also a carcinoma ex pleomorphic adenoma of the parotid). The results in both could fit with abnormalities superimposed on those typical of mixed tumors. The second PLGA reported derived from a minor salivary gland. It showed a completely different picture, distinguished by a hypodiploid, almost exclusively numerical, variation and the occurrence of a stemline characterized by only monosomy 22. Etiological differences were proposed as one possible explanation for the cytogenetical differences between the two types of PLGA.

Complex chromosomal changes in a primary squamous carcinoma of the parotid gland.

The chromosomal observations in a cultured primary epidermoid carcinoma of the parotid gland are reported. The tumour had a flat hyper-triploid mode with 7 recurrent wholly or partially identified marker types and 7-13 additional, mostly recurrent, markers, whose origin could not be clarified. There were also many recurring numerical deviations in most tumour cells. The picture was consistent with a neoplasma in an advanced stage of chromosomal progression. So far, 6q-markers with varying morphology are the only deviations found in most types of malignant salivary tumours and, in particular, in a high percentage of adenoid-cystic carcinomas. One possible explanation for these observations is the occurrence of one or more suppressor genes in 6q which may have relevance for malignant neoplasia in salivary gland tissues.

Capsaicin cough sensitivity is decreased in smokers.

Although capsaicin provocation has been used to evaluate treatment against cough, which is one of the most common respiratory symptoms, there are still methodological considerations that are not fully known. Capsaicin stimulates the unmyelinated slow C-fibres of the sensory nervous system, which leads to coughing. Smoking often leads to respiratory symptoms with cough and phlegm. The aim of this study was to examine the effect of smoking on capsaicin provocation. Subjectively healthy smokers and non-smokers were challenged with capsaicin in increasing doses. The coughs were counted and irritation of the lower airways was graded on a symptom score. Smokers reacted to provocation with significantly fewer coughs, but there was no difference regarding other symptoms. These results are in agreement with the hypothesis that nicotine inhibits or blocks C-fibres of the sensory nervous system of the lower respiratory tract. Clinically, this may serve to explain increasing airway symptoms that are often seen after cessation of smoking.

Nasobronchial relationship after cold air provocation.

Provocation with cold air in the nose causes broncho-obstruction while warm air causes bronchodilation in patients with asthma, but not in healthy subjects. These findings have suggested the existence of a nasobronchial reflex. The present study aimed to block this effect and evaluate the mechanisms underlying the effect on lung function after cold stimulation of the nose. Lung function, as measured with specific conductance and forced expiratory flow, was reduced after cold stimulation of the nose, but this effect could not be blocked by anesthetizing the nose or by inhaling an anti-cholinergic drug before the provocation. These results confirm the presence of a nasobronchial relationship, but not of a nasobronchial reflex.

Capsaicin inhalation test for identification of sensory hyperreactivity.

BACKGROUND: Patients with upper and lower airway symptoms and with pronounced sensitivity to chemical odours, such as perfumes, flower scents and tobacco smoke, have been suggested to have sensory hyperreactivity (SHR). The symptoms have been difficult to identify with physiological measurements and the effects of various medications are doubtful. However, these patients have been found to be more sensitive to inhalation of capsaicin than healthy people. The aim of this study was to establish limit values with the capsaicin inhalation test in patients with SHR. METHODS: Ninety-five consecutive patients with upper and lower airway problems, who were admitted for allergy testing, underwent a capsaicin inhalation test with three different concentrations. The number of coughs was registered during each challenge. Score systems were used for symptoms and influence on social life of sensitivity to odours. In relation to scored symptoms, the patients were grouped as SHR or not, and compared with 73 healthy controls. RESULTS: All patients and controls coughed on capsaicin in a dose-dependent manner. Symptom score of odour sensitivity in patients was positively correlated to the response of the test. Out of 95 patients, 15 (16%) were scored to SHR. Patients with SHR reacted more to the capsaicin inhalation test than the other patients and the healthy controls. The limit values for a positive capsaicin inhalation test for the SHR were determined to be 10, 35 and 55 coughs at 0.4, 2.0 and 10 microM capsaicin, respectively. CONCLUSION: The capsaicin inhalation test well reflects the degree of airway sensitivity to chemicals and to what extent the social life is influenced. The cut-off values of the test can distinguish patients with pronounced sensitivity to odours.

Nasal stuffiness during pregnancy.

OBJECTIVE: To investigate the occurrence of nasal stuffiness during pregnancy. STUDY DESIGN: Prospective longitudinal study, with collection of data during 1 year in a cohort of 2,264 pregnant women. METHODS: Self-reported nasal stuffiness in gestational weeks 12, 20, 30, and 36 was correlated to age, parity, body mass index, and smoking habits. RESULTS: The prevalence of nasal stuffiness increased during pregnancy and occurred in 27% of the women at 12 weeks of gestation, in 37% at 20 weeks, in 40% at 30 weeks and in 42% at 36 weeks. Sixty-five percent of the women reported stuffiness at some time when asked. It was commoner in multiparous than in nulliparous women. Age, body mass index, and smoking habits were not associated with nasal stuffiness. CONCLUSION: Self-reported nasal stuffiness for 3 or more weeks was common during pregnancy and could occur at any time in two thirds of the women. Treatment regimens to alleviate this symptom should be developed.

Nasal mucosal congestion after treatment with bromocriptine.

Nine women were given bromocriptine a few days after delivery in order to inhibit lactation. Nasal airway resistance to airflow (NAR) was recorded and blood samples were taken before treatment with bromocriptine, 2 to 3 hours after the first dose of this drug, and after 3 to 5 days on this treatment. All the women had increased nasal congestion after bromocriptine and NAR rose significantly. The prolactin, estradiol, and progesterone hormone levels decreased significantly, but no significant difference was found in the levels of thyroid-stimulating hormone (TSH) and vasoactive intestinal polypeptide (VIP). The bromocriptine effect may be caused by different mechanisms.

Ventilation of the paranasal sinuses studied with dynamic emission computer tomography.

This investigation's aim was to study a noninvasive method for determining the ventilation of the nasal sinuses. For this purpose, different insufflation techniques using xenon 133 were tried, along with different scintillation camera techniques. Xenon 133 gas was used for insufflation in the nose and sinuses, and the half-time of the washout curves was determined with the aid of digital scintillation cameras, one of which was capable of dynamic tomography. The tomographic procedure was superior because it made it possible to study the washout from the ethmoidal/sphenoidal sinuses as well. The washout was followed for up to 150 minutes. Great variations in washout were found between different sinuses and also in the same sinus over time. The single photon emission computed tomography (SPECT) technique, which is easy to perform and gives a limited absorbed dose to the patient, seems promising for the future evaluation of sinus ventilation and ostial function.

Glucocorticoid treatment for nasal polyps. The use of topical budesonide powder, intramuscular betamethasone, and surgical treatment.

BACKGROUND: The treatment of nasal polyps is controversial, and medical treatment alone has been little investigated to our knowledge. OBJECTIVE: To examine the efficacy of therapy using only topical budesonide powder and topical budesonide powder supplemented with surgical removal or intramuscular betamethasone. DESIGN: Randomized, double-blind comparison of 2 dosages and additional treatment, if therapy failed. After 1 year, treatment with medication was stopped, and the demand for renewed treatment was monitored for another year. PATIENTS: Patients with bilateral nasal polyps who demanded treatment were consecutively enrolled in a hospital outpatient clinic or specialty private practice. During a 15-month period from 1990 to 1992, a total of 126 patients entered the 2-year study. INTERVENTIONS: In phase 1, randomized and double-blind treatment with a topical medication, budesonide powder, 800 micrograms or 400 micrograms daily, or a placebo was given for 1 month. In phase 2, randomized and double-blind treatment with budesonide powder, 800 micrograms or 400 micrograms daily, was given. At the end of phase 1, failed therapy was supplemented by randomly assigned treatment of either surgical removal or a single injection of sustained released betamethasone. In phase 3, treatment with the medication was discontinued, and patients were monitored for another year. The time when treatment was required again was noted. The present article deals with phases 2 and 3. MAIN OUTCOME MEASURES: Patients' scores of treatment efficacy as well as symptoms and signs. Semiquantitative measurement of sense of smell and calculation of peak expiratory flow rate index based on nasal and oral peak expiratory flow. RESULTS: In all outcome measures, a comparison of the data before treatment with the corresponding figures during phase 2 showed statistically significant efficacy. The clinical course was described at the end of phase 2. About 85% of the patients, including those who received additional therapy because the initial therapy failed, rated total or substantial control over the symptoms. The 2 dosages investigated showed equal results. These findings were consistent with the signs recorded and the peak expiratory flow rate index. The results of phase 3 showed that 50% of patients had demanded treatment after 4 months, while 34% managed without medication after 1 year. CONCLUSIONS: The clinical course in this study showed that most patients with nasal polyps do well with medical treatment. Therefore, surgery was required in few patients. However, the potential of medical treatment should be further explored in future studies.

Influence of environmental temperature on human nasal mucosa.

Nasal mucosal blood flow and nasal patency were studied in seven healthy subjects in order to evaluate normal physiological reactions to cold and heat. Blood flow was measured by means of the 133Xe washout method, and nasal patency was determined by measuring maximal nasal expiratory air flow. In comparison with the results at room temperature (23 degrees C), there was a decreased blood flow and a decreased nasal patency after 20 minutes of exposure to cold (6 degrees C). After exposure to heat (40 degrees C), an unaltered blood flow and an increased nasal patency were registered. The results suggest that nasal patency is important for the conditioning of air and support the hypothesis that changes in nasal mucosal blood flow is engaged in body temperature regulation.

Adrenoceptors in the control of human nasal mucosal blood flow.

The blood flow in the human nasal mucosa is controlled by the functional state of the resistance vessels. This blood flow was studied by means of the 133Xe washout method. Using topical application of drugs that stimulate or block adrenoceptors, including clinical doses of nasal decongestants, we classified the adrenoceptors of the resistance vessels in the mucosa. The results suggest that stimulation of alpha2-adrenoceptors causes a reduction of nasal mucosal blood flow; stimulation of alpha1- and beta2-adrenoceptors seems to have no significant effects. Drugs that selectively stimulate alpha2-adrenoceptors, as well as those with preference for alpha1-adrenoceptors, cause nasal decongestion. To avoid the negative effects of a nasal mucosal blood flow reduction, it is suggested that a nasal decongestant with an alpha1-adrenoceptor stimulating effect should be preferable to a drug acting mainly on alpha2-adrenoceptors, provided that the decongestive effects are equal.

Effect of oxymetazoline on nasal and sinus mucosal blood flow in the rabbit as measured with laser-Doppler flowmetry.

The effect of topical oxymetazoline hydrochloride on the blood flow of the nasal and sinus mucosa of the rabbit was measured by laser-Doppler flowmetry. Oxymetazoline, the active component in clinically used nose drops, induced a dose-dependent decrease of the nasal mucosal blood flow. This effect has previously been shown in humans and suggests the presence of alpha 2-adrenoceptors in the nasal mucosa of the rabbit. Doses of oxymetazoline used clinically in humans induced a 50% reduction of blood flow in rabbits. Rhythmic variations in blood flow were seen in 30% of the rabbits after administration of oxymetazoline. Additionally, oxymetazoline induced a dose-dependent decrease of the mucosal blood flow in the maxillary sinus when the drug was applied in the nose. A vasoconstricting effect of oxymetazoline on the arteries penetrating the maxillary sinus ostium is a possible explanation. This can have positive as well as negative consequences on acute sinus infections.

Effect of oxymetazoline nose drops on acute sinusitis in the rabbit.

This investigation was designed to evaluate the effect of the common topical nasal decongestant oxymetazoline hydrochloride on the early local tissue defense in an experimental bacterial infection. For that purpose, a bilateral infection of the maxillary sinus was induced in 14 rabbits. Nose drops (oxymetazoline) were instilled in one nasal cavity, and placebo in the other. After 48 hours, the degree of infection was judged by using a semiquantitative inflammatory score to evaluate histologic preparations of the maxillary sinuses. On the oxymetazoline-treated side, we found a significantly higher degree of inflammation. We conclude that oxymetazoline nose drops, commonly used in acute rhinitis and sinusitis, interfere with the normal defense mechanisms during bacterially induced sinusitis, possibly by a decrease in mucosal blood flow.