[Analysis of clinical characteristics of partial olfactory dysfunction].

OBJECTIVE: To apply different types and concentrations of T&T olfactometer odorants to exam smell function and explore the clinical characteristics of partial olfactory dysfunction. METHODS: From March 2007 to May 2008, a total of 24 patients with olfactory dysfunction were examined by medical and psychiatric history enquiry, physical examination, smell testing and medical imaging. Olfactory function of each nostril was assessed separately by T&T olfactometer. The test contained five kinds of odorants at different concentrations. Recognition threshold (RT) scores for all five odorants and for each individual odorant were measured in all patients. RESULTS: Among them, total RT scores were normal while single odorant testing yielded only significant higher RT scores for one or two odorants. For patients who suffered partial olfactory dysfunction, 51.4% are for pleasant odors, while the rest are for unpleasant odors. CONCLUSION: Normal total RT scores and abnormal single RT scores of T&T olfactometer are present in partial olfactory dysfunction. As a special clinical manifestation of olfactory disorder, it may be easily ignored in smell testing.

[Clinical and magnetic resonance imaging characteristics of isolated congenital anosmia].

OBJECTIVE: To report a series of patients with isolated congenital anosmia and summarize their clinical and magnetic resonance imaging (MRI) characteristics. METHODS: Twenty patients with isolated congenital anosmia were reviewed retrospectively. A thorough medical and chemosensory history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials, sinonasal computed tomography scan and magnetic resonance image of olfactory pathway were performed in all patients. RESULTS: Neither ENT physical examination nor nasal endoscopy was remarkable. Subjective olfactory testing indicated all of them were of anosmia. No olfactory event-related potentials to maximal stimulus were obtained. Computed tomography scan was normal. MRI revealed the absence of olfactory bulbs and tracts in all cases. And hypoplasia or aplasia of olfactory sulcus was found in all cases. All the patients had normal sex hormone level. CONCLUSION: The diagnosis of isolated congenital anosmia is established on chief complaints, physical examination, olfactory testing and olfactory imaging. MRI of olfactory pathway is indispensable.

[Olfactory functional magnetic resonance imaging with modified OEP-98C olfactometer and event-related design].

OBJECTIVE: To explore the feasibility of functional magnetic resonance imaging (fMRI) in analysis of olfaction function with modified OEP-98C olfactometer and event-related design. METHODS: Six young right-handed men underwent olfactory fMRI with event-related design. OEP-98C olfactometer was modified to accommodate MR environment. There were 2 types of tasks in the experiment. In one task, only isoamyl acetate was used as odorant. In the other task, to avoid possible decreased olfactory attention, vanillin was given before each presentation of isoamyl acetate. RESULTS: In both tasks, uniform activation in piriform cortex and secondary olfactory cortexes was determined. The activation of piriform cortex was not significantly different between the two tasks (P > 0.01). CONCLUSIONS: With isoamyl acetate as odorant, modified OEP-98C olfactometer, and event-related design, olfaction fMRI can depict cortex activation at primary and secondary olfactory cortex. Applying other odorant with similar quality to avoid olfactory attention decrease can not promote depiction of activation in primary olfactory cortex.

[Olfactory event-related functional magnetic resonance imaging in young adults with normal sense of smell and anosmia patients].

OBJECTIVE: To explore the brain activation mapping following odor presentation with event -related functional magnetic resonance imaging. METHODS: Ten healthy young volunteers with normal sense of smell and 5 anosmia patients, all right-handed, underwent routine otorhinolaryngological examination and T&T subjective smelling test. Odorant isoamyl acetate was delivered by olfactometer synchronously with inspiration birhinally for 10 times with the interstimulus interval of 60 seconds. Functional magnetic resonance imaging (fMRI) based on the blood-oxygen-level dependent effect was carried out on a 3.0 T scanner, using gradient-recalled echo and echo-planar imaging technique, and the image data were analyzed with SPM2 software. RESULTS: Functional activations were found in the volunteers with normal sense of smell, but not in the patients with anosmia. The activation regions were present in the orbitofrontal gyrus, anterior cingulate gyrus, piriform cortex, insular gyrus, amygdala, thalamus, basal nuclei, temporal gyrus, and frontal gyrus. There were more active regions in the right hemisphere than in the left hemisphere, and there were 314 and 57 active voxels in the right and left hemispheres respectively. CONCLUSION: Olfactory event-related fMRI is an objective measurement of olfaction, and has potential clinical application value.

[Surgical management of metastatic disease in the conjunctive area between neck and thorax].

OBJECTIVE: To study the surgical management of metastatic disease in the conjunctive area between the neck and thorax and its efficacy. METHODS: Fourteen cases with metastatic node disease in the area between neck and thorax were collected and analysed. Eleven tumors were from the thyroid cancer, and the other three were from the hypopharyngeal cancer, esophagual cancer and malignant pheochromocytoma, respectively. The clavicle was displaced or resected, and the upper half of the manubrium might also be resected when necessary. The recurrent laryngeal nerve and phrenic nerve were exposed and protected. The metastatic disease was completely removed with the internal jugular and/or the brachiocephalic vein resected or spared, depending on the disease condition. RESULTS: In 10 cases with metastases from the thyroid, no local recurrence was found within the follow-up period from 2 to 5 years. In contrast, no patient with metastatic disease from hypopharyngeal or esophageal cancer survived more than 11 months. No serious complications were found in this group. CONCLUSIONS: The surgical treatment of node metastases in the conjunctive area between neck and thorax from the well-developed thyroid cancer has promising effect and is comparatively safe.

[Application of unilateral olfactory testing and clinical analysis of unilateral hyposmia].

OBJECTIVE: To investigate whether patients presenting with self-reported olfactory disorders demonstrates significant side difference in odour recognition by measuring separately for each nostril. METHODS: One hundred and four patients with chief complaint of hyposmia were evaluated by medical history, physical examination, T&T olfactory testing and medical imaging. Smell was tested using T&T olfactometry in each nostril separately. RESULTS: Based on the history and results from the clinical examination, unilateral sinonasal diseases and abnormal nasal structure were excluded. In almost one eighth of all presenting patients (13.46%), a side difference was detected. Especially, six of the patients were identified with lateralized hyposmia. CONCLUSIONS: Olfactory testing could be performed in each nostril separately. The above findings suggested that testing each nostril separately was necessary so as not to miss unilateral hyposmia as a special clinical manifestation of olfactory disorder.

Study of cochlear hydrops analysis masking procedure in patients with Meniere's disease and otologically normal adults.

BACKGROUND: The cochlear hydrops analysis masking procedure (CHAMP) is a new diagnostic technique for Meniere's disease (MD). But its value has not been well proven. This study aimed to evaluate the diagnostic value of CHAMP for MD. METHODS: CHAMP test was taken in three populations using the Auditory Evoked Potential system delivered by Bio-logic Systems Corporation: (1) otologically normal subjects; (2) patients clinically diagnosed with definite MD; (3) patients clinically diagnosed with probable and possible MD. RESULTS: According to the comparison between the normal and definite MD group, if the abnormal criterion of CHAMP was defined as latency delay less than 0.3 ms, then the corresponding sensitivity was only 52%. However, if the abnormal criterion was defined as latency delay between 0.6 and 3.8 ms, then a sensitivity of 93% and a specificity of 100% can be achieved. The complex amplitude ratio showed a significant overlap between normal and definite MD group. If the abnormal criterion was defined as a complex amplitude ratio less than 0.95, the corresponding specificity was only 50%. However, if the abnormal criterion was defined as less than 0.80, the corresponding sensitivity was 60%, and the specificity was 97%. If the abnormal criterion of CHAMP was defined as latency delay less than 0.6 ms or the complex amplitude ratio less than 0.80, CHAMP result can be obtained in all subjects with good sensitivity and specificity. CONCLUSIONS: CHAMP can differentiate patients with Meniere's disease from otologically normal subjects with high sensitivity and specificity. The recommended criterion of abnormal CHAMP was a latency delay less than 0.6 ms or a complex amplitude ratio less than 0.80.

[Comparison of tone burst evoked auditory brainstem responses with different filter settings for referral infants after hearing screening].

OBJECTIVE: Auditory brainstem responses (ABR) evoked by tone burst is an important method of hearing assessment in referral infants after hearing screening. The present study was to compare the thresholds of tone burst ABR with filter settings of 30 - 1500 Hz and 30 - 3000 Hz at each frequency, figure out the characteristics of ABR thresholds with the two filter settings and the effect of the waveform judgement, so as to select a more optimal frequency specific ABR test parameter. METHODS: Thresholds with filter settings of 30 - 1500 Hz and 30 - 3000 Hz in children aged 2 - 33 months were recorded by click, tone burst ABR. A total of 18 patients (8 male/10 female), 22 ears were included. RESULTS: The thresholds of tone burst ABR with filter settings of 30 - 3000 Hz were higher than that with filter settings of 30 - 1500 Hz. Significant difference was detected for that at 0.5 kHz and 2.0 kHz (t values were 2.238 and 2.217, P < 0.05), no significant difference between the two filter settings was detected at the rest frequencies tone evoked ABR thresholds. The waveform of ABR with filter settings of 30 - 1500 Hz was smoother than that with filter settings of 30 - 3000 Hz at the same stimulus intensity. Response curve of the latter appeared jagged small interfering wave. CONCLUSIONS: The filter setting of 30 - 1500 Hz may be a more optimal parameter of frequency specific ABR to improve the accuracy of frequency specificity ABR for infants' hearing assessment.

[Study of characteristic of the cochlear hydrops analysis masking procedure in normal adults].

OBJECTIVE: To study the characteristic of the cochlear hydrops analysis masking procedure (CHAMP) in normal adults, and to evaluate the diagnostic values of its parameters for membranous labyrinth hydrops. METHODS: Twenty otologically normal adults were recruited (male:female = 10:10), and their auditory brainstem responses (ABR) were obtained to six stimulus conditions using Bio-logic auditory evoked potential system: clicks presented alone (unmasked condition) and clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz respectively. RESULTS: The wave V latency of ABR to the high-pass masking pink noise clicks were longer than ABR to clicks alone. The latency delays of wave V for clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz compared to clicks alone were (0.30 ± 0.18), (0.97 ± 0.43), (1.65 ± 0.64), (3.21 ± 0.56), (4.66 ± 0.37) ms respectively. The complex amplitude ratio between ABR to click + 0.5 kHz high-pass noise and click alone was 0.95 ± 0.11. CONCLUSIONS: CHAMP is a promising diagnostic method for membranous labyrinth hydrops, and the latency delay of wave V might be used as the normal criterion. The specificity of the complex amplitude ratio need further evaluation in clinical work.

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection.

BACKGROUND: Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI). METHODS: We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer. RESULTS: An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable. CONCLUSIONS: We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrophysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.

Gene expression profiles in the olfactory bulb from a rat model of Alzheimer's disease.

Abnormalities and impaired functions of the olfactory system have been reported in Alzheimer's disease (AD), and these changes may appear much earlier than other clinical symptoms of AD. However, little is known about these abnormalities at the level of gene expression. In this study, we investigated alterations of expression of 22,012 genes in the olfactory bulbs of a rat model of AD by using a microarray approach. The rat model was produced by intracerebroventricular injection of amyloid-beta(25-35), which demonstrated pathological changes in olfactory bulbs and memory impairment in the Morris water maze test. We found that expression of 811 genes among the 22,012 genes was altered by more than 1.5-fold in the amyloid-beta-injected rats as compared with control injected rats. We analyzed the distribution of the 811 altered genes according to the Affymetrix criteria and found that the majority of these genes were related to cellular processes, binding, and enzyme activities. The alterations of three of these genes, i.e., calcineurin, olfactory receptor, and protein kinase C, were also confirmed by RT-PCR and Western blots. These studies provide new insight into the abnormalities of the olfactory system in AD and might help to further the understanding of the molecular mechanisms of AD.

[MRI features of olfactory bulb volume in healthy middle and old-aged persons.].

OBJECTIVE: To investigate the differences of olfactory bulb (OB) volumes between younger and older, male and female, left-side and right-side in healthy middle and old-aged persons by MRI. METHODS: Ninety five healthy middle and old-aged volunteers (male:female = 45:50) were divided into 2 groups, group one included persons aged from 50 to 69, group two included persons elder than 70. The left-side, right-side and both-side volumes of OB, the volumes of brain and the ratio of OB/brain were measured by MRI. RESULTS: (1) The left-side and both-side volumes of OB (x(-) +/- s), the volumes of brain [(39.89 +/- 8.7) mm(3), (81.70 +/- 16.8) mm(3) and (1281.86 +/- 140.2) cm(3)] in 50 - 69 years old group were respectively larger than those in >/= 70 years old group [(34.45 +/- 10.4) mm(3), (72.10 +/- 19.3) mm(3) and (1165.77 +/- 165.3) cm(3)], and the differences reached statistical significance (t were respectively 2.649, 2.449, 3.516, all P < 0.05). There were no significant differences of right-side OB volumes and the ratio of OB/brain between 50 - 69 years old group and >/= 70 years old group (t were respectively 1.904, 0.616, each P > 0.05). (2) The male's OB volumes of left-side, right-side and both-side, the brain volumes and the ratio of OB/brain were respectively larger than females', and the differences reached statistical significance (t were respectively 4.461, 3.630, 4.399, 3.800, 2.400, all P < 0.05). (3) The right-side OB volumes were larger than left-side's and significant differences were found in female group, 50 - 60 years old group and >/= 70 years old group (t were respectively 2.732, 2.117, 3.516, all P < 0.05). There were no significant differences of OB volumes between left-side and right-side in female (t = 2.649, P = 0.110). The ratio of right-side OB/brain were larger than the ratio of left-side's and the differences reached statistical significance (t = 3.183, P = 0.002). CONCLUSIONS: MRI could be used to measure the volume of OB. The older the people, the smaller the OB volumes. There was no influence of age on the ratio OB/brain. The OB volumes of right-side were larger than those of left-side. The OB volumes of male were larger than those of female.

[Analysis of abnormality of the middle ear in infant and young children].

OBJECTIVE: To discuss the diagnosis of middle ear abnormality in infants and young children. METHODS: To analyze retrospectively the data of audiology (including ABR, tympanometry) and CT scanning in 31 infants and young children who presented middle ear abnormality. RESULTS: Wave I latencies of ABR were delayed in 38 of 62 ears and not delayed in 15 ears, but CT scanning showed high density in 6 ears of these 15 ears. Wave I could not be elicited in 9 ears. Tympanometries were tested in 16 cases and were abnormal in 17 ears. CT scanning was carried out in 15 cases who's ABR and tympanometries showed abnormal. High signal intensity was present in mastoids and middle ear cavities in both ears of 12 cases and unilateral ear of 3 cases. Wave I latency of ABR was delayed and High signal intensity was present in mastoids and middle ear cavities in CT scanning of 13 ears. Wave I latency of ABR was normal, but high signal intensity was present in mastoids and middle ear cavities in CT scanning of 4 ears, there was no any ear which Wave I latency was delayed but CT scanning was normal. And disaccord among ABR, Tympanometry and CT scanning were showed. A typical case was reported. CONCLUSIONS: The most abnormality of the middle ear could be found used the tympanometry and I latency of ABR in infant and young children, but still there were some abnormality of the middle ear could not be showed. Some quandaries were existed and more sensitivity tests were needed in the diagnosis of abnormality in middle ears of infant and young children.

[Posttraumatic anosmia: olfactory event related potentials and MRI evaluation].

OBJECTIVE: Using olfactory event related potentials (OERP) and magnetic resonance to evaluate olfactory function in patients with posttraumatic anosmia. METHODS: Twenty four patients with posttraumatic anosmia were reviewed retrospectively. A thorough medical history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials, brain computed tomography scan and magnetic resonance image of olfactory pathway were performed in all patients. RESULTS: Subjective olfactory testing indicated 20 of 24 patients were birhinal anosmia, 2 with right nostril anosmia and left impairment, 2 with left anosmia and right normal. No OERP were obtained in 24 (20 were birhinal, 4 was monorhinal), except 4 cases with single nostril. Magnetic resonance imaging revealed the injures to the olfactory bulbs (100%), rectus gyrus (91.7%), orbital gyrus (67%), olfactory tracts (8%) and temporal lobes (8%). CONCLUSIONS: OERP can objectively evaluate posttraumatic olfactory function, and magnetic resonance of olfactory pathway can precisely identify the location and extent of injures.

[Clinical analysis of primary facial nerve neuroma].

OBJECTIVE: To analyze the clinical features of facial nerve neuroma about its diagnosis and management. METHODS: Ten patients with facial nerve neuroma were analyzed retrospectively from February 1993 to August 2005. The period of follow-up varied from 1.5 years to 10 years (mean 5 years). Facial nerve function was evaluated with House-Brackmann grading system. RESULTS: The patients complained of facial paralysis in 7 cases, otitis media in 1 case, a mass in parotid gland in 1 case and a mass on the side of the orbital on face in 1 case. Seven patients were undergone either CT scan or MRI or both. Image studies revealed mass located along the facial nerve course from the nerve endings to the intracranial parts. All the patients accepted the surgery. Intraoperative findings showed that the tumor location matched the image findings. Postoperative pathological diagnosis demonstrated 8 Schwannoma, 2 neurofibroma. There was partial tumor resection in 1 patient accepted and his nerve function was unchanged. Four patients were undergone facial nerve graft but 1 case failed while facial nerve function was improved in 3 other patients. Two patients underwent tumor resection while the continuity of facial nerve was preserved as result their facial nerve function improved respectively. No facial nerve reconstruction was done on other 2 patients. CONCLUSIONS: Multiple origins of facial nerve neuroma were noted and the most common system was facial nerve palsy. The decision on how to treat these patients should be individualized and based on initial facial function, growth rate, surgical experience and informed patient consent. The more effective methods need being seeked for the management of facial nerve neuroma.

[Clinical analysis of otogenic intracranial complications].

OBJECTIVE: To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College Hospital. METHODS: Retrospective study of 14 patients (10 males and 4 females, aged between 12 - 62 years, mean age 32.1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of otogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment. RESULTS: All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22.5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19.2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997, brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10.6 years with a mean time of 6.5 years without recurrence. CONCLUSIONS: Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis bedtimes and MRI seemed to have a better performance.

[Investigation of the characters of cervical lymph node metastases of primary malignant tumor beyond head and neck].

OBJECTIVE: To investigate the characters of cervical lymph node metastases of primary tumors beyond head and neck. METHODS: Among 466 cases of malignant tumor with cervical lymph node metastases treated in Peking Union Medical College Hospital from January 1989 to June 2004, 77 cases of tumor which sites primarily beyond head and neck were studied. Retrospective analysis of their clinical characters was done by LEVEL system. RESULTS: The primary sites of these 77 cases of malignant tumor consisted of lung, stomach, esophagus, galactophore, colon, mediastinum, ovary, uterus, pancreas, liver, mesentery, adrenal gland and rectum. The frequency of cervical lymph node metastases was 81.8% (63/77) in LEVEL V (50 in the left), 11.7% (9/77) in LEVEL IV, 5.2% (4/77) in LEVEL III, 1.3% (1/77) in LEVEL I separately. The proportion of the metastases of malignant tumor from primary site beyond head and neck in each region was 2.1% in LEVEL I, 3.7% in LEVEL III, 14.3% in LEVEL IV, 70.8% in LEVEL V. Among the cervical lymph node metastases of primary tumor beyond head and neck, 51.9% were low-grade adenocarcinoma, 15.6% were medial-grade adenocarcinoma, 11.7% were low-grade squamous cell carcinoma, 10.4% were medial-grade squamous carcinoma. CONCLUSIONS: The cervical lymph node metastases of malignant tumor might be seen from many organs beyond head and neck. The metastases from primary sites beyond head and neck usually focus on LEVEL V (81.8%), especially in the left. And the primary tumors beyond head and neck metastasis in this region were more than the tumors from head and neck locally. The histological type of the primary tumors were frequently low-medial grade carcinomas.

[Upper airway morphologic changes in obstructive sleep apnea hypopnea syndrome patients before and after orthognathic surgery and distraction osteogenesis].

OBJECTIVE: To investigate the morphologic changes of upper airway in obstructive sleep apnea and hypopnea syndrome (OSAHS) associated with micrognathism before and after orthognathic surgery and distraction osteogenesis, and subsequently to instruct clinical jobs effectively. METHODS: Nine OSAHS patients associated with micrognathism (8 males, 1 female, mean age: 28.6 years) received orthognathic surgery and (or) distraction osteogenesis, and the curative effect was evaluated according to the subjective feelings and PSG. Upper airway structure before and after the treatment was measured by Somatom Sensation 16 CT scanner. RESULTS: All 9 patients were clinically cured. The transverse length, the cross section area, and especially the sagittal length of the upper airway were obviously increased after the orthognathic surgery. The changes involved mainly in the velopharyngeal region and the laryngopharyngeal region, but not in the laryngopharyngeal region. CONCLUSIONS: The orthognathic surgery and distraction osteogenesis can treat the OSAHS patients with microgonathism effectively by increasing their velopharyngeal and laryngopharyngeal sagittal length of upper airway.