Feasibility of an interval, inspiration-triggered nocturnal odorant application by a novel device: a patient-blinded, randomised crossover, pilot trial on mood and sleep quality of depressed female inpatients.

It has been suggested that certain odorants positively affect mood, but this has not yet been scientifically tested in humans. The aim of the current study was to demonstrate the feasibility of a new odorant applicator and to assess the effects of nocturnal intermittent rose odorant application on mood, and quality of sleep and dreams in depressed female inpatients. We hypothesised that mood as primary outcome will improve. Twenty-seven normosmic, 18- to 49-year-old female, depressed inpatients were investigated in a randomised, placebo-controlled, crossover study. Exclusion criteria were rhinitis, hyp- or anosmia. During sleep, an interval-controlled, inspiration-triggered applicator added rose concentrate to the inspirated air. There were three consecutive nights of each odorant and placebo application and a wash-out phase. Patients completed standardised questionnaires on mood, dreams, and sleep quality. Four patients dropped out (n = 1: non-compliance in filling in the questionnaires, n = 3: intolerance of nasal tube). Otherwise, this novel odorant applicator was well tolerated. Application of the odorant showed no significant mood differences between rose and placebo, however, some subdomains of sleep quality and mood showed a positive trend towards improvement by rose application. The feasibility of this new device and of nasal tubes could be shown. Odorant application is well tolerated. It may have a positive influence on quality of mood and sleep in depressed patients. A longer application phase is planned to obtain convincing evidence for our hypothesis.

Occurrence of lymph node metastasis in early-stage parotid gland cancer.

Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer.

A new crimping device for stapedectomy prostheses.

OBJECTIVE: To describe a newly designed microforceps for easy and stable crimping of a prosthesis loop to the incus' long process in stapes surgery RESULTS: We developed a crimping tool with two innovative improvements. First, the tip of the crimping device is arcuated and thus able to span the loop of the prosthesis entirely around the incus long process. Second, a retaining spring is implemented into the handle. This passive opening mechanism of the crimper avoids the switch from flexor to extensor muscle group movements in the forearm of the surgeon while switching from crimping to unclosing the forceps. This maneuver, which is considered the most delicate in ear surgery, can be performed by variations of the flexor muscle group tonus only. CONCLUSION: The new crimping tool has proved to be reliable in firm attachment of the prosthesis' loop to the incus long process. Furthermore, because of the passive open-up mechanism movements of the surgeon's hand, wriggling excursions of the tip of the forceps are minimized and the risk of incus luxation is reduced.

Impact of recurrent head trauma on olfactory function in boxers: a matched pairs analysis.

Recently, interest in the health of boxers has been raised by a petition of the British Medical Association to restrict boxing. However, scientific data on permanent damage are rare and typical localisations of injuries were yet to be defined. The aim of this study was to determine whether there are changes in the sense of smell in people undergoing recurrent head traumas. The hypothesis to be tested was if boxers had a reduced olfactory function. We used a matched pairs analysis design. Fifty healthy, male athletes underwent subjective olfactometry using Sniffin'Sticks testing (including threshold, discrimination and identification, TDI). Nasal endoscopy was performed and a thorough, questionnaire-based history was obtained. These data were correlated with normative data from healthy subjects. Statistical analysis was based on matched pairs analysis by t-tests, i.e. boxers and healthy (non-boxing) subjects. Boxers showed a mean TDI score of 32.5 compared to 35.1 of non-boxing controls (p=0.003). The olfactory threshold (p<0.001) and odour identification (p<0.05) were significantly decreased in boxers; whereas odour discrimination was unaffected. Performance of odour identification showed a correlation with cushioning of the gloves (p<0.05), and thus seems a protective measure regarding the sense of smell. Boxing seems to affect olfactory function, particularly by reducing the olfactory threshold. Furthermore, cushioning of the gloves can be protective and should be increased to safeguard sportsmen from physical damage. Boxing can serve as a model for central regeneration after trauma.

Cervical hemorrhage due to spontaneous rupture of the superior thyroid artery: Case report and review of the literature.

BACKGROUND: Beneath the different reasons for cervical masses, a spontaneous hemorrhage presents a rare and life-threatening condition. METHODS AND RESULTS: We present the rare case of a 62-year-old man who was presented with a dramatically enlarging cervical mass causing respiratory distress because of upper airway compression. An endotracheal intubation was lifesaving and avoided tracheotomy. A CT scan revealed a hematoma in the region of the left external carotid artery. An emergency angiography embolized a ruptured branch of the superior thyroid artery and surgery evacuated the hematoma. We discuss the rarity of the condition, reasons for a spontaneous rupture of the artery, and the diagnostic and treatment strategy. In addition, we review the literature on spontaneous thyroid artery hemorrhages, which, up to now, have been described only for the inferior thyroid artery. CONCLUSION: We conclude that the optimal management for cases of cervical hematoma is intubation, diagnosis, and angiography before surgery.

Thresholds in nasal histamine challenge in patients with allergic rhinitis, patients with hyperreflectory rhinopathy, and healthy volunteers.

BACKGROUND: Characteristic symptoms of hyperreflectory rhinopathy include recurrent sneezing, nasal obstruction, and nasal secretion without an allergic background. The diagnosis can only be made if all differential diagnoses have been excluded. So far no clinical test has been established to reliably diagnose hyperreactivity of the nasal mucosa. The present study aimed to investigate whether nasal provocation with histamine allows identification of patients with hyperreflectory rhinopathy. MATERIALS AND METHODS: One-sided nasal challenge with histamine was applied to 13 patients with allergic rhinitis, 13 patients with hyperreflectory rhinitis, and 12 healthy volunteers. Histamine concentrations used were 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, and 16.0 mg/mL. Test results were quantified using a symptom score (positive at values above 3) and active anterior rhinomanometry (positive at a reduction of airflow of 40% or more in comparison to challenge with solvent). RESULTS: While there was a significant difference between controls and patients with allergic rhinitis or hyperreflectory rhinopathy, respectively, no significant difference was observed between the two groups of patients. Results indicated that one-sided nasal provocation with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. In terms of the differentiation between subjects with hyperreactivity of the nasal mucosa and healthy controls, the sensitivity of one-sided nasal histamine provocation with 1 mg/mL was found to be 100%; its specificity was 83% if it was evaluated by rhinomanometry and symptom score. CONCLUSION: The present results indicate that one-sided nasal challenge with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. However, the test does not differentiate between patients with allergic rhinitis and patients with hyperreflectory rhinitis.

Local and systemic administration of corticosteroids in the treatment of olfactory loss.

BACKGROUND: The aim of this study was to evaluate the benefit of patients with olfactory dysfunction from local (group A) or systemic (group B) administration of corticosteroids. METHODS: This unblinded study was conducted at a smell and taste outpatient clinic of an institutional referral center. Patients with olfactory loss after infections of the upper respiratory tract, patients with apparent sinonasal disease, and patients suffering from "idiopathic" smell loss were included. Effects of mometasone nasal spray, administered for 1-3 months, were studied in 37 patients. In addition, effects of oral prednisolone were analyzed in 55 patients who received decreasing doses over 21 days, starting with a dose of 40 mg. Olfactory function before and after treatment was measured. RESULTS: Although odor identification scores tended to increase (p = 0.05), mometasone nasal spray did not significantly improve olfactory function, when looking at the entire group of patients or when analyzing the three diagnostic categories separately. In contrast, after systemic administration of corticosteroids, improvement of olfactory function was seen over all diagnostic categories (p < 0.001). Interestingly, olfactory function also improved in patients diagnosed with olfactory loss after upper respiratory tract infection (p = 0.05) and in patients initially diagnosed with "idiopathic," olfactory dysfunction (p = 0.008). CONCLUSION: In many patients, local application of corticosteroids appears to have little or no positive effect on olfactory dysfunction, especially when considering long-term changes. Duration of disease, the patient's age/sex, or the presence of parosmia does not appear to predict the response to therapy with corticosteroids.