Fast Screening of Olfactory Function Using the Q-Sticks Test.

OBJECTIVES: Classical, longer olfactory tests are associated with difficulties in everyday practice. The aim of this study was to investigate the clinical utility of the Q-Sticks test within the context of a multicenter study. METHODS: A total of 333 subjects, aged between 12 and 88 years, completed a 3-item Q-Sticks test and a longer Sniffin' Sticks identification test. We analyzed the sensitivity and specificity of the test results for different cutoffs for anosmia and hyposmia. RESULTS: Our study showed that the test can be used on subjects aged 12 years and older, regardless of their sex. The data indicated a test sensitivity and specificity of 91.8 and 92%, respectively, with a score of 2 taken as a cutoff for olfactory dysfunction. Conversely, normal olfactory function can be declared with high probability with a score of 3 in the Q-Sticks test. CONCLUSION: We reconfirmed that the Q-Sticks test is a good screening tool for everyday medical practice and in laboratory settings, although it has to be kept in mind that the test can produce false-negative results at a score of 3. The test was relatively sensitive to anosmia and differences between normosmic and hyposmic/anosmic patients.

Isolation, culture optimization and functional characterization of stem cell neurospheres from mouse neonatal olfactory bulb and epithelium.

The olfactory epithelium contains basal cells with stem cell characteristics, which have the capacity to differentiate throughout life into olfactory receptor neurons (ORNs). Here we investigate the in vitro characteristics of stem cells taken from the olfactory bulb (OB) and the olfactory epithelium (OE) of neonatal TIS21 knock-in mice. The major aim of the study was the generation of olfactory neurospheres (ONS) derived from OB and OE of neonatal mice as a tool to further analyze the elementary processes of ORN development. Our data showed that the presence of epidermal growth factor (EGF) and fibroblast growth factor (FGF) leads to a significant increase in number of ONS derived from OB but not from OE. The differentiation of ONSs led to the formation of different neuronal cell types, in particular to bipolar-shaped cells as well as putative pyramidal-neurons, astrocytes and oligodendrocytes. Immunohistochemical staining confirmed the presence of astrocytes and neurons in both types of ONSs. In order to investigate the functionality of the neurons we performed calcium imaging and patch-clamp experiments. Calcium imaging experiments revealed that the application of high potassium concentration provokes calcium transients. No excitable properties, neither sodium currents nor action potentials, were observed for the bipolar-shaped cells derived from OB and OE neurospheres, which means that these types of cells morphologically defined as putative neuronal cells, were not physiologically active. Interestingly, patch-clamp recordings performed in the pyramidal-shaped cells of OB neurospheres showed sodium and potassium currents as well as action potentials. Our study will help to establish further models in the field of olfactology.

Tumor site and disease stage as predictors of quality of life in head and neck cancer: a prospective study on patients treated with surgery or combined therapy with surgery and radiotherapy or radiochemotherapy.

In this prospective study, we compared the short-term quality of life (QOL) of two subgroups of head and neck cancers: oropharyngeal and laryngeal cancers. Patients treated with curative surgery, were asked to participate in the study using the EORTC QLQ-C30 and H&N35 questionnaires to examine QOL. The oropharynx group consisted of 32 (48 %) patients, while the larynx group consisted of 35 (52 %) patients. All patients were treated with either curative surgery alone or curative surgery combined with adjuvant radiotherapy or radiochemotherapy. The questionnaires were handed out pre- and post-therapy (10 months). At baseline, an impaired overall QOL (=EORTC QLQ-C30 global score) with a value of 53.4 for the whole patient collective was found; the overall QOL after 10 months improved (60.2, p < 0.05). Between the two patient groups, there was no difference in the global score after 10 months. The oropharynx patients described more problems with fatigue and oral cavity associated. The main symptoms in the larynx group were loss of sensual function and coughing. The present investigation revealed that the general post-therapy QOL in two subgroups of head and neck cancer reached a satisfying level.

Suture of the mucosa after the endoscopic LASER mucomyotomy of Zenker's diverticulum.

The treatment of choice of Zenker's diverticulum is the rigid endoscopic mucomyotomy. At our ENT department, we usually perform an endoscopic mucosal suture after the myotomy. We diagnosed 49 patients and treated 39 patients between 2003 and 2013 due to a Zenker's diverticulum. We used the classification of Brombart to determine the size of the diverticulum. Surgery was performed as an endoscopic LASER mucomyotomy with mucosal sutures or as an open approach with diverticulectomy and myotomy. Patients were phoned to ask for their complaints postoperatively. The symptoms were classified using a visual scale from 0 (no complaint) until 10 (same or more complaints than before the surgery). The distribution of the diverticulum's size was: 6 patients Brombart I, 11 patients Brombart II, 14 patients Brombart III and 18 patients Brombart IV. 10 patients did not undergo surgery. With 33 patients, we performed an endoscopic operation and 6 patients underwent an open approach. The scale of postoperative complaints was the following: 20 patients (0/10), 12 patients (1/10 or 2/10), 3 patients (3/10), 1 patient (6/10) and 1 patient (10/10). None of the patients suffered from severe complications such as mediastinitis. In 85% of the cases, an endoscopic approach could be performed. Postoperatively, 94% of the patients did not have any or just mild complaints. The risk of severe complications or recurrence of the diverticulum is low. The mucosal suture might reduce the risk of infections.

Audiometric Results of Open Cavity Tympanomastoidectomy in Advanced Attic Cholesteatoma.

In this retrospective study, we evaluated the audiometric results after using the retrograde mastoidectomy technique with open mastoid cavity for the removal of extended attic cholesteatomas. The described technique was used for cholesteatoma removal in 168 adult patients with an average follow-up time of 12 months. Due to cholesteatoma extension far into the mastoid, the disease was eradicated by the canal wall down (CWD) technique with the creation of an open mastoid cavity. Primary surgery was carried out in 47% of ears, with the remaining 53% representing revision surgery. In all cases, a classical CWD with an open mastoid cavity and partial obliteration with cartilage was created. A dry ear was achieved in 94% of cases. A postoperative air-bone gap ≤ 20 dB was achieved in 42.9% of the operated ears. 9.3% (n = 15) of the operated ears showed a postoperative air-bone gap > 30 dB. Important factors leading to significantly better hearing restoration were an intact malleus, the use of alloplastic titanium prostheses and primary surgery. Although most cholesteatomas nowadays can be eradicated with the canal wall up technique, in far advanced cholesteatomas, the CWD technique can be applied with acceptable postoperative hearing results.

Astringency is a trigeminal sensation that involves the activation of G protein-coupled signaling by phenolic compounds.

Astringency is an everyday sensory experience best described as a dry mouthfeel typically elicited by phenol-rich alimentary products like tea and wine. The neural correlates and cellular mechanisms of astringency perception are still not well understood. We explored taste and astringency perception in human subjects to study the contribution of the taste as well as of the trigeminal sensory system to astringency perception. Subjects with either a lesion or lidocaine anesthesia of the Chorda tympani taste nerve showed no impairment of astringency perception. Only anesthesia of both the lingual taste and trigeminal innervation by inferior alveolar nerve block led to a loss of astringency perception. In an in vitro model of trigeminal ganglion neurons of mice, we studied the cellular mechanisms of astringency perception. Primary mouse trigeminal ganglion neurons showed robust responses to 8 out of 19 monomeric phenolic astringent compounds and 8 polymeric red wine polyphenols in Ca(2+) imaging experiments. The activating substances shared one or several galloyl moieties, whereas substances lacking the moiety did not or only weakly stimulate responses. The responses depended on Ca(2+) influx and voltage-gated Ca(2+) channels, but not on transient receptor potential channels. Responses to the phenolic compound epigallocatechin gallate as well as to a polymeric red wine polyphenol were inhibited by the Gαs inactivator suramin, the adenylate cyclase inhibitor SQ, and the cyclic nucleotide-gated channel inhibitor l-cis-diltiazem and displayed sensitivity to blockers of Ca(2+)-activated Cl(-) channels.

Upper airway obstructions and chronic otitis media: a clinical study.

PURPOSE: To investigate if pathologies causing upper airway obstructions are correlated with chronic otitis media. MATERIALS AND METHODS: One hundred fourteen patients with chronic otitis media and 114 healthy controls were enrolled in this study. Nasal septal deviation, Friedman and Mallampati scores were assessed for upper airway obstructions. Chronic suppurative otitis media was classified into tubotypmanic (n=80) and atticoantral (n=34) subtypes. Number of patients with septal deviation with a convexity to the same side as the affected ear in each CSOM subgroup was compared with chi-square test. The mean Mallampati and Friedman scores in tubotympanic disease group, atticoantral disease group and healthy controls were compared using Kruskal-Wallis test. RESULTS: Septal deviation occurred more frequently on the same side of ear pathology in patients with tubotympanic chronic suppurative otitis media (p=0.0005). Such a difference was not observed between the controls and patients with atticoantral chronic suppurative otitis media (p=0.718). No significant difference was noted between patients and controls in terms of Mallampati and Friedman scores (p=0.602 and p=0.836, respectively). Subtypes of chronic suppurative otitis media were not different from each other in terms of Mallampati and Friedman scores either (p=0.718 and p=0.708). CONCLUSION: Our results indicate that septal deviations may commonly occur on the same side with chronic otitis media. Therefore, septal deviations must be carefully investigated during the preoperative assessment of patients with CSOM. Elucidation of any possible causal relationship calls for further trials in larger series.

Functional results after cholesteatoma surgery in an adult population using the retrograde mastoidectomy technique.

In this retrospective study, we analyzed the functional results after using the retrograde mastoidectomy technique for cholesteatoma removal in an adult patient population. The described technique was used at a tertiary referral center for cholesteatoma removal in 218 adult patients, representing 242 operated ears, with an average follow-up time of 20.3 months. With the retrograde mastoidectomy technique, the cholesteatoma is removed posteriorly through the canal wall, from the epitympanic region toward the mastoid, with the option to reconstruct the posterior bony canal wall or create an open mastoid cavity, depending on the size of the defect. Primary surgery was carried out in 58.7 % ears, with the remaining 41.3 % representing revision surgery. In 151 cases, the posterior canal wall was reconstructed, and in 91 cases a classical CWD with an open mastoid cavity was created. In the majority of the cases (n = 213, 88.0 %), a primary hearing restoration was performed. There were 18 recurrences (12.7 %) in primary cases and 22 recurrences (22 %) in revision surgeries. Ninety percent of the recurrences (36 of 40 cases) occurred within 5 years. A postoperative air-bone gap of less than 20 dB was achieved in 61.6 % of the operated ears. Ears with a reconstructed posterior canal wall had significantly better hearing results than those cases in which a CWD procedure was used (air-bone gap of 17.6 versus 22.5 dB, p < 0.05). The retrograde mastoidectomy technique for cholesteatoma removal resulted in satisfying hearing results in the majority of the cases, with a recurrence rate comparable to the current literature.

Predictive value of disease severity on self-reported rating and quantitative measures of olfactory function outcomes after primary endoscopic sinus surgery. A prospective study.

BACKGROUND: This prospective study investigates the influence of primary Endoscopic Sinus Surgery (ESS) in patients with chronic rhinosinusitis (CRS) on olfactory function and on the patients' quality of life. We assess the role of preoperative disease severity measured by computed tomography (CT) scan in predicting outcome. METHODOLOGY: Adults undergoing ESS were examined preoperatively (n=92) and five months postoperatively. Coronal CT scans were evaluated referencing the Lund Mackay (LM) system. On the basis of the LM score, the collective was divided into two groups. We performed the olfactory test "Sniffin' Sticks" and handed out the specific health-related quality of life questionnaire SNOT-20. RESULTS: We could demonstrate that olfactory function of patients with strong opacification on CT scans improved by an average of 2.49 points more than olfactory function of patients with less severe disease. In terms of the self-reported rating of smell, the degree of amelioration differed significantly. Both groups showed an improvement in quality of life irrespective of severity of disease. CONCLUSION: Mean olfactory function of patients with a high degree of disease in CT scan improved more than that of patients with less opacification on CT scan. Patient's subjective perception of smell impairment was in line with these findings.

Human beta-Defensins in different states of diseases of the tonsilla palatina.

Tonsils are believed to play an important role during the development of the immune system. Although diseases of the tonsils like hypertrophy of the tonsil, acute tonsillitis, chronic tonsillitis or peritonsillar abscess are common, little is known about the underlying pathophysiology. Little is known about antimicrobial peptides produced by the tonsils. The human beta-Defensins 1-3 (hBD1-3) are naturally produced "antibiotics" with antimicrobial activity against different bacteria, fungi, and viruses. The objective of the study was to determine the concentrations for hBD1-3 in different states of diseases of the tonsilla palatina. After tonsillectomy and tissue fixation in formalin, total proteins were isolated from 38 samples (11 hypertrophy of the tonsil, 8 acute tonsillitis, 11 chronic tonsillitis, 8 peritonsillar abscesses). The protein concentration was determined and ELISA for hBD1-3 were performed. We also conducted immunofluorescence double stainings for the co-expression of streptococcus group A and hBD1-3. We could verify a significant difference for the mean hBD1 score of the acute tonsillitis in comparison to the hyperplastic tonsil, the chronic tonsillitis, and the peritonsillar abscess. There was no statistically significant difference in the hBD2 and hBD3 concentrations between the four groups. The immunofluorescence stainings showed that hBD1-3 and the streptococcus group A in the same place. We conclude that in the hyperplastic tonsilla palatina hBD1-3 play an important role. The mouth is constantly faced with a high bacterial load. During a tonsillitis, the hBD1 concentration is lower than in the non-acute infected tonsil because hBD1 is being consumed for fighting the bacterial infection. But, the existence of hBD1-3 in the tonsil cannot prevent the tonsillitis to become chronic.

Management of maxillary sinus inverted papilloma via transnasal endoscopic anterior and medial maxillectomy.

OBJECTIVE: To introduce and evaluate the effectiveness and safety of transnasal endoscopic anterior and medial maxillectomy (TEAMM) in the treatment of Krouse stage III inverted papilloma (IP) originating from the maxillary sinus. METHODS: A retrospective chart review was performed for 33 patients with Krouse stage III IP undergoing TEAMM in our hospital between 2003 and 2008. RESULTS: Tumors were completely resected through TEAMM. Sixteen cases had type I TEAMM, during which the nasolacrimal duct was preserved; 17 had type II TEAMM, during which the nasolacrimal duct was resected. The inferior turbinate was partially preserved in 26 cases. Patients were followed for a mean of 40.4 months. Recurrence developed in 2 patients, dry nose syndrome in 5 patients, and epiphora in 1 patient. Squamous cell carcinoma occurred in 1 patient. CONCLUSIONS: TEAMM is an effective and safe technique in the management of Krouse stage III IP and provides good exposure of operative cavities during follow-up.

Biopsies of olfactory epithelium in patients with Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder involving several neuronal systems. Impaired olfactory function may constitute one of the earliest symptoms of PD. However, it is still unclear to what degree changes of the olfactory epithelium may contribute to dysosmia and if these changes are different from those of other hyposmic or anosmic patients. This study aimed to investigate the hypothesis that olfactory loss in PD is a consequence of specific PD-related damage of olfactory epithelium. Biopsies of 7 patients diagnosed with PD were taken. Six patients with PD were hyposmic, one anosmic. As non-PD controls served 9 patients with hyposmia, 9 with anosmia, and 7 normosmic individuals. Further, nasal mucosa of 4 postmortem individuals was investigated. Immunohistochemical examinations were performed with antibodies against olfactory marker protein (OMP), protein gene product 9.5 (PGP 9.5), beta-tubulin, (BT), proliferation-associated antigen (Ki 67), the stem cell marker nestin, cytokeratin, p75NGFr, and alpha-synuclein. Most of the biopsy specimens exhibited irregular areas of olfactory-like, dysplastic epithelium positive for either PGP 9.5 or BT, but negative for OMP. No major histochemical differences in either the expression or distribution of these proteins were observed in the olfactory epithelium of patients with PD compared with controls. Reverse transcription PCR (RT-PCR) data indicated mRNA for OMP in almost all subjects, independently of their olfactory performance. These data support the idea that olfactory loss in Parkinson's disease is not a consequence of damage to the olfactory epithelium but rather results from distinct central-nervous abnormalities.

Protein isolation from ear wax made easy.

Cerumen is a waxy substance with a mixture of different lipids and and not yet identified proteins. Analysing ear wax can be quite laborious because of the different and sometimes interfering components. Therefore, time-consuming techniques such as chromatography or spectrometry were used to gain informations about the components of ear wax. Conclusions were drawn from immunohistochemical detections of special proteins within the skin or the glands of the external ear canal about the existence of these proteins within the ear wax. But directly analysing the proteins within the ear wax was difficult. We, therefore, worked out a method to isolate proteins from ear wax. Ear wax was collected from 16 adults with no infections of the external ear canal. The protein isolation was conducted using the Qproteome Mammalian Protein Prep Kit by Qiagen in two different kind of ways (cell and lysat fraction). Afterwards, we performed a quantification of the total protein concentration using the BCA method. There was a statistical significant difference in the total protein concentration between the two different (cell and lysat fraction) described ways. Furthermore, it is a fast and easy method to extract proteins from ear wax. The benefit of the described method and the field of application will be discussed.

Correlation of orbital dysmorphisms with nasal polyposis: a clinical study.

We aimed to investigate if orbital dysmorphisms were more common in patients with long-standing and advanced nasal polyposis. A total of 42 nasal polyposis patients and 55 healthy controls were enrolled in this study. The distances between medial and lateral canthi were measured using a sliding caliper, and distances between medial and lateral orbital walls were evaluated on paranasal sinus CT scans. The results were compared using Student's t test and Mann-Whitney U test. The distance between medial canthi was found to be significantly increased in nasal polyposis patients compared to controls (P = 0.004). No difference was observed between patients and controls in terms of distances between lateral canthi, medial orbital walls and lateral orbital walls. Anatomic changes regarding orbital morphology may occur in patients with long-standing and advanced nasal polyposis. Early diagnosis and appropriate treatment is of paramount importance in the management of nasal polyposis, since significant anatomic changes leading to orbital dysmorphisms may occur in advanced and long-standing cases. Studies on larger series must be conducted to unveil the morphologic changes and genetic predisposition in nasal polyposis.

Long-term quality of life evaluation after laser microsurgery with or without adjuvant radiotherapy for laryngeal carcinoma.

OBJECTIVES: We evaluated long-term quality of life of patients successfully treated with either laser-assisted microsurgery alone or combined with adjuvant radiotherapy for laryngeal carcinoma. PATIENTS AND METHODS: The study included 53 patients who were treated by laser surgery and 16 patients who were treated by laser surgery combined with adjuvant radiotherapy. Quality of life was evaluated with two validated questionnaires: the global EORTC QLQ-C30 and the head and neck specific EORTC QLQ-H&N35. The mean follow-up was 59 months (range 10 to 111 months). RESULTS: Patients receiving adjuvant radiotherapy showed a significantly lower level of global health status. Surprisingly, the two treatment groups showed close similarities with respect to symptoms specific to the head and neck region. The most frequent complaints were coughing and speech problems in both groups. On the other hand, patients with a follow-up duration of more than or less than five years did not differ significantly with regard to the global health status. CONCLUSION: Adjuvant radiotherapy must be selectively utilized in patients treated with laser surgery for laryngeal carcinoma.