Intra Nasal Use of Ethylene Diamine Tetra Acetic Acid for Improving Olfactory Dysfunction Post COVID-19.

BACKGROUND: COVID-19 has been associated with olfactory dysfunction in many infected patients. The rise of calcium levels in the nasal secretions plays an essential role in the olfaction process with a desensitization effect on the olfactory receptor neurons and a negative impact on the olfaction transmission. Ethylene diamine tetra acetic acid (EDTA) is a chelating agent that can bind free calcium in the nasal secretions, thereby reducing the adverse effects of calcium on olfactory function. OBJECTIVES: The objective of this work is to demonstrate the effect of intranasal EDTA on improving olfactory dysfunction following COVID-19. METHODS: Fifty patients with a history of COVID-19 and olfactory dysfunction that persisted for more than 6 months were enrolled in the current prospective randomized clinical trial. Participants were randomized into 2 equal groups. Twenty-five patients were treated with olfactory training only, while the remaining 25 patients received treatment with olfactory training and a topical nasal spray of ethylene diamine tetra acetic acid. The olfactory function was assessed before treatment and 3 months later using the Sniffin' Sticks test. Additionally, the determination of calcium level in the nasal secretions was performed using an ion-selective electrode before treatment and 3 months later. RESULTS: Eighty-eight percent of the patients treated with olfactory training in addition to EDTA exhibited clinical improvement, while 60% showed improvement in patients treated with olfactory training only. Furthermore, a significant decrease in the measured calcium level in the nasal secretions was demonstrated after the use of ethylene diamine tetra compared to patients treated with olfactory training only. CONCLUSION: Ethylene diamine tetra acetic acid may be associated with an improvement of the olfactory function post-COVID-19.

A Myriad of Scleroma Presentations: The Usual and Unusual.

To prospectively study a series of scleroma patients with a focus on socioeconomic status, clinical presentation, pathology, microbiology, and treatment. A total of 52 patients diagnosed with scleroma were included in the study. Demographic data of the patients were collected and clinical, radiographic, and histopathologic findings were analyzed. Biopsies from atypical patients were sent for electron microscopic examination. Patients were treated both medically and surgically with clinical follow-up to determine outcomes and the incidence of recurrence. Fifty-two patients were included in the study. There were 23 males (44.2%) and 29 females (55.8%). The highest incidence of scleroma was identified in individuals from poor, rural areas in the third to fourth decades of life. The nose was affected in all cases. Other affected sites included the nasopharynx, soft and hard palate, larynx and trachea, lacrimal passages, skin, and gingiva. Some patients had atypical presentations. Complete follow-up of all patients was hindered by non-compliance with clinic visits and the long duration of medical treatment. Recurrence or relapse of the granulomatous lesions after initial improvement occurred in 11 patients (21.2%) within 1 to 3 years. Scleroma is a stubborn, chronic, granulomatous bacterial disease. The diverse presentations may mimic neoplasms and other granulomatous conditions. We present cases with unusual presentations and demonstrate the transmission electron microscopic features of these lesions. Furthermore, we confirm the importance of achieving full eradication of the etiologic bacilli to prevent recurrent disease.

Effect of passive smoking on the ultrastructure of the nasal mucosa in children.

OBJECTIVES/HYPOTHESIS: Passive exposure to cigarette smoke has been implicated in a number of respiratory childhood disorders. Most studies concerning smoking were directed to its carcinogenic effect on the lungs. However, the effects of smoking on nasal respiratory mucosa have not been widely studied. The aim of the present study was, therefore, to study the ultrastructural changes in the nasal mucosa of a pediatric population exposed to passive smoking. STUDY DESIGN: The study included 20 children between the ages of 5 and 11 years, who were scheduled for tonsillectomy and at the same time had a positive history of prolonged exposure to household passive smoke. Another 10 children with a negative household smoking history were included as a control group. All children were nonatopic and with a negative family history of allergy. None of them had adenoids or infective rhinosinusitis. METHODS: At the time of surgery, a 1-mm(3) biopsy was taken was taken from the lower border of the inferior turbinate. The specimens were processed and examined with electron microscopy RESULTS: Examination of the nasal mucosa showed several ultrastructural changes. These included patchy loss of cilia, generalized loss of cilia, squamous metaplasia, hyperplasia of goblet cells and seromucinous acini, and vascular congestion. More severe changes were observed with longer passive exposures to cigarette smoke. The study did not disclose any evidence of ongoing allergic reaction or neoplastic transformations. CONCLUSIONS: Children exposed to passive cigarette smoke may develop several structural changes in the respiratory nasal mucosa with subsequent negative effects on its ciliary activity and mucociliary function. As a result of these effects, defense mechanisms of the nose may be ruined or lost, and those children may develop persistent sinonasal infections. Exposure of these children to passive smoking for longer periods of time may also induce other significant changes that were not detected in the present study.