Efficacy of Normalising Serum Zinc Level for Patients with Olfactory Dysfunction and Zinc Deficiency.

INTRODUCTION: Zinc deficiency may worsen the severity of olfactory dysfunction; however, the relationship between serum zinc levels and therapeutic effects on olfactory dysfunction remains uncertain. This study investigated the relationship between normalising serum zinc levels and the therapeutic effects on olfactory dysfunction. METHODS: Forty-two patients diagnosed with post-infectious, posttraumatic, and idiopathic olfactory dysfunction, with serum zinc levels < 70 µg/dL, were included in the study. All patients were treated with mecobalamin, tokishakuyakusan, and polaprezinc. The patients were divided into 2 groups: the zinc-normalised (≥ 70 µg/dL) and zinc-deficient (< 70 µg/dL) groups, based on their post-treatment serum zinc levels. Olfactory test results were compared in each of the 2 groups. RESULTS: The patients were treated for a median of 133 days. The zinc-normalised group had significantly better results in all olfactory tests (detection/recognition thresholds of the T&T olfactometer, odour identification test (Open Essence), visual analogue scale for olfactory dysfunction, self-administered odour questionnaire). In contrast, only the self-administered odour questionnaire showed a significant improvement in the zinc-deficient group, with no significant differences observed in the other olfactory tests. When comparing the changes in the olfactory test scores between the 2 groups, significant differences were observed in the detection/recognition thresholds of the T&T and Open Essence results. CONCLUSION: These findings suggest that patients with olfactory dysfunction may have difficulty improving their olfactory function if they also have zinc deficiency. Furthermore, normalisation of zinc deficiency may contribute to the improvement of olfactory dysfunction with general treatment.

Characteristics of higher depressive tendency in the patients with olfactory disorder.

OBJECTIVE: Most patients with olfactory dysfunction experience stress and anxiety because of the inconvenience and changes caused by the loss of olfaction. However, psychological assessment is not performed routinely in patients with olfactory dysfunction, and the characteristics of these patients with psychological depression are unclear. METHODS: In this study, we used the Self-rating Depression Scale to evaluate the degree of depression in patients who visited our clinic with olfactory dysfunction and examine the characteristics of these patients with strong depressive tendencies. Patients who visited our clinic between April 2019 and March 2020 with complaints of olfactory dysfunction were included in the study. RESULTS: A total of 180 patients (79 male and 101 female) underwent olfactory examination and completed the Self-rating Depression Scale. Eighty-six and 94 patients were included in the low depression and high depression groups, respectively. Binomial logistic regression analysis showed significant positive associations of Self-rating Depression Scale scores with female sex and the presence of parosmia/phantosmia (p < 0.05). CONCLUSION: In our study, approximately half of the patients with olfactory dysfunction had depressive tendencies especially in female and parosmia/phantosmia patients. We believe that psychological assessments, such as that with the SDS, can help identify patients with olfactory dysfunction who may be at a greater risk of developing depression.

The impact of multidisciplinary approaches on the outcomes of olfactory neuroblastoma treated with postoperative radiotherapy.

BACKGROUND: We investigated the outcomes of postoperative radiation therapy for olfactory neuroblastoma (ONB) and our cross-departmental collaboration to enhance the effectiveness of cancer treatment. METHODS: We retrospectively evaluated 22 patients with ONB who underwent postoperative radiotherapy after tumor resection. En bloc resection was performed; pathology specimens were prepared in coronal sections; and irradiation fields were determined after discussion with radiation oncologists, head and neck surgeons, and pathologists. RESULTS: The overall survival and local control rates were 95.5% and 100%, respectively, at a median 37-month follow-up. The 3- and 5-year disease-free survival (DFS) rates were 64.4% and 56.3%, respectively. Of the 22 patients, 9 (8 Kadish C and 1 Kadish B) had disease recurrence. Of the nine patients, five had positive margins and two had closed margins; cervical lymph node recurrence occurred in six, and distant metastasis with or without cervical lymph node recurrence occurred in three. DFS analysis of risk factors showed no statistically significant differences, but positive margins were a significant recurrence factor in multivariate analysis. CONCLUSIONS: The local control rate of ONB treated with postoperative radiation therapy was 100%. This may be attributed to cross-departmental cooperation between head and neck surgeons, pathologists, and radiation oncologists, which resulted in accurate matching of CT images for treatment planning with the location of the tumor and positive margins. Longer follow-up periods are required to evaluate the effectiveness of our strategy.

Effect of basic fibroblast growth factor with collagen/gelatin fixture in a rabbit model of nasal septum perforation.

Introduction: The treatment of nasal septum perforation solely by surgical intervention presents significant challenges. This study evaluated the effect of basic fibroblast growth factor (bFGF) in combination with collagen/gelatin on wound healing of nasal septum perforation in a rabbit animal model. Methods: A nasal septum perforation rabbit model was created. bFGF was added to a collagen/gelatin fixture and placed adjacent to the perforation, which is a complete defect. The rabbits were divided into three groups: the sham group that underwent the surgical procedure only, bFGF (-) group that received collagen/gelatin fixture without bFGF, and bFGF(+) group that received collagen/gelatin fixture with bFGF. The dimensions of the perforations were measured after 4 weeks, and the septum was subjected to histological examination. Results: All perforations remained open in the sham group (closure rate: 20.4%-83.1%). The closure rates of the bFGF(-) and bFGF(+) groups were 49.4%-68.8% and 72.7%-100%, respectively. No significant difference was noted in the closure rates between the sham and bFGF(-) groups; however, significant differences were observed between the sham and bFGF(+) groups, and the bFGF(-) and bFGF(+) groups (p < 0.05), indicating that bFGF promoted perforation closure. Conclusions: The study demonstrated that bFGF with collagen/gelatin carrier promoted wound healing in a rabbit model of nasal septum perforation.

Translation, cultural adaptation, and validation of the Standardized Cosmesis and Health Nasal Outcomes Survey in Japanese (J-SCHNOS).

BACKGROUND: Rhinoplasty is one of the most popular plastic surgery techniques. The evaluation of both functional and cosmetic aspects of rhinoplasty is essential for planning and assessing surgery results. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a validated questionnaire used to assess both functional and aesthetic symptoms in patients with nasal problems, and it has been translated into several languages. The purpose of this study was to translate, culturally adapt, and validate the SCHNOS in Japanese among patients undergoing rhinoplasty. METHODS: This was a prospective validation study of the Japanese version of the SCHNOS (J-SCHNOS). The first phase involved translation and cross-cultural adaptation of the SCHNOS. The second phase included validation of the J-SCHNOS among native Japanese speakers. RESULTS: In total, 357 participants completed the final version of the J-SCHNOS (219 males and 138 females; mean age 43.4 years). The J-SCHNOS showed high internal consistency with excellent Cronbach's alpha values for both obstruction (SCHNOS-O) (0.96) and cosmetic (SCHNOS-C) (0.93) domains. The reproducibility was high, with an excellent intraclass correlation coefficient (ICC) >0.9 for all items. Exploratory factor analysis showed unidimensional structures in both the SCHNOS-O and the SCHNOS-C. CONCLUSION: The J-SCHNOS is a reliable and valid tool to assess the severity of nasal problems in patients undergoing rhinoplasty.

A case of recurrent chronic eosinophilic pneumonia after switching from benralizumab to dupilumab.

Dupilumab inhibits interleukin-4Rα and suppresses type 2 inflammation. Careful administration of dupilumab is required because it increases the blood eosinophil count secondary to a decrease in local eosinophil counts, sometimes resulting in eosinophilic complications. We herein report a case of recurrent chronic eosinophilic pneumonia after switching from benralizumab to dupilumab. A 54-year-old man with a history of eosinophilic pneumonia presented to our hospital with symptoms of cough, fever, and phlegm production six months after beginning dupilumab administration for recurrent chronic rhinosinusitis. When using dupilumab, it is essential to carefully monitor patients' eosinophil trends and pulmonary symptoms.

Nasal Packing Materials and Placement Duration on Wound Healing in Nasal Mucosa: An Animal Study.

OBJECTIVE: The histological findings of wound healing depending on different nasal packing materials and replacement periods were lacking. METHODS: Mucosal defects were created in the nasal septum of rabbits and covered with Spongel®, Algoderm®, or Nasopore®, which were cleaned on Day 14. To investigate the effect of replacement durations, Spongel® was removed on Days 3 and 7. All nasal septal specimens were collected on Day 28. Samples without packing material were prepared as controls. Depending on residual packing materials in the regenerated tissue, specimens were classified into the remnant and non-remnant groups, and morphology was compared using epithelium grade score and subepithelial thickness. RESULTS: The epithelium grade score in the Spongel-14d group was lower than that in the other groups (p < 0.05). Subepithelial thickness was higher in the Algoderm-14d and Spongel-14d groups (p < 0.05). Epithelium grade scores were higher and subepithelial thicknesses were lower in the Spongel-3d and -7d groups than in the Spongel-14d group. Epithelium grade score was lower and subepithelial thickness was higher in the remnant group (n = 10) than in the non-remnant group (n = 15; p < 0.05). CONCLUSIONS: Differences in packing materials and placement durations affected wound healing of nasal mucosa. The selection of appropriate packing materials and replacement duration was considered essential for ideal wound healing. LEVEL OF EVIDENCE: NA Laryngoscope, 134:562-568, 2024.

Simple and safe resection of the crista galli.

A critical procedure in the transcribriform approach is the resection of the crista galli. However, the standard technique for crista galli resection has several disadvantages. We reviewed the cases of patients with olfactory neuroblastomas who underwent an endoscopic endonasal transcribriform approach using a newly developed technique for crista galli resection. We performed a cadaveric study to measure the superior accessibility limits using the proposed method. We included 38 patients with olfactory neuroblastomas in this study. The tumor invaded the posterior crista galli in four patients. The anterior end of the crista galli was not invaded by the tumor. Our cadaveric study showed that the dura was approachable to the point that was 7.4 ± 1.3 mm superior and 23.2 ± 7.2 mm lateral to the foramen cecum following crista galli removal. By resecting the crista galli in advance, manipulation of the superior dura became feasible.

Effects of Increased Nasal Volume due to Topical Adrenaline on the Voice.

OBJECTIVES: Resonance properties of the nasal and sinus cavities are involved in the individuality of speech. However, detailed information on how alterations in the nasal cavity morphology affect voice quality is lacking. The aim of the present study was to investigate the effects of structural changes in the nasal cavity on voice production by spraying a topical adrenaline solution with a vasoconstrictive effect into the nasal cavity, causing nasal mucosal contraction. STUDY DESIGN: Prospective. METHODS: Overall, 51 adult volunteers were recruited from the Otorhinolaryngology Outpatient Department of the Jikei University Hospital from June to September 2022. Among them, 20 completed acoustic rhinometry and voice recordings before and after adrenaline spraying. The nasal consonant [N] uttered with the mouth completely closed was recorded for 5 seconds. The remaining 31 volunteers completed all auditory experiments. This was conducted to determine whether the changes in voice before and after adrenaline spraying could be discriminated against by the participants. RESULTS: The nasal volume had increased 5 and 10 minutes after spraying compared to that before spraying, reaching a significance at 10 minutes (P = 0.06). It had increased at 2 and 5 cm from the external nostrils compared to that within 3 cm of the external nostrils (P = 0.04). Among the 31 volunteers in the auditory experiments, 30 had a discrimination rate >90%, with a mean of 96.3% (standard error, 3.2). The spectral envelope of the 16 frequency bands varied significantly at 500-Hz increments (P = 0.0006). In particular, changes in the high-frequency bands were larger between 4500 and 6000 Hz. CONCLUSIONS: Nasal enlargement with 0.02% topical adrenaline affects the spectral envelope, particularly in the high-frequency bands between 4500 and 6000 Hz, and perceptibly alters the voice.

Preoperative prediction of sinonasal papilloma by artificial intelligence using nasal video endoscopy: a retrospective study.

Sinonasal inverted papilloma (IP) is at risk of recurrence and malignancy, and early diagnosis using nasal endoscopy is essential. We thus developed a diagnostic system using artificial intelligence (AI) to identify nasal sinus papilloma. Endoscopic surgery videos of 53 patients undergoing endoscopic sinus surgery were edited to train and evaluate deep neural network models and then a diagnostic system was developed. The correct diagnosis rate based on visual examination by otolaryngologists was also evaluated using the same videos and compared with that of the AI diagnostic system patients. Main outcomes evaluated included the percentage of correct diagnoses compared to AI diagnosis and the correct diagnosis rate for otolaryngologists based on years of practice experience. The diagnostic system had an area under the curve of 0.874, accuracy of 0.843, false positive rate of 0.124, and false negative rate of 0.191. The average correct diagnosis rate among otolaryngologists was 69.4%, indicating that the AI was highly accurate. Evidently, although the number of cases was small, a highly accurate diagnostic system was created. Future studies with larger samples to improve the accuracy of the system and expand the range of diseases that can be detected for more clinical applications are warranted.

Application of Digital Subtraction Angiography in Predicting the Outcomes of Intraoperative Hemorrhage of Juvenile Nasopharyngeal Angiofibroma.

OBJECTIVE: Juvenile nasopharyngeal angiofibroma (JNA) is a very rare hemorrhagic vascular tumor that predominantly affects adolescent boys. The tumor is relatively large when detected, and the risk of intraoperative bleeding is high. We aimed to examine factors associated with intraoperative blood loss in JNA surgery. METHODS: Thirteen patients with JNA who underwent surgery at the Jikei University Hospital between 2009 and 2020 were retrospectively reviewed, and factors associated with blood loss were examined by single regression analysis. RESULTS: The mean age was 20.8 ± 7.7 years. Preoperative angiographic images were evaluated in 9 of the 13 cases. The 6 patients with the largest bleeding volumes, all had residual nutrient vessels from the internal carotid artery (ICA), with an average number of 2.5 vessels. The mean blood loss of patients with residual nutrient vessels from the ICA was 3037 ± 2568 mL. Single regression analysis of bleeding volume against the number of remaining nutrient vessels from the ICA and the total peak contrast density of nutrient vessels (Cmax) standardized by region of interest showed that the coefficient was positive (P < 0.05 for both), confirming a significant correlation between the 2, respectively. CONCLUSIONS: The amount of bleeding significantly correlated with the number of remaining nutrient vessels from the ICA after preoperative embolization and with the total Cmax/region of interest. The ability to predict the amount of preoperative blood loss using this study will facilitate proposals for external incisions in patients with JNA.

Evaluating tooth extraction as a stand-alone treatment for odontogenic sinusitis.

BACKGROUND: There are multiple treatment methods for odontogenic sinusitis (OS); however, the optimal treatment remains unclear. AIMS/OBJECTIVE: To determine the cure rate of OS after tooth extraction and the factors contributing to the cure. MATERIAL AND METHODS: We prospectively identified 37 patients diagnosed with OS with an indication for causative tooth extraction. Before and three months after tooth extraction, the patients were assessed using sinus computed tomography and classified as either cured or uncured based on the absence or presence of soft tissue shadow in the maxillary sinus. The prognostic factors were analysed by comparing the two groups. RESULTS: There were ten patients for whom all data could be obtained. The mean age of the patients at the time of tooth extraction was 53.8 ± 12.9 years (range, 34-75 years). In seven patients, the soft tissue shadow in the maxillary sinus disappeared; these patients were classified as cured. Uncured patients were significantly younger than cured patients (59.9 vs. 39.7 years). CONCLUSIONS AND SIGNIFICANCE: Tooth extraction effectively treated OS in 70% of patients. However, even after tooth extraction, OS may not improve, particularly in younger patients.

Characteristics of Extranodal NK/T-Cell Lymphoma, Nasal Type, Compared with Nasal Diffuse Large B-cell Lymphoma.

Background: Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. Methods: The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. Results: A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. Conclusion: ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration.

Relationship between the severity of olfactory dysfunction and serum zinc levels.

PURPOSE: Although the association between zinc deficiency and olfactory dysfunction is inconclusive, zinc deficiency causes apoptosis of the olfactory ensheathing cells which is involved in olfactory nerve turnover and axon regeneration, thereby suggesting a possible relationship. We investigated the relationship between serum zinc levels and olfactory function in patients with olfactory dysfunction. METHODS: Ninety patients who had been diagnosed with post-infectious, posttraumatic, drug-induced, neurological and idiopathic olfactory dysfunction were included. Patients were divided into zinc normal group and zinc deficiency groups according to three reference values for serum zinc levels (60, 65, 70 µg/dL). The results of olfactory tests and patient backgrounds were used to compare the differences between the two groups. RESULTS: There were significantly worse detection and recognition thresholds in the T&T olfactometer and Open Essence (odor identification test) results in the zinc deficiency group (< 60 µg/dL). In addition, significant correlations between olfactory tests (detection/recognition thresholds in the T&T olfactometer and Open Essence results) and serum zinc levels < 65 µg/dL were observed. The zinc deficiency group < 70 µg/dL with idiopathic olfactory dysfunction had significantly worse olfactory tests (detection/recognition thresholds in the T&T olfactometer and Open Essence). In addition, there was a significant correlation between the detection/recognition thresholds in the T&T olfactometer and serum zinc levels in idiopathic olfactory dysfunction. CONCLUSIONS: Our findings suggest that zinc deficiency may exacerbate the severity of olfactory dysfunction. Furthermore, idiopathic olfactory dysfunction may be partly caused by zinc deficiency.

Endoscopic-assisted total maxillectomy with precise surgical margins.

In traditional open maxillectomy, identifying the posterior margin is difficult because of its deep location and bleeding from the pterygoid venous plexus. Here, we present our endoscope-assisted total en bloc maxillectomy technique and discuss its merits and demerits compared to previously reported methods. We developed an endoscope-assisted total en bloc maxillectomy procedure. We reviewed a series of total maxillectomies performed with and without endoscopic assistance to verify the advantages of endoscopic assistance over conventional total maxillectomy. We analyzed (1) the precision using the distance of the remaining pterygoid process, (2) the operation time, and (3) blood loss. The length of the remnant pterygoid process was significantly shorter in the endoscopic assistance group. The operation time and blood loss were not significantly different between the two groups. Endoscopic assistance makes total maxillectomy more precise without requiring additional time and is a reasonable option for total maxillectomies.

Improving situation recognition using endoscopic videos and navigation information for endoscopic sinus surgery.

PURPOSE: Endoscopic sinus surgery (ESS) is widely used to treat chronic sinusitis. However, it involves the use of surgical instruments in a narrow surgical field in close proximity to vital organs, such as the brain and eyes. Thus, an advanced level of surgical skill is expected of surgeons performing this surgery. In a previous study, endoscopic images and surgical navigation information were used to develop an automatic situation recognition method in ESS. In this study, we aimed to develop a more accurate automatic surgical situation recognition method for ESS by improving the method proposed in our previous study and adding post-processing to remove incorrect recognition. METHOD: We examined the training model parameters and the number of long short-term memory (LSTM) units, modified the input data augmentation method, and added post-processing. We also evaluated the modified method using clinical data. RESULT: The proposed improvements improved the overall scene recognition accuracy compared with the previous study. However, phase recognition did not exhibit significant improvement. In addition, the application of the one-dimensional median filter significantly reduced short-time false recognition compared with the time series results. Furthermore, post-processing was required to set constraints on the transition of the scene to further improve recognition accuracy. CONCLUSION: We suggested that the scene recognition could be improved by considering the model parameter, adding the one-dimensional filter and post-processing. However, the scene recognition accuracy remained unsatisfactory. Thus, a more accurate scene recognition and appropriate post-processing method is required.

Mucosal Epithelial Preservation of Free Nasal Grafts Depending on the Recipient Site.

OBJECTIVES/HYPOTHESIS: Reconstruction of mucosal defects using free mucosal grafts has become a common procedure during endoscopic sinus surgery. Epithelialization of mucosal grafts affects postoperative complications and outcomes, which could be influenced by different recipient tissue. However, morphological changes occurring in the grafts transplanted over different tissues remain unexplored. STUDY DESIGN: An animal study. METHODS: Free mucoperichondrial grafts were prepared from the nasal septum of rabbits; the cartilage group had reconstruction on the nasal septal cartilage, and the perichondrium group had reconstruction on the contralateral perichondrium. The nasal septum was removed after 1 and 4 weeks of reconstruction, and the graft was histologically evaluated. RESULTS: After 1 week of reconstruction, the mucosal epithelium of grafts in the cartilage group disappeared, whereas the columnar epithelium of grafts was preserved in the perichondrium group. After 4 weeks of reconstruction, the mucosal defect site was covered with mucosal epithelium in both groups. However, while squamous epithelium was mostly observed in the cartilage group, columnar epithelium containing the healthy ciliary and goblet cells was observed in the perichondrium group. Statistically significant differences were detected in the parameters of epithelial morphology between the two groups, which were higher in the perichondrium group. CONCLUSIONS: In the reconstruction of mucosal defects using free mucosal grafts, difference in recipient tissue affects the graft epithelial morphology. LEVEL OF EVIDENCE: NA Laryngoscope, 132:2301-2306, 2022.

A Case of Granulomatosis with Polyangiitis (GPA) Where a Multicystic Nasal Septal Abscess Aided in the Diagnosis.

A 69-year-old male patient presented to the hospital with a chief complaint of nasal obstruction. Physical examination revealed swelling of the anterior nasal septum and nasal dorsum and tender indurated oedema of the dorsum of both hands. Blood tests showed an elevated inflammatory response, and contrast-enhanced computed tomography (CT) showed a polycystic abscess in the nasal septum. Emergency surgery and histopathology were performed on the day of the initial visit for incisional drainage. Intraoperative findings showed white necrosis between the nasal septal cartilage and nasal septal mucosa, as well as white necrosis and pus accumulation in the periosteum and soft tissue of the piriform aperture and the nasal bone. The patient underwent endoscopic dissection and drained as much as possible, and the abscess and surrounding normal nasal septal mucosa were sampled for diagnostic purposes. The patient was diagnosed with vasculitis based on the clinical findings, pathological examination results, and blood test results. After the diagnosis was confirmed, steroid and cyclophosphamide pulse administration was initiated, and the swelling of the anterior nasal septum and nasal dorsum and the bilateral dorsal indentation oedema improved markedly. The patient is now doing well and will continue to be carefully monitored in the outpatient clinic.

MRI tractography reveals the human olfactory nerve map connecting the olfactory epithelium and olfactory bulb.

The olfactory nerve map describes the topographical neural connections between the olfactory epithelium in the nasal cavity and the olfactory bulb. Previous studies have constructed the olfactory nerve maps of rodents using histological analyses or transgenic animal models to investigate olfactory nerve pathways. However, the human olfactory nerve map remains unknown. Here, we demonstrate that high-field magnetic resonance imaging and diffusion tensor tractography can be used to visualize olfactory sensory neurons while maintaining their three-dimensional structures. This technique allowed us to evaluate the olfactory sensory neuron projections from the nasal cavities to the olfactory bulbs and visualize the olfactory nerve maps of humans, marmosets and mice. The olfactory nerve maps revealed that the dorsal-ventral and medial-lateral axes were preserved between the olfactory epithelium and olfactory bulb in all three species. Further development of this technique might allow it to be used clinically to facilitate the diagnosis of olfactory dysfunction.