Olfaction in chronic rhinosinusitis: comparing two different endonasal steroid application methods.

Limited olfactory improvement after topical steroid therapy in chronic rhinosinusitis (CRS) patients might result from restricted drug access to the olfactory cleft. The aim of our study was to investigate the difference between two methods to topically administer steroids with respect to olfaction: (1) conventional nasal spray and (2) a device using pressure and vibration to distribute steroid aerosol endonasally. A prospective study was performed in patients with olfactory impairment due to chronic rhinosinusitis with and without nasal polyps. While the first group used the conventional dexamethasone nasal spray, the second group used the device over a period of 12 days. Olfactory testing was done at 0, 2, and 8 weeks using Sniffin' Sticks test. A significant olfactory improvement was found after 2 weeks of treatment with either steroid (p = 0.005). However, there was no significant difference between the different methods of steroid application. There is a significant olfactory improvement in CRS patients following topical dexamethasone therapy, but no obvious superiority of one of the two ways to administer the steroid.

Olfactory function in patients with postinfectious and posttraumatic smell disorders before and after treatment with vitamin A: a double-blind, placebo-controlled, randomized clinical trial.

OBJECTIVES/HYPOTHESIS: In this study we investigated the effectiveness of vitamin A in postinfectious and posttraumatic smell disorders. A possible effect of vitamin A is likely due to the stimulation of regeneration and repair of the peripheral olfactory system. STUDY DESIGN: Double-blind, randomized, placebo-controlled clinical trial. METHODS: A total of 52 patients (age range, 20-70 years; mean age, 52 years) participated, 26 of whom received placebo (7 male, 19 female) and another 26 verum (8 male, 18 female). A standardized history was obtained in each patient. Olfactory function was measured by means of the Sniffin' Sticks test kit, a validated technique to investigate odor thresholds, odor discrimination, and odor identification. Vitamin A was prescribed at a dose of 10,000 IU per day for 3 months. Follow-up testing was performed on average 5 months after the first investigation. RESULTS: Forty-four percent of all patients reported recovery of their sense of smell; 29% of the participants exhibited significant improvement in measured olfactory function. However, there was no significant difference between the outcome of patients receiving verum or placebo. CONCLUSIONS: The systemic application of vitamin A at a dose of 10,000 IU per day for 3 months does not appear to be useful in the treatment of postinfectious or posttraumatic olfactory loss.

Topographical differences in the sensitivity of the human nasal mucosa to olfactory and trigeminal stimuli.

The olfactory and trigeminal systems play a role in the sensation of odors. The intrinsic optical signal (IOS) imaging method allows visualization of the neuronal activity. The IOS was measured after the nasal epithelium had been exposed to olfactory (H(2)S) and trigeminal (CO(2)) stimuli. The IOS was measured in the area of the middle turbinate. The response patterns of H(2)S and CO(2) on the middle turbinate were different, and some overlap between regions of activation was also observed. The response to CO(2) (20%) on the medial side of the middle turbinate was significantly higher than the response on the lateral side. In contrast, the response to H(2)S (5.6 ppm) was greater on the lateral side than on the medial side. There were no significant differences in response between the medial and lateral sides of the middle turbinate to stimuli of lower concentration (H(2)S 2.8 ppm, CO(2) 5% and 10%). These data suggest that the middle turbinate has regions which are sensitive to both olfactory and trigeminal stimuli.

Treatment of postinfectious olfactory disorders with minocycline: a double-blind, placebo-controlled study.

OBJECTIVES/HYPOTHESIS: Infection of the upper respiratory tract is one of the most common causes of olfactory loss. One of the possible underlying pathologic pathways is an increase of apoptosis of olfactory receptor neurons. Therefore, treatment with the antibiotic minocycline, which has been shown to act as an antiapoptotic agent, is thought to accelerate improvement of olfactory function. To investigate this idea, 55 patients with postinfectious olfactory dysfunction were tested for their olfactory ability. STUDY DESIGN: Randomized, prospective, double-blind, placebo-controlled. METHODS: Olfactory function was examined by means of a standardized psychophysical method (Sniffin' Sticks) before and 7 months after a 3-week treatment with either minocycline (2 × 50 mg/d) or a placebo. RESULTS: Statistical analyses did not reveal any influence of the treatment on the progress of olfactory function, possibly indicating that pathologic changes other than apoptosis contribute to postinfectious olfactory loss, either on a peripheral level (e.g., scarring/reorganization of the olfactory epithelium) or on a central nervous level. CONCLUSIONS: In conclusion, the present results indicate that minocycline in the given dosage has little or no effect on the recovery of human olfactory function following postinfectious olfactory loss. However, spontaneous recovery is found in approximately 20% of the patients over an observation period of 7 months.

Investigation of interactions between texture and ortho- and retronasal olfactory stimuli using psychophysical and electrophysiological approaches.

UNLABELLED: Flavor is a result of the complex combination of olfactory, gustatory and trigeminal sensations perceived during oral processing of foods, including thermal, painful, tactile and/or kinesthetic effects. Aim of this study was to better understand interactions between synchronous tactile (texture) and olfactory (odor) sensations, using a psychophysical and an electrophysiological approach. Texture stimuli were aliquots of lean milk and thickened lean milk. A butter aroma was presented either orthonasally or retronasally after oral processing and before swallowing the oral stimulus or in the absence of an oral stimulus. Eighteen subjects (11 women, 7 men, mean age 24 years), naïve to the expected effects, rated both odor and texture intensity of each stimulus. Event-related potentials (ERP) were obtained from five recording positions. For the psychophysical data, the presence of an oral stimulus increased odor intensity, irrespective of odor presentation route. For the electrophysiological data, both early and late chemosensory ERPs were affected by odor conditions, texture conditions, and their respective interaction. IN CONCLUSION: (1) perceptual interactions occurred between food texture and odor, with cross-modal interactions being found for both orthonasal and retronasal odor administration, and (2) these interactions between texture and odor occur at both primary-sensory and cognitive evaluative levels of stimulus processing. The temporal dimension plays then a critical role in the investigation of odor-texture interactions.

Olfactory FMRI in patients with Parkinson's disease.

Hyposmia is one of the early signs in idiopathic Parkinson's disease (PD). Olfactory stimuli were applied during fMRI scanning to show disease-related modulation of central nervous system structures and to advance our understanding of olfactory dysfunction in PD patients. All participants received either unpleasant stimuli that smelled like rotten eggs or pleasant ones that smelled like roses. Using a block design at a 1.5 T scanner we investigated a total of 8 PD patients (mean age 60 ± 10.9 years) and 13 age matched controls (mean age 58 ± 9.6 years). PD duration ranged from 1 to 9 years (mean 6.63 years); patients had an average "Unified Parkinson's Disease Rating Scale III" score of 23.25 (range, 6-46). Olfactory function was established using the "Sniffin' Sticks" test battery. Patients tended to rate the stimuli presented during fMRI scans as less intense, but also as more pleasant than controls. fMRI results revealed differences between PD patients and controls which depended on the type of stimulation. While both pleasant and unpleasant stimulation was associated with lower activation in the amygdalo-hippocampal complex in patients compared to controls, increased activity in response to pleasant stimuli was observed in the striatum and the left inferior frontal gyrus. In contrast, unpleasant stimulation led to hypoactivation of the ventral striatum in patients (but not in controls) and did not enhance left inferior frontal activity. These results may partly reflect differences between PD patients and healthy controls in the processing of primary dimensions of odors, intensity, and valence.

Idiopathic phantosmia: outcome and clinical significance.

BACKGROUND/AIM: Little is known about the clinical significance of phantosmia. The literature on phantosmia indicates that this symptom has a wide range of differential diagnoses. However, most cases of phantosmia remain of unknown origin. Our goal was to follow up patients with idiopathic phantosmia, with special regard to improvement rates and possible severe health conditions preceded by phantosmia of unknown origin. METHODS: Forty-four patients with idiopathic phantosmia which had consulted our Ear-Nose-Throat Smell and Taste Clinic over the last 10 years were contacted by telephone and underwent a structured medical interview. RESULTS: None of the patients had developed any severe health condition or Parkinson's disease. More than 5 years after the occurrence of phantosmia, more than 50% of the patients experienced disappearance (31.8%) or improvement (25%). In the remaining cases, phantosmia did not change (38.7%) or became worse (<5%). CONCLUSION: The main findings of the present study were that idiopathic phantosmia improves or disappears in almost two thirds of the patients after more than 5 years, and that idiopathic phantosmia seems to be more likely a harmless symptom rather than a reliable predictor of early Parkinson's disease or other severe diseases.

Anatomy of the nasal cavity determines intranasal trigeminal sensitivity.

BACKGROUND: Aim of this study was to investigate whether intranasal anatomy plays a role in intranasal trigeminal sensitivity. MATERIAL AND METHODS: A total of 65 healthy subjects (30 female, 35 male) participated in this study (age range 18-35 years). Nasal cavities were assessed using magnetic resonance imaging (MRI). The area of the nasal cavity was measured in 5 coronal sections distributed across the length of the nasal cavity. Trigeminal function was assessed by determining thresholds for CO2, and responses to suprathreshold stimulation with CO2 and menthol (intensity ratings; event-related potentials). In addition, rhino-manometric measures were obtained. RESULTS: A positive correlation was found between the size of the nasal cavity and trigeminal event-related potentials in response to suprathreshold CO2 and menthol stimuli. By contrast, no such correlations were found between nasal cavity size and CO2 thresholds. Results from rhino-manometry correlated only with the size of the nasal cavity in the nasal valve area. CONCLUSIONS: These data suggest that, at least at a suprathreshold level, nasal anatomy plays a significant role in determining interindividual differences in the sensitivity to trigeminal stimuli.

Effects of olfactory training in patients with olfactory loss.

OBJECTIVES: Olfactory function is known to be modulated by repeated exposure to odors. The aim of this investigation was whether patients with olfactory loss would benefit from "Training" with odors in terms of an improvement of their general olfactory function. It was hypothesized that olfactory Training should produce both an improved sensitivity towards the odors used in the Training process and an overall increase of olfactory function. STUDY DESIGN: The prospective study was performed in patients with olfactory dysfunction. METHODS: One group of patients performed the Training (n = 40), whereas another part did not (n = 16). Exclusion criteria for patients were sinunasal disease. Olfactory training was performed over a period of 12 weeks. Patients exposed themselves twice daily to four intense odors (phenyl ethyl alcohol: rose, eucalyptol: eucalyptus, citronellal: lemon, and eugenol: cloves). Olfactory testing was performed before and after training using the "Sniffin' Sticks" (thresholds for phenyl ethyl alcohol, tests for odor discrimination and odor identification) in addition to threshold tests for the odors used in the training process. RESULTS: Compared to baseline, training patients experienced an increase in their olfactory function, which was observed for the Sniffin' Sticks test score and for thresholds for the odors used in the training process. In contrast, olfactory function was unchanged in patients who did not perform olfactory training. The present results indicate that the structured, short-term exposure to selected odors may increase olfactory sensitivity.

Optical recordings from the human nasal mucosa in response to olfactory stimulation.

Using the intrinsic optical signal the present study aimed to investigate changes in blood flow at the nasal epithelium in response to specific olfactory stimulation. Recording equipment included an endoscope, a CCD camera, and a light source of 617 nm. Two concentrations of the specific olfactory stimulant H(2)S (2.8 and 5.6 ppm), generated by a computer-controlled olfactometer, were used for olfactory stimulation. Eight healthy normosmic volunteers participated. Using 5.6 ppm H(2)S stimuli, responses were typically recorded from the olfactory cleft, middle turbinate, and middle meatus while responses were less pronounced for 2.8 ppm H(2)S stimuli. Response areas were significantly larger for the 5.6 ppm H(2)S stimuli. While further experiments are needed, recordings of the intrinsic optical signal may be used to obtain responses from the nasal cavity to specific olfactory stimuli.

Recovery of olfactory function following closed head injury or infections of the upper respiratory tract.

OBJECTIVE: To investigate the outcome of olfactory function in patients with olfactory loss following infections of the upper respiratory tract (post-URTI) or head trauma. DESIGN: Retrospective patient-based study. SETTING: Smell and Taste Outpatient Clinic at a university hospital. PATIENTS: A total of 361 patients (228 women, 133 men) were included. MAIN OUTCOME MEASURES: Olfactory function was assessed using the "Sniffin' Sticks" test battery, which result in a threshold, discrimination, and identification score. The mean interval between first and last visit was 14 months. RESULTS: In comparing the overall threshold, discrimination, and identification scores between the last and first visit, olfactory function improved in 26% of the patients whereas it decreased in 6%. The cause of olfactory impairment had a significant effect on the recovery rate of olfactory function. Within the post-URTI group (n = 262), 32% of the patients improved, but in the posttraumatic group (n = 99) only 10% improved. In patients with post-URTI olfactory loss, a negative correlation was found between age and recovery of olfactory function. In general, the factor "sex" had no significant effect on recovery of smell function. CONCLUSIONS: To our knowledge, the series of patients presented herein is the largest in the literature to date in which standardized testing methods were used to assess the progression of impaired olfaction. It showed that the rate of improvement of olfactory function was significantly higher in patients with post-URTI dysosmia compared with patients with posttraumatic dysosmia. During an observation period of approximately 1 year, more than 30% of patients with post-URTI olfactory loss experienced improvement, whereas only 10% of patients with posttraumatic olfactory loss experienced improvement. Furthermore, age plays a significant role in the recovery of olfactory function.

Differences between orthonasal and retronasal olfactory functions in patients with loss of the sense of smell.

OBJECTIVE: To investigate differences between orthonasal and retronasal olfaction in patients with loss of the sense of smell without taste complaints. DESIGN: Electrophysiological and psychophysical testing of orthonasal and retronasal olfactory functions. SETTING: Outpatient clinics. PATIENTS: A series of 18 patients who had olfactory loss due to various reasons but no "taste" complaints. MAIN OUTCOME MEASURES: Orthonasal and retronasal olfactory functions assessed by olfactory event-related potentials and psychophysical smell tests. RESULTS: Psychophysical testing revealed retronasal olfaction to be normal or slightly altered, whereas orthonasal olfaction was either absent or severely compromised. Findings from nasal endoscopic examinations and computed tomographic scans were within the reference range in all subjects. In response to orthonasal stimulation there were neither detectable olfactory event-related potentials nor any with small amplitudes, whereas olfactory event-related potentials in response to retronasal stimulation were clearly present in some patients. CONCLUSION: These clinical observations, together with the psychophysical and electrophysiological findings, suggest that orthonasal and retronasal olfaction might be processed differently.

Reduced olfactory bulb volume in post-traumatic and post-infectious olfactory dysfunction.

The olfactory bulb is a highly plastic structure the volume of which partly reflects the degree of afferent neural activity. In this study, 22 patients with post-infectious olfactory deficit, nine participants with post-traumatic olfactory deficit, and 17 healthy controls underwent magnetic resonance volumetry of the olfactory bulb. Patients presented with significantly smaller olfactory bulb volumes than controls; significant correlations between olfactory function and bulb volume were observed. Patients with parosmia exhibited smaller olfactory bulb volumes than those without parosmia. Findings indicate that smell deficits leading to a reduced sensory input to the olfactory bulb result in structural changes at the level of the bulb. Reduced olfactory bulb volumes may also be considered to be characteristic of parosmia.