RESUMO
OBJECTIVE: This study demonstrated statistical correlations between a novel self-administered odor questionnaire (SAOQ) and other olfaction tests in patients with olfactory disorders, and the usefulness of this questionnaire was discussed. MATERIALS AND METHODS: Between December 2004 and November 2009 (5 years), the SAOQ was completed by 405 healthy people without any nasal diseases (Group A) and 539 patients with an olfactory disorder (Group B) at the Department of Otolaryngology, Hyogo College of Medicine. This was a prospective study. The SAOQ proposed by the Japan Rhinology Society is a self-administered survey consisting of 20 smell-related items: "steamed rice, miso, seaweed, soy sauce, baked bread, butter, curry, garlic, orange, strawberry, green tea, coffee, chocolate, household gas, garbage, timber, stercus, sweat, flower, and perfume". The normal reference range of scores (%) of the SAOQ was calculated in Group A. To determine whether the results of the SAOQ were correlated with those of visual analogue scale (VAS) and T&T olfactometer, pre- and post-treatment results of the SAOQ and olfaction tests were analyzed. RESULTS: The questionnaire response rates were 99.5% (403/405 people) in Group A and 95.9% (517/539 patients) in Group B. The statistically normal reference level of the SAOQ was determined as more than 70%. In Group B, the mean pre-treatment SAOQ score (20.4%), VAS score (16.5%), and T&T recognition threshold (5.0) significantly improved to values of 46.7%, 41.1%, and 4.1 after treatments, respectively (n=249). Both pre- and post-treatment SAOQ scores (ΔQ) had statistically significant relationships with those of VAS and T&T (n=249). CONCLUSION: The utility of the SAOQ as an easy method of estimating olfaction was suggested.
Assuntos
Odorantes , Transtornos do Olfato/fisiopatologia , Olfato/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Limiar Sensorial , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The objective of this study was to review the various clinical features associated with Wegener's granulomatosis (WG) in the head and neck region and to discuss the difficulty of diagnosing patients with early stage WG. METHODS: Between January 1998 and August 2007, WG was diagnosed and treated in 16 patients at the Department of Otolaryngology, Hyogo College of Medicine. Clinical and operating records of these patients were analyzed retrospectively. Diagnosis was based on the Japanese criteria proposed by the Japanese Ministry of Health and Welfare in 1998. RESULTS: Ten patients (62.5%) had a definite diagnosis of WG, and the other six patients (37.5%) had a probable diagnosis of WG. The period from the onset to diagnosis was between 1 month and 30 years. The generalized form of WG was observed in three patients (18.8%), and the limited form of WG was observed in the other 13 patients (81.2%). Nasal, aural, and ophthalmic symptoms were initially presented in 10, 3, and 3 patients, respectively. Cytoplasmic pattern antineutrophil cytoplasmic antibodies (cANCAs) and perinuclear pattern ANCA (pANCA) were positively detected in 68.8% (11/16) and 27.2% (3/11) of the patients, respectively. Five of 14 patients (35.7%) had pathologic features of WG in biopsy samples from the head and neck region. Three patients in whom a diagnosis of WG was difficult are presented, and immediate lessons of our experience were discussed. CONCLUSIONS: This study emphasized the difficulty of diagnosing WG, particularly at an early stage and when limited to the head and neck region. The biggest challenge faced in diagnosing WG is that it requires a high index of suspicion. When WG was suspected, we should obtain an accurate medical history from patients and repeat serologic and histopathologic examinations.
Assuntos
Granulomatose com Poliangiite/diagnóstico , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Anticorpos Anticitoplasma de Neutrófilos/análise , Sedimentação Sanguínea , Proteína C-Reativa/análise , Otorreia de Líquido Cefalorraquidiano/etiologia , Doenças dos Nervos Cranianos/etiologia , Dacriocistite/etiologia , Diplopia/etiologia , Dor de Orelha/etiologia , Epistaxe/etiologia , Exoftalmia/etiologia , Feminino , Seguimentos , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/imunologia , Perda Auditiva/etiologia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Nariz/anormalidades , Estudos Retrospectivos , Esclerite/etiologia , Zumbido/etiologia , Acuidade VisualRESUMO
This study retrospectively analyzed the clinical features of patients with paranasal sinus cysts. Between April 1995 and March 2008 at Hyogo College of Medicine, we performed sinus surgery on 218 patients with paranasal sinus cysts. There were 125 men and 93 women with the mean age of 57.5 years (17-85 years old). Diagnosis was based on the preoperative endonasal and radiological findings as well as surgical findings. The patients were followed for 6 months or more after surgery. Of 218 patients, postoperative cysts were observed in 173 patients (79.4%), and idiopathic cysts were found in 45 patients (20.6%). In postoperative cysts, the maxillary sinus was the most common lesion (124/173 patients, 71.7%). Most patients (53.8%) presented with cheek swelling and pain. The mean interval between the first and most recent surgery was 31.2 years (4-55 years). Among idiopathic cysts, anterior ethmoid sinus (19/45 patients, 42.2%) and frontal sinus (15/45 patients, 33.3%) were common lesion sites. More than a half of them (53.3%) presented with ophthalmologic symptoms. For treatment, endoscopic sinus surgery (ESS) was performed on 206 patients. The navigation system for ESS was utilized in 6 patients (2.8%). External approaches were required in 23 patients (10.6%). The Caldwell-Luc procedure for maxillary sinus cysts and Killian's procedure for frontal sinus cysts were performed on 18 and 5 patients, respectively. Dacryocystorhinostomy (DCR) with the endonasal approach was additionally performed on 4 patients with epiphora due to postoperative maxillary sinus cysts. Recurrence of cysts was observed in 5 patients (2.3%) at the mean interval of 25 months after surgery, comprising three patients with maxillary sinus cysts, one patient with a frontal sinus cyst, and one patient with a sphenoid sinus cyst. In conclusion, most paranasal sinus cysts (approximately 80%) occurred postoperatively. Symptoms were predominantly ophthalmologic. Selecting an endoscopic and/or an external approach is critical, considering minimally invasive surgery and risk of recurrence.
Assuntos
Cistos/cirurgia , Doenças dos Seios Paranasais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/diagnóstico , Cistos/epidemiologia , Cistos/etiologia , Endoscopia/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Doenças dos Seios Paranasais/diagnóstico , Doenças dos Seios Paranasais/epidemiologia , Doenças dos Seios Paranasais/etiologia , Fatores de Tempo , Adulto JovemAssuntos
Cistos/complicações , Granulomatose com Poliangiite/complicações , Síndromes de Compressão Nervosa/etiologia , Doenças do Nervo Óptico/etiologia , Doenças dos Seios Paranasais/complicações , Cistos/diagnóstico , Feminino , Granulomatose com Poliangiite/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Tomografia Computadorizada por Raios X , Testes de Campo Visual , Campos VisuaisRESUMO
OBJECTIVE: To investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed. METHODS: Thirty-five patients underwent surgery with unilateral (n=32) or bilateral (n=3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points. RESULTS: In unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either. CONCLUSION: These findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.
Assuntos
Nervo da Corda do Tímpano/cirurgia , Orelha Média/cirurgia , Complicações Pós-Operatórias , Distúrbios do Paladar/etiologia , Adolescente , Adulto , Idoso , Criança , Colesteatoma da Orelha Média/cirurgia , Feminino , Seguimentos , Humanos , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Otite Média/cirurgia , Estudos Prospectivos , Recuperação de Função Fisiológica , Inquéritos e Questionários , Língua/inervaçãoRESUMO
OBJECTIVE: To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report. STUDY DESIGN: Prospective study. PATIENTS: Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media. METHODS: Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery. RESULTS: The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%. CONCLUSION: Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Limiar Auditivo , Otite Média/complicações , Perfuração da Membrana Timpânica/cirurgia , Adolescente , Adulto , Idoso , Audiometria de Tons Puros , Criança , Pré-Escolar , Doença Crônica , Estudos de Avaliação como Assunto , Feminino , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Miringoplastia , Otite Média/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Perfuração da Membrana Timpânica/etiologiaAssuntos
Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/etiologia , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Olfato/fisiologia , Esteroides/administração & dosagem , Administração Intranasal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Resultado do TratamentoRESUMO
The odor stick identification test (OSIT) is a new test of olfactory function recently developed for Japanese people. The purpose of the present study was to evaluate this test in relation to T&T olfactometry and the cross-cultural smell identification test (CC-SIT) by applying to 110 Japanese patients with olfactory disturbance. The averaged recognition thresholds for five odorants in T&T olfactometry, the number of correct answers in the CC-SIT and the rates of identification of 13 odorants in the OSIT were compared. The visual analogue scale (VAS) was also used to evaluate symptoms. The rate of identification of OSIT showed high and significant correlation coefficients with the averaged recognition thresholds of T&T olfactometry (-0.766, P < 0.001), with the number of correct answers in CC-SIT (0.754, P < 0.001) and with the VAS score (0.591, P < 0.001). In addition, on the identification performance measured by OSIT, we found significant differences between all pairs of four degrees of olfactory dysfunction except for one pair. Thus, we conclude that OSIT is useful for evaluating olfactory dysfunction in Japanese people.
Assuntos
Transtornos do Olfato/diagnóstico , Povo Asiático , Comparação Transcultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Odorantes , Transtornos do Olfato/etnologia , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: Contact endoscopy is a technique used to obtain detailed images of living epithelium in the fields of gynecology, rhinology and laryngology. Video microscopy is useful for observation of the surface of tongue papillae. In the present study, we attempted to apply the contact endoscopy technique together with video microscopy to observe tongue papillae, and to study the correlation between the condition of fungiform papillae and taste function. METHODS: Ten subjects (3 men, 7 women) were divided into two groups based on the results of a taste examination by electrogustometry. We compared the shape and blood vessels of the papillae between normal taste and taste disorder groups. RESULTS: In the normal taste group, round shaped papillae and clear blood vessels were observed with both microscopy and contact endoscopy. In the taste disorder group, flat and irregular papillae were observed with microscopy. Blood vessel flow of the papillae was observed to be poor with contact endoscopy. CONCLUSION: These findings suggested that the images of microscopy and contact endoscopy were related to taste function, and both techniques were useful for evaluating taste function.
Assuntos
Endoscopia/métodos , Distúrbios do Paladar/diagnóstico , Língua , Gravação de Videoteipe , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microscopia/instrumentação , Pessoa de Meia-Idade , Papilas Gustativas/anatomia & histologia , Papilas Gustativas/irrigação sanguínea , Papilas Gustativas/patologia , Distúrbios do Paladar/etiologia , Língua/anatomia & histologia , Língua/irrigação sanguínea , Língua/patologiaRESUMO
OBJECTIVE: We have observed that, in cases of smell loss, patients often complain of taste loss as well even though they actually have normal gustatory acuity according to gustatory tests; we have defined such symptoms as "flavor disturbance". The clinical features of flavor disturbance are reported in this paper. MATERIAL AND METHODS: A total of 297 patients (99 males, 198 females; mean age 55.5 years) were treated for olfactory disturbance at the hospital of Hyogo College of Medicine between July 1995 and August 2001. Sixty-six out of 297 patients (22.5%) also experienced taste disturbance, and 49 of these 66 cases were evaluated by means of smell and taste tests. These 49 patients who complained of taste and smell loss were classified into two groups according to the results of their smell and taste tests. Patients who only complained of olfactory disturbance were also reviewed. RESULTS: There was no relationship between the severity of olfactory disturbance and the degree of flavor disturbance. The incidence of flavor disturbance was high in patients with sudden olfactory disturbance after upper respiratory tract infection or head trauma and low in those with slowly progressive olfactory disturbance. The symptoms of flavor disturbance improved regardless of whether smell was improved or not. CONCLUSIONS: The patients with flavor disturbance tended to misrecognize that they had taste loss because of sudden smell loss, and there were more of these cases than we expected. When patients with smell and taste loss are treated, flavor disturbance should also be considered.
Assuntos
Transtornos do Olfato/complicações , Distúrbios do Paladar/complicações , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/terapia , Nervos Periféricos/fisiologia , Olfato/fisiologia , Paladar/fisiologia , Distúrbios do Paladar/terapiaRESUMO
To study the recovery of function of the chorda tympani nerve, we examined by electrogustometry 79 patients (83 ears) with both preoperative normal function of the nerve and operative preservation of the nerve, every 2 days during hospitalization and at 6 months after surgery. For symptoms such as tongue numbness and taste disturbance, patients with noninflammmatory (NI) diseases (13/20 or 65.0%) showed a significantly higher rate of symptoms than did patients with chronic otitis media (COM; 13/35 or 37.1%) at 2 weeks after surgery (p = .032). The patients with NI diseases (5/20 or 25.0%) tended to show a higher rate of symptoms than did the COM patients (2/35 or 5.7%) or cholesteatoma patients (2/28 or 7.1%) at 6 months after surgery. The rate of recovery of the EGM threshold to normal at 2 weeks after surgery was significantly lower in NI disease patients (6/20 or 30.0%) than in COM patients (23/ 35 or 62.9%) or cholesteatoma patients (19/28 or 67.9%; p = .015 and .008, respectively). Thus, the patients with NI diseases had postoperative symptoms and elevation of EGM threshold more frequently than did the patients with inflammatory diseases.
Assuntos
Nervo da Corda do Tímpano , Orelha Média/cirurgia , Cirurgia do Estribo , Paladar/fisiologia , Adolescente , Adulto , Fatores Etários , Audiometria , Criança , Pré-Escolar , Colesteatoma da Orelha Média/cirurgia , Implantes Cocleares , Interpretação Estatística de Dados , Orelha Média/anormalidades , Eletrodiagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/cirurgia , Otosclerose/cirurgia , Limiar Gustativo , Fatores de Tempo , Membrana Timpânica/lesõesRESUMO
The purpose of this study was to evaluate the degree of damage in the geniculate ganglion and its target organ as a result of chorda tympani (CT) injury. We performed unilateral transection of the rat CT and examined expression of the activating transcription factor 3 (ATF3), a neuronal injury marker, and the growth-associated protein 43 (GAP-43), a regeneration-associated molecule. The mean proportion of ATF3-immunoreactive (ir) neurons in the geniculate ganglion was approximately 32% at 3 days after CT injury, but these neurons were never detected in the naive ganglion. Using in situ hybridization, the mean percentage of GAP-43 mRNA-labeled neurons (signal : noise ratio > or = 10) was observed to have increased significantly to approximately 60% for 1-7 days after CT injury, while that in the naive ganglion was < 15%. The results of morphological studies using scanning electron microscopy and immunohistochemistry indicated that atrophic change and reduction of protein gene-product 9.5-ir fibers in the denervated papillae, mainly in the intragemmal region, were observed after CT injury. Increase in GAP-43 mRNA, suggesting CT axonal regeneration, may have a role in recovery from taste disorders. However, this regenerative process may be involved in abnormal activity in the axotomized neurons or the adjacent intact neurons and so one must not disregard the existence of injured geniculate ganglions when considering the treatment of diseases that cause CT injury.
Assuntos
Nervo da Corda do Tímpano/lesões , Proteína GAP-43/análise , Gânglio Geniculado/patologia , Fatores de Transcrição/análise , Fator 3 Ativador da Transcrição , Animais , Atrofia , Biomarcadores/análise , Gânglio Geniculado/fisiologia , Imuno-Histoquímica , Masculino , Regeneração Nervosa , Ratos , Ratos Sprague-DawleyRESUMO
The olfactory acuity of 29 patients receiving laryngectomy was prospectively studied. The olfactory acuity was evaluated by Jet Stream Olfactometer (JSO) and Alinamin test preoperatively and at 3, 6 and 12 months postoperatively. The findings of nasal/olfactory mucosae were also observed by rigid endoscope. Based on the results of JSO, the averages of detection/recognition thresholds tended to increase 3 months postoperatively, then the averaged thresholds tended to decrease thereafter. There were significant differences between preoperative values and those 3 months after surgery, but there were no significant differences between preoperative values and these 6/12 months after surgery. Nasal respiratory mucosae observed 12 months after laryngectomy showed atrophic nasal mucosa in 11/14 patients. However, olfactory mucosae appeared normal in all of the patients observed. These results suggested that the function of the olfactory epithelium remained intact after laryngectomy.
Assuntos
Laringectomia/efeitos adversos , Olfato , Idoso , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Nervo Olfatório/fisiologia , Neoplasias da Glândula Tireoide/cirurgia , Fatores de TempoRESUMO
OBJECTIVE: There are few reports about following up olfactory acuity of the patients who have post-traumatic olfactory dysfunction. In this study, we studied about patients with post-traumatic olfactory dysfunction for a short period under a treatment. METHODS: The olfactory function of 27 patients with head trauma was studied. The olfactory acuities of all the patients were examined using olfactory tests before the treatment, and 18 patients were examined again after the treatment. Olfactory functions were evaluated in 26 patients by T&T olfactometry and in 27 patients by Alinamin test. All of the patients were treated with a local injection of suspended steroid solution into the nasal mucosa [J Otolaryngol Jpn 102 (1999) 1175]. RESULTS: Before the treatment, 16 patients (61.5%) presented anosmia, five patients (19.2%) presented severe hyposmia, three patients (11.5%) presented moderate hyposmia, and two patients (7.7%) presented mild hyposmia. Eighteen cases (69.2%) were negative for the Alinamin test and eight cases (30.8%) were positive. The improvement rates of recognition and detection thresholds by T&T olfactometry were 35.3 and 23.5%, respectively. CONCLUSION: Olfactory dysfunction caused by head trauma can be recovered to a limited degree in some cases by the local injection of steroid within the relatively short period from the start of the therapy.