Possible effects of low testosterone levels on olfactory function in males / Possíveis efeitos dos baixos níveis de testosterona na função olfativa em homens

Abstract Introduction: Functions attributed to androgens have increased, ranging from the role in hypothalamic-pituitary-gonadal axis and reproductive behaviors to modulation of cognition, mood and some other functions. Sex differences and changes in circulating sex hormones affect human sensory function. In the literature, authors reported this kind of influence for olfaction predominantly in females. Objective: To investigate the effects of low testosterone levels on olfactory functions in males, in this prospective clinical study. Methods: Male patients diagnosed with prostate cancer were included. Thirty-nine patients with prostate cancer whose testosterone levels were lower than 50 ng/dL due to castration, were the study group. Thirty-one patients with prostate cancer who were not castrated with testosterone levels higher than 50 ng/dL were selected as the control group. Acoustic rhinometry and peak nasal inspiratory flow tests were performed for all participants; and for evaluation of olfactory function, both groups completed the Connecticut chemosensory clinical research center olfactory test. Results: The mean ages of the patients and controls were 69.6 ± 7.2 (57-89) and 66.3 ± 5.8 (50-78) years, respectively (= 0.039). There was a significant difference between groups in terms of testosterone levels (p < 0.0001). The multivariate logistic regression revealed testosterone level as the only predictive factor determining the difference between the groups. In terms of olfactory parameters, all scores were lower in the emasculated group (butanol threshold test p = 0.019, identification p = 0.059, and Connecticut center score p = 0.029) There was a significant correlation between testosterone levels and olfactory parameters (p = 0.023; p = 0.025 for identification and Connecticut center scores, respectively). Conclusion: Low testosterone levels in males have negative effects on olfactory functions. Further molecular research is required to understand the connection between testosterone and olfaction.

Resumo Introdução: As funções atribuídas aos andrógenos aumentaram, variam desde o papel no eixo hipotálamo-hipófise-gonadal e comportamentos reprodutivos até a modulação da cognição, humor e outras funções. As diferenças entre os sexos e as mudanças nos hormônios sexuais circulantes afetam a função sensorial humana. Na literatura, os autores relataram esse tipo de influência para o olfato, principalmente no sexo feminino. Objetivo: Investigar os efeitos dos baixos níveis de testosterona nas funções olfativas em homens, neste estudo clínico prospectivo. Método: Pacientes do sexo masculino com diagnóstico de câncer de próstata foram incluídos no estudo. Compreenderam o grupo de estudo 39 pacientes com câncer de próstata cujos níveis de testosterona eram inferiores a 50 ng/dL devido à castração. Foram determinados como grupo controle 31 pacientes com câncer de próstata que não foram emasculados, com níveis de testosterona superiores a 50 ng/dL. Testes de rinometria acústica e pico de fluxo inspiratório nasal foram feitos para todos os participantes; e para avaliação da função olfativa, ambos os grupos concluíram o teste olfativo do Connecticut chemosensory clinical research center. Resultados: A média da idade dos pacientes e controles foi de 69,6 ± 7,2 (57 ± 89) e 66,3 ± 5,8 (50 ± 78) anos, respectivamente (= 0,039). Houve uma diferença significante entre os grupos em relação a níveis de testosterona (p < 0,0001). A regressão logística multivariada revelou o nível de testosterona como o único fator preditivo que determinou a diferença entre os grupos. Em termos de parâmetros olfativos, todos os escores foram menores no grupo castrado (teste do limiar de butanol p = 0,019, identificação p = 0,059 e escore do Connecticut center p = 0,029). Houve uma correlação significante entre o nível de testosterona e os parâmetros olfativos (p = 0,023; p = 0,025 para identificação e escore do Connecticut center, respectivamente). Conclusão: Baixos níveis de testosterona em homens têm efeito negativo na função olfativa. Mais pesquisas moleculares são necessárias para entender a conexão entre testosterona e olfação.

Possible effects of low testosterone levels on olfactory function in males.

INTRODUCTION: Functions attributed to androgens have increased, ranging from the role in hypothalamic-pituitary-gonadal axis and reproductive behaviors to modulation of cognition, mood and some other functions. Sex differences and changes in circulating sex hormones affect human sensory function. In the literature, authors reported this kind of influence for olfaction predominantly in females. OBJECTIVE: To investigate the effects of low testosterone levels on olfactory functions in males, in this prospective clinical study. METHODS: Male patients diagnosed with prostate cancer were included. Thirty-nine patients with prostate cancer whose testosterone levels were lower than 50ng/dL due to castration, were the study group. Thirty-one patients with prostate cancer who were not castrated with testosterone levels higher than 50ng/dL were selected as the control group. Acoustic rhinometry and peak nasal inspiratory flow tests were performed for all participants; and for evaluation of olfactory function, both groups completed the Connecticut chemosensory clinical research center olfactory test. RESULTS: The mean ages of the patients and controls were 69.6±7.2 (57-89) and 66.3±5.8 (50-78) years, respectively (p=0.039). There was a significant difference between groups in terms of testosterone levels (p<0.0001). The multivariate logistic regression revealed testosterone level as the only predictive factor determining the difference between the groups. In terms of olfactory parameters, all scores were lower in the emasculated group (butanol threshold test p=0.019, identification p=0.059, and Connecticut center score p=0.029) There was a significant correlation between testosterone levels and olfactory parameters (p=0.023; p=0.025 for identification and Connecticut center scores, respectively). CONCLUSION: Low testosterone levels in males have negative effects on olfactory functions. Further molecular research is required to understand the connection between testosterone and olfaction.

The Prevalence of Tonsillar Human Papilloma Virus Infection in Istanbul, Turkey: A Human Cadaver Study.

OBJECTIVE: To investigate the prevalence of tonsillar human papillomavirus infection in Istanbul, the most populous city of Turkey. METHODS: Tonsil specimens were obtained from 206 cadavers aged 18 to 89 years. Tonsillectomy was performed during routine autopsy for each subject in the 24 hours after death. After dissolution, tissues were processed with the polymerase chain reaction (PCR) method to identify HPV DNA. The data obtained from the DNA sequencer were processed in the database of GenBank®. RESULTS: One hundred sixty-six (80.6%) male and 40 (19.4%) female cadavers were included in the study. One case demonstrated HPV-16, one had HPV-82, one had HPV-55 and one had HPV-13. All four cases were male. Prevalence of tonsillar HPV was 1.94% and of HPV 16 was 0.48%. CONCLUSION: The prevalence of tonsillar HPV infection was found 1.94% and of HPV 16 0.48% in our study.

Salivary Eosinophil Cationic Protein in Allergic Rhinitis.

OBJECTIVE: Eosinophil cationic protein (ECP) plays a significant role in the pathogenesis of atopic diseases such as allergic rhinitis (AR) and asthma. Using saliva as a diagnostic material is a non-invasive, simple method. Analysis of ECP in saliva was shown as an alternative diagnostic contribution in patients with asthma. In this study we aimed to assess a possible association between the levels of salivary ECP and the diagnosis of AR by comparing serum ECP and salivary ECP levels. METHODS: Thirty-five allergic rhinitis patients (study group) sensitive to Dermatophagoides farinae (D2) in skin prick test (SPT) and 35 nonallergic, SPT negative, healthy volunteers (control group) were included in the study. Salivary ECP, serum ECP and specific IgE D2 levels were measured. RESULTS: Distribution of age and gender were similar in the study and the control groups (p>0.05). Serum specific IgE D2 levels were significantly higher in the study group compared to the control group (p<0.001). ECP levels in saliva and serum did not show any significant difference in between study and control groups (p=0.738; p=0.796, respectively). No significant difference was found between the levels of ECP in between the serum and the saliva of study and control groups. (p=0.504; p=0.589, respectively). There was no significant correlation between saliva and serum ECP levels of both groups.(r=-0.191/p=0.114). CONCLUSION: Serum and saliva ECP levels seem close to each other and were comparable in both groups, but we did not find any correlation between them Although we hypothesized that saliva ECP may be used as a non-invasive method for the diagnosis of AR, it seems that this parameter is not helpful in diagnosis of AR.

The Impact of Septal Deviation on Intranasal Schirmer Test Values.

OBJECTIVE: Intranasal Schirmer test serves as an objective measurement for evaluation of nasal secretion and humidity. This study aimed to evaluate the effect of septal deviation on nasal secretion and humidity by measuring the intranasal Schirmer test values in patients who had septal deviation and compare it to the values of our healthy volunteers. METHODS: The study included 52 patients with nasal septum deviation and 52 volunteers without any rhinologic complaints or deviated nasal septum. Intranasal Schirmer test was performed to all patients and volunteers for both nasal cavities. RESULTS: The intranasal Schirmer test values of the convex (deviated) side were lower than that of the concave (non-deviated) side (20.71 and 23.35 respectively); although this difference was not statistically significant (p=0.054,). After excluding the four patients with equal Schirmer test results on both sides, 70% (34/48) of our patients had lower intranasal Schirmer test values on the deviated side. There was no statistically significant difference between the Schirmer test values of the patients with septal deviation and the volunteers without septal deviation (p>0.05). CONCLUSION: The Schirmer test values of the deviated sides were less than the values of the contralateral side in majority of our patients. This finding supports the negative effect of nasal septum deviation on nasal humidification, although the difference did not reach statistical significance.

The seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in patients undergoing septoplasty / Soroprevalência de hepatite B, hepatite C e vírus da imunodeficiência humana em pacientes submetidos a septoplastia

Abstract Introduction Worldwide, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus are major health problems. Healthcare workers are at risk of transmitting blood-borne viruses, and surgeons have a higher risk of exposure to blood and higher rates of percutaneous injury than other healthcare workers. Septoplasty is among the 3 most commonly performed otolaryngological surgeries worldwide. Objective To determine the seroprevalence of Hepatitis B surface antigen, Hepatitis C virus antibody, and Human Immunodeficiency Virus antibody in patients undergoing septoplasty with and without turbinate surgery under general anesthesia, and to determine if preoperative testing should be performed in such patients. Methods This retrospective cross-sectional study included 3731 patients that underwent septoplasty with and without turbinate surgery between January 2005 and July 2015. HBsAg, anti-HCV, and anti-HIV seropositivity in the patients was evaluated retrospectively. Results Mean age of the patients was 36 years (range: 11-81 years). In all, 117 (3.6%) patients were positive for HBsAg, 12 (0.3%) were positive for anti-HCV, and 7 (0.2%) were positive for anti-HIV. Conclusions Education of healthcare workers combined with routine preoperative serological testing in patients undergoing septoplasty under general and local anesthesia are needed to increase awareness of hepatitis B and C, and HIV infection among healthcare workers and patients in order to decrease the transmission rate.

Resumo Introdução No mundo todo, os vírus da hepatite B (VHB), da hepatite C (VHC) e da imunodeficiência humana (HIV) são problemas de saúde importantes. Os profissionais de saúde correm o risco de contrair vírus transmitidos pelo sangue e os cirurgiões têm um maior risco de exposição ao sangue e taxas mais elevadas de lesões percutâneas do que os outros profissionais de saúde. A septoplastia está entre as três cirurgias otorrinolaringológicas mais comumente feitas em todo o mundo. Objetivo Determinar a soroprevalência de anticorpos HBsAg, anti-HCV e anti-HIV em pacientes submetidos a septoplastia com e sem cirurgia de concha nasal sob anestesia geral e determinar se deve ser feito teste pré-operatório nesses pacientes. Método Este estudo transversal retrospectivo incluiu 3.731 pacientes submetidos à septoplastia com e sem cirurgia de concha nasal entre janeiro de 2005 e julho de 2015. A soropositividade para HBsAg, anti-HCV e anti-HIV nos pacientes foi avaliada retrospectivamente. Resultados A idade média dos pacientes foi de 36 anos (intervalo: 11-81); 117 (3,6%) foram positivos para HBsAg, 12 (0,3%) para anti-HCV e sete (0,2%) para anti-HIV. Conclusões A educação de profissionais de saúde combinada com testes sorológicos rotineiros pré-operatórios em pacientes submetidos a septoplastia sob anestesia geral e local é necessária para aumentar a conscientização sobre a hepatite B e C e a infecção pelo HIV entre profissionais de saúde e pacientes para diminuir a taxa de transmissão.

Ototoxicity associated with topical administration of diclofenac sodium as an otic drop: An experimental animal study.

OBJECTIVES: The aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration. METHODS: Twenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated. RESULTS: No significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups. CONCLUSION: Diclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.

How does radioactive iodine affect the nose?

OBJECTIVES/HYPOTHESIS: To determine the effect of radioactive iodine (RAI) treatment on the nasal mucosa and nasal functions. STUDY DESIGN: Prospective clinical study. METHODS: This study included 41 patients (31 female and 10 male) who were treated with RAI for papillary thyroid carcinoma. A visual analogue scale (VAS) was used for subjective evaluation of nasal symptoms. The saccharine test, nasal Schirmer test, and acoustic rhinometry were used for objective evaluation of nasal functions. All tests were administered at baseline (before RAI treatment), and then 1 month and 1 year post-RAI treatment. Only 21 of the patients could be evaluated after 1 year of treatment and were included in the study's analysis. RESULTS: VAS obstruction and dryness scores 1 month and 1 year post-RAI were significantly higher than the baseline scores (P < .05 and P < .05, respectively). Mean cross-sectional area values 1 month and 1 year post-RAI did not differ significantly from baseline values (P > .05 and P > .05, respectively). Schirmer test results 1 month and 1 year post-RAI treatment were significantly lower than at baseline (P < .05 and P < .05, respectively). Saccharine test results 1 month and 1 year post-RAI were significantly higher than at baseline (P < .05). CONCLUSIONS: RAI treatment can adversely affect the nasal mucosa. Nasal dryness and obstruction can occur immediately after RAI treatment. Additional research is warranted to further elucidate the effects of RAI treatment on nasal function. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2698-2702, 2017.

Long-term results of pillar implant procedure.

OBJECTIVES: This study aims to investigate the long-term efficiency and reliability of the Pillar Implant (PI) procedure. PATIENTS AND METHODS: Between January 2008 and January 2010, a total of 27 patients (16 males, 11 females; mean age 45.8±7.2 years; range 31 to 58 years) who were diagnosed with low obstructive sleep apnea syndrome and simple snoring underwent the PI procedure in this retrospective, nonrandomized study. The patients were evaluated preoperatively with visual analog scale (VAS) scores in terms of snoring, dysphagia, mouth dryness, foreign body sensation, and pain at the first month, third month, and sixth year intervals. RESULTS: Based on the snoring scale, VAS scores were statistically significantly lower in the first month, third month and sixth year compared to preoperative scores (p=0.001, p=0.008, p=0.017, respectively). There was no pain in any patients beyond the third day. The VAS score averages in all evaluations were higher by statistical significance relative to the preoperative averages (p=0.018, p=0.027, p=0.025, respectively). Mouth dryness was encountered in seven patients. It persisted in seven patients at the third month and in five patients at the sixth year interval. The VAS score averages were statistically significantly higher in all evaluations compared to the preoperative scores (p=0.017, p=0.018, p=0.042, respectively). CONCLUSION: Pillar implant is an efficient, reliable method in the long-term; however, it should be considered that it could cause complaints such as dysphagia, foreign body sensation, and mouth dryness.

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses.

OBJECTIVE: Fine-needle aspiration biopsy (FNAB) is widely used in the management of salivary gland masses. Its main advantage is its ability to differentiate benign from malignant disease. In this study, we aimed to evaluate the diagnostic ability of FNAB in salivary gland masses. METHODS: The records of patients who had undergone FNAB before parotidectomy or submandibular gland excision between 2005 and 2013 were retrospectively analyzed. FNAB results were classified as negative, positive, suspicious for malignancy, and non-diagnostic. Preoperative FNAB results were compared with definitive histopathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB results were calculated. RESULTS: A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%). The sensitivity, specificity, PPV, NPV and accuracy of FNAB results were 76.9%, 95.4%, 75%, 95.9%, and 92.6%, respectively. The rate of a suspicious cytology was 5.2% (15 patients) and that of a non-diagnostic cytology was 8.8% (25 patients). CONCLUSION: FNAB is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counselling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results.

Effect of anti-adhesive barrier use on laryngotracheal movement after total thyroidectomy: an electrophysiological study.

Impairment of laryngotracheal movement is a possible complication after total thyroidectomy. Here, we aimed to investigate the frequency and extent of impairment of laryngotracheal movement after total thyroidectomy and the effect of anti-adhesive barrier hyaluronic acid-carboxymethylcellulose membrane positioning between strap muscles and laryngotracheal complex on deglutition. The study design is prospective clinical study. Istanbul Training and Research Hospital, Laboratory of Electrophysiology, Istanbul Training and Research Hospital. The patients who underwent total thyroidectomy were selected and dichotomized according to use of seprafilm. Each group consisted of 8 female patients. All patients were assessed clinically and electrophysiologically in the pre/postop period. Electrophysiological investigations included cricopharyngeal muscle (CPM) electromyography (EMG), submental EMG, single bolus analysis [foreburst, reburst, swallowing (pause) patterns], laryngotracheal movement analysis and results were compared between two groups. CPM EMG was normal in both groups. Duration of submental muscle activity during dry and 15 cc water swallowing was similar between two groups (P = 0.751). Pause duration was shorter in group with seprafilm (P < 0.01). Dysphagia limit was 15 cc in both groups. The fore/rebound bursts duration, the time of laryngeal elevation, closure and suspension were similar (P = 0.954). We concluded that use of seprafilm between larynx and strap muscles during total thyroidectomy does not have any adverse effects on swallowing. Anti-adhesive barrier can be used safely during thyroid surgery.

The role of matrix metalloproteinases in recurrent tonsillitis.

OBJECTIVE: The aim of this study was to investigate the status of matrix metalloproteinases (MMP-2, MMP-7, MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) due to dysregulated turnover of connective tissue matrices in children with recurrent tonsillitis (RT). METHODS: Forty-four patients with RT were enrolled in the study. All patients with RT were graded according to the hypertrophy degree of the tonsillar tissue from grade I to grade IV. Patients with grade I tonsillar hypertrophy and grade II tonsillar hypertrophy were accepted as group A, patients with grade III tonsillar hypertrophy and grade IV tonsillar hypertrophy were accepted as group B Tonsillectomy was performed via the usual dissection-snare method. Tonsillar specimens of superficial and core region were evaluated for MMP-2, MMP-7, MMP-9 and TIMP-1 analysis. RESULTS: There was no statistical significance according to the MMP-2, MMP-7, MMP-9 and TIMP-1 activity of superficial part and core regions in both groups individually, MMP-9 level of both the superficial and core regions in group B had statistical significant higher results than group A (p=0.026, p=0.06 respectively). MMP-7 level of the superficial part in group B patients also had statistical significant higher results than group A (p=0.025). However, there was no statistical difference found between superficial and core region MMP-2 and TIMP-1 levels of group A and group B. Related to this, balance between MMP-7-9 and TIMP-1 activities tended to slip MMP-7 and MMP-9 sides with increased tonsillar grade. CONCLUSIONS: Results from this study suggest that the presence of MMPs in tonsil tissue consolidates the involvement of degraded extracellular matrix proteins in the pathophysiology of chronic tonsillitis. MMPs activity showed diffuse dissemination in the tonsillar tissue and especially MMP-9 and MMP-7 are the main promoters of the extracellular matrix that responded to inflammatory changes in the tonsillar tissue. Further studies are needed concerning the possible efficiency of selective MMP inhibitors on tonsillar tissue.