[The forgotten cranial nerve--clinical importance of olfaction].
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Abstract:
Hyposmia is often undiagnosed despite the known negative effect on taste, appetite and life quality. However, a new focus on the first cranial nerve has emerged as a consequence of a discovered connection between neurodegenerative disorders and hyposmia. In Parkinson's disease and Alzheimer's disease hyposmia is not only one of the earliest clinical presentations, the degree of hyposmia also correlates with the later progression of these two conditions. Hyposmia should not be ignored nor accepted; instead it should be integrated in any neurological examination, especially in elderly patients.Keywords:
Hyposmia
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Hintergrund: Die Prüfung des Geruchssinnes gewinnt zunehmend an klinischer Bedeutung. Basierend auf Riechdisketten, einer neuartigen Applikationsart von Riechstoffen, wurde ein Screeningtest des Geruchssinnes entwickelt und validiert. Material und Methode: Grundlage des Tests waren 8 verschiedene Riechstoffe, welche mit wiederverwendbaren Disketten appliziert wurden. Der Test wurde konzipiert als triple forced multiple choice test, so dass man als Resultat ein Score von 0-8 richtigen Antworten erhielt. Um den Test zu validieren, wurde dieser bei 91 Probanden mit normalem Geruchssinn sowie bei 13 Probanden mit Hyposmie oder Anosmie durchgeführt. Zusätzlich führten dieselben Probanden auch den sniffin* sticks Test durch, einen bereits validierten Screeningtest des Geruchssinnes. Resultate: Unter den 91 Probanden mit normalem Geruchssinn erreichten im Diskettentest 10 einen Score von 7 Punkten und 81 den Maximalwert von 8 Punkten. Die 13 Probanden mit Hyposmie oder Anosmie wiesen Werte zwischen 0 und 5 Punkten auf. Aufgrund des Testdesigns besitzen Probanden mit einem Score von 7 oder 8 Punkten mit 99,74% Wahrscheinlichkeit einen normal funktionierenden Geruchssinn. Im sniffin' sticks Test erreichten 85 der Probanden mit subjektiv normalem Geruchssinn einen Score im Normbereich, 6 lagen knapp darunter. Von den 13 Probanden mit subjektiver Hyposmie oder Anosmie wurden im sniffin' sticks Test 12 als pathologisch erkannt, bei einem Probanden lag der Score im Normbereich. Schlußfolgerungen: Der entwickelte Screeningtest mit Riechdisketten erkennt Probanden mit normal funktionierendem Geruchssinn und kann diese von Probanden mit Hyposmie oder Anosmie abgrenzen. Die verwendeten Riechdisketten erwiesen sich als zuverlässig und komfortabel und bieten sich als Alternative zu anderen Applikationsformen von Riechstoffen an.
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OBJECTIVE: To assess the role of endoscopic treatment in patients of chronic rhinosinusitis.DESIGN: Prospective study; interventional type; randomised design.METHOD: 32 patients with chronic rhinosinusitis treated by Endoscopic Sinus Surgery (ESS) were analyzed.They were studied from July 2012 to May 2013.Surgery was performed under general anaesthesia and various procedures were performed depending upon the pathology detected in the clinical and radiological examinations.Patients were followed post operatively regularly with nasal endoscopy and their improvement of symptoms noted at 3 months and 6 months and complication if any taken care of in between.RESULTS: Facial pain was subsided in 14 out of 17 patients, showing improvement in 82% of patients.Nasal obstruction was relieved in 24/27 patients which is improvement in 88%.Nasal discharge was subsided in 16/18 patients.Hyposmia and Anosmia were improved in 81% (09/11) of the patients.83% (15/18) improvement was seen in patients complaining of headache.Overall improvement of symptoms was observed in 27 out of 32 patients that is 84.4 % of patients at 6 months of follow up.CONCLUSION: Endoscopic sinus surgery succeeds in providing above 80% symptom relief to the patients.Complications in sinus surgery are minimal in experienced hand.Endoscopic surgery is the definitive treatment of chronic rhinosinusitis in patients not responding to medical therapy. INTRODUCTION:Chronic rhinosinusitis is one of the most frequent otolaryngologic disease encountered.(Black well DL et al) 1 A general histopathological definition of sinusitis is inflammation of the nasal and the paranasal sinus mucosa.In addition osteitis of the underlying bone can occur.(Giacchi RT et al) 2 Previously a distinction was made between rhinitis (symptoms centered on nasal cavity) and sinusitis (symptoms centered on the paranasal sinus).Clinical experience has taught that the contiguous lining of the nose and the sinuses are affected.Therefore, the term sinusitis was expanded to rhinosinusitis.(Lanza DC et al, Lund VJ et al) 3,4 Children less than 15 years and adult between the age of 25 and 64 years are more frequently affected.(Annon J, Glikich R 1995, Kaliner M 1997) 5,6 The location and extent of different rhinosinusitis pathological condition implies a detailed knowledge of the anatomic organization of the paranasal sinuses and first and foremost of the ethmoid sinuses.The structures of the lateral nasal wall and paranasal sinuses fall into two anatomically and physiologically distinct categories: the anterior and the posterior ethmoid complex.The basal lamella of the middle turbinate is the clear and distinct separation between the two ethmoid complexes, according to definition, patterns of mucociliary transports and embryological development.The ostiomeatal complex is a functional entity of the anterior ethmoid complex that represent the final common pathway for drainage and ventilation of the frontal, maxillary and the anterior ethmoid cells.(Kennedy DW 1995) 7
Chronic Rhinosinusitis
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A screening test of olfaction was developed with reusable diskettes as applicators of 8 different odorants. Using a questionnaire with illustrations, the test was designed as a triple forced multiple choice test resulting in a score of 0 to 8 correct answers. To validate the test, 102 volunteers with normal olfaction, as well as 22 patients with subjective hyposmia or anosmia, were tested. To compare the developed test with an already validated method, the same persons also performed the sniffin' sticks screening test. The results indicate that the screening test with smell diskettes recognizes patients with normal olfaction and consistently distinguishes them from patients with hyposmia or anosmia.
Hyposmia
Anosmia
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Objective: To investigate the reasons of olfaction disorders in children. Method:121 children with olfaction disorders were detected by olfaction test, nasal endoscope and CT.Result: Among the 121 cases,103 cases were hyposmia, 29 cases were anosmia, in which one side was hyposmia ,the other side was anosmia in 11 cases. There were 54 cases(43.0%) with chronic sinusitis, 29 cases(24.0%) with allergic rhinitis,14 cases(11.6%) with nasal polyps and chronic rhinitis,atrophic rhinitis,etc. Conclusion: Chronic sinusitis is the main reason of children olfaction disorders, besides it, allergic rhinitis should be considered.
Hyposmia
Anosmia
Nasal Polyps
Chronic sinusitis
Nose diseases
Chronic Rhinosinusitis
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Olfactory disorders frequently occur in rhinological disease. Different subjective and objective test methods are available to assess the sense of olfaction. Among the subjective methods, screening tests and threshold measurements are commonly used to quantify hyposmia or anosmia. Qualitative methods are available using discrimination and identification tests. Objective methods are used in research and in some medicolegal situations. Objective tests include olfactory evoked potentials, functional Magnetic Resonance Imaging and functional Positron Emission Tomography. The measurement of the sense of smell helps to assess the whole spectrum of the effects of nasal disease. This is especially important before rhinological surgery, because a non-detected smell disorder in patients with rhinological disease is common. The assessment of a pre-existing hyposmia or anosmia helps to avoid a postoperative claim that this was caused by surgery. A variety of validated screening tests for olfaction is available and they are a useful tool to document whether a patient is able to smell.
Hyposmia
Anosmia
Rhinology
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Background
Olfactory loss is common in Parkinson’s disease (PD), can distinguish PD from other disorders, and may even identify prodromal PD. However, olfaction worsens with ageing, and is poorer in men than women, so clear definitions are required to interpret olfaction test results.Objectives
To collate types of olfaction identification tests used in the assessment of PD, and the definitions for hyposmia that were used.Methods
Published papers with original data using olfaction identification tests in patients with PD, or possible prodromal PD, were categorised according to the methods used.Results
Four main methods of commercially produced olfaction testing were reported. Analysis methods varied as follows: (1) Raw score values (number of items correct/total number of items), sometimes using age/sex matching with controls, or applying age and/or sex as a covariate in statistical analysis; (2) Cut-offs from score values to categorise as normosmic/hyposmic, although different cut-points were applied between some studies; or (3) Values below age- and sex-derived centiles or standard deviations.Conclusions
Significant variations in methods for testing olfaction and defining hyposmia are problematic. However, standardisation of the definition of hyposmia in PD in future studies is feasible, based on a minimum set of age and sex stratification criteria.Hyposmia
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Middle turbinate (MT) lateralization is one of the common causes of endoscopic sinus surgery (ESS) failure and often necessitate revision surgery. To avoid this sequala, surgeons have attempted several methods to keep the MT medialized. One such method is conchopexy. However, the impact of this procedure on olfaction remains unclear.A retrospective cohort study was conducted to compare the subjective olfaction outcome of ESS in patients for whom conchopexy was performed and in controls where a spacer was applied in the middle meatus. Also, the risk of lateralization in both techniques was compared. In addition, other factors related to the outcome of olfaction, such as age, gender, type of chronic rhinosinusitis (CRS), and partial resection of the MT, were assessed.Out of 299 patients with CRS who underwent ESS, 134 met our inclusion criteria. In total, 62.7% were male and 37.3% were female, and their mean age was 37.4 years. Sixty-one patients (cases) underwent conchopexy, and 73 patients (controls) underwent insertion of a middle meatus spacer. None of the subjects in both groups developed anosmia or hyposmia as a complication. The improvement of olfaction was almost equal in both groups (for anosmia: 92.9% in cases vs. 87.5% in control; for hyposmia 87.1% in cases vs. 89.7% in control). In patients with anosmia, the improvement of olfaction was lower when the MT was partially resected (71.4% vs. 95.7%); whereas, in patients with hyposmia, the improvement was not significantly different (87% vs. 93.8% when the MT was partially resected). The improvement of olfaction was higher in patients with allergic fungal sinusitis (AFS) and CRS with nasal polyps (CRSwNP) than in those with CRS without nasal polyps (CRSsNP). The MT lateralization was almost equal in both groups (9.0% in cases vs. 9.6% in controls).Conchopexy does not affect olfaction subjectively. The improvement of olfaction is related more to the underlying disease, i.e., less improvement occurs in cases of CRSsNP. The risk of lateralization is equal with either conchopexy or middle meatus spacer.
Hyposmia
Anosmia
Meatus
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