Olfactory Change Research Articles

Long-term Results of Radiofrequency Turbinoplasty for Allergic Rhinitis Refractory to Medical Therapy

To study the long-term outcomes of radiofrequency (RF) turbinate surgery for the treatment of allergic rhinitis refractory to medical therapy. A retrospective review of a prospective data set. Tertiary referral center. A total of 146 patients with allergic rhinitis refractory to medical therapy undergoing RF turbinoplasty were included. A standard 0 to 10 visual analog scale (VAS) was used to assess the allergic symptoms including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes prior to RF turbinoplasty and at 6 months and 5 years postoperatively. The long-term clinical benefits and complications were reviewed. Statistical analysis was determined by repeated measures of analysis of variance. No adverse reactions such as bleeding, infection, adhesions, or olfactory change were encountered. Of the 146 patients, 119 were followed up at least 5 years postoperatively. Five years after treatment, 101 patients had complete data available for analysis. They reported improvement of nasal obstruction, with the mean (SD) VAS score decreasing from 6.65 (1.92) to 4.45 (2.54). The mean (SD) VAS score changed from 5.90 (2.79) to 3.79 (2.97) for rhinorrhea; from 5.15 (2.77) to 3.50 (2.77) for sneezing; from 3.67 (3.03) to 2.41 (2.30) for itchy nose; and from 2.94 (3.02) to 2.02 (2.42) for itchy eyes (all P<.001, paired t test with Bonferroni correction). This long-term study has demonstrated that the RF turbinoplasty for allergic rhinitis appears to be an effective and safe tool for treating allergic rhinitis refractory to medical therapy.

Preoperative Prognostic Factors for Olfactory Change after Functional Endoscopic Sinus Surgery

Functional endoscopic sinus surgery (FESS) has been considered to improve the olfactory function in patients with chronic rhinosinusitis. However, which factors might affect the olfactory outcome after FESS has not been well investigated. A total of 70 patients with chronic rhinosinusitis who underwent FESS were enrolled in the study. The potential prognostic factors for improvement in olfaction after FESS were evaluated in these patients. On the day before FESS, the olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test, the University of Pennsylvania Smell Identification Test, and a short-term odor memory/discrimination test, and were reevaluated by the same methods 6 months after FESS. The degree of nasal obstruction, the second minimal cross-sectional area measured by acoustic rhinometry, computed tomography scores before FESS, the degree of preoperative olfactory loss indicated by threshold and identification scores, and coexistence of nasal polyps or allergic rhinitis were not significantly reliable to influence the rates of olfactory improvement after FESS. Degree of nasal obstruction, extent of rhinosinusitis disease, and coexistence of nasal polyps or allergic rhinitis did not predicate the overall possibility of any olfactory improvement after FESS.

S285 – Long-Term Efficacy of RF Turbinoplasty for Allergic Rhinitis

Objectives To study the long-term outcomes of radiofrequency turbinoplasty for the treatment of allergic rhinitis. Methods 146 consecutive patients who underwent radio-frequency turbinoplasty due to allergic rhinitis refractory to medical therapy were enrolled in this study. A 0–10 visual analog scale (VAS) was used to assess the allergic symptoms including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes preoperatively and 5 years postoperatively. The long-term clinical benefits and complications were reviewed. Statistical analysis was determined by paired t-test. Results None of the patients had obvious discomfort except mild numbness over the teeth (27/146, 18.5%) during operation. No long-term adverse reactions, including bleeding, infection, adhesion, or olfactory change were encountered. 119 patients had a minimum follow-up of 5 years and complete data available for analysis. The response rate was 60.5% (72/119). 18 patients received additional nasal surgery due to no obvious response to the surgery. These patients were excluded from the final analysis. 5 years after the treatment, the other 101 patients obtained improvement of nasal obstruction, with the VAS degree changing from 6.65 ± 1.92 to 4.45 ± 2.54 (p&lt;0.0001). The VASs of rhinorrhea, sneezing, itchy nose, and itching eyes changed from 5.90 ± 2.79 to 3.79 ± 2.97, 5.15 ± 2.77 to 3.50 ± 2.77, 3.67 ± 3.03 to 2.41 ± 2.30 and 2.94 ± 3.02 to 2.02 ± 2.42, respectively (all p&lt;0.0001). Conclusions The long-term study demonstrated that radiofrequency turbinoplasty appears to still be effective and safe for treating allergic rhinitis refractory to medical therapy.

Neural correlates of olfactory change detection

Detecting changes in a stream of sensory information is vital to animals and humans. While there have been several studies of automatic change detection in various sensory modalities, olfactory change detection is largely unstudied. We investigated brain regions responsive to both passive and active detection of olfactory change using fMRI. Nine right-handed healthy, normosmic subjects (five men) were scanned in two conditions while breathing in synchrony with a metronome. In one condition, subjects mentally counted infrequent odors (Attend condition), whereas in the other condition, subjects' attention was directed elsewhere as they counted auditory tones (Ignore condition). Odors were delivered via a nasal cannula using a computer-controlled air-dilution olfactometer. Infrequently occurring olfactory stimuli evoked significant ( P < .05, corrected) activity in the subgenual cingulate and in central posterior orbitofrontal cortex, but only in the Ignore condition, as confirmed by direct comparison of the Ignore session with the Attend session ( P < .05, corrected). Subgenual cingulate and posterior orbital cortex may therefore play a role in detecting discrepant olfactory events while attention is otherwise engaged in another sensory modality.

Olfactory Discrimination and Transient Mood Change in Young Men and Women: Variation by Season, Mood State, and Time of Day

Odor performance varies by clinical state and gender, though little is known about its variation by season or time of day. Many odors, including lavender, induce transient mood changes. This study explored discrimination differences between various lavender oil blends and their effects on transient mood in the morning and evening in depressed and nondepressed adults. We also determined seasonal influences on these measures. A total of 169 subjects, 98 women and 71 men (mean age ± SD, 19.3 ± 1.6 y) participated, with different subjects studied at different times of the year. The Beck Depression Inventory (BDI) classified subjects as depressed (score ≥10; N = 57) or nondepressed (score <10; N = 112). In the discrimination test, subjects compared pairs of two different lavender oil blends or a control. Transient change in mood was assessed by the Profile of Mood States (POMS) after each trial of five lavender blends interspersed by three control odors. Tests were conducted in the morning (08:00–10:00 h) and evening (18:00–20:00 h). In all subjects, discrimination was significantly better for some odor pairs than for others, thus demonstrating test specificity. Discrimination was better overall in the fall than winter/spring and better in depressed than nondepressed subjects for specific odor pairs. No significant gender or time-of-day differences in discriminability were detected. There were, however, significant group differences in transient mood profiles. Current depressed state affected mood response, with lavender increasing anger in depressed subjects only. In addition, depressed subjects and men, whether or not depressed, exhibited diurnal mood variation, with better mood in the evening; the former group also showed more evening energy. All subjects were more confused in the morning than evening. Season also affected transient mood; winter/spring-tested subjects reported more vigor than fall-tested subjects. In addition, summer-tested subjects showed more tension in the morning, whereas fall-tested subjects showed the opposite pattern in the evening. In all subjects, lavender increased fatigue, tension, confusion, and total mood disturbance, and it decreased vigor. The study showed that both chronobiological (seasonal and time-of-day) and clinical factors modify discrimination and mood response to odors. Brief lavender odor presentation may serve as a nonphotic method for altering mood in young depressed and nondepressed adults particularly during the fall, a time of heightened discriminability.

Olfactory Dysfunction in Head Injured Workers

Olfactory dysfunction following trauma has been widely reported and is currently compensable according to existing American Medical Association guidelines when it occurs in the occupational setting. Its presence and the risk factors for its development, however, have not been clearly delineated in occupationally head injured workers. In order to assess this phenomenon, a series of 365 consecutive head injured workers from 1993-1997 was assessed in order to determine the incidence of post-traumatic olfactory dysfunction and its association with the severity of the head injury, the mechanism of injury and other neurotological abnormalities in the same cohort group. Olfactory dysfunction was identified in 13.7% (9.3% with anosmia, 4.4% with hyposmia/dysosmia). It was more likely where the loss of consciousness >1 h ( p <0.002), in more severe head injuries (grades II-V) ( p <0.001) and when skull fracture ( p <0.001) occurred. The direction of the blow applied to the skull did not influence its presence, although radiologically confirmed skull fractures in the frontal, occipital, skull base and midface were twice as likely as temporal and parietal fractures to result in an olfactory change. From a neurotologic perspective, approximately 21.9% of head injured workers were determined to have recognizable evidence of cochleovestibular dysfunction. Olfactory dysfunction as a physical finding post-head injury compares favourably with the presence of post-traumatic benign positional paroxysmal vertigo (BPPV) and its atypical variants in 11.2% of head injured workers.

労災による頭部外傷後のきゅう覚障害 障害発生の因子解析を中心に

Olfactory dysfunction following head trauma has been widely reported, but the risk factors regarding its development have not been fully elucidated. Therefore, 365 head injury patients, who were examined by the senior author (JAR) in Canada between 1993 and 1997, were assessed to determine the incidence of posttraumatic olfactory dysfunction and its association with the severity of head injury and the mechanism of injury in the same cohort group.Olfactory dysfunction was identified in 13.7% (9.3% with anosmia, 4.4% with hyposmia). It occurred more often in cases of loss of consciousness >1hr (p=0.0005), severe head injuries (grade I vs III: p=0.000001) (grade I vs V; p<0.00001) and skull fractures (p=0.0001). The direction of the blow applied to the skull did not influence its presence although radiologically confirmed skull fractures in the frontal, occipital, skull base and midface were more likely than temporal and parietal fractures to result in an olfactory change (p<0.01).Moreover by multivariate analysis, hypogeusia, nasal bone fracture, occipital bone fracture, skull base fracture, and positive rhinoscopic findings were found to be the most valuable or most closely related factors/conditions in that order among 46 factors that were initially presumed to cause posttraumatic smell disorder.