Chemosensory function in Wegener's granulomatosis: a preliminary report

Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips” and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patient

Longitudinal Testing of Olfactory and Gustatory Function in Patients with Multiple Sclerosis

Background The aim of the study was to investigate changes of the olfactory and gustatory capacity in patients with multiple sclerosis (MS). Methodology 20 MS patients were tested longitudinally for 3 years after initial testing. The Threshold Discrimination Identification test (TDI) was used for subjective olfactometry. Objective olfactometry was performed by registering olfactory evoked potentials (OEP) by EEG. The Taste Strip Test (TST) was used for gustatory testing. Results 45% of the patients showed olfactory dysfunction in the follow-up TDI test and 50% showed delayed OEP´s. 20% of the patients showed gustatory dysfunction on follow-up visit. The patients showed mild disease activity with 0,3 ± 0,5 relapses over the testing period and no significant change of their olfactory and gustatory capacity. The olfactory capacity for the discrimination of odors correlated inversely with the number of relapses (r = -0.5, p ≤ 0.05). The patients were aware of their olfactory deficit. Conclusions Olfactory and gustatory dysfunction is a symptom in MS patients and may be a useful parameter to estimate disease progression in MS patients. As the discrimination of odors is processed in higher central regions of the central nervous system (CNS), the results suggest that olfactory dysfunction could be due to CNS damage

Persistierende Riechminderung nach COVID-19 – Empfehlungen der Arbeitsgemeinschaft Olfaktologie und Gustologie der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Der Artikel soll die existierende Literatur zu mit COVID-19 („coronavirus disease 2019“) assoziierten Riechstörungen nicht vollständig aufarbeiten, sondern die für die HNO-ärztliche Praxis relevanten Forschungserkenntnisse zusammenfassen sowie Empfehlungen zur Diagnostik und Therapie bei persistierenden Riechstörungen nach COVID-19 geben

Reduced Mass and Diversity of the Colonic Microbiome in Patients with Multiple Sclerosis and Their Improvement with Ketogenic Diet

Background: Colonic microbiome is thought to be involved in auto-immune multiple sclerosis (MS). Interactions between diet and the colonic microbiome in MS are unknown. Methods: We compared the composition of the colonic microbiota quantitatively in 25 MS patients and 14 healthy controls.Fluorescence in situ hybridization (FISH) with 162 ribosomal RNA derived bacterial FISH probes was used. Ten of the MS patients received a ketogenic diet for 6 months. Changes in concentrations of 35 numerically substantial bacterial groups were monitored at baseline and at 2, 12, and 23/24 weeks. Results: No MS typical microbiome pattern was apparent.The total concentrations and diversity of substantial bacterial groups were reduced in MS patients (P < 0.001). Bacterial groups detected with EREC (mainly Roseburia), Bac303 (Bacteroides), and Fprau (Faecalibacterium prausnitzii) probes were diminished the most. The individual changes were multidirectional and inconsistent. The effects of a ketogenic diet were biphasic. In the short term, bacterial concentrations and diversity were further reduced. They started to recover at week 12 and exceeded significantly the baseline values after 23–24 weeks on the ketogenic diet. Conclusions: Colonic biofermentative function is markedly impaired in MS patients.The ketogenic diet normalized concentrations of the colonic microbiome after 6 months

New technique in dignostic and treatment of olfactory dysfunction

Der Riechsinn ist entwicklungsgeschichtlich gemeinsam mit dem Geschmackssinn der ältesteTeil des Endhirns. Bei nicht so weit entwickelten Wirbeltieren ist der Riechsinn sogar das einzig vorhandene Sinnesorgan. Bei Säugetieren wie Hunden, Nagetieren oder einigen Vogelarten nimmt das Riechorgan eine ganz besondere Stellung ein. Er dient hier unter anderem zur Lokalisation von Nahrung, dem Unterscheiden von Freund und Feind sowie dem Erkennen des anderen Geschlechts. Daher ist bei diesen Lebewesen das olfaktorische System sehr gut entwickelt. Der Geruchssinn spricht auch uns Menschen tiefer an als andere Sinnesorgane, da durch die Kopplung an das limbische System Riecheindrücke gewisse Erinnerungen und Emotionen in uns auslösen können. Dem Riechsinn wurde im Hals-Nasen-Ohrenbereich lange Zeit weniger Bedeutung in der Diagnostik geschenkt als anderen Sinnesorganen wie dem Hör- und Gleichgewichtssinn. Vergleicht man die Errungenschaften auf dem Gebiet der Hördiagnostik und der Rehabilitation des Hörorgans sowohl operativ als auch mittels implantierbarer Hörgeräten sind die - nicht zuletzt aufgrund der erst 1994 gegründeten Arbeitsgemeinschaft für Olfaktologie und Gustologie - vorangetriebenen wissenschaftlichen Untersuchungen des Riechorgans immer noch weit von dem entfernt, was in den anderen Bereichen bereits möglich ist. Umso wichtiger scheint es, diesen Forschungsbereich weiter voranzutreiben, um dem ältesten und für die Lebensqualität des Menschen sehr wichtigen Sinnesorgan, dem Riechsinn, den Platz einzuräumen, der ihm zusteht und um eine entsprechende Diagnostik und Therapie von Riechstörungen zu ermöglichen. Wenn man bedenkt, dass sich der Riechsinn im Bereich des Nasendachs befindet und der äußeren Nase wichtige - die respiratorische Funktion und die ästhetische Funktion - Aufgaben zukommen, darf man diesen speziellen Abschnitt der Nase nicht außer Betracht lassen. Die vorliegende Habilitationsschrift beschäftigt sich mit neuen Optionen sowohl in der Diagnostik als auch Therapie von Riechstörungen. Neben der wissenschaftlichen Auswertung der klinischen Ergebnisse war auch die Praktikabilität von Interesse.From the point of view of historical development, the sense of smell, together with the sense of taste, is the oldest part of the endbrain. In less developed species of vertebrates, the olfactory sense is even the only existing sensory organ. In the case of mammals, such as dogs, rodents or some species of birds, the olfactory organ has a particularly important role to play. For these, it serves, among other things, to locate food, to distinguish friend from foe as well as to recognise the opposite sex. Hence, the olfactory system of these living creatures is highly developed. The sense of smell also evokes a stronger response from us human beings than other sensory organs, since, due to its being coupled with the limbic system, olfactory impressions may trigger in the human certain memories and emotions. During diagnosis in the ENT field, less attention has been paid to the olfactory sense than other sensory organs, such as hearing and the sense of balance. If one compares the advances achieved in the field of aural diagnostics and rehabilitation of the hearing organ, both operative as well as by implantable hearing aids, scientific progress in the examination of the olfactory organ - not least thanks to the Working Group for Olfactology and Gustology, only established in 1994 - is still far behind the achievements now possible in other fields. Hence, it seems all the more important to forge ahead in this field of research in order to give the oldest, and for our quality of life highly important sensory organ, i.e. the sense of smell, the status it deserves and to enable adequate diagnosis and therapy for olfactory disorders. If one considers that the olfactory organ is situated in the area of the roof of the nose and that the outer nose assumes important functions, i.e. the respiratory and aesthetic function, then one cannot refrain from giving consideration to this particular section of the nose. This professorial dissertation deals with new options both in the diagnosis and in the treatment of olfactory disorders. Besides the scientific evaluation of the clinical findings, the aspect of practicability was also a matter of interest

Long-term results in obstructive sleep apnea syndrome (OSAS) after laser-assisted uvulopalatoplasty (LAUP).

Obstructive sleep apnea syndrome (OSAS) is a serious disease. The etiology of and optimum therapy options for this disorder have been much discussed and have been the subject of many publications. One much discussed therapy option is laser-assisted uvulopalatoplasty (LAUP). Despite conflicting opinions and guidelines which recommend that it should not be used, it remains in use. Patients who had previously undergone this procedure were invited for follow-up appointments, at which they were asked to complete a questionnaire, underwent an ENT examination and underwent sleep laboratory analysis using a portable sleep lab device. The average time since LAUP treatment was 11 years. The cohort comprised 25 patients. The average preoperative apnea-hypopnea-index (AHI) score was 25.25/h; the average postoperative AHI score 23.62/h. Closer examination of our data enabled us to identify 10 responders (40%) and 15 non-responders (60%). 12% (3/25) of non-responders experienced either no reduction in their AHI score or an increase compared to their preoperative AHI score of less than 5/h. In the remaining 48% (12/25), AHI increased by more than 5/h compared to the preoperative figure. Our questionnaire showed that 40% (10/25) of patients suffered from dry mouth and 20% (5/25) from foreign body sensation. The data led us to conclude that laser-assisted uvulopalatoplasty can indeed result in a reduction in AHI score comparable to other mucosal resection methods. Also in common with these methods, the efficacy of the therapy reduces with time and the procedure carries a high risk of bringing about an increase in the patient's AHI score

Schematic representation of laser-assisted uvulopalatoplasty (LAUP).

<p>The left-hand diagram shows complete resection of the uvula, the right-hand diagram shows preservation of the uvula by means of para-uvular incisions <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100211#pone.0100211-Berger1" target="_blank">[6]</a>.</p

Polysomnograpy results showing preoperative and postoperative severity category, difference, means, age, preoperative BMI, time in months since LAUP and pre and postoperative AHI.

<p>* OSA severity: AHI <5/h  =  normal; 5–20/h  =  mild; 21–40/h  =  moderate, >40/h  =  severe.</p><p>** Subjective snoring score: 0–2 =  rare; 3–5 =  occasional; 6–8 =  often; 9–10 =  always.</p

Overview of classification criteria, showing designations, abbreviations and definitions.

<p>Overview of classification criteria, showing designations, abbreviations and definitions.</p