Intranasal sodium citrate solution improves olfaction in post-viral hyposmia

Background: Calcium plays an integral role in olfactory signal transduction, including feedback inhibition. Sodium citrate acts as a calcium sequestrant and when applied intranasally, reduces free calcium available for feedback inhibition, which should theoretically improve olfaction. We aimed to investigate the utility of intranasal sodium citrate in improving the olfactory function of hyposmic patients, by performing this prospective placebo controlled, single-blinded trial. Methodology: Monorhinal olfactory testing for odour identification and threshold was performed in hyposmic patients using “Sniffin’ Sticks”, before and after treatment. Treatment consisted of sodium citrate solution application to the olfactory cleft. Sodium chloride solution was applied to the contralateral olfactory cleft, which therefore acted as placebo control. Patients were blinded to the side of sodium citrate application, and side of treatment was randomized between patients. Results: 57 patients participated in the trial, aged 22-79. Causes of hyposmia included: post-viral (7); posttraumatic (10); sinonasal (30) and idiopathic (10). Compared with placebo, there was significant improvement in the identification scores of participants with post-viral hyposmia, following sodium citrate treatment. No significant change in olfactory function occurred for either identification or threshold in any other aetiological subgroup. Conclusions: Intranasal sodium citrate may be of benefit to patients with post-viral hyposmia

Validation Study of the Sniffin' Sticks olfactory test in a British population.

OBJECTIVE: The 'Sniffin' Sticks' olfactory test contains pen-like odour dispensing devices which are used to assess olfactory threshold, discrimination and identification. Odour identification is strongly dependent on familiarity with the odours and has an important cultural component which has limited the usefulness of other validated tests. The 'Sniffin' Sticks' test was developed in Germany and is validated in other countries but not in the UK. This study aims to validate the applicability of 'Sniffin' Sticks' in a local population. DESIGN: Prospective controlled study. SETTING: Rhinology or olfactory disorder clinic. PARTICIPANTS: About 82 subjects, 33 healthy volunteers with a reported normal sense of smell, and 49 patients with an impaired sense of smell presenting either at a rhinology or an olfactory disorder clinic. Each subject's olfactory function was assessed using the 'Sniffin' Sticks' test with a maximum score of 48. MAIN OUTCOME MEASURES: Threshold, discrimination and identification scores along with the combined olfactory score. RESULTS: The mean age of the subjects tested was 46.7 years; 46 female and 36 male. In the patient group 36 were hyposmic and 13 anosmic. In the healthy volunteers group all subjects were normosmic. In the control group the mean combined olfactory score was 34.5 (±2.5). The mean combined score in the patients group was 20.8 (±7.4). Odour threshold scores were 3.7(±2.8) for patients (hyposmics and anomics) and 8.3(±1.8) for controls. In the identification test the controls mean score was 13.6 (±1.2) for while the patients' mean score was 8.6 (±3.5). CONCLUSIONS: In our sample of the local population the combined olfactory and odour identification scores for healthy volunteers and patients with olfactory disorders are comparable with the normative data published on large samples of European populations. However, modification of a few of the distracters is recommended for British patients based on our findings

Improvement of chronic rhinitis under aspirin.

In a subset of Aspirin_tolerant asthmatics, administration of Aspirin improves respiratory symptoms. We present a patient with chronic rhinosinusitis with nasal polyps who exhibited relief of nasal obstruction and nasal discharge and improvement in the sense of smell following oral administration of 150 mg of Aspirin daily. Improvement in the patency of the nasal passages was documented by nasal endoscopy and magnetic resonance imaging. Improvement of olfactory function was documented by validated psychophysical olfactory testing and by means of olfactory event_related potentials

Olfactory and haptic crossmodal perception in a visual recognition task

Olfactory perception is affected by cross-modal interactions between different senses. However, although the effect of cross-modal interactions for smell have been well investigated, little attention has been paid to the facilitation expressed by haptic interactions with a manipulation of the odorous object’s shape. The aim of this research is to investigate whether there is a cortical modulation in a visual recognition task if the stimulus is processed through an odorous cross-modal pathway or by haptic manipulation, and how these interactions may have an influence on early visual-recognition patterns. Ten healthy non-smoking subjects (25 years ± 5 years) were trained to have a haptic manipulation of 3-D models and olfactory stimulation. Subsequently, a visual recognition task was performed during an electroencephalography recording to investigate the P3 Event Related Potentials components. The subjects had to respond on the keyboard according to their subjective predominant recognition (olfactory or haptic). The effects of haptic and olfactory condition were assessed via linear mixed-effects models (LMMs) of the lme4 package. This model allows for the variance related to random factors to be controlled without any data aggregation. The main results highlighted that P3 increased in the olfactory cross-modal condition, with a significant two-way interaction between odor and left-sided lateralization. Furthermore, our results could be interpreted according to ventral and dorsal pathways as favorite ways to olfactory crossmodal perception

Olfactory and haptic crossmodal perception in a visual recognition task

Olfactory perception is affected by cross-modal interactions between different senses. However, although the effect of cross-modal interactions for smell have been well investigated, little attention has been paid to the facilitation expressed by haptic interactions with a manipulation of the odorous object’s shape. The aim of this research is to investigate whether there is a cortical modulation in a visual recognition task if the stimulus is processed through an odorous cross-modal pathway or by haptic manipulation, and how these interactions may have an influence on early visual-recognition patterns. Ten healthy non-smoking subjects (25 years ± 5 years) were trained to have a haptic manipulation of 3-D models and olfactory stimulation. Subsequently, a visual recognition task was performed during an electroencephalography recording to investigate the P3 Event Related Potentials components. The subjects had to respond on the keyboard according to their subjective predominant recognition (olfactory or haptic). The effects of haptic and olfactory condition were assessed via linear mixed-effects models (LMMs) of the lme4 package. This model allows for the variance related to random factors to be controlled without any data aggregation. The main results highlighted that P3 increased in the olfactory cross-modal condition, with a significant two-way interaction between odor and left-sided lateralization. Furthermore, our results could be interpreted according to ventral and dorsal pathways as favorite ways to olfactory crossmodal perception

Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis

PurposeTo evaluate the outcomes of endonasal dacryocystorhinostomy (EN-DCR) surgery in patients with sarcoidosis.MethodsRetrospective chart review of all patients with sarcoidosis undergoing EN-DCR in 6 practices from 1999-2011.ResultsWe included 18 procedures in 14 patients (8 female, 6 male) who underwent EN-DCR for acquired NLDO secondary to sarcoidosis. The mean age was 53.7 (range 38-82). The presenting symptom in all cases was epiphora. Eight patients (57%) complained of having additional nasal congestion. Surgery was performed using endoscopic powered-type DCR with flaps in 12/18 (67%) and non-endoscopic mechanical EN-DCR in 6/18 (33%). In 15 (83%) cases the lacrimal sac and nasal mucosa appeared abnormally yellowish, crusty, oedematous and friable. Five patients were treated with pre-operative oral steroid and overall 8 patients had oral prednisolone post operatively, 30-60 mg tapered within 10 days-8 weeks. One patient had difficulties in tapering down the oral steroids at 6 months of follow-up. All patients were free of epiphora and patent to syringing, with nasal endoscopy revealing free flow of fluorescein through the ostium at a mean follow-up of 11.3 months (median follow-up 9 months).ConclusionsAll 18 cases of acquired nasolacrimal duct obstruction secondary to sarcoidosis were treated successfully with EN-DCR. An abnormal appearance of the nasal mucosa is an important sign. Nasal congestion is a frequent sign. A successful outcome may not depend on intensive long-term therapy with local or systemic steroids. Mechanical or powered EN-DCR for nasolacrimal duct obstruction secondary to sarcoidosis achieves encouraging medium-term outcomes.Inbal Avisar, Alan A. McNab, Peter J. Dolman, Bhupendra Patel, Jean-Louis deSousa, Dinesh Selva, and Raman Malhotr