Olfactory function appears to be influenced by repeated odor stimulation. We conducted a nonrandomized, nonblinded, retrospective study of the impact of an 8-month period of olfactory training in patients with olfactory dysfunction. Our study population was made up of 46 adults-14 men and 32 women (mean age: 59.17 ± 13.25 yr)-with olfactory dysfunction of different etiologies (sinonasal: n = 15; post-upper-respiratory-tract infection [URTI]: n = 16; post-traumatic: n = 7; and idiopathic: n = 8). All patients had been previously treated without success with systemic or topical corticosteroids. For their training, patients exposed themselves to four different odors twice a day. Olfactory function was evaluated at baseline and again at 4 and 8 months, and results were quantified in the form of each patient's TDI (threshold, discrimination, and identification) score. Of the 46 patients, 28 had undergone olfactory training only, while the remaining 18 had received topical corticosteroids in addition to training. At study's end, the mean overall TDI score in the entire group increased by 4.09 points over baseline-a statistically significant increase (p = 0.01); this increase was mainly attributable to improvement in the identification component of the TDI, which increased by 2.51 points (p = 0.02). Among the 18 patients who received a topical corticosteroid in addition to training, the mean TDI increased by 6.83 points (p = 0.001), primarily because of improvements in the discrimination and identification components. The 28 patients who underwent olfactory training alone experienced a mean increase in the identification component of only 2.20 points (p = 0.14) after 8 months. Olfactory function in the post-URTI patients increased significantly at 4 months. We conclude that olfactory discrimination and identification can be enhanced by the addition of a topical corticosteroid to a program of defined, daily, short-term exposure to olfactory training.
Chronic rhinosinusitis may cause olfactory dysfunction and affects quality of life in patients. In a prospective study we investigated the effect of topical application of corticosteroids through pressure-pulsed inhalation as treatment option of chronic rhinosinusitis with olfactory disorder. Patients with sinonasal olfactory disorder according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) were allocated to the new nasal inhalation therapy or a systemic corticosteroid therapy, each receiving a corticosteroid course of 12 days. 18 patients received topical corticosteroid pressure-pulsed inhalation (AMSA, Schumacher, Dausenau) and 15 systemic corticosteroid. Olfactory function was measured before and after treatment using the Threshold Discrimination Identification score (TDI score) and visual analogue scales. Lund Mackay score (LMS) was measured before starting treatment. Olfactory function (OF) increased from 17.5 ± 6.4 to 21 ± 7.9 TDI points (p \ 0.0005) after 2 months. OF decreased again to 19.5 ± 6.0 after 6 months (p = 0.007). OF increased from 17.0 ± 8.9 to 22.0 ± 9.5 points (p = 0.002) with systemic treatment after 2 months. In the follow-up period of 6 months, the mean TDI score dropped to 20.0 ± 9.2 points (p = 0.01). There was no correlation between LMS and TDI. Treatment of chronic rhinosinusitis with pressure-pulsed inhalation was demonstrated to be effective. Multicenter investigations with large participant numbers are needed.
Olfactory disorders are not rare and affect quality of life in patients. The purpose of our study was to evaluate the outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in otherwise therapyrefractory olfactory disorder. In a prospective clinical investigation, 20 patients (7 male, 13 female, mean age 53.2 ± 15.34) with olfactory disorder and 10 patients (8 male, 2 female, mean age 52.5 ± 17.55) without olfactory disorder underwent ITR under videoendoscopic control with a continuous diode laser in ''contact'' mode after topical anesthetic preparation. Treatment efficiency was assessed before and 2 months after surgery. Subjective nasal airflow (NA) and the olfactory function were rated by means of visual analogue scales (VAS). Olfactory function was assessed using the ''Sniffin' Sticks'' test battery. VAS showed very low median values for intraoperative pain (0) [0-1.20] and high postoperative patient satisfaction (8) [5][6][7][8][9]. After 2 months there was no significant improvement of objective olfactory function as measured by the TDI score (threshold, discrimination and identification). The VAS displayed a slight significant improvement in the group of patients with olfactory disorder from 2.95 to 3.65 (P = 0.04). After 2 months, NA data revealed a statistically significant improvement of subjective VAS from 5.05 to 6.25 (P \ 0.0005) and of objective NA from 353.77 to 443.50 (P = 0.007) as measured by rhinomanometry in both groups. Outpatient diode laser ITR represents an effective option providing recovery by NA improvement but not a significant improvement of the olfactory function.
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