Bernard Bertrand

Assessment of olfactory and trigeminal function using chemosensory event-related potentials

GOALSnTo give an overview on the theoretical and practical applications of chemosensory event-related potentials.nnnMETHODSnChemosensory event-related potentials (ERPs) may be elicited by brief and precisely defined odorous stimuli. Based on the principles of air-dilution olfactometry, a stimulator was developed in the late 1970s, which allows stimulation of the olfactory neuroepithelium and the nasal mucosa with no concomitant mechanical stimulation. Chemosensory ERPs were obtained after stimulation of the olfactory nerve (olfactory ERPs) or the trigeminal nerve (somatosensory or trigeminal ERPs). The characteristics of the stimulator for chemosensory research as well as the variables influencing the responses are discussed in this paper.nnnRESULTSnImplementation and normative data from our department are reported with different clinical examples from otorhinolaryngologic clinic. The bulk of the evoked response consists of a large negative component (often referred to as N1), which occurs between 320 and 450 ms after stimulus onset. This component is followed by a large positive component, often referred to as P2, occurring between 530 and 800 ms after stimulus onset. Absence of olfactory ERPs and presence (even with subtle changes) of somatosensory ERPs is a strong indicator of the presence of an olfactory dysfunction.nnnCONCLUSIONSnThis review examines and discusses the methods of chemosensory stimulation as well as the electrophysiological correlates elicited by such stimuli. The clinical applications of chemosensory ERPs in neurology and otorhinolaryngology are outlined.

Olfactory bulb volume in patients with sinonasal disease.

Background The aim of this study was to assess the volume of the olfactory bulb (OB) in patients with chronic rhinosinusitis (without nasal polyposis at the endoscopic evaluation) and to evaluate the correlation between this measure and the degree of sinonasal inflammation. Methods Patients with sinonasal disease (SND; n = 22) were compared with healthy controls (n = 16) using orthonasal and retronasal olfactory test results and OB volumes measurement calculated by planimetric manual contouring using standardized methods. The Lund-Mackay score (originally described for CT scan) was also used to gauge sinonasal inflammation (SND score). Results The two groups were not significantly different in terms of age or distribution of sex. Patients had significantly higher right- and left-sided SND scores than controls. There was no significant group difference between patients and controls with regard to OB volume. However, patients with an SND score ≥12 had larger OB volumes than patients with higher SND scores (p < 0.001). Even when controlling for the subjects’ age, a significant correlation was present between OB volume and SND score (r =-0.52; p = 0.001) with smaller OB volumes being associated with a higher degree of sinonasal pathology. Conclusion OB volume correlated with the SND score, which is an indicator of the degree of sinonasal inflammation. SND patients with a slight decrease or even normal olfactory function may already exhibit changes in their OB volume. This study also seems to emphasize the idea that OB volume changes are more sensitive to subtle changes in the olfactory system than results from psychophysical testing.

Genetic evidence for a role of IL33 in nasal polyposis

To cite this article: Buysschaert ID, Grulois V, Eloy P, Jorissen M, Rombaux P, Bertrand B, Collet S, Bobic S, Vlaminck S, Hellings PW, Lambrechts D. Genetic evidence for a role of IL33 in nasal polyposis. Allergy 2010; 65: 616–622.

The Value of Injectable Collagen in Vocal and Glottic Rehabilitation

SummaryIn 1962, Arnold used injectable Teflon to reintroduce Brünings technique for rehabilitating the paralysed vocal cord. Although Teflon would not appear to be carcinogenic, the technique is not entirely trouble-free. Injectable collagen as a biological implant seems to be an attractive alternative since it is a component part of the extracellular protein matrix. In actual clinical use, the collagen is easily injectable, is well-tolerated by patients, and is only subject to limited resorption. It also undergoes some transformation into living connective tissue with neovascularization. Our study was carried out on 14 patients: 13 had vocal cord paralyses from various causes and 1 had vocal cord atrophy as a sequel to traumatic injury. The therapeutic indication for correction in all of these patients was dysphonia for which speech therapy had failed to produce an adequate result. One patient was found to suffer from symptomatic aspiration as well. The actual technique of surgery involved the injection of a mean quantity of 1.5 cc collagen into the submucosal tissue of the affected cord during direct laryngoscopy. Postoperatively, all of our patients showed improved dysphonia without secondary effects occurring from the collagen. We also found lessened aspiration in our patient so affected. Our period of follow-up to date ranges from 3–12 months.

A Pott's puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review.

A Potts Puffy Tumour (PPT) is a rare clinical entity, which, traditionally has been described as an acute abscess with periosteitis secondary to osteomyelitis of the external table of the frontal bone of the skull, complicating an acute frontal sinusitis. The aim of this article is to present a case of progressively evolving PPT, which emerged during the course of a common rhinitis, in a patient who, thirty years previously, had undergone a reconstruction of the frontal sinus involving osteosynthesis. The patient was treated with antibiotic therapy coupled with external access surgery using the Cairn Unterberger approach. This allowed the drainage of pus, the removal of infected osteosynthetic material and a complete debridement of osteomyelitic bone from the affected area. Frontal sinus obliteration was undertaken using methyl methacrylate, preferable in this case to hydroxyapatite, due to the direct communication with the neighbouring sinus cavities and the presence of defective bone in the superior orbit. A review of literature available on Medline up to January 2008 reveals that this is the third published case of PPT complicating a frontal reconstruction.

Triosite Implants and Fibrin Glue in the Treatment of Atrophic Rhinitis: Technique and Results

Nine patients with primary or secondary atrophic rhinitis were treated by narrowing of the nasal fossae using a new surgical technique (derived from the Eryes procedure) in which a Triosite® and fibrin glue mixture is implanted via the labial vestibule route. The results were good or excellent in seven patients. No rejections occurred. Osseocoalescence, as evaluated by computed axial tomography at 6 months, was good. Inspiratory intrasnasal pain in patients with postsurgical atrophic rhinitis improved following the operation.

Relationship of chronic ethmoidal sinusitis, maxillary sinusitis, and ostial permeability controlled by sinusomanometry: Statistical study

Three hundred sixty‐seven successive patients suffering from chronic maxillary sinusitis (CMS) were thoroughly examined by means of maxillary sinusoscopy, a CT scan of the facial sinuses, and sinusomanometry (SMM). Ninety‐eight cases of unilateral CMS, 269 cases of bilateral CMS, and 444 chronic ethmoidal sinusitis (CES) cases were evaluated. According to SMM, the maxillary ostia were divided into two groups: 1. maxillary ostium patency (MOP) group and 2. the maxillary ostium nonpatency (MONP) group. The unilateral and bilateral pathologies were separately analyzed so as to minimize the effects of general or systemic causes on the results. MONP is, in both bilateral and unilateral groups, significantly linked with the presence of ethmoidal sinusitis (P < 10−6; P = .026), while the correlation between MOP and the ethmoid status does not appear to be significant in either group. Thus, there seems to be a close relationship between CES and maxillary ostial dyspermeability in cases of CMS.

Sinonasal involvement as a rare extraintestinal manifestation of Crohn's disease.

Crohn’s disease is a chronic idiopathic slowly developing transmural inflammation of the digestive system. It usually involves the small intestine and/or the area around the anus but can also affect the entire gastrointestinal tract anywhere from the mouth to the anus. Extra intestinal manifestations occur frequently and multiple organ systems may be affected: the skin, joints, spine, eyes, liver and bile ducts. In contrast, nasal manifestations are extremely rare and only a few cases have been reported up to date in the worldwide literature. The authors report two cases with nasal manifestations concomitant to intestinal Crohn’s disease and go over the relevant literature on such an association.

Successful endonasal dacryocystorhinostomy in a patient with Wegener's granulomatosis.

Wegener’s granulomatosis (WG) is one form of idiopathic autoimmune vasculitis. The disease has a predilection for the upper and lower respiratory tracts (lungs, nose, sinus), and kidneys. WG may be systemic, severe, and potentially lethal, but it may also be limited to the otolaryngological area or to the eyes and the orbits. Obstruction of the lacrimal pathway is a possible complication of the disease that affects approximately 7% of patients with WG. It usually occurs as a direct extension of sinonasal disease and typically is a late manifestation. Management of such a condition is generally viewed as difficult. We report the case of a patient with a quiescent WG limited to the otolaryngological area. This patient presented a bilateral obstruction of the nasolacrimal ducts caused by bilateral extensive adhesions in the nasal cavity. Because she had several episodes of left-side acute dacryocystitis which necessitated several courses of broad-spectrum antibiotics, she successfully underwent an endonasal endoscopic dacryocystorhinostomy using a diode laser and powered instrumentation. The authors describe the clinical case, the surgical technique, and review the literature.

Understanding Pathophysiological Concepts Leading to Obstructive Apnea

Obstructive sleep apnea (OSA) results from a combination of several factors leading to the obstruction of the upper respiratory tract (URT). OSA represents a systemic pathophysiological entity and leads to many comorbidities such as hypertension, coronary ischemia, and stroke. Patients with this pathophysiological entity experience also an increased risk of postoperative complications. Obesity is certainly the main cause of developing OSA. However, many other predisposing factors influence the genesis of obstructive apnea. It is important to understand the complexity of the interactions between predisposing factors to understand the relationship between weight loss following obesity surgery and the improvement in the severity of OSA. In this narrative review, we expose the seven major categories of predisposing factors that interact to generate obstructive apneas in patients, namely the anatomic abnormalities of the URT, the mechanical and the metabolic responses of the upper airway musculature, the loop gain, the arousal threshold, and the hormonal abnormalities. The genesis of apnea is the result of a complex dynamic interaction between the anatomical risk factors and the compensatory neuromuscular reflexes. All of these points are integrally part of the perioperative care of the obese patients. Finally, we will discuss different options for weight reduction.