Evangelia Tsakiropoulou

Use of olfactory training in post-traumatic and postinfectious olfactory dysfunction.

There is evidence that the olfactory system can be modulated by repeated exposure to odors, a procedure called olfactory training. The aim of this study was to assess the effectiveness of olfactory training in patients with postinfectious and post‐traumatic olfactory dysfunction.

Impact of menthol inhalation on nasal mucosal temperature and nasal patency.

Background Menthol is a natural herbal compound. Its isomer L-menthol presents the characteristic peppermint scent and is also responsible for the cooling sensation when applied to nasal mucosal surfaces because of stimulation of trigeminal cold receptors. The aim of this study was to assess the effect of menthol inhalation on end-inspiratory nasal mucosa temperature and nasal patency. Methods Eighteen healthy volunteers with a mean age of 30 years were enrolled in this study. Objective measurements included the septal mucosal temperature within the nasal valve area by using a miniaturized thermocouple as well as active anterior rhinomanometry before and after inhalation of l-menthol vapor. All subjects completed a visual analog scale (VAS; range, 1–10) evaluating nasal patency before and after menthol. Results The mean end-inspiratory mucosal temperature ranged from 27.7°C (±4.0) before menthol inhalation to 28.5°C (±3.5) after menthol inhalation. There were no statistically significant differences between the temperature values before and after menthol inhalation (p > 0.05). In addition, no statistically significant differences between the rhinomanometric values before and after menthol inhalation were observed. Sixteen of the 18 subjects reported an improvement of nasal breathing after menthol inhalation by means of the VAS. Conclusion Menthol inhalation does not have an effect on nasal mucosal temperature and nasal airflow. The subjective impression of an improved nasal airflow supports the fact that menthol leads to a direct stimulation of cold receptors modulating the cool sensation, entailing the subjective feeling of a clear and wide nose.

Pediatric sialendoscopy under local anesthesia: Limitations and potentials

OBJECTIVE Sialendoscopy in children is a recently described procedure. The small amount of existed literature presents the procedure under general anesthesia. We report our experience on pediatric sialendoscopy under local anesthesia at an outpatient setting. METHODS In a period of 1.5 years 9 children with age >8 years suffering from recurrent parotid swellings were assessed with sialendoscopy. In 8 out of 9 cases the parents accepted a procedure under local anesthesia. In 7 cases the procedure was completed uneventfully however in one case was discontinued and repeated under general anesthesia. The endoscope used was a 1.1mm Marchal type. Prior to endoscopy xylocaine solution 4% was applied on the papilla area for 15min. Intraductal injection of xylocaine 2% (5ml) was performed prior the insertion of the endoscope. During the procedure parents evaluated pain by means of a 6-point smiley scale. Social life and school activity were also evaluated by means of an 11-point scale pre- and 1 year post-sialendoscopy. RESULTS Seven out of eight children (8 sialendoscopies) tolerated and completed the sialendoscopy assessment. The mean duration of the procedure was 39.2min. No major complications were reported at the early post-endoscopy period. Four children presented no further swellings, two experienced one recurrence and one needed a repeat sialendoscopy (3 recurrent episodes). Sialendoscopy findings showed fibrinous debris in 4 children, mucous plugs in 2, evidence of sialodochitis with purulent debris in one child and stenosis in 3 children. The diagnosis in our cases was Juvenile Recurrent Parotitis in 6 children and chronic microbial parotitis in one case. Social life and school activity were improved in 6 children 1-year post-sialendoscopy according to parents ratings. CONCLUSIONS Sialendoscopy under local anesthesia can be an alternative option in children of age >8 years and satisfactory cooperative skills, avoiding unnecessary general anesthesias and hospital stay.

Nasal air conditioning in relation to acoustic rhinometry values

Background Changes of nasal dimensions can influence the air-conditioning capacity of the nose because of alterations of airflow patterns. The goal of this study was to evaluate the correlation between intranasal temperature and humidity values and nasal dimensions, assessed by means of acoustic rhinometry. Methods Eighty healthy volunteers (40 men and 40 women; median age, 51 years; range, 20–84 years) were enrolled in the study. In total, 160 nasal cavities were examined. All volunteers underwent a standardized acoustic rhinometry. Additionally, intranasal air temperature and humidity measurements at defined intranasal detection sites within the anterior nasal segment were performed. Results There was no statistically significant difference between the right and left side of the nose regarding air temperature, absolute humidity, and acoustic rhinometric values. A negative correlation was established between the rhinometric nasal volumes/minimal cross-sectional areas and air temperature and absolute humidity values at the three intranasal detection sites. Conclusion According to our results, nasal volumes and cross- sectional areas relevantly influence nasal air conditioning. A healthy nasal cavity with smaller volumes and cross-sectional areas seems to present a more effective air-conditioning function than a too “wide” open nose because of changes in airflow patterns. This observation should be considered as a limitation for overly extensive nasal surgery especially of the turbinates.

Fat myringoplasty outcome analysis with otoendoscopy: who is the suitable patient?

Objective This study evaluates the success of fat graft myringoplasty under local anesthesia in relation to the size and location of the perforation and the presence of myringosclerosis using otoendoscopy findings. Study Design Prospective cohort study. Setting Tertiary referral center. Materials and Methods Eighty-two patients without history of previous ear surgery underwent a fat graft myringoplasty under local anesthesia and followed up for 6 months. The fat graft harvested from the ear lobe in all cases. Otoendoscopy was used to record preoperative perforation and postoperative course. Measurements on endoscopic findings performed with Adobe acrobat software. Factors assessed were perforation size, location and myringosclerosis preoperatively, and residual perforation and graft neoangiogenesis postoperatively. Pure tone audiogram preoperatively and postoperatively was performed. Results Successful closure of the perforation was observed in 70 (85.36%) of 82 ears. The success rate significantly decreased when the size of perforation was more than 30% of the pars tensa. The anterior location was not a good prognostic factor for a successful procedure. Myringosclerosis did not correlate with the success rate of the procedure. Angiogenesis to the fat graft divided in 3 categories according to its origin: the handle of malleus, tympanic rim, and mixed with an equal distribution. The air conduction thresholds of 42 ears were slightly improved (mean, 9.3 dB), whereas the thresholds of 29 ears remained unchanged. Conclusion A fat graft myringoplasty achieves its highest success rate in perforations smaller than 30% of the pars tensa. Tympanosclerosis should not be a contraindication for fat grafting.

Influence of the turbinate volumes as measured by magnetic resonance imaging on nasal air conditioning.

Background Changes in nasal airflow caused by varying intranasal volumes and cross-sectional areas affect the contact between air and surrounding mucosa entailing alterations in nasal air conditioning. This study evaluates the correlation between nasal air conditioning and the volumes of the inferior and middle turbinates as measured by magnetic resonance imaging (MRI). Methods Fourteen healthy volunteers were enrolled. Each volunteer had been examined by rhinomanometry, acoustic rhinometry, intranasal air temperature, and humidity measurements at defined intranasal sites as well as MRI of the nasal cavity and the paranasal sinuses. The volumetric data of the turbinates was based on the volumetric software Amira. Results Comparable results were obtained regarding absolute humidity values and temperature values within the nasal valve area and middle turbinate area for both the right and the left side of the nasal cavity. No statistically significant differences were found in the rhinomanometric values and the acoustic rhinometry results of both sides (p > 0.05). No statistical correlations were found between the volumes of the inferior (mean, 6.1 cm3) and middle turbinate (mean, 1.8 cm3) and the corresponding humidity and temperature values. Additionally, the air temperature and humidity values did not correlate with the rhinometrical endonasal volumes (0–20 mm and 20–50 mm from the nasal entrance). Conclusion The normal range of volumes of the inferior and middle turbinate does not seem to have a significant impact on intranasal air conditioning in healthy subjects. The exact limits where alterations of the turbinate volume negatively affect nasal air conditioning are still unknown.

Nasal air-conditioning after partial turbinectomy: myths versus facts.

Background Turbinectomy, although a common procedure, is often accused of having a negative impact in all nasal functions. This study is the first in vivo study that evaluates objectively the effect of partial turbinectomy on nasal air-conditioning capacity. Methods In total, 57 patients with prior partial inferior turbinectomy and 28 healthy controls were examined. Intranasal temperature and humidity values were measured at the level of the head of inferior and middle turbinate. Nasal patency was evaluated by means of acoustic rhinometry. The clinical assessment was completed with nasal endoscopy and the Nasal Obstruction Symptom Evaluation questionnaire for subjective evaluation of nasal patency. Results Significant changes of temperature were found in both detection sites with 13% reduced heating capacity of the air at the level of the inferior and 19% at the level of the middle turbinate, respectively. No similar results were found for humidity measurements. No correlations were found between air-conditioning values and acoustic rhinometry results for both study groups. Nasal endoscopy revealed normal healing in all patients. No major complications were reported by the patients. Their subjective ratings of nasal obstruction were similar to healthy controls. Conclusion Partial turbinectomy seems to have a negative impact on intranasal air heating but not to humidification. This effect has no impact on clinical condition and subjective perception of surgical outcome.

Impact of external nasal strips on nasal geometry and intranasal air-conditioning.

Background The anterior nasal segment is the most effective part of the nasal airways when it comes to warming and humidification of the inhaled air. Any changes in nasal geometry in this segment modifying the airflow could therefore affect nasal air conditioning. The goal of this study was to examine ifexternal nasal strips have an influence on intranasal geometry and air-conditioning. Methods Twenty healthy volunteers (mean age, 36 years) were enrolled in the study. All volunteers received active anterior rhinomanometry and acoustic rhinometry before and while wearing commercially available external nasal strips. In addition, in vivo air temperature and humidity were measured with and without nasal strips at the defined intranasal sites. Results No statistically significant changes in temperature, humidity, and rhinomanometric values were detected during the use of nasal strips (p > 0.05). The statistical analysis of the acoustic rhinometric results showed a significant increase (p < 0.05) in the minimal cross-sectional areas (MCA) 1 (0–2 cm) and MCA2 (2–5 cm) and the nasal volume (Vol) 1 (0–2 cm). On the other hand, the nasal strips did not significantly alter the nasal Vol2 (2–5 cm; p > 0.05). Conclusion Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips did not relevantly alter intranasal air-conditioning. The application of nasal strips entails an increase in MCAs but not in nasal airflow Vol.

Intranasal trigeminal function in patients with empty nose syndrome

Trigeminal nerve mediates the perception of nasal airflow. This study examines whether impaired intranasal trigeminal function is a part of the paradoxical nasal obstruction sensation in patients with empty nose syndrome (ENS).

Olfactory dysfunction as first presenting symptom of cranial fibrous dysplasia.

Fibrous dysplasia (FD) is a benign bone disorder presenting with a variety of clinical manifestations. This is the first reported case of anosmia as presenting symptom of FD. We present the case of a 72-year-old female patient with a progressive olfactory dysfunction. Clinical examination revealed evidence of chronic rhinosinusitis; therefore the patient was treated with a course of oral corticosteroids. The patient had no improvement in her olfactory ability and imaging studies were ordered. Bony lesions characteristic of craniofacial FD were found, causing obstruction of the central olfactory pathway. This case emphasises the need to conduct further investigations in patients with rhinosinusitis and olfactory dysfunction especially when they present no response to oral steroid treatment.