George E. Murty

Comparison of Subjective Perception with Objective Measurement of Olfaction

OBJECTIVE: To see if nasal peak inspiratory flow rate and subjective sense of smell had any correlation with olfactory thresholds. STUDY DESIGN AND SETTING: A cohort study of 186 normal volunteers was recruited from among staff and visitors at a university hospital. Olfactory thresholds were detected for each subject (103 with eucalyptol and 83 with phenethyl alcohol), along with nasal peak inspiratory flow (PIFR). Subjective sense of smell, along with nasal symptoms, mood, and alertness, were recorded on visual analogue scores. RESULTS: Subjective perception of smell had no correlation with olfactory thresholds detected (P = 0.4057) and the other subjective measures also had no correlation. There was a significant relationship of PIFR to thresholds in the group tested with phenethyl alcohol (P = 0.002). CONCLUSION: As with the sensation of nasal patency, the self-assessment of a subjects sense of smell has poor correlation with their actual olfactory ability. SIGNIFICANCE: A patients history cannot be relied upon when determining their olfactory ability and formal testing should be performed. EBM rating: A-1b

Does the use of the combined oral contraceptive pill cause changes in the nasal physiology in young women

Background Changes in nasal physiology have been observed during pregnancy and the menstrual cycle. The role of female hormones in these changes is unclear. The aim is to investigate the effect of the modern combined oral contraceptive pill (COCP). Methods Eleven women were recruited from a family planning clinic. Anterior rhinoscopy, peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time, and rhinitis quality-of-life questionnaire (RQLQ) scores were recorded at days 1 and 14 pre- and post-COCP. Results Increased nasal obstruction midcycle pre-COCP, with significant differences for anterior rhinoscopy (p = 0.001) and peak inspiratory flow rate (p = 0.022), was found. No statistical difference was shown between pre- and post-COCP results apart from day 1 anterior rhinoscopy findings (p = 0.05). Conclusion The modern COCP has no significant effect on nasal physiology.

Preliminary characterization of mucin from effusions of cleft palate patients.

Middle ear effusions from children undergoing myringotomy were classified into three groups — Cleft palate, thick (mucoid), and thin (serous). Mucin was purified from each of the three groups using CsCl equilibrium density gradient centrifugation. Analysis of the cleft palate mucin on Sepharose CL-2B showed it was excluded and therefore of large molecular weight. It could be broken down Into smaller glycopeptide units by proteolysis and these glycopeptides had, based on elution position, a larger hydrodynamic size than those from the thick mucin. Intrinsic viscosity measurements demonstrated that the intact mucins could be ranked in order of molecular space occupancy; cleft palate > thick > thin. Amino acid analysis showed the cleft palate mucin to have an amino acid composition similar to other mucins, with serine, threonine, and proline constituting 41% by weight of the protein core. Thiol analysis gave evidence of a possible difference in polymerization between the three mucins, in that thin (the smallest mucin) contained the lowest number of thiols. This preliminary analysis of cleft palate mucin suggests a mucin with larger glycopeptide units forming an intact mucin of larger hydrodynamic size than either thick or thin middle ear mucins from anatomically normal children.

The effect of female hormone manipulation on nasal physiology.

Background This study was performed to establish whether the ovarian hormone beta-estradiol has any influence on nasal physiology when manipulated during in vitro fertilization treatment. Methods Women undergoing in vitro fertilization (IVF) treatment at the Assisted Conception Unit, Leicester Royal Infirmary, were recruited. Nasal peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance, olfactory thresholds, quality of life, and serum 17-beta-estradiol levels were measured at each visit. Subjects were studied at the beginning of their IVF treatment and then at one or two additional occasions while they received synthetic follicule-stimulating hormone with a final set of results taken at the end of their treatment. Results Results were analyzed using paired t-tests. There was no statistical difference between any of the data sets for any of the variables during the process of IVF treatment. Conclusion Increasing levels of beta-estradiol that occur in IVF treatment cause no significant effect on nasal physiology in contrast to the effects seen during pregnancy.

Variability of vascularity in nasal mucosa as demonstrated by CD34 immunohistochemistry

• Regional anatomical variations in the nasal vasculature have not been studied histologically.

Does hormone replacement therapy in post-menopausal women have any effect upon nasal physiology?

BACKGROUND Previous studies have suggested that the female menstrual cycle, pregnancy and the oral contraceptive pill have an effect upon nasal physiology. OBJECTIVES This study aimed to assess the effects upon nasal physiology of female hormone replacement therapy in post-menopausal women. This has not been previously studied. METHODS Twenty post-menopausal women (age range 36 to 70 years; mean age 57.0 years) underwent measurements of the nasal airway, including anterior rhinoscopy, peak nasal inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time and rhinitis quality of life questionnaire. Measurements of nasal patency were recorded prior to commencing hormone replacement therapy and at a time point 77-195 days (mean 101.9 days) following commencement. RESULTS There was no statistical difference found for any of the variables, using the paired t-test (p > 0.05 for all). CONCLUSIONS Female hormone replacement therapy has no discernable effect upon nasal physiology and should not be considered a cause of rhinitic symptoms.

Which variables matter in smell tests in the clinic

BACKGROUND Testing of olfactory thresholds in the clinic is becoming more common, with commercially produced tests now available. The effect of common potential variables in the clinic setting on these results is unclear. If many variables must be controlled, tests become more complex and a universally accepted olfactory test becomes less likely. OBJECTIVES The aim of this study was to determine which potential variables the clinician needs to consider when testing olfaction in the out-patient clinic. METHODS The study was conducted in a clinic setting at a university hospital, using 103 normal volunteers, comprising staff members and patients and relatives from the ENT clinic waiting room. The subjects recruited had no active rhinological complaints, were not taking any medications and were aged between 16 and 70 years. An olfactory threshold was established for each subject for the odour eucalyptol. Gender, smoking status, age, peak nasal inspiratory flow, ambient temperature and relative humidity were all recorded. RESULTS For eucalyptol, the distribution of values for olfactory thresholds in the normal population lies around the concentration 10(-3) log vol/vol. There was no significant effect of smoking status, tester, ambient temperature or humidity on the thresholds obtained. CONCLUSIONS The above variables do not have a significant effect on olfactory thresholds elicited in the clinic. The clinician therefore need not attempt to control these factors when testing olfaction in the out-patient setting. These findings bring the implementation of a universal, reliable and easily administered measurement of olfaction a step closer.

Canalicular adenoma of the parotid gland

Canalicular adenomas are a rare form of benign tumour that occur in salivary glands, occurring mainly in the upper lip and minor salivary glands of the buccal mucosa. The authors report the fifth case and the first in the otorhinolaryngological literature of a canalicular adenoma of the parotid gland. Its specific histological features are difficult to detect on fine needle aspiration and its multifocal nature can lead to recurrence and this must be considered in the clinical management.

Olfactory clearance: what time is needed in clinical practice?

OBJECTIVE To determine olfactory adaptation and clearance times for healthy individuals, and to assess the effect of common variables upon these parameters. STUDY DESIGN AND SETTING Fourteen healthy volunteers were recruited for a series of tests. Their initial olfactory threshold levels for phenethyl alcohol were determined. After olfactory exposure to a saturated solution of phenethyl alcohol (i.e. olfactory adaptation), the time taken for subjects to return to their initial olfactory threshold was then recorded (i.e. olfactory clearance). Visual analogue scale scores for subjective variables were also recorded. RESULTS The 14 subjects performed 120 tests in total. Despite consistent linear trends within individuals, olfactory clearance times varied widely within and between individuals. The mean olfactory clearance time for phenethyl alcohol was 170 seconds (range 81-750). Univariate analysis showed a relationship between olfactory clearance times and age (p = 0.031), symptoms (p = 0.029) and mood (p = 0.048). CONCLUSIONS When testing a persons sense of smell in a clinical setting, recent exposure to similar smells should be noted, and a period of 15 minutes needs to be allowed before retesting if using phenethyl alcohol. Other variables need not be controlled, but greater clearance time may be needed for older patients.

What is the short term effect of perfumes on olfactory thresholds

OBJECTIVES Body sprays and perfumes are commonly worn by patients attending ENT out-patients clinics. Their effect on performance in olfactory testing is unknown. The aim of this study was to determine whether olfactory thresholds are altered by the presence of such fragrances. MATERIALS AND METHODS One hundred and sixty healthy volunteers, aged 18 to 65 years, underwent olfactory thresholds testing. Each was then exposed to one of four strong perfumes, applied in a facemask for two minutes, and the thresholds were retested. RESULTS AND ANALYSIS All olfactory thresholds worsened after being exposed to the strong perfumes of Lynx and Impulse body sprays, with the strongest effect being on olfactory detection of phenylethyl alcohol (p<0.001). CONCLUSIONS Strong perfumes can have a negative effect on olfactory thresholds. SIGNIFICANCE Patients attending olfactory threshold testing need to be advised not to wear body sprays or perfumes.