Michael Katotomichelakis

Olfaction-associated quality of life in chronic rhinosinusitis: Adaptation and validation of an olfaction-specific questionnaire†

To detect validity and reliability of the Questionnaire of Olfactory Disorders (QOD) compared to other quality‐of‐life (QoL) questionnaires, to explore its ability to reflect olfaction‐related QoL changes, and to investigate age‐ and gender‐related effects of olfactory changes on QOD results.

Inflammatory patterns in upper airway disease in the same geographical area may change over time.

Background Inflammatory patterns of nasal polyps (NPs) may vary. Changes over time have not been investigated so far. This study was designed to evaluate the inflammatory patterns of NPs in Thailand at two time points 12 years apart, explore differences in Staphylococcus aureus (SA) mucosal carriage rates over time, and the latters relationship with the inflammatory patterns. Methods Formalin-fixed nasal tissue was obtained from 89 (47 in 1999 and 42 in 2011) patients suffering from chronic rhinosinusitis with NPs (CRSwNPs). Tissues were evaluated for eosinophils, neutrophils, IgE+ cells, IgE and macrophage mannose receptors, interleukin (IL)-5 and IL-17 cytokine profile, and the presence of SA, using automated immunohistochemistry and peptide nucleic acid–fluorescence in situ hybridization. Results We found a significant increase in the absolute values of eosinophils and IgE+ cells in the 2011 CRSwNP tissue series compared with 1999 and a significant but smaller increase in neutrophils. Semiquantitative evaluation revealed significantly higher mean values of positive cells for all studied inflammatory markers in the 2011 group of patients, except for the high-affinity IgE receptor. This “eosinophilic shift” of inflammation was accompanied by higher SA carriage, as well as higher frequencies of SA invasion (54.8% versus 10.6%; p < 0.001) in the 2011 compared with 1999 subjects. Patients with asthma were more likely to have higher SA carriage rates compared with nonasthmatic patients. Conclusion There was a shift from predominantly neutrophilic to eosinophilic CRSwNPs in Thai patients within 12 years, with an increase in various inflammatory markers including IgE, which is associated with an increase in intramucosal presence of SA.

Olfactory dysfunction in type 2 diabetes mellitus: an additional manifestation of microvascular disease?

We evaluated olfactory dysfunction in 154 adults (74 men, mean age 60.9 ± 11.9 years), of whom 119 had type 2 diabetes mellitus (T2DM). Olfactory function was assessed with “Sniffin’ Sticks.” A total Threshold-Discrimination-Identification (TDI) score was calculated. Type 2 diabetes mellitus, hypertension, and hyperlipidemia were associated with lower olfactory scores (all TDI scores <0.001). Age was negatively associated with odor threshold, odor identification, and TDI score (P = .009, <.001, and <.001, respectively). After adjusting for age, gender, body mass index, smoking, alcohol, diabetes, hypertension, hyperlipidemia, and cardiovascular disease, only T2DM and hypertension were associated with TDI score (R square = 0.281). Diabetic complications were associated with olfactory dysfunction (P = .006): TDI scores were lower in the presence of diabetic peripheral neuropathy (P = .017) and retinopathy (P = .047). In conclusion, T2DM and hypertension are independently associated with olfactory dysfunction while diabetic peripheral neuropathy and retinopathy are significantly associated with lower olfactory scores. The clinical relevance of these findings needs to be further examined.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases.

Background The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. Methods One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). Results Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. Conclusion Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Allergic rhinitis and aspirin-exacerbated respiratory disease as predictors of the olfactory outcome after endoscopic sinus surgery.

Background Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS). Methods A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin’ Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18). Results Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic. Conclusion The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.

Overall survival and clinicopathological characteristics of patients with breast cancer in relation to the expression pattern of HER-2, IL-6, TNF-α and TGF-β1.

The present study was conducted to investigate the prognostic significance of co-expression patterna of HER-2, IL-6, TNF-a and TGF-β1 in breast cancer, by correlating the number of markers with positive expression with clinicopathological characteristics indicative of tumor progression and overall survival. One hundred thirty consecutive patients with primary breast cancer were prospectively included and evaluated. Serum concentrations of the above markers were measured by ELISA. Median split was used to subdivide patients with marker positive or negative expression. The presence of ≥ 3 positive markers was independently associated with extended lymph node (>3) involvement (aOR, 11.94, p=0.001) and lymphovascular invasion (aOR, 12.04, p=0.018), increasing the prognostic significance of each marker considered separately. Additional prognostic information regarding survival was also provided; as the number of positive markers increased, a gradually reduction of survival time was observed. In addition, patients with 4 positive markers had significantly shorter survival (25 vs 39 months, p=0.006) and a more than 4 fold increased risk of death (aHR, 4.35, p=0.003) compared to patients with 3 positive markers. Our findings suggest that the coexpression pattern of these four markers could be used clinically as a useful marker for tumor extension and outcome of breast cancer.

Laparoscopic Cholecystectomy in a Patient with Situs Inversus Using Ultrasonically Activated Coagulating Scissors. Report of a Case and Review of the Literature

Abstract Situs inversus totalis is a rare defect with a genetic predisposition, which can present difficulties in the management of abdominal pathology, especially in laparoscopic surgery, due to the mirror-image anatomy. Herein, we report on a patient with situs inversus totalis and symptomatic cholelithiasis. The patient had a successful laparoscopic cholecystectomy, using ultrasonically activated coagulating scissors. Diagnostic pitfalls and technical details of the laparoscopic cholecystectomy are discussed and a review of the relevant literature is presented.

Is the width of the labyrinthine portion of the fallopian tube implicated in the pathophysiology of Bell's palsy?: A prospective clinical study using computed tomography

The pathogenetic mechanisms underlying Bells palsy remain obscure, despite the extensive relevant research. Magnetic resonance imaging (MRI) studies have strongly indicated that facial nerve edema cannot be regarded as the sole etiologic factor, because it might persist long after full clinical recovery, or might be demonstrated in the clinically unaffected side or healthy controls. The aim of this study was to investigate the hypothesis that a narrow facial canal might be implicated in the pathophysiology of Bells palsy.

Improvement of olfactory function for quality of life recovery

To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered.

Biometric Predictive Models for the Evaluation of Olfactory Recovery after Endoscopic Sinus Surgery in Patients with Nasal Polyposis

Background Determination of predictive factors and specific values of olfactory function after endoscopic sinus surgery (ESS) using objective diagnostic methods may support consultation of respective patients. This study was designed to assess the longitudinal olfactory functional outcome after ESS in patients with severe chronic rhinosinusitis (CRS) with nasal polyposis, to evaluate associated clinical factors and to provide statistical models for prediction of olfactory recovery. Methods One hundred sixteen patients with nasal polyposis refractory to medical treatment underwent ESS. Olfactory testing was performed preoperatively and 1, 3, and 6 months after surgery using “Sniffin’ Sticks” (Burghardt, Wedel, Germany). Using multivariate linear and logistic regression analysis, statistical models were generated to predict (i) the 6th-month composite threshold-discrimination-identification (TDI) score and (ii) the probability of attaining normal olfaction at 6 months. Results A significant stepwise increment of all olfactory function indices was found over time. Factors influencing final olfactory recovery were patients’ age, duration of olfactory deficit, previous paranasal sinus surgery, and aspirin-exacerbated respiratory disease. The first model explained 70% of the observed variation in postoperative TDI scores. The second model correctly classified 76% of the patients. Conclusion A significant progressive improvement of olfaction for at least 6 months was observed after ESS. The statistical models developed may be useful for consultation of ESS candidates in clinical practice.