Philippe Rombaux

High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea

Induced nasal obstruction can cause obstructive apnoeas in healthy subjects during sleep, but the relationship between nasal resistance measured during wakefulness and obstructive sleep apnoea syndrome (OSAS) is weak. It was postulated that if the subjects could not breathe through the nose, the oral airway must be used, but if this airway is narrowed as well, then it could precipitate sleep-disordered breathing (SDB). Nasal patency, Mallampati score (MS), neck circumference and body mass index were measured in 202 subjects referred to the authors hospital to undergo a full-night polysomnography for suspicion of SDB. A significant correlation was found between the MS and apnoea/hypopnoea index measured during sleep. However, the relationship between these parameters was only significant in patients with nasal obstruction. The relative risk of having OSAS with a MS of III or IV was 1.95 for the whole group and 2.45 in patients with nasal obstruction. In conclusion, a high Mallampati score represents a predisposing factor for obstructive sleep apnoea syndrome, especially if it is associated with nasal obstruction. These patients merit special attention from both the sleep physician and the anaesthetist.

Increasing olfactory bulb volume due to treatment of chronic rhinosinusitis—a longitudinal study

Differentiation of progenitor cells into neurons in the olfactory bulb depends on olfactory stimulation that can lead to an increase in olfactory bulb volume. In this study, we investigated whether the human olfactory bulb volume increases with increasing olfactory function due to treatment of chronic rhinosinusitis. Nineteen patients with chronic rhinosinusitis were investigated before and after treatment. For comparison, additional measurements were performed in 18 healthy volunteers. Volumetric measurements of the olfactory bulb were based on planimetric manual contouring of magnetic resonance scans. Olfactory function was evaluated separately for each nostril using tests for odour threshold, odour discrimination and odour identification. Measurements were performed on two occasions, 3 months apart. In healthy controls, the olfactory bulb volume did not change significantly between the two measurements. In contrast, the olfactory bulb volume in patients increased significantly from the initial 64.5 +/- 3.2 to 70.0 +/- 3.5 mm(3) on the left side (P = 0.02) and from 60.9 +/- 3.5 to 72.4 +/- 2.8 mm(3) on the right side (P < 0.001). The increase in olfactory bulb volume correlated significantly with an increase in odour thresholds (r = 0.60, P = 0.006, left side; r = 0.49, P = 0.03, right side), but not with changes in odour discrimination or odour identification. Results of this study support the idea that stimulation of olfactory receptor neurons impacts on the cell death in the olfactory bulb, not only in rodents but also in humans. To our knowledge, this is the first longitudinal study that describes an enlargement of the human olfactory bulb due to improvement of peripheral olfactory function.

Multi-morbidities of allergic rhinitis in adults : European Academy of Allergy and Clinical Immunology Task Force report

AbstractnnThis report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.n

Congenital fistula of the fourth branchial pouch

Abstract Between 1986 and 1995, 128 patients were treated for various head and neck congenital malformations at Saint-Luc University Hospital, Louvain. We report three cases of fourth branchial pouch cysts requiring surgical removal. One of these cases presented with a third branchial pouch remnant on the same side and subsequently a fourth branchial pouch sinus. To our knowledge, this is the first case published in the literature. A fourth branchial pouch sinus tract can become manifest clinically by recurrent episodes of neck abscess or acute suppurative thyroiditis (especially in infants). The tract can be identified with a barium swallow during the period of latency and hypopharyngeal endoscopy under general anesthesia. Total excision of the fistula with dissection up to the pyriform sinus with or without a left thyroid gland lobectomy and isthmectomy is the treatment of choice.

Downregulation of polymeric immunoglobulin receptor and secretory IgA antibodies in eosinophilic upper airway diseases.

Immunoglobulin (Ig) A represents a first‐line defence mechanism in the airways, but little is known regarding its implication in upper airway disorders. This study aimed to address the hypothesis that polymeric Ig receptor (pIgR)‐mediated secretory IgA immunity could be impaired in chronic upper airway diseases.

Olfactory Impairment Is Correlated with Confabulation in Alcoholism: Towards a Multimodal Testing of Orbitofrontal Cortex

Background Olfactory abilities are now a flourishing field in psychiatry research. As the orbitofrontal cortex appears to be simultaneously implicated in odour processing and executive impairments, it has been proposed that olfaction could constitute a cognitive marker of psychiatric states. While this assumption appears promising, very few studies have been conducted on this topic among psychopathological populations. The present study thus aimed at exploring the links between olfaction and executive functions. These links were evaluated using two tasks of comparable difficulty, one known to rely on orbitofrontal cortex processing (i.e., a confabulation task), and one not associated with this area (i.e., Stop-Signal task). Methodology/Principal Findings Twenty recently detoxified alcoholic individuals and twenty paired controls took part in an experiment evaluating olfactory abilities and executive functioning (i.e., Stop-Signal task and confabulation task). Comorbidities and potential biasing variables were also controlled for. Alcoholic individuals exhibited impaired performance for high-level olfactory processing and significant confabulation problems as compared to controls (but no deficit in Stop-Signal task), even when the influence of comorbidities was taken into account. Most importantly, olfactory abilities and confabulation rates were significantly correlated in both groups. Conclusions/Significance Alcoholism jointly leads to olfactory and memory source impairments, and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggest that olfaction could become a reliable cognitive marker in psychiatric disorders. Moreover, it underlines the need to take into account these olfactory and source memory impairments in a clinical context.

PREVALENCE OF LYMPH NODES IN THE APEX OF LEVEL V: A PLEA AGAINST THE NECESSITY TO DISSECT THE APEX OF LEVEL V IN MUCOSAL HEAD AND NECK CANCER

We assessed the prevalence of histologically proven normal or invaded lymph nodes in the apex of level V.

Chemosensory event-related potentials in alcoholism : a specific impairment for olfactory function

Olfactory abilities are crucial in the development and maintenance of alcoholism, but while they have been widely explored in other psychiatric states, little is known concerning this sensorial modality among alcoholics. The present study explored the brain correlates of the olfaction deficit in alcoholism. Ten alcoholics and ten matched controls took part in psychophysical and electrophysiological olfactory testing. At behavioural level, we showed odor identification deficits in alcoholism, for orthonasal and retronasal testing. Electrophysiological data showed abnormalities (in latency and amplitude) for N1 and P2 olfactory components among alcoholics, which constitutes the first description of the cerebral correlates of olfactory impairments in alcoholism. This deficit appears associated with alterations in the brain structures responsible for the secondary, cognitive processing of odors. These results underline the need to take into account olfactory deficits in clinical practice and in studies exploring brain correlates of craving by means of alcohol odors.

Chronic Rhinosinusitis and Olfactory Dysfunction

Chronic rhinosinusitis (CRS) is defined, according to the European Position Paper on Rhinosinusitis and Nasal Polyps , as “presence of two or more symptoms one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip) +/- facial pain/pressure +/- reduction or loss of smell for >12 weeks”. Olfactory disorder thus appears to be one of the diagnosis criteria for CRS with or without nasal polyposis, underlining the importance of this specific symptom among patients with CRS. Inversely, CRS appears to be the most common cause of olfactory dysfunction in patients presenting to smell evaluating centers and account for 14-30% of the cases. What underlines the intimate connection between CRS and olfactory dysfunction. Several studies have shown that the quality of life is severely impaired in patients suffering from olfactory disorders. It is thus important to detect this symptom and to provide an optimal treatment to patients. Nowadays, we have medical and surgical treatments that may relieve patients but these results are still hazardous. Good management and good support to patients highly depend on a good knowledge of this entity. We will thus review important issues about CRS and olfactory dysfunction, beginning with generalities about olfactory dysfunction, to continue with pathophysiology of this entity, assessment of olfactory function in patients, the contribution of imaging and finally effects of current treatments on olfactory function.

Immune Defence Mechanisms: Comparing Upper and Lower Airways in Chronic Airway Diseases

Several epidemiological, pathophysiologic and clinical data demonstrate the interrelationship between upper and lower airways, and common features between inflammatory pathways and disorders of the nasal and bronchial mucosa have been emphasized both in the clinic (ARIA guidelines [1]) and in basic science, and reflected by numerous reviews on this topic. In contrast, detailed comparative analysis of basic defence mechanisms in upper versus lower airways and its clinical relevance is lacking. It is becoming increasingly clear that airway epithelium plays a key role in driving key initiating steps of immune defence (either protective or deleterious) against inhaled antigens and particles. Epithelial cells respond to changes in the external environment by secreting a large array of antimicrobial host defence molecules, cytokines and chemokines following exposure to and activation by pathogen molecular patterns, and link in concert with dendritic cells innate to antigen-specific adaptive immunity. However, the type of epithelial response to `pathogens and danger signals may differ between upper and lower airways, as well as according to genetic background. This review provides an updated, extensive and comparative review of immune defence mechanisms of the respiratory tract, in upper versus lower airways, including most relevant changes observed during chronic airway diseases and how these may translate into different clinical features.