Sadamu Takayasu

Olfactory dysfunction in patients with head trauma

OBJECTIVE There are few reports about following up olfactory acuity of the patients who have post-traumatic olfactory dysfunction. In this study, we studied about patients with post-traumatic olfactory dysfunction for a short period under a treatment. METHODS The olfactory function of 27 patients with head trauma was studied. The olfactory acuities of all the patients were examined using olfactory tests before the treatment, and 18 patients were examined again after the treatment. Olfactory functions were evaluated in 26 patients by T&T olfactometry and in 27 patients by Alinamin test. All of the patients were treated with a local injection of suspended steroid solution into the nasal mucosa [J Otolaryngol Jpn 102 (1999) 1175]. RESULTS Before the treatment, 16 patients (61.5%) presented anosmia, five patients (19.2%) presented severe hyposmia, three patients (11.5%) presented moderate hyposmia, and two patients (7.7%) presented mild hyposmia. Eighteen cases (69.2%) were negative for the Alinamin test and eight cases (30.8%) were positive. The improvement rates of recognition and detection thresholds by T&T olfactometry were 35.3 and 23.5%, respectively. CONCLUSION Olfactory dysfunction caused by head trauma can be recovered to a limited degree in some cases by the local injection of steroid within the relatively short period from the start of the therapy.

Clinical study of flavor disturbance.

Objective We have observed that, in cases of smell loss, patients often complain of taste loss as well even though they actually have normal gustatory acuity according to gustatory tests; we have defined such symptoms as “flavor disturbance”. The clinical features of flavor disturbance are reported in this paper. Material and Methods A total of 297 patients (99 males, 198 females; mean age 55.5 years) were treated for olfactory disturbance at the hospital of Hyogo College of Medicine between July 1995 and August 2001. Sixty-six out of 297 patients (22.5%) also experienced taste disturbance, and 49 of these 66 cases were evaluated by means of smell and taste tests. These 49 patients who complained of taste and smell loss were classified into two groups according to the results of their smell and taste tests. Patients who only complained of olfactory disturbance were also reviewed. Results There was no relationship between the severity of olfactory disturbance and the degree of flavor disturbance. The incidence of flavor disturbance was high in patients with sudden olfactory disturbance after upper respiratory tract infection or head trauma and low in those with slowly progressive olfactory disturbance. The symptoms of flavor disturbance improved regardless of whether smell was improved or not. Conclusions The patients with flavor disturbance tended to misrecognize that they had taste loss because of sudden smell loss, and there were more of these cases than we expected. When patients with smell and taste loss are treated, flavor disturbance should also be considered.

A Clinical Study of Azithromycin Hydrate for Acute Sinusitis with Special Regard to Methods of Oral Administration

Azithromycin hydrate (AZM) is a new macrolide antimicrobial. In this study, we evaluated the clinical efficacy of AZM for acute sinusitis. The patients were randomly divided into two groups. Twenty-five patients (Group A) were given a daily 500-mg oral dose of AZM for 3 days, and 26 patients (Group B) were given the same dose of AZM two times with a 1-week interval. The clinical efficacy rate was 85.2% in Group A and 88% in Group B, and there was no significant difference in the efficacy rates between these groups. These findings suggested that AZM was useful for the treatment of acute sinusitis and that a 500-mg oral dose of AZM for 3 days should be sufficient.

Long-Term Follow-Up of Argon Plasma Surgery for the Perennial Nasal Allergy

Abstract Objectives: Argon plasma surgery is a new electrosurgical modality. The advantages of this surgery are coagulating of the target tissue without contact. We had reported the short-term effect of this surgery for perennial nasal allergy (Laryngoscope 111:147－152，2001). The purpose of this study was to evaluate the long-term effect of this surgery for perennial nasal allergy. Methods: In a prospective study, 241 patients (106 males, 135 females) with perennial nasal allergy were treated with this surgery. The surgery was performed with APC-300 and ICC-200 (Erbe Co, Tubingen, Germany). The surface of the inferior turbinate was coagulated. The patients’ nasal symptoms and objective evaluations of intranasal findings were assessed before surgery and at 1, 3, and 6 months and 1 and over 2 years after the surgery. Results: Nasal stuffiness was improved in 113 of 118 (95.8%) patients after 1 month, in 74 of 85 (87.1%) patients after 3 months, in 32 of 41 patients, in 25 of 35 patients after 1 year, and in 15 of 25 patients after 2 years. Rhinorrhea and sneezing were improved in about 60%. Congestion of the inferior turbinate was reduced in 114 of 118 (96.6%) patients after 1 month, in 81 of 85 (95.3%) patients after 3 months, in 34 of 41 patients after 6 months, in 22 of 35 patients after 1 year and in 16 of 25 patients after 2 years. Conclusion: Turbinate surgery with argon plasma coagulator for perennial nasal allergy showed excellent effects, especially on nasal stuffiness. The effects lasted relatively long-term.

Olfaction of rhinosinusitis with bronchial asthma

Objectives: Thyroid and parathyroid pathology may coexist; classically, this is described in multiple endocrine neoplasia. Other non-syndromic scenarios result in pathologies of these endocrine organs coexisting. This can create a challenge in the clinical decision making and management of these patients. It is preferred to deal with both problems in one operative procedure if surgery is required. Methods: A retrospective review of cases of synchronous thyroid and parathyroid pathology that was managed surgically over a 30-year period by a half-dozen endocrine surgeons at a single university medical center. Results: Over a dozen cases of synchronous thyroid and parathyroid disease were discovered. All required surgical management of thyroid and parathyroid conditions. Reasons included removal of thyroid goiter for access to an adenoma, worrisome thyroid lesions coexistent with a parathyroid adenoma, and intrathyroid parathyroid adenoma. Cases of incidental discovery of a second endocrine condition while the first was evaluated will be reported. Conclusion: A head and neck endocrine surgeon needs to be aware of the possible co-existence of thyroid and parathyroid pathologies so that, when encountered, they can be safely and efficiently managed in a single procedure.