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Imbs S, Deyrail B, Nguyen DT, Hossu G, Blum A, Gondim Teixeira PA, Rumeau C, Jankowski R, Gillet R. Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings? Eur Radiol 2024:10.1007/s00330-023-10564-9. [PMID: 38206402 DOI: 10.1007/s00330-023-10564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE(S) To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.
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Affiliation(s)
- Sara Imbs
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
| | - Baptiste Deyrail
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Rumeau
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Roger Jankowski
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France.
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Fieux M, Rumeau C, De Bonnecaze G, Papon JF, Mortuaire G. Surgery for chronic rhinosinusitis with nasal polyps: An update. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:297-304. [PMID: 37838602 DOI: 10.1016/j.anorl.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006-2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10-15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.
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Affiliation(s)
- M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Université de Paris Est Creteil, Inserm, IMRB, CNRS ERL 7000, 94010 Créteil, France.
| | - C Rumeau
- Service ORL, CHRU-Nancy, université de Lorraine, 54000 Nancy, France; Université de Lorraine, DevAH, 54000 Nancy, France.
| | - G De Bonnecaze
- Université de Lorraine, DevAH, 54000 Nancy, France; Service d'ORL et chirurgie cervico-faciale, pôle clinique des voies respiratoires, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse, France; Laboratoire Center for Anthropobiology and Genomics of Toulouse, université Paul-Sabatier Toulouse III, 31059 Toulouse, France.
| | - J F Papon
- Service d'ORL, de chirurgie cervico-faciale, hôpital Kremlin Bicêtre, Assistance publique-Hôpitaux de Paris, 94270 Paris, France; DMU Neuroscience, Le Kremlin-Bicêtre, université Paris-Saclay, Inserm, IMRB, CNRS ERL 7000, 94010 Créteil, France.
| | - G Mortuaire
- Service d'ORL et de chirurgie cervico-faciale, hôpital Huriez, CHU de Lille, rue Michel-Polonovski, 59000 Lille, France; INFINITE - Institute for Translational Research in Inflammation, université de Lille, Inserm U1286, 59000 Lille, France.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Papadakis CE, Chimona TS, Chaidas K, Ladias A, Zisoglou M, Proimos EK. Effect of oral steroids on olfactory function in chronic rhinosinusitis with nasal polyps. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:343-348. [PMID: 33676882 DOI: 10.1016/j.anorl.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022]
Abstract
AIMS The present study aimed to investigate the effects of oral steroids on olfactory disturbances in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). MATERIAL AND METHODS This is a prospective randomized non-blinded study. Selected CRSwNP patients (n=140), with hyposmia, were devided into two groups; group A received a 7-day course of oral steroids with a 12-weeks course of nasal steroids and douching; group B received a 12-weeks course of nasal steroids and douching. Assessment included Sniffin' Sticks scores, visual analogue scale score for olfaction and discomfort (VASsmell, VASdis), the Sinonasal Outcome Test-22, Greek-version (SNOT22-Gr) and the endoscopic appearance (EAS). OBJECTIVES The main objective was to compare the olfactory effect of the different therapy in group A and group B, at 2, 12 and 24 weeks. Accessory objectives included the comparison of EAS, VASdis and SNOT22-Gr between groups, the evaluation of the therapeutic outcome duration, and, the investigation of potential correlation between the evaluated parameters. RESULTS The 2-weeks evaluation showed a significant statistical difference (P<0.001) for all parameters except VASdis. Olfactory outcomes (Sniffin' Sticks and VASsmell scale scores) were found significantly better in group A at the 24-weeks evaluation (P<0.001). Within groups, the therapeutic result remained stable between the 12-weeks and 24-weeks evaluation (P>0.05). Sniffin' Sticks score was strongly correlated at 12-weeks evaluation with EAS (rho=0.58, P<0.001). CONCLUSION Our results suggest that a combination treatment of oral and nasal steroids in well-selected patients with CRSwNP may result in early olfaction restoration with a possible long-term effect.
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Affiliation(s)
- C E Papadakis
- ENT Department, Chania General Hospital, Chania, Crete, Greece
| | - T S Chimona
- ENT Department, Chania General Hospital, Chania, Crete, Greece
| | - K Chaidas
- ENT Department, John-Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - A Ladias
- ENT Department, Chania General Hospital, Chania, Crete, Greece
| | - M Zisoglou
- ENT Department, Chania General Hospital, Chania, Crete, Greece
| | - E K Proimos
- ENT Department, Chania General Hospital, Chania, Crete, Greece.
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Li J, Palmer G, Shankar S, Villwock MR, Chiu AG, Sykes KJ, Villwock JA. Essential Oil Olfactory Test: Comparison of Affordable Rapid Olfaction Measurement Array (AROMA) to Sniffin' Sticks 12. OTO Open 2020; 4:2473974X20962464. [PMID: 33748649 PMCID: PMC7905729 DOI: 10.1177/2473974x20962464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives To further demonstrate the validity of Affordable Rapid Olfaction Measurement Array (AROMA), an essential oil−based smell test, and compare it to the Sniffin’ Sticks 12 Test (SST12). Study Design Prospective cross-sectional study. Setting Academic medical center. Methods Fifty healthy individuals without sinonasal disease were recruited to the study. AROMA has been previously validated against the University of Pennsylvania Smell Identification Test. The current study tests 2 additional higher concentrations to increase the ability to detect olfactory reserve. Healthy participants completed AROMA, SST12, Sino-Nasal Outcome Test (SNOT-22), and Questionnaire of Olfactory Disorders (QoD). Spearman correlations were used to evaluate AROMA, SST, SNOT-22, and QoD. Results AROMA demonstrated strong test-retest reliability (r = 0.757, P < .01). AROMA showed a moderate correlation to SST12 (ρ = 0.412, P < .01). Age and SNOT-22 were significantly correlated (P < .05) with AROMA (ρ = −0.547, −0.331, respectively), and age was weakly correlated with SST (ρ = −0.377, P < .01). Median percent correct scores were as follows: SST12 identification, 92%; AROMA detection, 90%; and AROMA identification, 81%. Median correct odor identification of AROMA concentrations at 1×, 2×, 4×, and 8× were 64%, 75%, 92%, and 92%, respectively. Conclusion AROMA has a moderate correlation with SST12. AROMA is more strongly correlated than SST12 to age and SNOT-22. AROMA’s stronger correlation with subjective olfactory status, low cost, and adaptability may help remove barriers to routine olfactory testing in the clinic.
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Affiliation(s)
- Jennifer Li
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
- Jennifer Li, Department of Otolaryngology, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2010, Kansas City, KS 66160, USA.
| | - Gracie Palmer
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Suraj Shankar
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R. Villwock
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G. Chiu
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer A. Villwock
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Updating nasalisation: From concept to technique and results. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:327-334. [DOI: 10.1016/j.anorl.2018.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.
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Affiliation(s)
- R Jankowski
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - P Gallet
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - D T Nguyen
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France.
| | - C Rumeau
- Service d'ORL et Chirurgie Cervico-Faciale, CHRU de Nancy, Hôpitaux de Brabois, Bât Louis Mathieu, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
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