1
|
Alobid I, Calvo-Henríquez C, Viveros-Díez P, López-Chacón M, Rojas-Lechuga MJ, Langdon C, Marin C, Mullol J. Validation of Visual Analogue Scale for loss of smell as a quick test in chronic rhinosinusitis with nasal polyps. J Investig Allergol Clin Immunol 2023; 34:0. [PMID: 37675801 DOI: 10.18176/jiaci.0937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Diagnostic criteria of chronic rhinosinusitis with nasal polyps (CRSwNP) include, among others, olfactory dysfunction (OD). We hypothesize that patients suffering with CRSwNP are good at self-assessing their sense of smell through visual analogue scale (VAS) compared to smell tests. METHODS A controlled cross-sectional study was planned. Adults diagnosed with severe CRSwNP waiting for endoscopic sinus surgery were included. A cohort of healthy controls was also studied. All participants performed Barcelona smell test (BAST-24), sinonasal outcomes test 22 (SNOT-22), and VAS for loss of smell. CRSwNP underwent blood test (eosinophils count, total serum IgE), CT scan (Lund-Mackay Score), and nasal endoscopy. RESULTS 138 severe CRSwNP and 40 controls subjects were included. The BAST-24 identification score was strongly correlated with the VAS score in the CRSwNP group (rho=-0.79, p<0.001) but not in the control group (rho=-0.14; p=0.39), this difference between groups being statistically significant (p<0.001). A significant correlation of SNOT-22 item 21 (loss of smell) was also found with BAST-24 identification (rho=-0.65, p<0.001), this difference being statistically significant (Z=-2.43; p=0.015). In the ROC curve, the area under the curve (AUC) was 0.85 with 72.5% sensitivity and 93.1% specificity. CONCLUSION This study demonstrates a potential role of the VAS score for the screening of OD in severe CRSwNP in daily clinical practice.
Collapse
Affiliation(s)
- I Alobid
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona University, Barcelona, Catalonia, Spain
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
| | - C Calvo-Henríquez
- Rhinology unit, ENT Department. Hospital Complex of Santiago de Compostela, Spain
- Young-Otolaryngologists of the International Federations of Oto-rhino- laryngological Societies (YO-IFOS) study group
| | - P Viveros-Díez
- ENT department. University Hospital of Valladolid, Valladolid, Spain
| | - M López-Chacón
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona University, Barcelona, Catalonia, Spain
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
| | - M J Rojas-Lechuga
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain
| | - C Langdon
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona University, Barcelona, Catalonia, Spain
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
| | - C Marin
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
| | - J Mullol
- INGENIO, IRCE, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain
| |
Collapse
|
2
|
Langdon C, Lehrer E, Berenguer J, Laxe S, Alobid I, Quintó L, Mariño-Sánchez F, Bernabeu M, Marin C, Mullol J. Olfactory Training in Post-Traumatic Smell Impairment: Mild Improvement in Threshold Performances: Results from a Randomized Controlled Trial. J Neurotrauma 2018; 35:2641-2652. [PMID: 29790420 DOI: 10.1089/neu.2017.5230] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic Brain Injury (TBI) can be associated with partial or total smell loss. Recent studies have suggested that olfactory outcome can be positively modulated after olfactory training (OT). This study's aim was to investigate OT's potential role in smell recovery after TBI-induced olfactory loss. A prospective, randomized, and controlled study was developed. Patients with TBI-induced olfactory dysfunction (n = 42) were randomized into an experimental group with OT and a control group without (nOT). OT was performed twice daily with a six odor training set during 12 weeks. Olfactory loss was assessed using subjective olfactometry (Barcelona Smell Test [BAST] 24), a visual analogue scale (VAS), and n-butanol threshold (n-BTt) at baseline at 4, 12, and 24 weeks. Additionally, patients underwent MRI of the olfactory brain and olfactory bulbs (OB). Based on the MRI results, an overall score (0-16) was developed to associate the structural neurological damage with olfactory outcomes. The primary outcome was the change in olfactory measurements (VAS and BAST-24) between baseline and 12 weeks. The secondary outcome was the association of the MRI score with olfactory outcomes at baseline, and the impact on quality of life (QoL). After 12 weeks of training, OT patients showed a significant improvement in n-BTt (0.6 ± 1.7 OT vs. -0.6 ± 1.8 nOT, p < 0.05), but not in the smell VAS and BAST-24 scores. Olfactory outcomes (VAS, BAST-24, and n-BTt) were significantly associated with MRI structural findings (p < 0.001), but not with the OB volume or olfactory sulcus length. The present study suggests that 12 weeks of OT mildly improves the olfactory threshold in TBI, whereas the overall MRI score may be used as an imaging marker of olfactory dysfunction and disease severity in TBI patients.
Collapse
Affiliation(s)
- Cristóbal Langdon
- 1 Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic , Barcelona, Catalonia, Spain .,2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain
| | - Eduardo Lehrer
- 1 Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic , Barcelona, Catalonia, Spain .,2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain
| | - Joan Berenguer
- 2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain .,3 Neuroradiology Unit, Department of Radiology and Imaging Diagnostic Center, Hospital Clínic , Barcelona, Catalonia, Spain
| | - Sara Laxe
- 4 Brain Injury Unit, Guttmann Institute Foundation and Neurorehabilitation Hospital, Autonomous University of Barcelona , Barcelona, Catalonia, Spain .,5 Germans Trias i Pujol Science Health Institute Foundation , Barcelona, Catalonia, Spain
| | - Isam Alobid
- 1 Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic , Barcelona, Catalonia, Spain .,2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain .,6 Center for Biomedical Research Network in Respiratory Diseases (CIBERES) , Barcelona, Catalonia, Spain
| | - Llorenç Quintó
- 7 Barcelona Institute of Global Health, Hospital Clínic - University of Barcelona , Barcelona, Catalonia, Spain
| | - Franklin Mariño-Sánchez
- 2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain .,6 Center for Biomedical Research Network in Respiratory Diseases (CIBERES) , Barcelona, Catalonia, Spain
| | - Montserrat Bernabeu
- 4 Brain Injury Unit, Guttmann Institute Foundation and Neurorehabilitation Hospital, Autonomous University of Barcelona , Barcelona, Catalonia, Spain .,5 Germans Trias i Pujol Science Health Institute Foundation , Barcelona, Catalonia, Spain
| | - Concepció Marin
- 2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- 1 Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic , Barcelona, Catalonia, Spain .,2 Clinical and Experimental Respiratory Immunoallergy (IRCE), August Pi i Sunyer Biomedical Research Institute (IDIBAPS) , Barcelona, Catalonia, Spain .,7 Barcelona Institute of Global Health, Hospital Clínic - University of Barcelona , Barcelona, Catalonia, Spain
| |
Collapse
|
3
|
de Haro-Licer J, González-Fernández A, Planas-Comes A, González-Ares JA. Olfactory Disorder Pattern In Patients With Neurological Diseases Excluding Psychiatric And Traumatic Aetiologies. Acta Otorrinolaringol Esp (Engl Ed) 2018; 69:318-324. [PMID: 29580587 DOI: 10.1016/j.otorri.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The most common cause of olfactory ENT disorders are colds and flu, chronic sinusitis, allergies and traumatic brain injury. Rarer aetiologies include certain neurological, psychiatric and metabolic injuries. TARGET The aim of this paper was to check the sort of olfactory disorders found in people who have suffered a brain injury, excluding: cranial traumas, psychiatric diseases, epilepsy, Parkinson's and Alzheimer's disease, and synaesthesia. MATERIAL AND METHODS A descriptive study based on 61 patients with diagnoses of various neurological injuries, which were tested by BAST-24 olfactometer. The results were compared with those of a control group (n= 120). RESULTS The results show major impairment in these patients' olfactory sense. The neurological injury patients were able to detect from 60-77% of the odours, while the control group were able to detect between 98-100%. The neurological patients were able, at best, to identify, 11-32% of the odours correctly, while the control group were able to correctly detect between 59 -75%. The differences between odour detection and correct identification were statistically significant (p<.05). CONCLUSIONS We concluded: a) Neurological injury, not caused by traumatic brain injury, psychiatric disorders or ENT diseases, ranged from 68-89% of the olfactory failures. b) We must bear in mind that these sorts of injuries can cause olfactory disorders. c) ENT and Neurologists should collaborate in the treatment of these disorders.
Collapse
Affiliation(s)
- Josep de Haro-Licer
- Servicio de Otorrinolaringología, Hospital Municipal de Badalona-BSA, Barcelona, España. 15583jhl.@comb.cat
| | | | - Albert Planas-Comes
- Servicio de Neurología-Medicina Interna, Hospital Municipal de Badalona-BSA, Barcelona, España
| | | |
Collapse
|
4
|
Alobid I, Benítez P, Cardelús S, de Borja Callejas F, Lehrer-Coriat E, Pujols L, Picado C, Mullol J. Oral plus nasal corticosteroids improve smell, nasal congestion, and inflammation in sino-nasal polyposis. Laryngoscope 2013; 124:50-6. [PMID: 23901043 DOI: 10.1002/lary.24330] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/24/2013] [Accepted: 07/08/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the effect of oral plus intranasal corticosteroids on subjective outcomes (smell and nasal congestion) and objective outcomes (tissue eosinophilia and nitric oxide) in severe nasal polyposis (NP). STUDY DESIGN After a 4-week steroid washout period (w0), severe NP were randomized into a treatment group (n = 67) that receive oral prednisone for 2 weeks (w2) plus intranasal budesonide for 12 weeks (w12), and a control group (n = 22) that received no steroid treatment. METHODS Barcelona Smell Test 24 (BAST-24), nasal congestion, tissue eosinophilia, and nasal nitric oxide (nNO) were assessed. RESULTS Before treatment, patients showed a significant impairment of smell detection (30.7 ± 39.5%), identification (7.1 ± 16.1%), and forced choice (13.8 ± 23.3%) in BAST-24 compared to healthy population. At w2, the treatment group showed a significant improvement in detection, identification, and forced choice. Positive effect was also seen after 12 weeks of intranasal corticosteroids. A significant reduction of nasal congestion (1.17 ± 1.0 vs. 2.73 ± 0.5) and polyp tissue eosinophilia (10.9 ± 4.2 vs. 41.2 ± 12.2) with an increase of nNO (650 ± 317 vs. 420 ± 221 ppb) were observed at w2 compared to w0 and to the control group. These effects were also seen at w12. CONCLUSIONS Combined oral and intranasal corticosteroids improve smell and nasal congestion and decrease nasal inflammation, as measured by reduced tissue eosinophilia and increased detection of nNO. Severity of smell loss correlates with degree of nasal congestion but not with inflammation, as measured by tissue eosinophilia or nasally exhaled nNO. Our findings suggest that improvement in smell may be related to improved conduction of odorants to the olfactory neuroepithelium.
Collapse
Affiliation(s)
- Isam Alobid
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, (CIBERES), Barcelona, Catalonia, Spain
| | | | | | | | | | | | | | | |
Collapse
|