嗅觉训练治疗嗅觉障碍的临床观察
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摘要
目的初步探讨复杂香味进行嗅觉训练对外伤或上呼吸道感染引起的嗅觉障碍的疗效。方法 2016年12月～2018年3月于中国医科大学附属第一医院门诊收治的外伤及上呼吸道感染后嗅觉障碍患者36例,其中男12例,女24例;年龄20～80岁,平均年龄(47.61±16.68)岁,病程3～60个月,平均病程(13.58±13.51)个月。分别按病因分为上呼吸道感染组(19例)和外伤组(17例),按嗅觉下降程度分为嗅觉下降组(18例)和嗅觉丧失组(18例)。均采用患者自行购买的4种味道明显不同的香水进行嗅觉训练,治疗前后进行嗅觉综合VAS评分,并分别对香味、臭味进行嗅觉评分。用Fisher确切概率法进行统计学分析。结果所有患者均完成治疗方案,总有效率为55.56%(20/36)。嗅觉下降组有效率77.78%(14/18),嗅觉丧失组有效率33.33%(6/18),经比较差异具有统计学意义(P<0.05)。上呼吸道感染后嗅觉障碍组有效率73.68%(14/19),外伤后嗅觉障碍组有效率35.29%(6/17),经比较差异具有统计学意义(P<0.05)。治疗有效患者中50.00%(10/20)对香味感知的恢复明显优于臭味,经比较差异具有统计学意义(P<0.05)。结论本研究所采用的嗅觉训练方案具有简便易行、灵活度高、患者负担轻、患者依从度高的特点,对嗅觉障碍患者有一定的疗效,其中对有残余嗅觉的患者疗效更显著,上呼吸道感染引起的嗅觉障碍比外伤后的嗅觉障碍更易于恢复。另外,嗅觉训练通常采用香味嗅剂,因而有重要警示作用的臭味嗅觉恢复明显落后于香味,应该受到重视。
Objective This study was to explore the effects of olfactory training via complex perfume patterns on patients with olfactory dysfunction due to head trauma or upper respiratory tract infection.Methods From December 2016 to March 2018, 36 patients with olfactory dysfunction due to head trauma or upper respiratory tract infection were treated in First Affiliated Hospital of China Medical University, including 12 males and 24 females, aged from 20 to 80 years, with an average age of 47.61± 16.68 years old; course of 3 months to 60 months, the mean course of 13.58 ± 13.51 months. The patients were divided into "upper respiratory tract infection group"(19 cases) and "trauma group"(17 cases) according to the etiology, and "olfactory decline group"(18 cases) and "olfactory loss group"(18 cases) according to the degree of olfactory decline. Four kinds of perfumes with obviously different flavors purchased by the patients themselves were used for olfactory training. Comprehensive olfactory VAS scores were evaluated before and after olfactory training, which was performed for all the patients. Olfactory comprehensive VAS score was performed before and after treatment, and olfactory score was performed for aroma and odor respectively. Fisher exact probability method was used for statistical analysis(P=0.05).Results Thirty-six patients completed the whole regimen. The total effective rate was 55.56%(20/36) and the cure rate was 13.89%(5/36). The effective rate of the olfactory loss group was 33.33%(6/18); The effective rate of the olfactory decline group was 77.78%(14/18), and the difference was statistically significant(P< 0.05). The effective rate of the olfactory dysfunction group duo to upper respiratory tract infection was 73.68%(14/19);the effective rate of the olfactory dysfunction group due to head trauma was 35.29%(6/17), and the difference was statistically significant between them(P< 0.05). Among the patients with effective treatment, 50.00%(10/20) was significantly superior to the recovery of odor perception, and the difference was statistically significant(P<0.05).Conclusions The therapeutic regime of the olfactory training adopted in this study is characterized by the simple and convenient operation, high flexibility, low cost on patients, and high compliance of patients. Certain therapeutic effects were observed for patients with residual smell and patients with upper respiratory tract infection induced olfactory dysfunctions. Scent is commonly used as an odorant in olfactory training. However, odor has an important warning effect and it deserves more attention that the odor recovery lags significantly behind the scent.
Objective This study was to explore the effects of olfactory training via complex perfume patterns on patients with olfactory dysfunction due to head trauma or upper respiratory tract infection.Methods From December 2016 to March 2018, 36 patients with olfactory dysfunction due to head trauma or upper respiratory tract infection were treated in First Affiliated Hospital of China Medical University, including 12 males and 24 females, aged from 20 to 80 years, with an average age of 47.61± 16.68 years old; course of 3 months to 60 months, the mean course of 13.58 ± 13.51 months. The patients were divided into "upper respiratory tract infection group"(19 cases) and "trauma group"(17 cases) according to the etiology, and "olfactory decline group"(18 cases) and "olfactory loss group"(18 cases) according to the degree of olfactory decline. Four kinds of perfumes with obviously different flavors purchased by the patients themselves were used for olfactory training. Comprehensive olfactory VAS scores were evaluated before and after olfactory training, which was performed for all the patients. Olfactory comprehensive VAS score was performed before and after treatment, and olfactory score was performed for aroma and odor respectively. Fisher exact probability method was used for statistical analysis(P=0.05).Results Thirty-six patients completed the whole regimen. The total effective rate was 55.56%(20/36) and the cure rate was 13.89%(5/36). The effective rate of the olfactory loss group was 33.33%(6/18); The effective rate of the olfactory decline group was 77.78%(14/18), and the difference was statistically significant(P< 0.05). The effective rate of the olfactory dysfunction group duo to upper respiratory tract infection was 73.68%(14/19);the effective rate of the olfactory dysfunction group due to head trauma was 35.29%(6/17), and the difference was statistically significant between them(P< 0.05). Among the patients with effective treatment, 50.00%(10/20) was significantly superior to the recovery of odor perception, and the difference was statistically significant(P<0.05).Conclusions The therapeutic regime of the olfactory training adopted in this study is characterized by the simple and convenient operation, high flexibility, low cost on patients, and high compliance of patients. Certain therapeutic effects were observed for patients with residual smell and patients with upper respiratory tract infection induced olfactory dysfunctions. Scent is commonly used as an odorant in olfactory training. However, odor has an important warning effect and it deserves more attention that the odor recovery lags significantly behind the scent.
引文
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[2] 边志刚,姜涛,曹志伟.鼻窦炎鼻息肉患者鼻内镜手术后嗅觉功能障碍转归因素分析 [J].中国耳鼻咽喉颅底外科杂志,2008,14(3):192-196.Bian ZG,Jiang T,Cao ZW.Analysis of the factors leading to olfactory dysfunction after endoscopic sinus surgery in patients with sinusitis and nasal polyps [J].Chin J Otorhinolaryngol skull Base Surg,2008,14(3):192-196.
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[15] 于东歌.“鼻三针”配合穴位注射治疗嗅觉障碍疗效观察 [J].中医临床研究,2014,6(25):23-24.Yu DG.Clinical observation on treating dysosmia with Nose 3-Needle plus acupoint injection[J].Clinical Journal of Chinese Medicine,2014,6(25):23-24.
[16] Konstantinidis I,Tsakiropoulou E,Bekiaridou P,et al.Use of olfactory training in post-traumatic and postinfectious olfactory dysfunction[J].Laryngoscope,2013,123(12):E85-90.
[17] 陈敬华,武琦琦,江凤仙,等.嗅觉训练对慢性鼻窦炎患者嗅觉障碍的治疗效果 [J].中国实用医药,2017,12(17):163-164.Chen JH,Wu QQ,Jiang FX,et al.Therapeutic effect of olfactory training on olfactory disorders in patients with chronic sinusitis[J].China Practical Medical,2017,12(17):163-164.
[18] Damm M,Pikart LK,Reimann H,et al.Olfactory training is helpful in postinfectious olfactory loss:A randomized,controlled,multicenter study[J].Laryngoscope,2014,124(4):826-831.
[19] Konstantinidis I,Tsakiropoulou E,Constantinidis J.Long term effects of olfactory training in patients with post-infectious olfactory loss[J].Rhinology,2016,54(2):170-175.
[20] Altundag A,Cayonu M,Kayabasoglu G,et al.Modified olfactory training in patients with postinfectious olfactory loss[J].Laryngoscope,2015,125(8):1763-1766.
[21] Patel ZM,Wise SK,DelGaudio JM.Randomized controlled trial demonstrating cost-effective method of olfactory training in clinical practice:essential oils at uncontrolled concentration[J].Laryngoscope Investig Otolaryngol,2017,2(2):53-56.
[22] Herrada G,Dulac C.A novel family of putative pheromone receptors in mammals with a topographically organized and sexually dimorphic distribution[J].Cell,1997,90(4):763-773.
[2] 边志刚,姜涛,曹志伟.鼻窦炎鼻息肉患者鼻内镜手术后嗅觉功能障碍转归因素分析 [J].中国耳鼻咽喉颅底外科杂志,2008,14(3):192-196.Bian ZG,Jiang T,Cao ZW.Analysis of the factors leading to olfactory dysfunction after endoscopic sinus surgery in patients with sinusitis and nasal polyps [J].Chin J Otorhinolaryngol skull Base Surg,2008,14(3):192-196.
[3] 高旭栋,崔娜,安立峰,等.嗅觉障碍常见病因、治疗及预后[J].临床耳鼻咽喉头颈外科杂志,2014,28(20):1623-1627.Gao XD,Cui N,An LF,et al.Etiologies,treatment and prognosis of olfactory dysfunction[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2014,28(20):1623-1627.
[4] Hummel T,Rissom K,Reden J,et al.Effects of olfactory training in patients with olfactory loss [J].Laryngoscope,2009,119(3):496-499.
[5] Pekala K,Chandra RK,Turner JH.Efficacy of olfactory training in patients with olfactory loss:a systematic review and meta-analysis[J].International Forum of Allergy & Rhinology,2016,6(3):299-307.
[6] Poletti SC,Michel E,Hummel T.Olfactory training using heavy and light weight molecule odors [J].Perception,2017,46(3-4):343-351.
[7] Oleszkiewicz A,Hanf S,Whitcroft KL,et al.Examination of olfactory training effectiveness in relation to its complexity and the cause of olfactory loss[J].Laryngoscope,2018,128(7):1518-1522.
[8] Gaines AD.Anosmia and hyposmia [J].Allergy Asthma Proc,2010,31(3):185-189.
[9] 刘剑锋,韩红蕾,庞春红,等.糖皮质激素雾化吸入和嗅觉训练治疗感冒后嗅觉障碍 [J].中国耳鼻咽喉头颈外科,2015,22(12):623-626.Liu JF,Han HL,Pang CH,et al.Glucocorticoid aerosol inhalation and olfactory training for the treatment of olfactory disorders after a cold [J].Chinese Archives of Otolaryngology-Head and Neck Surgery,2015,22(12):623-626.
[10] Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[11] 姜涛,边志刚,曹志伟.嗅觉障碍患者鼻内镜术后嗅黏膜形态学观察 [J].中国耳鼻咽喉颅底外科杂志,2008,14(2):98-102.Jiang T,Bian ZG,Cao ZW.Morphological changes of olfactory mucous in patients with dysosmia before and after endoscopic sinus surgery[J].Chin J Otorhinolaryngol Skull Base Surg,2008,14(2):98-102.
[12] Seiden AM,Duncan HJ.The diagnosis of a conductive olfactory loss [J].Laryngoscope,2001,111(1):9-14.
[13] Hummel T,Heilmann S,Huttenbriuk KB.Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract[J].Laryngoscope,2002,112(11):2076-2080.
[14] 关瑞桥,邹伟.针刺治疗颅脑外伤所致嗅觉障碍32例 [J].上海针灸杂志,2015,34(11):1116.Guan RQ,Zou W.Acupuncture treatment of 32 cases of olfactory disturbance caused by craniocerebral trauma[J].Shanghai Journal of Acupuncture and Moxibustion,2015,34(11):1116.
[15] 于东歌.“鼻三针”配合穴位注射治疗嗅觉障碍疗效观察 [J].中医临床研究,2014,6(25):23-24.Yu DG.Clinical observation on treating dysosmia with Nose 3-Needle plus acupoint injection[J].Clinical Journal of Chinese Medicine,2014,6(25):23-24.
[16] Konstantinidis I,Tsakiropoulou E,Bekiaridou P,et al.Use of olfactory training in post-traumatic and postinfectious olfactory dysfunction[J].Laryngoscope,2013,123(12):E85-90.
[17] 陈敬华,武琦琦,江凤仙,等.嗅觉训练对慢性鼻窦炎患者嗅觉障碍的治疗效果 [J].中国实用医药,2017,12(17):163-164.Chen JH,Wu QQ,Jiang FX,et al.Therapeutic effect of olfactory training on olfactory disorders in patients with chronic sinusitis[J].China Practical Medical,2017,12(17):163-164.
[18] Damm M,Pikart LK,Reimann H,et al.Olfactory training is helpful in postinfectious olfactory loss:A randomized,controlled,multicenter study[J].Laryngoscope,2014,124(4):826-831.
[19] Konstantinidis I,Tsakiropoulou E,Constantinidis J.Long term effects of olfactory training in patients with post-infectious olfactory loss[J].Rhinology,2016,54(2):170-175.
[20] Altundag A,Cayonu M,Kayabasoglu G,et al.Modified olfactory training in patients with postinfectious olfactory loss[J].Laryngoscope,2015,125(8):1763-1766.
[21] Patel ZM,Wise SK,DelGaudio JM.Randomized controlled trial demonstrating cost-effective method of olfactory training in clinical practice:essential oils at uncontrolled concentration[J].Laryngoscope Investig Otolaryngol,2017,2(2):53-56.
[22] Herrada G,Dulac C.A novel family of putative pheromone receptors in mammals with a topographically organized and sexually dimorphic distribution[J].Cell,1997,90(4):763-773.