-
摘要: 目的 回顾性分析嗅觉障碍患者的病因及其临床特点，观察嗅觉障碍患者的味觉功能，探讨嗅觉障碍患者进行味觉功能检查的必要性。方法 收集2015—2021年就诊于嗅觉味觉诊疗中心的335例连续嗅觉障碍患者资料，分别进行详细的病史询问、专科检查、嗅觉功能检查(Sniffin' Sticks测试)和味觉功能检查(全口味觉功能检查)。采用SPSS 17.0统计软件分析不同病因的嗅觉障碍患者的临床特点以及影响味觉功能的相关因素。结果 不同原因导致的嗅觉障碍性疾病占门诊全部嗅觉障碍患者的比例分别为：头部外伤36.4%，上呼吸道感染22.1%，鼻腔鼻窦炎症性疾病15.5%，特发性嗅觉障碍11.9%，先天性失嗅9.6%，有害气体接触等其他原因4.5%。不同病因导致的嗅觉障碍性疾病的临床特点有所不同：外伤性嗅觉障碍患者大部分表现为嗅觉丧失(χ2=27.958，P < 0.001)，其发病无性别及年龄差异(均P>0.05);上呼吸道感染后嗅觉障碍多表现为嗅觉丧失(χ2=21.568，P < 0.001)，且呈现明显的性别和年龄差异，多见于女性患者(χ2=5.898，P < 0.05)，中老年人发病率较高(χ2=12.963，P < 0.001);炎症性嗅觉障碍患者多以嗅觉丧失为临床表现(χ2=12.106，P < 0.05)，男性多于女性(χ2=4.655，P < 0.05);特发性嗅觉障碍多发生于中老年人(χ2=5.284，P < 0.05)，发病无性别差异(P>0.05);先天性失嗅表现为嗅觉丧失，发病无性别差异(P>0.05)。约39%的嗅觉障碍患者同时伴有味觉障碍，其味觉功能的损伤程度与病因有关(r=0.368，P < 0.05)，而与嗅觉功能、年龄和性别均无相关性(均P>0.05)。结论 头部外伤、上呼吸道感染、鼻腔鼻窦炎症性疾病和特发性嗅觉障碍是临床就诊患者嗅觉障碍的主要原因，不同病因导致的嗅觉障碍性疾病的临床特点有所不同。部分嗅觉障碍患者同时伴有味觉障碍，其味觉功能的损伤程度与病因有关，因此在临床工作中需重视对嗅觉障碍患者进行味觉功能的评估。Abstract: Objective To analyze the etiology and clinical features of patients with olfactory disorders (OD), and to explore the importance of gustatory testing in patients with OD.Methods Clinical data of 335 consecutive patients with OD who seek medical consultation in the smell and taste center from the year 2015 to 2021 was retrospectively analyzed. The clinical characteristics of patients with OD were analyzed thorough a structured interview of medical history, otolaryngologic examinations, olfactory tests(Sniffin' Sticks test) and gustatory function test(whole-mouth taste test). SPSS 17.0 software was used to analyze the clinical characteristics of patients with OD and related factors which have effect on gustatory function.Results Among the patients, 36.4% of them caused by head trauma, 22.1% for upper respiratory tract infection(URTI), 15.5% for rhinosinusitis diseases(RSD), 11.9% for idiopathic, 9.6% for congenital anosmia, and 4.5% for other causes, respectively. The features were different in patients with different kinds of OD: most patients with head trauma were anosmic(χ2=27.958, P < 0.001), and no difference was found in gender and age(P>0.05 for both); most patients with URTI were anosmic(χ2=21.568, P < 0.001), and female patients were more than male(χ2=5.898, P < 0.05), elder patients were more than younger(χ2=12.963, P < 0.001); most patients with RSD were anosmic(χ2=12.106, P < 0.05), and male patients were more than female(χ2=4.655, P < 0.05); elder patients were more than younger for idiopathic OD(χ2=5.284, P < 0.05), but no sex difference was found(P>0.05); patients with congenital anosmia were all lost their smell since they were born, and no sex difference was found in the disease(P>0.05). Fifty-seven of 146(39%) patients whose gustation was assessed had gustatory dysfunction. Gustatory function was significantly associated with the causes of OD(r=0.368, P < 0.05), but not related to olfactory function, age and sex(P>0.05 for all).Conclusion The leading causes of olfactory dysfunction were head trauma, URTI, RSD, and idiopathic causes. Each of OD had its own distinct clinical features. Gustatory dysfunction were common in patients with OD, and gustatory function was related to the causes of OD. High priority should be given to gustatory function evaluation for the patients with OD.
-
Key words:
- olfactory dysfunction /
- gustatory dysfunction /
- etiology /
- clinical features
-
-
[1] Huang Z, Huang S, Cong H, et al. Smell and Taste Dysfunction Is Associated with Higher Serum Total Cholesterol Concentrations in Chinese Adults[J]. J Nutr, 2017, 147(8): 1546-1551. doi: 10.3945/jn.117.250480
[2] Eliyan Y, Wroblewski KE, McClintock MK, et al. Olfactory Dysfunction Predicts the Development of Depression in Older US Adults[J]. Chem Senses, 2021, 46: bjaa075. doi: 10.1093/chemse/bjaa075
[3] Agyeman AA, Chin KL, Landersdorfer CB, et al. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis[J]. Mayo Clin Proc, 2020, 95(8): 1621-1631. doi: 10.1016/j.mayocp.2020.05.030
[4] Hummel T, Nesztler C, Kallert S, et al. Gustatory sensitivity in patients with anosmia[J]. Chem Senses, 2001, 26: 1118.
[5] 王志会, 王临虹, 齐士格, 等. 中国老年人慢性便秘睡眠障碍和嗅觉异常状况调查[J]. 中华老年医学杂志, 2013, 32(7): 786-789. doi: 10.3760/cma.j.issn.0254-9026.2013.07.031
[6] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 嗅觉障碍诊断和治疗专家共识(2017年)[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(7): 484-494. doi: 10.3760/cma.j.issn.1673-0860.2018.07.002
[7] Gudziol H, Hummel T. Normative values for the assessment of gustatory function using liquid tastants[J]. Acta Otolaryngol, 2007, 127(6): 658-661. doi: 10.1080/00016480600951491
[8] 黄小兵, 郭怡辰, 魏永祥. 全口味觉检查法在健康成人味觉功能评估中的信度研究[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(8): 698-701. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202108006.htm
[9] Gudziol V, Hoenck I, Landis B, et al. The impact and prospect of traumatic brain injury on olfactory function: a cross-sectional and prospective study[J]. Eur Arch Otorhinolaryngol, 2014, 271(6): 1533-1540. doi: 10.1007/s00405-013-2687-6
[10] Liu J, Pinto JM, Yang L, et al. Gender difference in Chinese adults with post-viral olfactory disorder: a hospital-based study[J]. Acta Otolaryngol, 2016, 136(9): 976-981. doi: 10.3109/00016489.2016.1172729
[11] Duncan HJ, Seiden AM. Long-term follow-up of olfactory loss secondary to head trauma and upper respiratory tract infection[J]. Arch Otolaryngol Head Neck Surg, 1995, 121(10): 1183-1187. doi: 10.1001/archotol.1995.01890100087015
[12] Deems DA, Doty RL, Settle RG, et al. Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center[J]. Arch Otolaryngol Head Neck Surg, 1991, 117(5): 519-528. doi: 10.1001/archotol.1991.01870170065015
[13] Murphy C, Schubert CR, Cruickshanks KJ, et al. Prevalence of olfactory impairment in older adults[J]. JAMA, 2002, 288(18): 2307-2312. doi: 10.1001/jama.288.18.2307
[14] Barna M, Komatsu T, Bi Z, et al. Sex differences in susceptibility to viral infection of the central nervous system[J]. J Neuroimmunol, 1996, 67(1): 31-39. doi: 10.1016/0165-5728(96)00022-7
[15] Vest RS, Pike CJ. Gender, sex steroid hormones, and Alzheimer's disease[J]. Horm Behav, 2013, 63(2): 301-307. doi: 10.1016/j.yhbeh.2012.04.006
[16] Litvack JR, Fong K, Mace J, et al. Predictors of olfactory dysfunction in patients with chronic rhinosinusitis[J]. Laryngoscope, 2008, 118(12): 2225-2230. doi: 10.1097/MLG.0b013e318184e216
[17] Tan BK, Chandra RK, Pollak J, et al. Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis[J]. J Allergy Clin Immunol, 2013, 131(5): 1350-1360. doi: 10.1016/j.jaci.2013.02.002
[18] Liu J, Pinto JM, Yang L, et al. Evaluation of idiopathic olfactory loss with chemosensory event-related potentials and magnetic resonance imaging[J]. Int Forum Allergy Rhinol, 2018, 8(11): 1315-1322. doi: 10.1002/alr.22144
[19] Yao L, Pinto JM, Yi X, et al. Gray matter volume reduction of olfactory cortices in patients with idiopathic olfactory loss[J]. Chem Senses, 2014, 39(9): 755-760. doi: 10.1093/chemse/bju047
[20] Ponsen MM, Stoffers D, Twisk JW, et al. Hyposmia and executive dysfunction as predictors of future Parkinson's disease: a prospective study[J]. Mov Disord, 2009, 24(7): 1060-1065. doi: 10.1002/mds.22534
[21] Han P, Georgi M, Cuevas M, et al. Decreased electrogustometric taste sensitivity in patients with acquired olfactory dysfunction[J]. Rhinology, 2018, 56(2): 158-165. doi: 10.4193/Rhin17.186
[22] Fark T, Hummel C, Hähner A, et al. Characteristics of taste disorders[J]. Eur Arch Otorhinolaryngol, 2013, 270(6): 1855-1860. doi: 10.1007/s00405-012-2310-2
[23] Gagnon L, Vestergaard M, Madsen K, et al. Neural correlates of taste perception in congenital olfactory impairment[J]. Neuropsychologia, 2014, 62: 297-305. doi: 10.1016/j.neuropsychologia.2014.07.018
[24] Parma V, Ohla K, Veldhuizen MG, et al. More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis[J]. Chem Senses, 2020, 45(7): 609-622. doi: 10.1093/chemse/bjaa041
[25] Yang L, Wei Y, Zhang W, et al. Examination of chemosensory functions in patients with dysosmia[J]. Med Sci Monit, 2012, 18(3): CR154-159.
-
计量
- 文章访问数: 1154
- PDF下载数: 516
- 施引文献: 0
下载: