Effects of traditional Chinese acupuncture in post-viral olfactory dysfunction

Article (PDF Available)inOtolaryngology Head and Neck Surgery 142(4):505-9 · April 2010with176 Reads
DOI: 10.1016/j.otohns.2010.01.012 · Source: PubMed
Abstract
To date, recovery of olfactory function after viral infection of the upper airway cannot be achieved reliably with pharmacotherapy. The aim of this study was to evaluate the effects of traditional Chinese acupuncture (TCA) on olfactory function in patients with persistent post-viral olfactory dysfunction (PVOD). Historical cohort study. University Medical Center, Department of Otorhinolaryngology. A total of 15 patients presenting to the outpatient clinic with PVOD were treated by TCA in 10 weekly, 30-minute sessions. Subjective olfactometry was performed with the Sniffin' Sticks test set. Treatment success was defined as an increase in Sniffin' Sticks test scores of at least six points. The effects of TCA, obtained with the chi(2) test, were compared with those of matched pairs suffering from PVOD who had been treated with vitamin B complex over 12 weeks. Eight patients treated with TCA had improved olfactory function compared with two treated with vitamin B complex. chi(2) test revealed a significantly better outcome in olfactory function in patients undergoing acupuncture compared with patients receiving vitamin B complex (P = 0.02). TCA possibly offers a new therapeutic regimen for post-viral dysosmia. More research in a larger case series is needed before a clearer picture will emerge.
Effects
of
traditional
Chinese
acupuncture
in
post-viral
olfactory dysfunction
Julia
Vent, MD, PhD, Djin-Wue Wang, MD, and Michael
Damm, MD,
Cologne, Germany
No
sponsorships or
competing interests have
been disclosed.for
this article.
ABSTRACT
OBJECTIVE: To date,
recovery
of olfactory
function
after
viral
infection of the upper airway cannot be achicvcd reliably with
pharmacotherapy.
The aim of this study was to evaluate the effects
of traditional Chinese acupuncture
(TCA)
on olfactory function in
patients
with
persistcnt post-viral
olfactory dysfunction
(PVOD).
STUDY DESIGN: Historical cohort study.
SETTING: Univcrsity Medical Center, Department of Otorhino-
laryngology.
SUBJECTS AND METHODS: A total
of
l5
patients present-
ing
to the outpatient clinic with PVOD were treatcd
by
TCA in 10
weekly, 30-minute
sessions. Subjective olfactometry
was
per-
formed with
the Sniffin' Sticks test set. Treatment success was
defined as an
increase in
Sniffin' Sticks test scores of at
least
six
points.
The
effects of
TCA,
obtained
with
the
Xt
tcst, were com-
pared
with
those of matched
pairs
suffering from PVOD who had
been treated
with vitamin
B cornplex over
l2
weeks.
RESULTS: Eight
patients
treated with TCA had irrproved ol-
factory function
cornpared
with
two treated
with vitamin B
corn-
plex.
1:
test rcvealed a
significantly better outcome
in
olfactory
function in
patients
undergoing zlcupuncture compared with
pa-
tients receiving vitamin B complex
(P
....
0.02).
CONCLUSION: TCA
possibly
offers a new therapeutic
regi-
men for
post-viral
dysosmia. More research irr
a
larger
case
series
is
needed
before a clearer
picture
will
errerge.
@
2010 American Academy
of Otolaryngology-Head and Neck
Surgery
Foundation. All rights reserved.
f,
mong
the
various
causes ofacquired olfactory dysfunc-
.{a.tions
are
viral
upper respiratory tract infections, si-
nonasal disease, and trauma
after a
fall
on the back of
the
head involving the coup-contrecoup mechanism.l In the
olfactory
clinic
of the
Department
of Otolaryngology, Uni-
versity
of Cologne
Medical
Centre,
post-viral
olfactory dys-
function
(PVOD)
makes
up the largest
group
of
patients,
including more than a third
of all dysosmic
patients.r
This
distribution of underlying causes of dysosmia is comparable
to the
populations
reported
by other smell and taste centers.
Otolaryngology-Head
and Neck
Surgery
i.2010l, 142,505-509
ORIGINAL
RESEARCH-GENERAL OTOLARYNGOLOGY
To date, there
is no validated
pharmacotherapyl2
for PVOD;
however. attemDts have been made to
establish a
standardized
tl'eatment.' In
the
literature, systemic and topical steroidsr''l
as
well as vitamin B supplementation,'5
caroverine,6 alpha lipoic
acid,7 and other drugs
were used to treat those
patients. The
Lrnderlying treatment strategy
is to enhance regeneration of the
olfactory
epithelium. The olfactory epithelium undergoes
a
continuing regeneration,
with
a balance
of apoptosis and
neuro-neogenesis.o Disturbed balance and dominant
apoptosis
(as
in PVOD) result in a net loss of olfactory
neurons and thus
in reduced olfactory
function.s The regeneration of olfactory
function can consequently be achieved by
suppressing cell
death and inflammation, as
well
as by
promoting
regrowth of
olfactory
neurons
(i.e.,
neuro-neogenesis). However, currently
no reliable
therapy
for PVOD is available.
The efficacy of
alternative or complementary
medicine is
often
regarded with criticism among academics
in the Westenr
world.
Despite the
increasing
popularity
among lay
people
and
patients,
objective data about results are
rarely
published
in
scientific literature, In the
literature, there is only one case
report of treatment of anosmia
with acupuncture, and its meth-
ods
(e.g.,
olfactometry)
are not
standardized."
Nevertheless, a
placebo-controlled
study by
Brandt et alro and a large
retro-
spective series
by
Hauswald et al
rr
showed a significant
im-
provement
in
smell
and taste disorders after trcatment
with
acupuncture.
Traditional Chinese acupuncture
(TCA)
is
one
of the
oldest
healing methods in the world, reaching back
in his-
tory at least 2000
years.
TCA mirrors different meridians,
energy lines,
and
spots of the body that are balanced
in
a
healthy
physique.
Traditional Chinese medicine seeks to
reestablish an equilibrium of forces
in the
diseased
body
between the energies of
yin
and
yang
(contrary
energies
such
as fire
and
water, hot
and cold),
which are distorted in
the diseased body.
There
are
various methods in acupunc-
ture.
The
traditional
Chinese method has been modified by
Europeans
to
laser beam acupuncturel2 and auricular acupunc-
ture;rr the latter was developed by Nogier
from
Lyon,
France,
as a
micro
system technique of acupuncture,
in which all body
pafis
are depicted on areas
of
the concha auris.
l:l
Received
October
2,2009: revised
January 6,
2010t
accepted January I l. 2010.
0194-5998/$36.00
@
2010 American
Academy of Otolaryngology-Head
and
Neck
Surgery Foundation.
AII rights
reserved
doi:
10. 1016/i.otohns,20
10.01 .01 2
506
Otolaryngology-Head
and
Neck Surgery,
Vol 142,
No 4, April 2010
The aim of this
historical cohort str-rdy
was
to
assess the
impact of TCA on
post-viral
hyp- or
anosmic
patients
and
compare them
with
a control
group
treated with
oral
admin-
istration of a vitamin B comolex,
Patients and Methods
In the olfactory clinic oI the
Department
of Otolaryngology,
University
of
Cologne Medical Center, consecutive
patients
with
post-viral
dysosmia were offered sessions ol TCA
from January [o December' 2008. Inclusion critelia were
PVOD that failed to improve
or
resolve for
more than six
months under oral administration of
steroids,
followed by
topical application of steroid drops to the olfactory
cleft.
Exclusion criteria were
all
other
conditions
for
smell loss,
previous
surgery of the nose and the
paranasal
sinuses, and
acute
or
chronic inflammatory
nasal disease. The study
was
approved
by
the institutional review
board of the University
of Cologne
Medical
Center.
In 2008, I 5
patients
(mean
age
63.
I
years,
range 48-73
r'
6.8
years)
were treated with acupuncture
for
post-viral
srnell
loss and failed to improve under
the described
standardized
treatment. The
olfactory
dysfunction had
persisted
ior 4.3
years
in the mean
(range
2-10
years).
A
thorough
medical
history
of
Western rnedicine
and traditional Chinese rnedi-
cine
(with
special regard to the energy levels) was
taken
with
standardized
questionnaires.
Addi
tionally, a systen.ratic
otorhinolaryngologic
physical
examination including
en-
doscopy
of the olfactory cleft was
performed
to exclude
nasal
pathologies
(e.g.,
acute and chronic rhinosinusitis).
The acupunclure treatment was carried
or.rt by a Chinese
physician
(author
D.-W.W.),
who had
been
trained and had
practiced
in
China
for
more than a decade. The local
punc-
ture
points
were
the lung meridians near the
sternum,
the
life
points
at the radial
pulse/wrist
area bilaterally, and local,
individual
points
indicated by the
ying
and
yang
imbalance.
The needle could be turned
clockwise at
insertion
for ton-
ization
or
counterclockwise
for a more sedating effect ol'
those
points
and energy centers. The following injection
points
were chosen: DuMai l6
and
20,
Di20, Lu 7 and 9, Ma
36,
and Ni3. The needles were
lelt in
place
for 30 minutes,
and the acupLrncture sessions
were repeated weekly for l0
weeks. There were l0 insertion points
of acupuncture nee-
dles
per
session and
patien(.
The
olfactory
function was
evaluated by the Sniffin'
Sticks
Testra
(Burghart
GmbH,
Wedel,
Germany) before
and after treatment. Odorants were
presented
in
felt-tipped
pens;
for odor
presentation,
the
cap was removed
by the
investigator and the
pen's
tip was
placed
in
front of the
subject's nostrils for
approximately 15 seconds. This test
battery assessed
olfactory
function
bilaterally and involved
subtests for odor threshold
(T),
discrimination
(D),
and
identification
(I).
The
sum score of the
subtest results
(TDI
score) was used as a
measure of olfactory function, which
allowed
grouping
of
patients
into anosmic
(TDI
score
=
15),
hyposmic
(15
<
TDI score
<
30),
and
normosmic
(30
<
TDI
score)
groups.la
The
results of TCA
were
compared
with
matched
pairs
suffering
from PVOD
who had been treated
with
oral
vita-
min
B complex
(Br
:
thiamine,
Bo
:
pyridoxine,
and B',
:
cobalamine) over
l2 weeks. The outcome of the
participants
were analyzed retrospectively
as a historical cohort study
and compared
with matched
pairs
(matched
for age, initial
olfactory
performance,
and cause of olfactory
loss). Treat-
ment success
was
defined
as
an
increase in TDI scores of
at
least
six
points.
This increase was
previously
described as a
signi{icant
change in olfactory function.r5 A
X2
test
was
used to compare the number of
patients
who were
success-
fully treated in both
groups.
Statistical analysis
was
performed
with
SPSS
version 17
(SPSS
Inc., Chicago, IL). The results
were
given
as
means
with
SD
(-r)
in
text and
tables. The alpha level was
set
at
0.05.
The
power
analysis showed a statistical
power
of 0.9.
Results
No harm or adverse events
were
encountered during
and
after
the
treatment
phases
in either of the two
groups.
All
patients
completed
the study.
The mean TDI
score
oi the TCA
group was 13.-5
(-1
5.4)
points
belbre undergoing treatment and
17.9
(+
6.5)
points
after completion of ilcupuncture treatment
(Table
l).
The
matched
pairs
of the
group
treated with vitamin B complex
improved in TDI score from 13.0
1-t
3.5) to 15.8
1-t-
4.3;
points.
According to our definition of treatment success
(i.e.,
increase
in
TDI
score ol six
points
or
more), olfactory
function improved in
the acupuncture
group
in eight
pa-
tients, whereas only two improved under vitamin B supple-
mentation flable 2).
The
12
test
revealed
a significantly
better outcome in
olfactory function in
patients
undergoing acupuncture com-
par-ed
with
patients
receiving a vitamin B complex
(P
:
0.02). Nevertheless, one
patient's
olfactory
function deteri-
orated after acupunclure.
Discussion
In
lhe
present
study, about
half
ol
the
patients
suffering
from PVOD had improved ollactory fr:nction after l0 weeks
of TCA. This
study shows
the strong
potential
of TCA to
help
recover olfactory
function after viral
dysosmia.
The exact
pathogenesis
of
PVOD remains unclear.r"
Some authors suggest that a viral infection
(e.g.,
influenza
viruses)
of the olfactory mllcosa leads to a
predominant
apoptosis
in
the oifactory
neurons
and
thus
to olfactory
loss.
Wang
et alrT detected a
virus,
parainfluenza
virus type
3
(PIV3),
in epithelial samples of
22
of
25
(88.0Vo)
PVOD
patients.
Forty
percent
of these
patients
were anosmic and
60
percent
were hyposmic by the Cross-Cultural Smell
Identification Test
(CC-SIT).
The high detection rate of
PIV3
in the turbinate epithelial cells of PVOD
patients
suggests
that PIV3
may
be
among the
causative viruses
of
PVOD. Konstantinidis et
alrs showed
that PVOD
exhibits
spring seasonality, with
peaks
in
March and May, and
Vent
et al
Effects
of traditional Chinese acuouncture
in
Table 1
Raw numbers of age and olfactory
function
(presented
as Sniffin' Sticks
TDI scorel of
patients
before and after
treatment, including categories of normosmic, hyposmia, or anosmia in both
groups
(TCA
and vitamin B
treatment)
Before treatment After treatment
501
Gender
TDI
Age
score
Oua
ntitative
a lteration
of olfactorV
function
TDI score
TDI
difference score
Ouantitative alteration
of olfactory
function
TCA
group
Vitamin
B
group
Male 73.0
Male 70.6
Female 61 .7
Female
60.3
Male 70.1
Female
60.2
Male
63.8
Female
59.9
Male 69,9
Male 56,8
Male
69.1
Female 59,1
Male 66.8
Female
48.0
Female 57.9
Female
42.0
Female
59.4
Female
63.9
Male
62.9
Female
58.0
Male 75.0
Female
58.3
Male
48.9
Female 69.8
Male 59.8
Male 68.3
Male 57.9
Male
58.3
Male 74.0
Female
64.9
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Hyposmia
Hyposmia
Hyposmia
Hyposmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Hyposmia
Hyposmia
Hyposmia
Hyposmia
Hyposmia
Anosmia
Hyposmia
Hyposmia
Hyposmia
Hyposmia
Anosmia
Hyposmia
Anosmia
Hyposmia
Anosmia
Hyposmia
Hyposmia
Anosmia
Hyposmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Anosmia
Hyposmia
Hyposmia
Anosmia
Anosmia
Hyposmia
Hyposmia
Hyposmia
9.00
10.00
7.00
'15.50
13.25
11.00
13.50
13.50
9.00
10.00
7,00
17.00
24.54
19.50
22.75
11.75
13.75
12.50
7.00
12.00
12.00
12.50
8.50
14.25
11.25
9.50
16.00
tY.z5
18.50
16.25
8.75
-2.00
9.00
9.75
10.00
7.25
-4.50
11.00
0.00
4.00
9.00
-5.25
-0.50
-0.75
-0.50
-0.25
2.00
2.00
2.O0
2.75
3.00
3.50
5.50
5.50
-U.5U
3.25
6.50
8.25
17.75
8.00
16.00
25.25
23.25
18.25
9.00
24.50
9.00
25.50
11.00
26.00
19.25
14.00
22.25
11.00
13.25
12.25
9.00
14.00
14.00
15.25
11.50
17.75
16.75
15.00
15.50
22.50
25.00
t4.3U
IDl, threshold
(T),
discrimination
(D),
and identification
(l)
[of
odor); TCA, traditional Chinese acupuncture.
hypothesized that
possible
causative factors were influenza
and
parainfluenza
viruses
(type
III), respectively.
Harris et alre explained
the PVOD that occurs
predom-
inantly in the elderly as follows:
Olfactory epithelium un-
dergoes significant changes
with
age. Over time,
patches
of
olfactory
epithelium are replaced with respiratory epithe-
liLrm; the epithelial layer also
may
become thinner
and
basal
cell
proliferation
is reduced. Central causes of olfactory
Table
2
Outcome
of olfactory function as measured by an increase of six
points
in the TDI score
TCA
group
Vitamin
B
group
Before treatment After treatment Before
treatment
After treatment
Anosmic
Hyposmic
Normosmic
ATDI
>
6
(73.3%\
(26.7%l
0
\66,7%)
0
11
(73.3%\
4
(26.t%\
10
(66.7%\
C
(JJ.J7o,
0
2
(13.3%l
5
10
11
4
I
(53,3%)
ICA, traditional
Chinese acupuncture; IDf
threshold
(T),
discrimination
(D),
and
identification
(l)
[of
odor].
Absolute number
and
percentage
of
patients
of
both
cohorts treated either with TCA or vitamin B before
and after
treatment. The
12
test revealed a significantly
better outcome in the number
of
volunteers
with a
TDI increase
of six or higher undergoing
acupuncture
compared with
patients
receiving vitamin
B complex
(P
:
0.02).
508
Otolaryngology-Head and Neck Surgery, Vol 142, No 4, April 2010
impairment
in the elderly are also supported by the theory
that aging leads to
atrophy of the nasal mucosa, leaving it
susceptibie
to infection. The
exact location of the damage
in
PVOD is not
yet
known, even
though biopsy findings by
Welge-Lussen
and Wolfensbergerz'r
showed
that direct
damage of the olfactory receptor cells was
very likely.
Although the
pathophysiology
of PVODs is not clear, the
methods
of treatment consist
of
cofiicosteroids,
supplemen-
tation
with vitamin
B complex, smell training, and
others.2-a
Heilmann
et als reported a
significant
increase
in olfactory
function after administration
of topical steroids and vitamin B
complex for six months. Whereas
the treatment with steroids
can reduce local inflammation, vitamin
B complex might have
a neuro-regenerative effect
on the cranial nerves. The effects of
vitamin B deficiency were extensively
studied in humans and
animal models by Scalabrino.2r Vitamin B deficiency has
negative
effects on neuro-neogenesis and myelinization, and
evokes changes in
cytokine,
neurotransmitter,
and
growth
fac-
tor
production
and
secretion, as
well
as the
generation
of
myelin
sheaths.
Nevertheless, none
of the study
patients
was
diagnosed
with
or suspected of suffering from vitamin B de-
ficiency, nor has
this ever been diagnosed or
suspected
in any
patient
with chemosensory
complaints at this center.
In contrast to the
pharmacological
therapies,
the aim of
acupuncture is to restore
a
physical
balance and to bring the
ying
and
yang
forces into an equilibrium.22 A recent re-
view23 describes the importance
of
alternative
or
comple-
mentary medicine. Since nearly 40
percent
of all
patients
in
general
are using alternative or complementary medicine,
this is
a
rising
issue in discussions of therapeutic options
with
patients,
as
well
as in
public
health or monetary as-
pects.
These
papers
suggest that TCA shows anti-inflam-
matory,
antioxidant, and anti-allergic
properties,
although
the mechanism of action is unclear.
Our
results
are supported by a study about acupuncture
in idiopathic taste disorders from Brandt
et al.rO
They
treated 17
patients
with
gustatory
dysfunction by
whole
body acupuncture administered with needles. The
treatment
success was defined as improvement in a validated,
subjec-
tive
gustatory
test
(based
on impregnated filter
papers,
the
so-called
taste
strips2a) by six
points
as
well
as
improved
quality
of life and mood. Gustatory function improved from
11.1 to 17.5
points
in the true
acupuncture
group,
whereas
the
sham
laser acupuncture
group
improved from 1 1.9 to
only 14.7
points.
In the true acupuncture
group,64.7 percent
of all
patients
improved with regard
to the definition of
treatment success compared with only 25
percent
in the
control sham
group.rn
However, the method of acupuncture
applied by
Brandt
et alro differed from the method we used.
They
used
identical
acupuncture
points
(Di4,
Ma 13, Ma44,
KG 23, LG
15, MP 6, Ex-KH 3,LG 20,3E 23,
OP
4,
OP34)
in every
patient,
whereas in
the
present
study, additional
individual
points
were
selected to improve the
ying
and
yang
balance.
With regard
to Chinese acupuncture
guide-
lines, it is not feasible
to standardize acupuncture treatment;
rather,
individualized therapy must
be offered.
A
method of sham acupuncture by
a
special
needie was
developed
by Streitberger
and Kleinhenz.2s This needle
does not
penetrate
the skin and can serve as a means for
controlling the effect
of
acupuncture. In light of the small case
number in our
study,
it was not feasible to use sham acupunc-
ture. However, receiving intense treatment
with
acupuncture
(which
involves many
personal
contacts between
patient
and
doctor) may have a very different
placebo
quality
than even
taking
a tablet
(vitamin
B substitute) that does
not
have side
effects. This outcome must be considered in this study.
To our knowledge, this is the first controlled cohort study
to investigate the effect of acupuncture on
post-viral
hypos-
mia
in
a large number of
patients,
although the
patients
were
not blinded to the type of therapy
received. Blinding
could
have been achieved with laser or sham acupuncture
(ran-
domly switching laser on and off, using sham
needle)
but
is
not feasible in TCA. In Chinese acupuncture, every
needle
insertion is believed to have an effect; thus, a
"mock"
insertion
of a
needle in
some
random
position
could have
negative effects on the energetic balance of the
patient.
Furthermore, the
good
results are explained by the
individ-
ualized therapy. However, this
individualized treatment
makes the acupuncture technique less comparable
or
scien-
tifically valuable.
We must understand that TCA is not
based on the same scientific,
rigid rules used in Western
medicine; thus, these
rules may not accurately evaluate the
treatment effects of TCA.
Hauswald et alir investigated the
effect of acupuncture on 80
patients
with olfactory dysfunc-
tion of various causes; however, of
the 42
patients
treated
with infectious
olfactory
dysfunction
(i.e.,
POVD
patients),
only 12 were anosmic and 30 were hyposmic.
Hyposmic
patients
tend to have a better
prognosis
in recovery of
olfactory dysfunction. The authors reported a
recovery rate
of 70
percent
of all
patients
and
also recommend acupunc-
ture as a treatment for PVOD.
A key finding of this historical
cohort study is that TCA
seems to be beneficial in treating steroid-reluctant
post-viral
hyposmia and is superior to the administration of
vitamin B
complex suppiementation.
Conclusion
The
present
study
was
conducted
to
gather pilot
data. About
half
of our
patients
improved their olfactory function under
TCA. Further investigations
in
a
larger
population
will have
to confirm this effect of acupuncture
in PVOD. Neverthe-
less, the observed high response rate of about 50
percent
for
TCA was superior to that of
vitamin B complex or that of
spontaneous remission and offers
a
possible
new therapeutic
regimen in
post-viral
dysosmia.
Author Information
From the Department
of Otorhinolaryngology,
Head and Neck Surgery,
University of Cologne Medical Center, Cologne, Germany
Vent et al Effects of traditional
Chinese acupuncture
in
509
Conesponding author: Julia
Vent,
MD, PhD, Department
of Otorhinolar-
yngology,
Head
and
Neck
Surgery, University
of Cologne
Medical
Center,
Kelpener
Str. 62, 50924 Cologne, Germany.
E-nrail address: Julia.vent@ uk-koeln.de.
Data were
partially
and orally
presented
at the Annual Meeting of the
Germany Academy of
Otolaryngology, Head and Neck Surgery, Bonn,
Germany,
May
3,
2008.
Author
Contributions
Julia
Vent, study design and conduct, data retrieval, manuscript pfcpara-
tion; Djin-Wue Wang, acupuncture,
data
retrievalt
Michael Damm, study
design, statistical
analysis, manuscript
preparation.
Disclosures
Competing interests: None.
Sponsorships:
None.
References
l. Damm M, Temmel A, Welge-Lussen
A, et al. Ollactory dysfunctions.
Epidemiology and therapy in
Germany, Austria and
Switzerland.
HNO
2004.52:l12-20.
2. Hummel T, Rissom
K, Reden J, et al. Effects
of olfactory
training in
patients
with
olfactory loss. Laryngoscope 2009;l 19:496-9.
3. Heilmann S, Huettenbrink KB, Hummel
T. Local and systemic ad-
ministration
of
corticosteroids
in the treatrnent
of ollactory
loss. Anr
J
Rhinol 2004: |
8:29-33.
4.
Stenner M,
Vent
J, Huettenbrink KB, et
al.
Topical
therapy
in anosnria:
relevance
of steroid-responsiveness. Laryngoscope 2008; I I
8:
| 68 l-6.
5.
Heilmann
S, Just
T,
Goktas O, et al.
lEffects
of systcmic or topical
administration of corticosteroids and vitamin B in patients with
olfac-
tory loss
f
. Laryn
gorhi
nootolo
Eie
20O4
:83
:1 29
-3
4.
6.
Quint
C, Temmel AF, Hummel T, ct al. 1'he quinoxaline
derivative
caroverine in the treatment of sensorineural sn.rell
disorders: a
proof-
of-concept study.
Acta
Otolaryngol 2002 1 22:81 1
-
8
| .
7. Humrnel T, Heilmann S, Huttenbrink KB. Lipoic
acid
in the LreaLrnent
of smell
dysfunction following viral
infection of the uppcr respiratory
tract. Laryn
gosc
ope 2O02, | 1 2:20'7 6
*
8O.
8. Kern RC, Conley DB, Haines
GK,
Ill,
et al. Pathology of the ollactory
mucosa: implications for
the treatment of olfactory dysfunction. La-
ryngoscope 2004t1 | 4:21
9
-
85.
9.
Michael W. Anosmia treated with acupuncture. Acupunct Med 2003:
2l:153-4.
I0. Brandt H, Hauswald B, langer H, et al. Efficacy of acupuncture in the
heatment of idiopathic taste disorders. Dt Ztschr f Akup 2008;5 I :24-3 L
ll. Hauswald B, Tiinzer K, Huettenbrink KB. Acupucture: results in
patients
with an- and hyposmia. Booklet
of
the symposium
of
the 2nd
acupuncture symposium of
Mainz, I 998. German
Society of
Acupunc-
ture.
March 21. 1998.
12. Pothman R, Yeh HL. The effects of treatment
with
antibiotics,
Iaser
and acupuncture
upon chronic maxillary
sinusitis
in chiidren. Arn
J
Chin
Med 1982;10(l-,1):55-8.
I3. Tanaka O, Mukaino Y. The effect of auricular acupuncture on olfac-
tory acuity. Am J Chin Mecl 19991.27(l):19-24.
14. Hurlmel T, Kobal
G, Gudziol
H, et al. Normative data for the
"Sniffin'
Sticks" including tests of odor identillcation, odor drscrimination, and
olfactory thresholds: an upgrade
based on
a
group
of
more than
3,000
subjects. Eur Arch
Otorhi
nolaryngol 200'7
;264:237
-
43.
I5. Reden
J, MLreller
A, Mueller
C,
et
al.
Recovery
of olfactory
function
following closcd head injury or infections of the upper respiratory
tract. Arch Otolaryngol
Head Neck
Surg
2006;132:265-9.
16, Mulphy C, Schubert CR, Cruickshanks KJ, et al. Prevalence of olfac-
tory irnpairment in older adults. JAMA 2002;288:2301-12.
17. Wang
JH,
Kwon HJ,
Jang
YJ. Detection
of
parainfluenza virus
3
in
turbinate epithelial cells of
postviral
olfactory dysfunction
patients.
Laryngoscope 2007
:
| 17 : |
445-9.
I 8. Konstantinidis I, Haehner A, Frasnelli J, et al. Postinfectious olfactory
dysfunction cxhibits a seasonal
pattern.
Rhinology
200644:.135-9.
19. Harris R, Davidson TM, Murphy
C,
et al. Clinical evaluation and
synlptoms
of
chemosensory impairment: one thousand consecutive
cases fror.n
the
Nasal Dysfunction
CIinic
in
San
Diego. Am J Rhinol
2006:20:l0l-8.
20. Welge-Lussen A, Wolfensberger M.
Olfactory
disorders following upper
rcspi ratory tract i nfections.
Adv
Otorhinolaryngol
2006:63 : 125 -32.
21.
Scalabrino G.
I'he multi-faceted
basis
of vitamin BI2
(cobalamin)
neurotrophism in adult central nervous system:
lessons learned from its
dcliciency. Prog Neurobiol 2O09
:88:203-20.
22. Zhact XX, Wang XX, Zhao Z, et al.Talk about nomenclature of twelve
rncridians liom
quantitative
yin-yang
theory. Zhongguo Zhen Jiu
2009:29:227-30.
23. Mainaldi T, Kapoor S,
Bielory L.
Complen.rentary
and alternativc
nredicine: herbs,
phytochemicals
and vitamins and their immunologic
efl'ects. J
A)lergy
Clin
lrnmunol 2009:123:283-94.
24. Landis I3N, Welge-Luessen A, Bramerson A, et al.
"Taste
Strips"-a
rapid,
lateralized,
gr.rstatory
bedside
identification test based on im-
pregnated
lilter
papers.
J
Neurol 2009:256:242-8.
25.
Streitbergel
K, Kleinhenz J. lntroducing a
placebo needle into
acu-
puncture
research. Lancet I9981352:364-5.
    • "To conduct a double-blind study, acupuncture and injection placebos would need to be administered to the control group; however, in this study, it was not feasible to use an acupuncture placebo. In Chinese acupuncture, every needle insertion is believed to exert an effect; therefore, the sham insertion of a needle at a random position could have negative effects on the patient's energy balance [11]. This is an important study that investigates the effects of acupuncture in PVOD patients who are refractory to standardized treatments. "
    [Show abstract] [Hide abstract] ABSTRACT: . The aims of this study were to assess the impact of traditional Chinese acupuncture (TCA) in postviral olfactory dysfunction (PVOD) patients who were refractory to standardized treatment and to compare the results with the impact observed in an observation group. Methods . Fifty patients who presented to the outpatient clinic with PVOD and were refractory to standardized treatment were included: 25 were treated with TCA and 25 patients were simply observed. A subjective olfactory test was performed using the University of Pennsylvania Smell Identification Test (UPSIT). The effects of TCA were compared with the results obtained in the observation group. Results . Improved olfactory function was observed in eleven patients treated with TCA compared with four patients in the observation group. This study revealed significantly improved olfactory function outcomes in patients who underwent acupuncture compared with the observation group. No significant differences in olfaction recovery were found according to age, gender, or duration of disease between the two groups; however, hyposmic patients recovered at a higher rate than anosmic patients. Conclusion . TCA may aid the treatment of PVOD patients who are refractory to drugs or other therapies.
    Full-text · Article · Feb 2016
    • "Peroral caroverine, an N-methyl-D-aspartic acid (NMDA) receptor antagonist [88], as well as sodium citrate nasal spray [95] have been shown to be effective in placebo-controlled studies. In addition to drug treatments, acupuncture [96][97][98][99]and olfactory training [100,101] have also been investigated. It is likely that any successful treatment of smell loss would also improve the associated symptoms of distorted olfactory perception. "
    [Show abstract] [Hide abstract] ABSTRACT: The negative consequences of olfactory dysfunction for the quality of life are not widely appreciated and the condition is therefore often ignored or trivialized. 1,000 patients with olfactory dysfunction participated in an online study by submitting accounts of their subjective experiences of how they have been affected by their condition. In addition, they were given the chance to answer 43 specific questions about the consequences of their olfactory dysfunction. Although there are less practical problems associated with impaired or distorted odor perception than with impairments in visual or auditory perception, many affected individuals report experiencing olfactory dysfunction as a debilitating condition. Smell loss-induced social isolation and smell loss-induced anhedonia can severely affect quality of life. Olfactory dysfunction is a serious condition for those affected by it and it deserves more attention from doctors who treat affected patients as well as from scientist who research treatment options.
    Full-text · Article · Jul 2013
    • "There are promising approaches but these are also being controversially debated, above all because blinded studies have not been undertaken. These include the use of acupuncture ([142] – see criticism in [143]) and the transcranial magnetic stimulation for parosmia and phantosmia ([144] – see criticism in [145] ). Other nonblinded studies report the effectiveness of caroverine for smell disorders. "
    [Show abstract] [Hide abstract] ABSTRACT: Smell and taste disorders can markedly affect the quality of life. In recent years we have become much better in the assessment of the ability to smell and taste. In addition, information is now available to say something about the prognosis of individual patients. With regard to therapy there also seems to be low but steady progress. Of special importance for the treatment is the ability of the olfactory epithelium to regenerate.
    Full-text · Article · Jan 2011
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