嗅裂疾病三例

Three cases report of olfactory cleft disease

目的报道一种新的嗅觉障碍疾病———嗅裂疾病,总结其临床特征、影像学特点以及治疗尝试。方法本组3例,均以完全失嗅为主诉。详细采集病史,行耳鼻咽喉科常规体检、鼻内镜检查。主观嗅功能测试使用T&T标准嗅觉计行嗅觉察觉阈和识别阈测试。以醋酸异戊酯为刺激剂行嗅觉事件相关电位测试,刺激量为2 m l。行鼻窦冠状位和轴位CT扫描。治疗方案:①抗生素治疗半个月;②糖皮质激素治疗半个月。结果鼻内镜检查患者双侧嗅裂处黏膜肿胀,嗅裂消失。T&T主观嗅觉测试均为完全失嗅,最大嗅刺激未引出嗅觉事件相关电位。鼻窦CT提示局限于双侧嗅裂的软组织影。抗生素治疗嗅觉无改善。局部和全身糖皮质激素治疗,1例嗅觉改善,但停药后嗅觉又消失,再次使用糖皮质激素治疗无效。另2例嗅觉无改善。结论嗅裂疾病是一种以嗅觉障碍为主诉,病变局限于嗅裂的疾病,鼻窦CT有助于确诊,抗生素和糖皮质激素治疗效果不理想。

Objective To report a new entity-olfactory cleft disease, and summarize the clinical characteristics, computerized tomography presentation, as well as the effect of trial therapy. Methods Three patients with chief complaint of anosmia were evaluated by thorough ENT examination, T＆T olfactory testing, sinonasal endoscopy, sinonasal computerized tomography imaging, and olfactory event-related potentials. All patients accepted trial therapy including antibiotics and corticosteroid. Results Complete obstruction of bilateral olfactory cleft with cleft mucosal edema was seen during endoscopy in all 3 patients. Anosmia was determined in all patients by T＆T olfactory testing. No olfactory event-related potentials was identified in all patients. CT revealed soft tissue image limited to bilateral olfactory cleft No olfactory improvement was found in 2 patients after trial medical therapy. One patient had transitory olfactory improvement after corticosteroid treatment. Conclusions Olfactory cleft disease is a new entity, with chief complaint of anosmia. Nasal endoscopy and computed tomography scanning provides the most information for the diagnosis. Effect of medical therapy is poor.