分鼻侧评估嗅觉功能及单侧嗅觉减退的临床分析

Application of unilateral olfactory testing and clinical analysis of unilateral hyposmia

目的了解嗅觉减退患者左右两侧嗅觉功能损伤程度是否相同。方法对104例以嗅觉减退为主诉的患者，通过病史采集了解嗅觉减退的相关病史及其现况，耳鼻咽喉科常规检查及鼻窦CT检查排除鼻腔结构异常或仅发生于单侧鼻腔一鼻窦的病变，并分别对左、右鼻侧进行T＆T嗅觉计嗅觉识别阈测试，评估患者每侧嗅觉功能。结果本组104例嗅觉减退患者，90例（86．5％）患者双侧嗅觉功能水平相同，14例（13．5％）患者双侧嗅觉功能水平不同，其中6例患者表现为单侧（左侧或右侧）嗅觉功能正常，而另一侧嗅觉功能减退。14例左右鼻侧嗅觉功能不同的患者，其常规查体及影像学检查均未见明显鼻腔结构异常或发生于单侧鼻腔鼻窦的病变。结论人类的左、右两个鼻腔分别拥有一个完整的嗅觉传导系统，尽管双侧受损概率相同，但受损程度可不同。单侧嗅觉减退作为嗅觉障碍的一种特殊表现形式，只有通过分鼻侧进行嗅觉功能评估，才能更全面地了解患者的嗅觉功能。

Objective To investigate whether patients presenting with self-reported olfactory disorders demonstrates significant side difference in odour recognition by measuring separately for each nostril. Methods One hundred and four patients with chief complaint of hyposmia were evaluated by medical history, physical examination, T＆T olfactory testing and medical imaging. Smell was tested using T＆T olfactometry in each nostril separately. Results Based on the history and results from the clinical examination, unilateral sinonasal diseases and abnormal nasal structure were excluded. In 14 patients （ 13.5% ） a side difference was detected. Especially, six of the patients were identified with lateralized hyposmia. Conclusions Olfactory testing could be performed in each nostril separately. The above findings suggested that testing each nostril separately was necessary so as not to miss unilateral hyposmia as a special clinical manifestation of olfactory disorder.