Publications by authors named "Boris Haxel"

16 Publications

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Nasale mukoziliäre Clearance und Vitamin-D-Mangel.

Boris Haxel

Laryngorhinootologie 2019 Oct 14;98(10):667-668. Epub 2019 Oct 14.

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October 2019

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review.

Boris R Haxel

Laryngoscope 2019 05 8;129(5):1053-1059. Epub 2019 Jan 8.

Department of Otolaryngology, Head and Neck Surgery, AMEOS Klinikum Haldensleben, Haldensleben, Germany.

Objective: Investigation of the postoperative olfactory function after sinus surgery for chronic rhinosinusitis (CRS) with and without polyps in a review.

Data Sources: PubMed.

Review Methods: A comprehensive literature search was conducted through June 2018 using relevant keywords. The titles/abstracts were reviewed to identify studies evaluating the sense of smell in CRS-patients pre- and postoperatively by either using the whole or parts of the University of Pennsylvania Smell Identification Test or the Sniffin' Sticks test. Study characteristics and outcome data of the included studies were extracted.

Results: In total, 106 studies were retrieved. Twenty-four studies comprising 1,956 patients were included after quality assessment. The number of patients investigated per study was 19 to 206. In the 24 studies, 959 patients with nasal polyps and 516 without nasal polyps were described. The follow-up times varied between 0.5 and 28 months. Twenty-three studies reported an improved sense of smell, at least in certain subgroups. An overall improvement was seen in approximately 50% of the included patients. Nasal polyposis and preoperative anosmia were associated with a higher chance of improvement in olfaction. In those studies that commented on deterioration after sinus surgery, a decrease in olfaction was found in a range from 0% to 10% of cases.

Conclusion: Olfaction can be improved by sinus surgery in about every second patient, especially if the patient had chronic rhinosinusitis with polyps, was anosmic, and had no prior surgery. A deterioration of sense of smell after surgery is rare. Laryngoscope, 129:1053-1059, 2019.
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May 2019

Trimethoprim/Sulfamethoxazol bei Rhinosinusitis – erste vorläufige Resultate.

Boris Haxel

Laryngorhinootologie 2018 12 10;97(12):832-833. Epub 2018 Dec 10.

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December 2018

Course of olfaction after sinus surgery for chronic rhinosinusitis.

Laryngoscope Investig Otolaryngol 2017 10 25;2(5):269-275. Epub 2017 Sep 25.

the Department of Otolaryngology, Head and Neck Surgery University Medical Center of the Johannes Gutenberg University Mainz Germany.

Background: The influence of surgery on olfaction in patients who suffer from chronic rhinosinusitis (CRS) is still not fully understood. Most particularly, the time course of the recovery is poorly studied.

Methods: The prospective study describes the results of the Sniffin' Sticks identification test in 41 subjects before (V1), 2 weeks after (V2), and 6 months after (V3) endonasal sinus surgery (ESS). Influencing factors (gender, revision surgery, nasal polyposis, and initial olfactory score) on the changes of the smell testing were evaluated.

Results: The whole cohort showed a significant improvement in Identification scores, from 8.63 to 10.24 after 2 weeks and to 10.68 after 6 months. Patients with nasal polyps revealed a similar increase in the identification test at V3 (+2.17 compared to +1.89 in those without polyps) but not at V2 (+1.30 compared to 2.00). The initial classification of olfaction was the only significant influencing factor. Patients who showed initially anosmic results improved (+4.87 at V2 and +4.73 at V3), as did patients in the hyposmic group (+0.58 resp. +1.42). Forty-four percent of the patients reached an improvement with regard to their diagnostic group.

Conclusions: This study of the evaluation of the sense of smell after ESS exhibits an improvement of olfaction already 2 weeks after surgery, which is stable for 6 months. CRSwNP and CRSsNP patients showed similar improvements of olfaction, although the recovery was slower in CRSwNP patients.

Level Of Evidence: 2b.
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October 2017

Correlation of skin test results and specific immunoglobulin E blood levels with nasal provocation testing for house-dust mite allergies.

Am J Rhinol Allergy 2016 Jan-Feb;30(1):60-4

Department of Otorhinolaryngology, Head and Neck Surgery, AMEOS Klinikum Haldensleben, Germany.

Background: Allergen-specific immunotherapy for house-dust mite (HDM) allergies is associated with lower success rates when compared with similar treatments for other inhalant allergens, such as grass or birch. One reason might be the greater difficulty in diagnosing patients with assumed HDM allergies because symptoms occur perennially and may differ from those of a conventional allergic rhinitis.

Objective: The aim of the study was to compare the different methods of diagnosis in patients with assumed HDM allergy.

Methods: We performed a retrospective analysis of nasal provocation tests (NPT) from patients (n = 161) evaluated for Dermatophagoides pteronyssinus (n = 127) and Dermatophagoides farinae (n = 104) allergies, and compared the results with other allergen testing methods (skin-prick test [SPT], intracutaneous test, and allergen specific immunoglobulin E levels [sIgE] to detect sensitization). Receiver operating characteristic curves were used for the analyses and the areas under the curve were calculated.

Results: For D. pteronyssinus and D. farinae, 86 and 70 complete data files, respectively, were available. For both tested HDMs, the results of the receiver operating characteristic curves showed a significant correlation for SPT and sIgE, with the results of the NPT (area under the curve, 0.742 to 0.763) but not for the intracutaneous test. In patients with a positive SPT (≥3 mm), an allergy was confirmed by the NPT in 69% of cases for D. pteronyssinus and 71% for D. farinae. A positive sIgE result (ImmunoCAP class of ≥2) was verified by the NPT in 69% of cases (D. pteronyssinus) and 70% (D. farinae).

Conclusion: The predictability value for a positive NPT result is best for SPT and sIgE. Nevertheless, even if the results of both test systems are combined, the positive predictive value that was achieved was only 0.77 for D. pteronyssinus and 0.69 for D. farinae. Therefore, in patients eligible for immunotherapy for HDM, an NPT should be performed before the start of the therapy to verify a clinically relevant allergy.
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December 2016

Olfaction in chemotherapy for head and neck malignancies.

Auris Nasus Larynx 2016 Feb 8;43(1):74-8. Epub 2015 Aug 8.

Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany.

Objective: Systemic chemotherapy for different malignancies occurs alongside various side effects, including reduced sensory function. To date, little is known about the effect of chemotherapeutic agents on olfaction. The aim of this study was to provide new data about changes in sense of smell during chemotherapy among patients with advanced squamous cell carcinomas of the head and neck region.

Methods: In a prospective, controlled cohort study of patients undergoing up to three courses of chemotherapy (cis- or carboplatin, 5-fluorouracil and docetaxel), olfaction was evaluated prior to and directly following completing a cycle, as well as 3 weeks later with the beginning of the next cycle. For evaluation of sense of smell, the established Sniffin' Sticks test with a determination of threshold, discrimination and identification (TDI) was used. Thirty-three patients (44-85 years old, 25 men and 8 women) were included in the study. Most malignancies were located in the oropharynx.

Results: Among the 28 patients who scored normosmic or hyposmic at the beginning of the study, the mean decrease in TDI-score was 0.72 points (24.0-23.2) in the first cycle, 2.1 points (24.5-22.4) in the second cycle and 0.77 points (24.2-23.4) in the third cycle. The decrease during the second cycle was significant. Age (>55 years) had a significant (negative) influence in the first and the second cycles. Smoking only showed a tendency to decreased TDI-scores in chemotherapy. In-between consecutive cycles an increase in TDI-score was obvious (+1.0 points after the first and +1.5 points after the second cycle).

Conclusion: Chemotherapy with cisplatin, 5-fluorouracil and docetaxel significantly affected sense of smell to a small extent. This effect was more pronounced in elderly patients and smokers. This fact must be taken into account as a possible additional negative effect in usually prevailing malnutrition in these patients. Furthermore, no cumulative effect of the administered therapeutic agents on olfaction could be proven during this study and recovery occurred within a 3-week period.
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February 2016

Controlled trial for long-term low-dose erythromycin after sinus surgery for chronic rhinosinusitis.

Laryngoscope 2015 May 25;125(5):1048-55. Epub 2014 Nov 25.

Department of Otorhinolaryngology, Head and Neck Surgery, AMEOS Klinikum Haldensleben, Haldensleben, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

Objectives/hypothesis: The efficacy of macrolides in chronic rhinosinusitis (CRS) is still under controversy. To date, only two double-blind, placebo-controlled studies have been published with differing results. None of these studies investigated the possible benefit of macrolides in the postoperative period. We conducted an investigator-initiated clinical trial using 250-mg erythromycin once a day over a period of 3 months, beginning the administration of either erythromycin or placebo 2 weeks after a surgical intervention for CRS.

Study Design: Randomized double-blind, placebo-controlled trial.

Methods: The concentrations of eosinophilic cationic protein (ECP) and myeloperoxidase in nasal secretion were chosen as primary outcome measures. Additionally, as a secondary outcome measure, changes in the Sino-Nasal Outcome Test-20 score, olfaction, saccharin transit time, nasal endoscopy score, and self-rating of nasal health using a visual analogue scale were evaluated.

Results: Sixty-seven patients after surgery for CRS with or without nasal polyps were screened, and 58 patients were randomized to the study groups. For the primary outcomes, the concentrations of ECP changed from 176.4 µl/l ± 79.0 to 226.1 µl/l ± 200.6 in the erythromycin group and from 186.9 µl/l ± 36.0 to 192.9 µl/l ± 189.2 in the placebo group; no statistical differences were found. Of the secondary outcomes, only the nasal endoscopy score showed a statistically significant improvement in the erythromycin group (from 2.6 ± 1.4 to 1.9 ± 1.5 points) compared to the placebo group (from 2.5 ± 1.3 to 2.6 ± 1.5 points). The subgroup of patients without nasal polyps in the erythromycin group showed a tendency to improvement in some secondary outcome criteria.

Conclusions: A general recommendation for long-term, low-dose erythromycin treatment after surgery for CRS cannot be given. In patients with CRS without nasal polyps, a tendency to improved parameters was detected.

Level Of Evidence: Ib.
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May 2015

Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study.

Laryngoscope 2014 Apr 19;124(4):826-31. Epub 2013 Sep 19.

Department of Otorhinolaryngology, University Hospitals of Cologne, Cologne, Germany.

Objectives/hypothesis: The aim of this study was to evaluate the effects of olfactory training (OT) on olfactory function in patients with persistent postinfectious olfactory dysfunction (PIOD).

Study Design: Randomized, single-blind, controlled, multicenter crossover study.

Methods: Twelve tertiary university medical centers participated. Investigations were performed at three visits (baseline, after 18 weeks, and after 36 weeks), including only subjects with PIOD of <24-months duration. At each visit, participants received detailed assessment of olfactory function. Seventy subjects trained with high concentrations of four odors for 18 weeks; the other half (n = 74) trained with low concentrations of odors. For the following 18 weeks this regimen was switched.

Results: After 18 weeks, olfactory function improved in the high-training group in 18 of 70 participants (26%), whereas only 11/74 improved in the low-training group (15%). In subjects with a duration of olfactory dysfunction of <12 months, olfactory function improved in 15/24 participants (63%) of the high-training group and in 6/31 participants (19%) of the low-training group (P = .03).

Conclusions: OT improves PIOD, and the use of odors at higher concentrations is beneficial to improvement. OT is a safe procedure and appears to be particularly useful in patients who start OT within 12 months after the onset of the disorder. OT is the first successful therapy regime in patients with PIOD.

Level Of Evidence: 1b.
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April 2014

Dysregulated survivin expression in nasal polyps of individuals with aspirin exacerbated respiratory disease.

Am J Rhinol Allergy 2012 Sep-Oct;26(5):380-4

Department of Otolaryngology, Head and Neck Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.

Background: A derailed balance of cell proliferation and apoptosis is presumed to result in cell hyperplasia as a typical feature of nasal polyps. Survivin, a protein of the inhibitors of the apoptosis family is proposed to promote polyp formation. However, studies concerning survivin expression in chronic rhinosinusitis (CRS) with nasal polyps are rare and the specificity of the survivin expression in nasal polyps from individuals with aspirin-exacerbated respiratory disease (AERD) has not been investigated.

Methods: Immunohistochemical survivin expression analysis was performed. Samples were taken from the ethmoid sinus of individuals with CRS with nasal polyps with and without AERD during sinus surgery and control specimens of the inferior turbinate from individuals without CRS. Cell cultures were stimulated with recombinant vascular endothelial growth factor (VEGF(165)) and the resulting survivin expression was analyzed by Western blot.

Results: The survivin expression of 61 specimens was analyzed by quantitative immunohistochemistry and a potential VEGF-dependant stimulation of survivin in cell cultures was investigated. The survivin expression in nasal polyps from individuals with AERD was increased compared with the controls (median, 1194 versus 927 arbitrary units [A.U.]; p = 0.054). Western blot analysis revealed in vitro a VEGF-dependant regulation of survivin in nasal polyps from individuals without AERD, but not in those with AERD (p = 0.05).

Conclusion: Enhanced survivin expression might result in decreased apoptosis and cellular hyperplasia as a part of the largely unknown pathophysiology of nasal polyp formation. Furthermore, we hypothesize a pathological, VEGF-independent constitutive survivin expression in nasal polyps of individuals with AERD.
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May 2013

Vascular endothelial growth factor expression in nasal polyps of aspirin-intolerant patients.

Arch Otolaryngol Head Neck Surg 2012 Mar;138(3):286-93

Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

Objective: To study differences between aspirin-tolerant patients and aspirin-intolerant patients concerning vascular endothelial growth factor (VEGF) expression. Recent publications strongly suggest the involvement of VEGF and its receptors in the pathophysiologic process of nasal polyps.

Design: We subjected 43 polyp specimens to semiquantitative immunohistochemical analysis. We quantified VEGF and its receptors (Flk, Flt, and neuropilin) in all samples. To gain insight into potential VEGF-mediated cellular responses, we determined proliferative (Ki67) and apoptotic (caspase 3) indices.

Patients: Polyp samples were obtained from 22 aspirin-intolerant patients and from 21 aspirin-tolerant patients, and control specimens were obtained from 24 subjects with healthy nasal respiratory mucosa.

Setting: Laboratory; Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

Main Outcome Measures: Expression levels of VEGF, VEGF receptors. and proliferative and apoptotic indices.

Results: We found higher expressed levels of VEGF and neuropilin and stronger proliferation in nasal polyps from aspirin-tolerant and aspirin-intolerant patients compared with controls. In polyps from aspirin-intolerant patients, VEGF was expressed at considerably higher levels compared with those from aspirin-tolerant subjects. Apoptotic activity remained unchanged in all 3 groups.

Conclusions: Nasal polyps from aspirin-tolerant and aspirin-intolerant patients are characterized by strong proliferation and high levels of VEGF and neuropilin expression. Nasal polyps from aspirin-intolerant patients show distinctly increased VEGF levels. The relevance of these findings for future therapeutic approaches is yet to be determined.
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March 2012

The Candy Smell Test in clinical routine.

Am J Rhinol Allergy 2011 Jul-Aug;25(4):e145-8

Department of Otolaryngology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.

Background: The "Candy Smell Test" (CST) has been introduced as a new testing method for the evaluation of the human sense of smell. In contrast to other established orthonasal smell tests, the CST addresses the retronasal application of odors, typical for food aroma effects during mastication and swallowing. The aim of this study was to evaluate the CST in a clinical setting in patients with olfactory dysfunction and normal controls against the Sniffin' Sticks test. Furthermore, cutoff points for normal and pathological results in the CST should be determined.

Methods: The olfactory performance of 96 patients presenting with olfactory disorders and 71 healthy controls was evaluated with the CST-comprised of 23 different aromatized smell candies and the extended Sniffin' Sticks test (threshold, discrimination, and identification). The control group was gender matched but included also younger persons.

Results: The tested subjects could easily understand the procedures and were motivated to participate. The CST correlated well with the Sniffin' Sticks for all tested subjects and for patients (n = 96) and controls (n = 71). The proposed cutoff value to differentiate normosmia from hyposmia in the CST was a score of <16 (i.e., 16 correctly identified odors) of 23. A score below 13 in the CST was the cutoff value for anosmia.

Conclusion: The CST is an easy-to-handle reliable tool to investigate retronasal olfaction suited for clinical determination of normosmia, hyposmia, and ansomia. In addition, it can be used for investigation where self-application is necessary such as in large survey studies.
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December 2011

Confocal endomicroscopy: a novel application for imaging of oral and oropharyngeal mucosa in human.

Eur Arch Otorhinolaryngol 2010 Mar 10;267(3):443-8. Epub 2009 Jul 10.

Department of Otolaryngology, Head and Neck Surgery, Johannes Gutenberg University, 55101 Mainz, Germany.

Confocal endomicroscopy is an emerging technique for intravital visualization of neoplastic lesions, but its use has so far been limited to the gastrointestinal (GI) tract. This study was designed to assess the feasibility of in vivo confocal endomicroscopy of different regions of the oropharyngeal mucosa and to evaluate different contrast agents. We examined five different regions of the human oropharynx in vivo, and images were collected in real time by using a confocal laser endoscope as formerly described for the GI tract. Additionally ex vivo specimens were examined using a topical contrast agent. Confocal scanning was performed at 488-nm illumination for excitation of exogenously applied fluorophores (topical acriflavine and intravenous fluorescein). Confocal endomicroscopy allowed for visualization of cellular and subcellular structures of the anterior human oropharyngeal region. Fluorescein staining yielded architectural details of the surface epithelium and also subepithelial layers. Images taken at increasing depth beneath the epithelium showed the mucosal capillary network. Acriflavine strongly contrasted the cell nuclei of the surface epithelium. The findings correlated well with the histology of biopsy specimens. This is the first report showing that the use of fluorescence confocal endomicroscopy represents a promising method to examine cellular details in vivo in different oropharyngeal regions in human.
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March 2010

Olfactory dysfunction after head injury.

J Head Trauma Rehabil 2008 Nov-Dec;23(6):407-13

Department of Otolaryngology, Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany.

Objective: To determine the incidence of olfactory dysfunction after head trauma using clinical and radiologic findings, quantitative assessment, and electro-physiologic methods.

Participants: A total of 190 patients with head trauma of different severity (n = 32 with mild traumatic brain injury (TBI), n = 94 with signs of moderate TBI, and n = 64 with severe TBI) 6 to 32 months prior to the study.

Design: Patients were selected retrospectively, surveyed by telephone (n = 190), and screened for olfactory function with Brief Smell Identification Test (n = 82). Those with olfactory dysfunction were assessed as outpatients using the Sniffin' Sticks (n = 19) and olfactory-evoked potential recording (n = 16).

Results: Twenty-one participants (11%) reported a decreased sense of smell after trauma. The incidence of olfactory dysfunction after head injury was 12.8%. The results of the odor-evoked potentials were heterogeneous. A significant correlation was found between olfactory dysfunction and the appearance of skull base fractures and intracranial hemorrhage or hematoma.

Conclusion: The site of trauma may be more relevant to prognosis than a simple probability (of olfactory loss) based on incidence. Odor-evoked potentials indicate that functional anosmia can occur even when there is some evidence of intact olfactory nerve function.
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April 2009

Objective assessment of terbinafine-induced taste loss.

Laryngoscope 2005 Nov;115(11):2035-7

Department of Otorhinolaryngology-Head and Neck Surgery, Smell and Taste Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.

Objectives: Terbinafine (Lamisil), a widely prescribed oral antifungal agent, reportedly induces taste loss in 0.6% to 2.8% of those taking the drug. However, many so-called taste problems reflect olfactory problems, and the sole empirical study published on this topic, based on whole-mouth testing of a single subject, found no terbinafine-related deficit. In this study, we quantitatively assessed, using well-validated taste and smell tests, chemosensory function in six patients complaining of taste disturbance after terbinafine treatment and compared their test scores to those of six age-, race-, and sex-matched normal controls.

Methods: Taste function was measured using a 96-trial regional test that assesses sweet, sour, bitter, and salty taste perception within the anterior (cranial nerve [CN] VII) and posterior (CN IX) lingual taste bud fields. Smell function was bilaterally evaluated using the 40-item University of Pennsylvania Smell Identification Test.

Results: Taste function for sweet-, sour-, and bitter-tasting stimuli was significantly depressed in both the anterior and posterior lingual regions. For sodium chloride, the decrements were confined to the posterior region. Olfactory function was within normal limits.

Conclusion: These findings 1) support anecdotal case reports of taste loss after terbinafine use, 2) demonstrate that all four major taste qualities are affected, and 3) suggest that olfactory dysfunction is not involved. Because self-report markedly underestimates chemosensory deficits, more extensive quantitative testing of patients receiving terbinafine will likely reveal a much higher prevalence of terbinafine-induced taste loss than currently reported. Since being older than 65 years of age and having a low body mass index are reportedly risk factors for terbinafine-induced taste loss, physicians should be particularly on the alert for elderly persons taking this medication who may become depressed or alter their food intake in response to decreased taste sensation.
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November 2005

Myeloperoxidase in nasal secretion as a cell-activation marker in acute sinusitis.

Am J Rhinol 2004 Mar-Apr;18(2):93-8

Department of Otorhinolaryngology, Mainz Medical School, Mainz, Germany.

Background: Acute bacterial infections of the upper respiratory tract, including the nasal sinuses, lead to an activation of neutrophil granulocytes. The protein myeloperoxidase (MPO) is released by this cell type only and therefore can act as a marker for activity of inflammation.

Methods: In a prospective multicenter study, 45 patients with acute bacterial sinusitis (diagnosed by clinical examination, ultrasonography, and X ray or computed tomography scan) were treated with two different antibiotics (Cefditoren or Cefuroxim twice a day for 10 days). Nasal secretions were collected with absorbing foam-rubber samplers and a concentration of MPO was evaluated before the therapy and after 7 +/- 1 days and 14 +/- 2 days of antibiotic treatment. The concentrations of MPO were measured by a radioimmunoassay method and the dilution factors were determined by the lithium method.

Results: Significant differences in the MPO concentration in nasal secretions between the first and third visit could be found in both groups (p < 0.01 each). No significant difference was seen within the two different antibiotics used.

Conclusion: Measurement of MPO concentration in nasal secretions showed a significant change after antibiotic treatment of acute bacterial rhinosinusitis. The reduction of MPO levels correlated with the observed clinical and radiological improvement of the disease. Additional investigations are needed to achieve more knowledge about basal concentrations of MPO in healthy persons and different activation patterns before it can be determined whether the MPO measurement could be a suitable method for monitoring the success of an antibiotic treatment in acute bacterial sinusitis.
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June 2004