Publications by authors named "Mandy Cuevas"

10 Publications

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Symptoms of Depression in Patients with Chemosensory Disorders.

ORL J Otorhinolaryngol Relat Spec 2021 Mar 23:1-9. Epub 2021 Mar 23.

Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany.

Introduction: Patients with chemosensory dysfunction frequently report symptoms of depression. The current study aims to clarify whether the type (smell dysfunction, taste dysfunction, and mixed smell and taste dysfunction), severity, duration, or cause of dysfunction have differential impacts on the symptoms of depression.

Methods: 899 patients with chemosensory disorders and 62 controls were included. Following a structured interview and an otorhinolaryngological examination, subjects underwent olfactory tests (Sniffin' Sticks), gustatory tests (taste sprays) and an assessment of depressive symptoms (Beck Depression Inventory). Information on the cause and duration of disorders was also collected.

Results: Patients with combined olfactory/gustatory dysfunction had higher depression scores than patients with smell dysfunction only and controls, and no significant difference was found between the smell dysfunction and controls. Anosmia patients, but not hyposmia patients, exhibited higher depression scores than controls. Among various causes of chemosensory disorders, patients from the posttraumatic group had higher depression scores than patients with other causes of chemosensory dysfunction (sinonasal, idiopathic, or postinfectious). Multiple linear regression analyses suggested that reduced olfactory function was associated with enhanced depression scores in the olfactory disorders group (B = -0.326, t = -2.294, and p = 0.02) and in all patients with chemosensory disorders (B = -0.374, t = -2.550, p = 0.017).

Discussion/conclusion: Simultaneously decreased input of olfaction and gustation seems to have an additive effect on the exacerbation of emotional dysfunction. Early intervention should be considered for depression symptoms in patients with mixed olfactory/gustatory dysfunction in clinical practice.
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http://dx.doi.org/10.1159/000513751DOI Listing
March 2021

[Biologics: A New Option in Treatment of Severe Chronic Rhinosinusits with Nasal Polyps].

Laryngorhinootologie 2021 02 1;100(2):134-145. Epub 2021 Feb 1.

Chronic rhinosinusitis (CRS) is defined as an inflammation of the nose and paranasal sinuses with prevalence of 10.9 % and by the presents of 2 or more symptoms, which last more than 12 weeks. The symptoms are nasal obstruction, nasal discharge (anterior/post nasal drip), facial pain or pressure and/or olfactory disorder. CRS has a high negative impact on an individual's quality of life. The pathogenesis is multifactorial and complex. CRS has been subclassified into 2 groups: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Regarding further knowledge of the inflammatory pathway the primary CRS is considered by endotype dominance, either type 2 or non-type 2. 80 % of the CRSwNP reveals a type 2 inflammation. The proteins, interleukin (IL)-4, IL-5, IL-13, and IgE were previously identified as key mediators in nasal polyp tissues pattern. CRSwNP is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. In most cases the control of the disease is a challenge. Patients with asthma but especially with Samter's triad are significantly more likely to have a recurrence of nasal polyps and undergo a second surgery following recurrence. In patients with severe CRSwNP, in whom the current standard of care including topical and oral corticosteroids, antibiotics and surgical procedures fail to control the disease, biologics can open new perspectives in treatment. They allow avoiding the possible adverse events resulting from repeated use of systemic corticosteroids and surgery. These biologics have a high impact on type 2 immune reaction and lead to a reduction of IgE as well as of local mucosal eosinophil migration and activation, resulting in a significant effect on nasal polyps, smell, quality of life and asthma comorbidity.
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http://dx.doi.org/10.1055/a-1309-6631DOI Listing
February 2021

Healthcare provision for insect venom allergy patients during the COVID-19 pandemic.

Allergo J Int 2020 8;29(8):257-261. Epub 2020 Dec 8.

Department and Outpatient Clinic for Dermatology and Allergology, University Hospital Munich, Munich, Germany.

The population prevalence of insect venom allergy ranges between 3-5%, and it can lead to potentially life-threatening allergic reactions. Patients who have experienced a systemic allergic reaction following an insect sting should be referred to an allergy specialist for diagnosis and treatment. Due to the widespread reduction in outpatient and inpatient care capacities in recent months as a result of the COVID-19 pandemic, the various allergy specialized centers in Germany, Austria, and Switzerland have taken different measures to ensure that patients with insect venom allergy will continue to receive optimal allergy care. A recent data analysis from the various centers revealed that there has been a major reduction in newly initiated insect venom immunotherapy (a 48.5% decline from March-June 2019 compared to March-June 2020: data from various centers in Germany, Austria, and Switzerland). The present article proposes defined organizational measures (e.g., telephone and video appointments, rearranging waiting areas and implementing hygiene measures and social distancing rules at stable patient numbers) and medical measures (collaboration with practice-based physicians with regard to primary diagnostics, rapid COVID-19 testing, continuing already-initiated insect venom immunotherapy in the outpatient setting by making use of the maximal permitted injection intervals, prompt initiation of insect venom immunotherapy during the summer season, and, where necessary, using outpatient regimens particularly out of season) for the care of insect venom allergy patients during the COVID-19 pandemic.
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http://dx.doi.org/10.1007/s40629-020-00157-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722411PMC
December 2020

Self-reported mini olfactory questionnaire (Self-MOQ): A simple and useful measurement for the screening of olfactory dysfunction.

Laryngoscope 2020 12 20;130(12):E786-E790. Epub 2019 Nov 20.

Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.

Objectives: Olfactory dysfunction is a common problem. However, too little attention has been paid to questionnaires used to evaluate quantitative olfactory dysfunction. Therefore, the current study aimed to develop a simple self-reported Mini Olfactory Questionnaire (Self-MOQ) for the screening of quantitative olfactory dysfunction in clinical practice.

Methods: Two hundred and eighty-five patients who had subjective complaints of olfactory disorder participated. The Sniffin' Sticks test score was used to define functional anosmia, hyposmia, or normosmia. We assessed the factor structure as well as internal consistency, convergent validity, and discrimination performance.

Results: The results showed that the final version of the Self-MOQ included only one factor with five items. The Self-MOQ has a good internal reliability (Cronbach's α = 0.84) and validity (r = -0.60, P < 0.001). The receiver operating characteristic analyses indicated that the Self-MOQ as compared to a visual analogue scale (VAS) is an effective measure for discriminating normosmic from hyposmic/anosmic patients, anosmic patients, and hyposmic patients.

Conclusion: The Self-MOQ is a simple, reliable and valid questionnaire to screen olfactory dysfunction in clinical practice that appears to be superior to the use of VASs but does not replace olfactory testing.

Level Of Evidence: 4 Laryngoscope, 2019.
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http://dx.doi.org/10.1002/lary.28419DOI Listing
December 2020

Effects of "trigeminal training" on trigeminal sensitivity and self-rated nasal patency.

Eur Arch Otorhinolaryngol 2018 Jul 9;275(7):1783-1788. Epub 2018 May 9.

Smell and Taste Center, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.

Purpose: Patients with the feeling of a congested nose not always suffer from an anatomical obstruction but might just have a low trigeminal sensibility, which prevents them from perceiving the nasal airstream. We examined whether intermittent trigeminal stimulation increases sensitivity of the nasal trigeminal nerve and whether this effect is accompanied by subjective improvement of nasal breathing.

Method: Thirty-five patients (M = 58.4 years; SD = 14.8; Min = 21 years; Max = 79 years; 43% females) and 30 healthy controls (M = 36.7 years, SD = 14.5; Min = 20 years; Max = 73 years; 60% females) participated in a study comprised of two sessions separated by "trigeminal training". During each session, trigeminal sensitivity towards CO, trigeminal lateralization abilities and ratings of nasal patency were assessed. Age and training compliance were controlled.

Results: "Trigeminal training" had a positive effect on trigeminal sensitivity in both groups, (p = .027) and this effect depended on the training compliance (p < .001). "Trigeminal training" had no effect on lateralization abilities of the subjects (p > .05). Ratings of nasal patency increased in patients (p = .03), but not in controls.

Conclusions: "Trigeminal training" consisting of intermittent presentation of diverse stimulants leads to an increase of trigeminal sensitivity, but this effect depended on the training compliance. Importantly, in patients, this training is also associated with an increase in self-rated nasal patency.
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http://dx.doi.org/10.1007/s00405-018-4993-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992236PMC
July 2018

Monitoring olfactory function in chronic rhinosinusitis and the effect of disease duration on outcome.

Int Forum Allergy Rhinol 2018 07 26;8(7):769-776. Epub 2018 Feb 26.

Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.

Background: Our primary aim in this study was to determine which of the "Sniffin' Sticks" subtest components (threshold, discrimination, or identification) best reflect overall change in olfactory function during treatment for chronic rhinosinusitis (CRS). Our secondary aim was to determine whether duration of CRS affects olfactory outcomes after treatment.

Methods: A retrospective cohort study was performed. Sniffin' Sticks test scores from patients medically treated for CRS at our center from 1999 to 2016 were analyzed. Only patients with 2 test scores available were included.

Results: Results from 408 patients were included (mean age, 56 years; male:female ratio, 217:191). There was a statistically significant improvement in threshold (T), discrimination (D), and identification (I) scores as well as the composite "TDI" score between the two testing sessions. Controlling for age, there was a significantly greater improvement in composite TDI score in patients with CRS of ≤24 months duration. As expected, we found statistically significant correlations between change in overall composite TDI score and change in threshhold, discrimination, and identification, between sessions. Of the individual subcomponents, change in discrimination correlated best with change in composite TDI score (r = 0.82, p < 0.0001). This relationship was maintained irrespective of duration of CRS.

Conclusions: In patients with CRS, odor discrimination appears to best reflect overall changes in olfactory function, as determined using the composite TDI score. Furthermore, olfactory outcomes are better when treatment is started sooner.
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http://dx.doi.org/10.1002/alr.22104DOI Listing
July 2018

Olfactory brain gray matter volume reduction in patients with chronic rhinosinusitis.

Int Forum Allergy Rhinol 2017 06 6;7(6):551-556. Epub 2017 Apr 6.

Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.

Background: Chronic rhinosinusitis (CRS) is a common inflammatory condition and a major cause of olfactory loss. Olfactory dysfunction has been associated with reduced olfactory bulb (OB) volume and gray matter (GM) density in the olfactory-related brain areas. The aim of this study was to investigate brain GM structural and OB volume alterations in patients with CRS.

Methods: Structural brain images were collected from 21 CRS patients and 31 healthy controls on a 3-T scanner. Voxel-based morphometry (VBM) was performed to investigate GM. Olfactory bulb volumes were measured using AMIRA software. Psychophysical olfactory testing for odor threshold (T) and identification (I) was performed using the Sniffin' Sticks battery.

Results: CRS patients had significantly lower scores for Sniffin' Sticks olfactory tests than controls (p < 0.001 for T, I, and combined T and I [TI] scores). Region-of-interest analyses revealed no difference in GM volume between CRS patients and healthy controls; however, in CRS patients with severe olfactory dysfunction, GM reduction was observed in the gyrus rectus, orbitofrontal cortex, thalamus, and the insula. In addition, no difference was observed for OB volume in CRS patients compared with healthy controls.

Conclusion: In this study we identified a reduction in gray matter in olfactory brain regions in CRS patients with severe olfactory dysfunction.
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http://dx.doi.org/10.1002/alr.21922DOI Listing
June 2017

Patterns of olfactory impairment reflect underlying disease etiology.

Laryngoscope 2017 02 24;127(2):291-295. Epub 2016 Aug 24.

Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.

Objective: We aimed to determine whether the pattern of olfactory impairment seen in psychophysical testing reflects underlying disease etiology.

Study Design: Retrospective cohort.

Methods: We performed a retrospective analysis of 1,226 patients from our tertiary referral center. Only hyposmic patients with the following conditions were included: postinfectious hyposmia, posttraumatic hyposmia, hyposmia secondary to sinonasal disease, and hyposmia secondary to Parkinson disease. Patients with anosmia were excluded.

Results: Using a repeated measures analysis of variance (within subject factor "test": threshold [T], discrimination [D], identification [I]; between subject factor: "etiology") with posthoc Bonferroni corrected t tests, we found significant interaction between the factors "test" and "etiology" (F = 8.46, P < 0.001), indicating that different causes of hyposmia produce different patterns of olfactory loss with respect to the individual subtests T, D, and I . Specifically, patients with Parkinson disease performed relatively well in odor threshold testing, but poorly in odor identification and discrimination compared with the other etiology groups. Conversely, patients with sinonasal disease performed well in odor identification and discrimination but poorly in odor threshold. Patients with postinfectious and posttraumatic hyposmia performed relatively well in both thresholds and discrimination but poorly in identification. However, patients with posttraumatic hyposmia had globally reduced scores compared with the other groups.

Conclusion: This is the first study to comprehensively show that patterns of olfactory impairment reflect underlying disease etiology. We suggest that multicomponent olfactory testing should be performed, especially if there is diagnostic uncertainty. However, to clearly separate different patterns of olfactory loss to the various causes at an individual level, more work is needed.

Level Of Evidence: 4. Laryngoscope, 2016 127:291-295, 2017.
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http://dx.doi.org/10.1002/lary.26229DOI Listing
February 2017

The administration of nasal drops in the "Kaiteki" position allows for delivery of the drug to the olfactory cleft: a pilot study in healthy subjects.

Eur Arch Otorhinolaryngol 2016 Apr 4;273(4):939-43. Epub 2015 Jul 4.

Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.

Systemic treatment with corticosteroids shows therapeutic effects, few patients benefit from intranasal topical drug application, probably due to limited access of the drug to the olfactory epithelium. The aim of the present study was to investigate how drops distribute within the nasal cavity when the "Kaiteki" position is performed. Thirteen healthy volunteers participated. Subjects were lying on the side with the head tilted and the chin turned upward. Blue liquid was used to visualize the intranasal distribution of the nasal drops. The investigation was carried out using photo documentation thorough nasal endoscopy; the intranasal distribution of the dye was judged by two independent observers in both a decongested state and a natural state where no decongestants had been used. With regard to the main criterion of this study, using the "Kaiteki" position, nasal drops reached the olfactory cleft in 96 % of the decongested cases and 75 % of the cases who had not been decongested. However, this difference was not statistically different. Because the "Kaiteki" maneuver is not too difficult to perform, it is more likely that topical steroids can be helpful in cases of olfactory loss.
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http://dx.doi.org/10.1007/s00405-015-3701-yDOI Listing
April 2016