Effects of radiotherapy on olfaction and nasal function in head and neck cancer patients

Gurushekar, Preethi Rose; Isiah, Rajesh; John, Subhashini; Sebastian, Tunny; Varghese, Lalee

doi:10.1016/j.amjoto.2020.102537

Cited by 17 publications

(22 citation statements)

References 13 publications

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“…The participants in our study recorded a high mean score in self-evaluation of smell function. This is in accordance with a study on HNC patients, 3 months after RT, where the patients subjectively did not notice smell dysfunction even though there was a signi cant reduction in olfactory function during RT [31]. Self-rating of olfactory function has been shown to have low reliability even in healthy subjects [32], thus a validated objective measurement is recommended when assessing smell function [32,33].…”

Section: Discussionsupporting

confidence: 87%

Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

Tanem

Stensvold

Wilberg

et al. 2022

Preprint

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Purpose Our aim was to investigate taste and smell functions in survivors, with a minimum of 2 years follow-up time, after treatment of childhood medulloblastoma/CNS-PNET. Methods This cross-sectional study included 40 survivors treated ≤ 20 years of age. Taste strips with four concentrations of sweet, sour, salt, and bitter were used to assess taste function in all participants. Score from 0-16; ≥ 9 normogeusia, < 9 hypogeusia, and complete ageusia which equals no sensation. No sensation of a specific taste quality equals ageusia of that quality. Thirty-two participants conducted smell testing using three subtests of Sniffin’ sticks; threshold, discrimination, and identification. Together they yield a TDI-score from 1-48; functional anosmia ≤ 16.00, hyposmia >16.00 - < 30.75, normosmia ≥ 30.75 - < 41.50, and ≥ 41.50 super smeller. Results were compared with normative data. Survivors subjectively rated their taste and smell functions using a numerical rating scale (NRS) score 0-10. Results Forty survivors with a mean follow-up of 20.5 years, 13 (32.5 %) were diagnosed with hypogeusia, nine (22.5 %) of these being ageusic of one or more taste qualities. Seventeen (53 %) of 32 participants were diagnosed with hyposmia. Comparing survivors with hyposmia to those with normosmia, a significant difference (p<0.05) was found in TDI-score and in all the subtests. The mean NRS score of subjective ratings of functions were high.Conclusion Our study showed impaired taste and smell functions in long-term survivors of childhood MB/CNS-PNET using objective measurements. However, subjective ratings did not reflect objective findings.

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Section: Discussionsupporting

confidence: 87%

Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

Tanem

Stensvold

Wilberg

et al. 2022

Preprint

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“…Such studies have utilized a variety of outcome metrics, including the UPSIT R , Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test, SS, and measurement of event-related potentials (ERPs) to assess odor threshold, discrimination, and identification (TDI), suggesting that RT-induced OD is both qualitative and quantitative. [415][416][417][418][419][420][421] Various mechanisms have been proposed regarding the pathophysiology of these observed changes, although there is limited evidence in their validation. Proposed mechanisms include direct cytotoxic damage to the OE, OB, or its supporting cells; impaired neurogenesis; treatmentinduced obstruction of the OC; and decreased vascular perfusion to the OC.…”

Section: F Postradiation Therapymentioning

confidence: 99%

International consensus statement on allergy and rhinology: Olfaction

Patel

Holbrook

Turner

et al. 2022

Int Forum Allergy Rhinol

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Background:The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). Methods: Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. Results:The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. Conclusion:This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.

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“… 17 Furthermore, several studies also found that the mucociliary clearance remarkably decreased in patients who endured RT. 18 , 19 Those findings indicated that IR induced damage of airway epithelium and increased the susceptibility of these patients to respiratory tract infections and inflammation.…”

Section: Introductionmentioning

confidence: 97%

“…Under homeostatic conditions, effective mucociliary clearance requires coordinated ciliary motility and appropriate mucus secretion. Previous studies indicated that RT damaged the mucociliary transport time, 19,37 which manifested associated clinical symptoms. Our previous study also reported that NPC patients post-RT have nasal and nasopharyngeal mucosal atrophy with decreased mucus secretion and mucosal dryness by anterior rhinoscopy.…”

mentioning

confidence: 97%

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro

Yang¹,

Liu²,

Liu³

et al. 2022

JIR

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Purpose Radiotherapy (RT) is the mainstay treatment for head and neck cancers. However, chronic and recurrent upper respiratory tract infections and inflammation have been commonly reported in patients post-RT. The underlying mechanisms remain poorly understood. Method and Materials We used a well-established model of human nasal epithelial cells (hNECs) that forms a pseudostratified layer in the air-liquid interface (ALI) and exposed it to single or repeated moderate dose γ-irradiation (1Gy). We assessed the DNA damage and evaluated the biological properties of hNECs at different time points post-RT. Further, we explored the host immunity alterations in irradiated hNECs with polyinosinic-polycytidylic acid sodium salt (poly [I:C]) and lipopolysaccharides (LPS). Results IR induced DNA double strand breaks (DSBs) and triggered DNA damage response in hNECs. Repeated IR significantly reduced basal cell proliferation with low expression of p63/KRT5 and Ki67, induced cilia loss and inhibited mucus secretion. In addition, IR decreased ZO-1 expression and caused a significant decline in the transepithelial electrical resistance (TEER). Moreover, hyperreactive response against pathogen invasion and disrupted epithelial host defense can be observed in hNECs exposed to repeated IR. Conclusion Our study suggests that IR induced prolonged structural and functional impairments of hNECs may contribute to patients post-RT with increased risk of developing chronic and recurrent upper respiratory tract infection and inflammation.

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Effects of radiotherapy on olfaction and nasal function in head and neck cancer patients

Cited by 17 publications

References 13 publications

Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

Taste and Smell Functions in Long-term Survivors after Childhood Medulloblastoma/CNS-PNET

International consensus statement on allergy and rhinology: Olfaction

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro

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