To Örebro University

The coronavirus disease 2019 pandemic has shed light on the post-viral olfactory dysfunction (PVOD). Post-viralolfactory dysfunction is temporary for most people and usually subsides when the common cold symptoms ameliorate. However, in some patients, this condition can persist for several weeks or months. The exact pathological mechanisms of persistent olfactory loss secondary to upper respiratory tract infection (URTI) is unknown, andthere is a lack of effective treatment. An increased understanding of pathology could possibly translate into newtherapeutic regimens. The aim of this systematic review is to synthesize primary data regarding histopathological and neuropathological findings in patients with PVOD secondary to URTI. The Preferred Reporting Items forSystematic Reviews and Meta-Analyses guidelines was followed. Databases PubMed and Web of Science weresearched with keywords and mesh terms to identify relevant articles. The quality of included studies was assessedwith the Newcastle–Ottawa Scale for observational studies. The search yielded a total of 847 articles, after excludingduplicates and articles that were not relevant. A total of 12 studies were selected. The main findings of this reviewwere: olfactory bulb (OB) volume was decreased in patients with PVOD, there was a negative correlation betweenOB volume and duration of olfactory loss, both primary and secondary olfactory cortex changes were found interms of structure and functionality, and the olfactory sensory neurons and nerve bundles were reduced in patientswith PVOD. The mechanisms of PVOD are complex. This review found that viral URTI is attributable to structural andfunctional changes at multiple locations of the olfactory system.

Background: In the diagnostic work up of allergy, determining allergen component-specific immunoglobulin E (IgE) is important for diagnosis, prognosis and choice of treatment.

Objective: The purpose of this study was to evaluate the performance of the immunoblotting assay (Euroline) in detection of IgE antibodies against timothy grass and birch pollen allergen components compared to fluorescent enzyme assay (ImmunoCAP, Phadia 250).

Methods: A total of 128 serum samples from patients allergic to timothy grass and birch pollen were analysed. The levels of IgE antibodies to timothy grass and birch pollen were measured using Euroline DPA-Dx pollen 1 and ImmunoCAP assay. The two methods were then compared on binary (positive vs negative), semi-quantitative (IgE classes) and quantitative (concentration) levels. The two methods were also compared to results from skin prick testing.

Results: The Euroline method showed a positive percentage agreement of 93% and negative percentage agreement of 94% with an overall accuracy of 94% when compared to ImmunoCAP. Kappa analysis showed moderate strength of agreement between the methods in determining IgE classes for 7/11 components tested. All components showed a positive correlation when analysed using Spearman's rank correlation.

Conclusions: Overall, we found that there is good correlation between the Euroline and ImmunoCAP methods in measuring IgE sensitization.

Background:  Patients show varied results to allergen immunotherapy (AIT. The reason for this variability is unclear.

Objective: To describe the relationship between AIT efficacy and demographic characteristics, as well as pre-treatment plasma levels of specific IgE-antibodies to grass and birch pollen.

Methods: A retrospective study was performed based on medical records of 128 patients who received AIT. The patients completed a questionnaire and pre-AIT plasma levels of allergen-specific IgE to grass and birch pollen were measured using EUROLINE DPA-Dx pollen 1 method. Results. Seventy percent of patients classified their allergic symptoms as less severe after AIT. Twenty-seven percent had received AIT targeting only grass pollen, 19% targeting only birch pollen, and 55% targeting both grass and birch. A total of 35 different IgE profiles were found across our study population. On comparison of the demographic characteristics and concentration of allergen-specific IgE-antibodies, no statistically significant differences could be found.

Conclusions: The majority of patients rated their allergic symptoms as less severe after AIT. No clear relationship could be demonstrated between pre-treatment allergen-specific IgE concentration, or demographic characteristics, and effect of AIT. There may be other factors underlying the different responses to AIT.

Tonsil tissue not located at known anatomical locations at the entry of aero-digestive system is called ectopic tonsil. This is rarely presented clinically and may lead to diagnostic confusion when encountered. The diagnosis of ectopic tonsil is challenging as it is usually asymptomatic and requires histopathological examination for definitive diagnosis. A case of patient with sublingual ectopic tonsillar tissue is described here. Otolaryngologists colleagues are encouraged to pay attention to this entity and consider it in the differential diagnosis of an unclear lump in the head and neck region especially, in the oral cavity.

Covid-19 har funnits i Sverige i drygt ett år nu, och vi lär oss mer och mer om sjukdomen. Covid-19 kan ge många olika symtom, och de som drabbas av sjukdomen blir sjuka i varierande grad. Vissa får bara lukt- och smakbortfall, feber eller huvudvärk, medan andra blir allvarligt sjuka och behöver vårdas länge i respirator. Behandlingen av patienter med covid-19 har utvecklats under året som gått. Att covid-19 kan ge nervpåverkan är nu känt – ett stort antal patienter får neurologiska symtom [1] och det publiceras fortlöpande fler och fler fallbeskrivningar gällande påverkan på en eller flera kranialnerver [2-5]. Den exakta korrelationen mellan de neurologiska komplikationerna och själva infektionen är fortfarande inte helt klargjord. Vi vill här presentera ett patientfall med påverkan på flera kranialnerver i samband med svår covid-19 och intensivvård. 

OBJECTIVE: This study comprised a long-term follow-up of a cohort of patients with chronic rhinosinusitis (CRS) regarding clinical features and symptomatology.

METHODS: Data from 42 patients with CRS were available from a previous study. Forty of these patients were alive and were contacted for inclusion after approximately 10 years. Patients completed a questionnaire about disease and symptoms, and underwent a clinical examination.

RESULTS: Thirty-four patients (85%) responded and could be included and evaluated. For the participants in this follow-up study median length of time between initial inclusion (C1) and follow-up (C2) was 11 years (range: 8-15). In some patients the CRS shifted phenotype over time, from CRS with nasal polyposis to CRS without nasal polyposis or vice versa. The median total visual analogue score for combined sinonasal symptoms for all patients was statistically significantly reduced at follow-up. For individual patients, scores for nasal congestion, nasal discharge, facial pressure, and hyposmia were also statistically significantly reduced. The most frequently reported symptom-relieving treatments were nasal steroids and saline rinsing of the nose. Self-reported general quality of life was statistically significantly improved at C2 compared to C1.

CONCLUSION: At long-term follow-up, symptoms were generally reduced and patients reported an improved quality of life. Patients can be given hope for eventual symptom relief. CRS is a chronic condition that seems to harbor the ability to alter its phenotype after several years. Topical corticosteroids and saline rinsing of the nose should be emphasized, since patients consider these treatments to be of high value.

Objective: This study aimed to elucidate the effect of Staphylococcus aureus and budesonide on the mRNA expression and the biologic role (caspase-1 activation and IL-1β secretion) of NLRP3 inflammasome in primary nasal epithelial cells (NECs) in patients with chronic rhinosinusitis (CRS) and healthy controls.

Material and Methods: Brush biopsies isolated from both patients and healthy controls were denoted respectively for our experiments. These were treated with S. aureus strains (four strains) only and in combination with budesonide (0, 10, 100, 1000 nM). NECs treated with only budesonide (0, 10, 100, 1000 nM) and untreated NECs were used as controls. Expression of NLRP3, caspase-1, IL-1β along with NLRC1/2 was analyzed by qPCR. Caspase-1 activity was measured by fluorogenic substrates Ac-YVAD-AMC. Enzyme-linked immunosorbent (ELISA) assay was performed to measure IL-1β production.

Results: The mRNA levels of NLRC1, NLRC2, caspase-1, and IL-1β significantly increased, while NLRP3 demonstrated a trend toward elevation in the CRS group compared to the healthy controls. Infection with S. aureus increased caspase-1 activity and IL-1β secretion. However, treatment with budesonide decreased mRNA expression of NLRC2 and IL-1β secretion.

Conclusion: Increase in the caspase-1 activity and IL-1β levels, due to possible activation of NLRP3 inflammasomes, upon S. aureus infection, may have an important role in the pathogenesis of CRS.

BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and the paranasal sinuses, often associated with an infection by Staphylococcus aureus (S. aureus). Disturbance in the function of ion channels is regarded as an etiological factor for pathogenesis of CRS.

AIMS: The study aims to measure the mRNA expression of the ENaC and CFTR ion channels in nasal epithelial cells (NECs) and to investigate the effect of both the budesonide and S. aureus on these ion channels.

MATERIALS AND METHOD: NECs biopsies obtained from healthy volunteers and patients with CRS. NECs were infected with S. aureus strains and/or budesonide to study the mRNA expression levels of the ENaC and CFTR ion channels.

RESULTS: The mRNA expression level of CFTR was increased while that of ENaC was decreased. S. aureus infection and budesonide treatment induced a significant modulation of ENaC and CFTR ion channels expression.

CONCLUSION: The CFTR and ENaC ion channel physiology are of importance in the pathogenesis of CRS. Exposure to S. aureus infection and treatment with budesonide modulated the mRNA expression of CFTR and ENaC ion channels.

SIGNIFICANCE: Better understanding of the pathophysiology of CRS.

Background and objectives: Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and the paranasal sinuses, often associated with an infection by Staphylococcus aureus (S. aureus). Disturbance in the function of ion channels is regarded as an etiological factor for pathogenesis of CRS. The study aims to measure the mRNA expression of the ENaC and CFTR ion channels in nasal epithelial cells (NECs) and to investigate the effect of both the budesonide and S. aureus on these ion channels.

Materials and Method: NECs biopsies obtained from healthy volunteers and patients with CRS. NECs were infected with S. aureus strains and/or budesonide to study the mRNA expression levels of the ENaC and CFTR ion channels.

Results: The mRNA expression level of CFTR was increased while that of ENaC was decreased. S. aureus infection and budesonide treatment induced a significant modulation of ENaC and CFTR ion channels expression.

Conclusion: The CFTR and ENaC ion channel physiology are of importance in the pathogenesis of CRS. Exposure to S. aureus infection and treatment with budesonide modulated the mRNA expression of CFTR and ENaC ion channels. The study is an effort for a better understanding of the pathophysiology of CRS. In order to reach further knowledge, studies on functional properties of the ENaC and CFTR ion channels are necessary.

Background: Sensorineural hearing loss is a significant problem worldwide and a condition that is not completely cured by currently available therapy. Gene therapy of the inner ear offers an exciting alternative and it has been suggested that this therapeutic modality could be used in treatment aiming at preventing, reversing or managing cochlear disorders. Because of their desired properties as an alternative to the viral vectors, non-viral vectors have been extensively explored for gene delivery. One example is chitosan, a biodegradable cationic polymer.

Objective: To evaluate the in vitro and in vivo transfection efficiency of chitosan as a non-viral gene carrier for gene delivery to cells of the inner ear.

Materials and Methods: Organotypic cultures of the hearing organ, the organ of Corti, were prepared from postnatal day 2 rats, and exposed to chitosan carrying plasmid DNA (pDNA) encoding for green fluorescent protein (GFP) for 24-48 hours. The in vivo transfection efficiency was tested at two time points, at one day or seven days after infusing chitosan/pDNA polyplexes through osmotic pumps into the cochlea of adult guinea pigs (n=41). The tissue was then processed for anti-GFP immunostaining (in vitro and in vivo) and RT-PCR (in vivo).

Results: The in vitro assessment showed prominent GPF transfection after 24-48 hours, while the in vivo GFP transfection in the inner ear was inconsistent and did not show good correlation with the in vitro transfection. Conclusion: It can be concluded that the using chitosan as a carrier for the in vivo transfection, is associated with varying and in consistent degree of transfection.