RICHARD LOUIS VOEGELS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Safety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis(2020) GARCIA, Ellen Cristine Duarte; ROSSANEIS, Ana Carolina; PIPINO, Alexandre Salvatore; GOMES, Gustavo Vasconcelos; PINNA, Fabio De Rezende; VOEGELS, Richard Louis; DOTY, Richard L.; VERRI, Waldiceu Aparecido; FORNAZIERI, Marco AurelioPurpose There is no standardized approach for preserving olfactory function in the side of the nose where biopsy of the olfactory epithelium (OE) is performed. Moreover, a gold standard technique for obtaining human OE in vivo is still lacking. We determined the efficacy of obtaining good-quality OE specimens suitable for pathological analysis from the lower half of the superior turbinate and verified the safety of this procedure in maintaining bilateral and unilateral olfactory function. Methods In 21 individuals without olfactory complaints and who had undergone septoplasty and inferior turbinectomy OE biopsy was made during septoplasty. Olfactory function, both unilateral and bilateral, was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) before and 1 month after the procedure. Specimens were marked with the olfactory marker protein for confirmation of OE presence. Results Ninety percent of the samples contained OE, although clear histological characterization was possible from only 62%. There was no deterioration of UPSIT scores either bilaterally or unilaterally on the side of the biopsy. Patients also maintained the ability to identify individual odorants. Conclusion Biopsies of the lower half of the superior turbinate do not affect olfactory function and show strong efficacy in yielding OE tissue and moderate efficacy for yielding tissue appropriate for morphological analysis. Future studies are needed to assess the safety of this procedure in other OE regions.
- Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?(2022) GARCIA, Ellen Cristine Duarte; LUZ, Lucas de Almeida; ANZOLIN, Lucas Kanieski; SILVA, Jose Lucas Barbosa da; DOTY, Richard L.; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; FORNAZIERI, Marco AurelioIntroduction: Olfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established. Objective: This study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum. Methods: During nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure. Results: Olfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT (R)]) between means before biopsy: 32.3 vs. postoperative: 32.5, p = 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p = 0.46). None out of the 56 different odorant identification significantly diminished (p > 0.05). Conclusion: The technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact. (c) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- Association of air pollution with olfactory identification performance of Sao Paulo residents: a cross-sectional study(2023) SCUSSIATTO, Henrique Ochoa; SILVA, Jose Lucas Barbosa Da; FIGUEIREDO, Alan Felipe; RAMOS, Rafael Antonio Matias Ribeiro; PINNA, Fabio De Rezende; VOEGELS, Richard Louis; PINTO, Jayant M. M.; FORNAZIERI, Marco AurelioObjectiveExposure to particulate matter of 10 mu m or less in diameter (PM10) has been implicated in pulmonary and cardiovascular diseases. However, the effect of PM10 on olfaction has not been well established. We estimated individual acute and chronic PM10 exposure levels in a large Brazilian cohort and related them to the ability to identify odors.MethodsAdults from Sao Paulo (n = 1358) were recruited from areas with different levels of air pollution. To verify individual exposure to air pollution, the averages of 30, 60, 90, 180 and 364 days of PM10 were interpolated to subjects' zip codes using the kriging method. Olfactory identification performance was tested using the University of Pennsylvania Smell Identification Test (UPSIT (R)). Multiple linear regressions were used to calculate the effect of air pollution on olfactory identification performance, controlling for demographic and other variables that affect the sense of smell.ResultsAcute exposures to PM10 were related to worse UPSIT (R) scores, including 30- (beta = - 0.94, 95% Confidence Interval [CI] - 0.98, - 0.89), 60- (beta = - 1.09, 95% CI = - 1.13, - 1.04) and 90-day intervals (beta = - 1.06, 95% CI - 1.10, - 1.02) (reference for beta: 1 mu m/m(3) increase in PM10 exposure per point decrease in UPSIT (R) score). Chronic exposures were also associated with worse olfaction for both 180- (beta = - 1.06, 95% CI - 1.10, - 1.03) and 364-day (beta = - 0.87, 95% CI - 0.90, - 0.84) intervals. As in prior work, men, older, low-income, and low-schooling people demonstrated worse olfactory performance.ConclusionAcute and chronic exposure to PM10 is strongly associated with olfactory identification performance in Brazilian adults. Understanding the mechanisms which underlie these relationships could help to improve chemosensory function with a large public health impact.
- Olfaction During Pregnancy and Postpartum Period(2019) FORNAZIERI, Marco Aurelio; PRINA, Douglas Manuel Carrapeiro; FAVORETO, Joao Paulo Maximiano; SILVA, Kleber Rodrigues e; UEDA, Denis Massatsugu; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; CAMERON, Leslie; DOTY, Richard L.Introduction Studies of the effect of pregnancy on olfactory function are contradictory-some report reduced function, others hypersensitivity, and still others no change at all. Our objectives were to quantify olfactory function in women during gestational and puerperal periods, to compare the olfactory test scores to those of non-pregnant women, and to explore the potential influence of rhinitis on olfactory function during these periods. Methods We evaluated olfactory function in 206 women with and without rhinitis-47 in the first trimester of pregnancy, 33 in the second, 44 in the third, 32 in the postpartum period, and 50 who were non-pregnant. Olfactory assessment was performed using the University of Pennsylvania Smell Identification Test (UPSIT) and ratings of the pleasantness and intensity of four common odors. Results Although total UPSIT scores did not differ among the study groups, pregnant and postpartum women identified some odors less well than did the controls. Pregnant women, especially in the first trimester, tended to consider some smells less pleasant. Rhinitis was adversely associated with the olfactory test scores of the pregnant and postpartum women. Conclusions The overall olfactory function of postpartum and pregnant women did not differ compared to controls; however, detection of some individual UPSIT items was adversely impacted (e.g., menthol, gingerbread, gasoline). Rhinitis was associated with reduced olfaction during pregnancy and puerperium.
- Reboot surgery for chronic rhinosinusitis with nasal polyposis: recurrence and smell kinetics(2022) GOMES, Sara Costa; CAVALIERE, Carlo; MASIERI, Simonetta; ZELE, Thibaut Van; GEVAERT, Philippe; HOLTAPPELS, Gabriele; ZHANG, Nan; RAMASAMY, Pathmanaban; VOEGELS, Richard Louis; BACHERT, ClausObjective To evaluate the time for recovery of the sense of smell in patients with CRSwNP who underwent Reboot surgery compared to patients undergoing ESS in a long-term follow-up study. Methods Data were collected retrospectively from 168 patients with severe uncontrolled CRSwNP, who underwent revision surgery, either as Extended Endoscopic Sinus Surgery (Reboot, 140 patients) or as regular Endoscopic Sinus Surgery (ESS, 28 patients) between January 1, 2014, and December 31, 2015, aiming to compare the outcome of surgeries after 2 years of follow-up. Sense of smell was scored as judged by the patient using scores 0 to 3 reflecting a percentage estimate of remaining smell. Results Smell improved similarly in the Reboot and ESS groups over the first 9 months, which was maintained over 24 months in the Reboot, but not the ESS group (p = 0.007 after 18 months, p = 0.001 after 24 months). Furthermore, polyp recurrence rates were significantly lower in the Reboot group. Conclusion Reboot surgery significantly improved olfactory function and significantly reduced nasal polyp recurrence rates over 2 years post-operatively. Therefore, Reboot should be considered for patients with uncontrolled severe CRSwNP, specifically when ESS failed, to offer long-term smell and a polyp-free status.
- A new cultural adaptation of the University of Pennsylvania Smell Identification Test(2013) FORNAZIERI, Marco Aurelio; DOTY, Richard L.; SANTOS, Clayson Alan dos; PINNA, Fabio de Rezende; BEZERRA, Thiago Freire Pinto; VOEGELS, Richard LouisOBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test.
- Adaptation of the Pediatric Smell Wheel (TM) to evaluate olfactory function in Brazilian children(2022) FORNAZIERI, Marco A.; EBARA, Lucas K.; ARAUJO, Rafael Goulart de; LIMA, Joao Vitor Fernandes; FAVARETO, Felipe B.; PINNA, Fabio R.; VOEGELS, Richard L.; DOTY, Richard L.Objective: Olfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell Wheel (TM) (PSW) to evaluate olfactory function in Brazilian children. Methods: We modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases. First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test's ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. Results: Eleven odors were identified for inclusion in the test. The test-retest reliability wasmodest (r = 0.54, p < 0.001), although likely attenuated based on the inclusion of only datafrom children with normal function. The test clearly differentiated the olfactory function ofchildren with adenoid hypertrophy from that of healthy children and demonstrated the returnof function after adenoidectomy. An overall score <7 was found useful in defining hyposmia, although additional age-related cut-points were also defined. Conclusion: A Brazilian version of the PSW was developed and validated and found to be efficacious in detecting smell dysfunction in children ranging in age from 5 to 12 years. (c) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial.
- High prevalence of olfactory dysfunction detected in treatment-naive patients with head and neck cancer(2023) SILVA, Jose Lucas Barbosa da; ANZOLIN, Lucas Kanieski; NICACIO, Samuel Pissinati; DOTY, Richard L. L.; PINNA, Fabio de Rezende; VOEGELS, Richard Louis; FORNAZIERI, Marco AurelioBackgroundPrevious studies demonstrated the difficulty of patients with Head and Neck Cancer (HNC) in sensing food taste, a function in which olfaction has a significant role. However, neither study employed psychophysical tests or control groups to establish the veracity of such complaints.Aims/objectivesIn this study, we quantitatively tested the olfactory function of HNC individuals and compared their function to that of healthy controls.MethodsThirty-one HNC naive treatment patients and thirty-one controls, matched for sex, age, schooling, and smoking, were tested with the University of Pennsylvania Smell Identification Test (UPSIT).ResultsThe olfactory function was significantly worse among the patients diagnosed with head and neck cancer [UPSIT cancer = 22.9(CI 95%: 20.5-25.4) vs. UPSIT controls = 29.1(CI 95%: 26.9-31.3); p < .001]. Most patients with HNC had olfactory disorders (n = 29, 93.5%). The risk of olfactory loss was higher in the cancer group [OR: 10.5(CI 95%: 2.1-51.9; p = .001)].Conclusion and significanceOlfactory disorders can be detected in more than 90% of patients with head and neck cancer when evaluated using a well-validated olfactory test. Smell disorders may be a potential marker for early diagnosis of HNC.
- Olfaction in nasal polyp patients after Reboot surgery: an endotype-based prospective study(2023) GOMES, Sara Costa; DELEMARRE, Tim; HOLTAPPELS, Gabriele; ZELE, Thibaut Van; DERYCKE, Lara; BONNE, Ellen; EECKELS, Anne-Sophie; ZHANG, Nan; VOEGELS, Richard Louis; BACHERT, ClausPurpose To report biomarkers present in the olfactory mucosa in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison with nasal polyps and to nasal mucosal tissues from control patients. To evaluate the kinetics of smell over 6 months in patients who underwent Reboot surgery. Methods Cohort study from May 2021 to May 2022. We collected samples of olfactory mucosa and nasal polyps from 16 CRSwNP patients and inferior turbinate samples from 20 control subjects. The study was not randomized for surgical and/or medical treatment. Samples were analyzed by Luminex and Unicap 100 to measure biomarkers of inflammation (IL1-beta, IL4, IL5, IL6, IL17, CCL3, CCL4, G-CSF, SE-IgE, total IgE and ECP). 12 of the CRSwNP patients underwent Extended Sniffin'tests at timepoints 1-4 days pre-surgery, and 1, 3 and 6 months after Reboot surgery. Results Type-2 markers were significantly elevated in OM and polyp tissue in CRSwNP (n = 16) vs. controls (n = 20), P < 0.05. TDI scores improved already 1 month (P < 0.05) after surgery and remained stable for 6 months. Type-2 inflammation in nasal polyps was associated with decreased sense of smell and taste before surgery, but improved after surgery (P = 0.048). Type-3 inflammation was present in the olfactory mucosa and was associated with a better sense of smell before surgery, but a smaller improvement of smell afterward. Conclusions Type-2 inflammation is present in the olfactory mucosa in CRSwNP patients and is associated with smell loss. Reboot surgery, aiming to completely remove inflamed sinus mucosa, significantly improves the smell in this group of patients.