Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?

Garcia, Ellen Cristine Duarte; Luz, Lucas de Almeida; Anzolin, Lucas Kanieski; Barbosa da Silva, José Lucas; Doty, Richard L.; Pinna, Fábio de Rezende; Voegels, Richard Louis; Fornazieri, Marco Aurélio

doi:10.1016/j.bjorl.2021.05.008

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 88 (05) • Sep-Oct 2022 • https://doi.org/10.1016/j.bjorl.2021.05.008 copy

Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Olfactory biopsies from the superior part of the nasal septum did not significantly affect smell capacity.
These biopsies obtain high rates of olfactory neurons.
The described procedure also provides olfactory epithelium proper for morphological analysis.

Abstract

Introduction

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®]) 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.

Keywords
Smell; Olfactory mucosa; Immunofluorescence; Biopsy; Neurons

Odor	Before (% of correct answers, 95% CI)	After (% of correct answers, 95% CI)
Pizza	64.7 (37.7-84.7)	64.7 (37.7-84.8)
Bubble gum	76.5 (48.2-91.9)	70.6 (42.9-88.5)
Menthol	82.4 (53.7-94.9)	88.2 (59.2-97.5)
Cherry	82.4 (53.7-94.9)	88.2 (59.2-97.5)
Motor oil	70.6 (42.9-88.5)	52.9 (28.0-76.5)
Peppermint	94.1 (62.7-99.3)	94.1 (62.7-99.5)
Banana	82.4 (53.8-94.9)	58.8 (32.7-80.7)
Clove	94.1 (62.7-99.4)	88.2 (59.2-97.5)
Leather	100	100
Coconut	82.4 (53.5-94.9)	88.2 (59.2-97.5)
Onion	94.1 (62.7-99.4)	100
Fruit juice	88.2 (59.1-97.5)	94.1 (62.7-99.4)
Baby powder	94.1 (62.7-99.4)	100
Jasmine	64.7 (37.7-84.7)	70.6 (42.9-88.5)
Cinnamon	88.2 (59.1-97.5)	70.6 (42.9-88.5)
Gasoline	17.6 (5.1-46.3)	17.7 (5.1-46.3)
Strawberry	100	100
Coffee	64.7 (37.7-84.7)	47.1 (23.5-71.9)
Gingerbread	94.1 (62.7-99.3)	100
Apple	76.5 (48.2-91.9)	100
Perfume	94.1 (62.7-99.4)	82.4 (53.7-94.9)
Flower	76.5 (48.2-91.9)	88.2 (59.2-97.5)
Peach	82.4 (53.7-94.9)	100
Tire	94.1 (62.7-99.4)	88.2 (59.2-97.5)
Pickles	47.1 (23.5-71.9)	47.1 (23.5-71.9)
Pineapple	82.4 (53.7-94.3)	94.1 (62.7-99.4)
Raspberry	88.2 (59.2-97.5)	100
Orange	82.4 (53.7-94.9)	88.2 (59.2-97.5)
Walnuts	58.8 (32.7-80.7)	58.8 (32.7-80.7)
Watermelon	100	94.1 (62.7-99.4)
Solvent	82.4 (53.8-94.9)	76.5 (48.2-91.9)
Grass	70.6 (42.9-88.5)	64.7 (37.7-84.8)
Smoke	88.2 (59.1-97.5)	88.2 (59.2-97.5)
Wood	64.7 (37.7-84.8)	70.6 (42.3-88.5)
Grape	82.4 (53.7-94.9)	88.2 (59.2-97.5)
Garlic	94.1 (62.7-99.4)	88.2 (59.2-97.5)
Soap	94.1 (62.7-99.4)	88.2 (59.2-97.5)
Natural gas	94.1 (62.7-99.4)	94.1 (62.7-99.4)
Rose	58.8 (32.8-80.8)	52.9 (28.0-76.5)
Peanut	70.6 (42.9-88.5)	88.2 (59.1-97.5)

Odor	Before (% of correct answers, 95% CI)	After (% of correct answers, 95% CI)
Orange	88.9 (37.4-99.1)	100
Leather	55.6 (19.5-86.6)	55.6 (19.5-86.6)
Cinnamon	44.5 (13.4-80.5)	66.7 (26.2-91.9)
Mint	100	100
Banana	88.9 (37.4-99.1)	88.9 (37.4-99.1)
Galician lemon	66.7 (26.2-91.9)	44.5 (13.4-80.5)
Licorice	44.5 (13.4-80.5)	55.6 (19.5-86.6)
Paint solvent	33.4 (8.1-73.8)	55.6 (19.5-86.6)
Garlic	100	87.5 (31.9-99.1)
Coffee	71.4 (21.5-95.8)	87.5 (31.9-99.1)
Apple	42.9 (9.1-84.9)	37.5 (8.7-79.2)
Clove	100	100
Pineapple	85.7 (25.7-99.1)	75.0 (27.3-95.9)
Rose	100	87.5 (31.9-99.1)
Fennel	100	100
Fish	100	100

Odor	Before (% of correct answers, 95% CI)	After (% of correct answers, 95% CI)
Orange	71.4 (21.5-95.8)	100
Leather	85.7 (25.7-99.1)	100
Cinnamon	85.7 (25.7-99.1)	50.0 (14.4-85.7)
Mint	100	100
Banana	100	100
Galician lemon	57.1 (15.1-90.9)	62.5 (20.8-91.4)
Licorice	71.4 (21.5-95.8)	75.0 (27.6-95.9)
Paint solvent	42.9 (9.1-84.9)	25.0 (4.1-72.4)
Garlix	88.9 (37.4-99.1)	88.9 (37.4-99.1)
Coffee	33.4 (8.1-73.8)	55.6 (19.5-86.6)
Apple	33.4 (8.1-73.8)	11.1 (0.9-62.6)
Clove	55.6 (19.5-86.6)	88.9 (37.4-99.1)
Pineapple	77.8 (32.9-96.1)	88.9 (37.4-99.1)
Rose	66.7 (26.2-91.9)	100
Fennel	88.9 (37.4-99.1)	88.9 (37.4-99.1)
Fish	88.9 (37.4-99.1)	100

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author at: Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Clínica, Londrina, PR, Brazil. marcofornazieri@uel.br (M.A. Fornazieri).