The objective of this study was to perform a systematic review of the literature for application of intranasal sodium citrate in the patients with olfactory dysfunction to help determine the sodium citrate treatments for this condition. Two authors independently searched the data base (Medline, Scopus, and the Cochrane database) for relevant studies from inception to January 2018. Included studies were randomized controlled studies published in English comparing topical sodium citrate application (treatment group) with saline (control group) in patients who had olfactory dysfunction. Outcomes of interest included the change of olfactory identification and threshold during 2 hours post-treatment. Three studies were enrolled in the meta-analysis. Compared with control group, treatment group did not increase posttreatment score of olfactory identification [standardized mean difference (SMD)=-0.03; 95% confidence interval (CI)=-0.29-0.24; I²=0%] and olfactory threshold (SMD=0.18; 95% CI=-0.09-0.45; I²=0%) significantly. In the degree of pre-post improvement of two outcomes, although treatment group statistically showed the significant improvement in olfactory threshold (SMD=0.30; 95% CI=0.05-0.55; I²=17%), the clinical significance of this outcome was meaningless. Similarly, there was no significant difference in olfactory identification between two groups (SMD=0.17; 95% CI=-0.11-0.45; I²=22%). Unlike the recent favorable results, our summated results presented the uselessness for the local application of sodium citrate in improving patient's olfactory function. However, we also had some limitation such as small sample size and inconsistent application methods. Therefore, larger trials and standardized methodology are needed to reach more stronger and exact results.
Citric Acid ; Humans ; Sample Size ; Sodium

The objective of this study was to perform a systematic review of the literature for application of intranasal sodium citrate in the patients with olfactory dysfunction to help determine the sodium citrate treatments for this condition. Two authors independently searched the data base (Medline, Scopus, and the Cochrane database) for relevant studies from inception to January 2018. Included studies were randomized controlled studies published in English comparing topical sodium citrate application (treatment group) with saline (control group) in patients who had olfactory dysfunction. Outcomes of interest included the change of olfactory identification and threshold during 2 hours post-treatment. Three studies were enrolled in the meta-analysis. Compared with control group, treatment group did not increase posttreatment score of olfactory identification [standardized mean difference (SMD)=-0.03; 95% confidence interval (CI)=-0.29-0.24; I²=0%] and olfactory threshold (SMD=0.18; 95% CI=-0.09-0.45; I²=0%) significantly. In the degree of pre-post improvement of two outcomes, although treatment group statistically showed the significant improvement in olfactory threshold (SMD=0.30; 95% CI=0.05-0.55; I²=17%), the clinical significance of this outcome was meaningless. Similarly, there was no significant difference in olfactory identification between two groups (SMD=0.17; 95% CI=-0.11-0.45; I²=22%). Unlike the recent favorable results, our summated results presented the uselessness for the local application of sodium citrate in improving patient's olfactory function. However, we also had some limitation such as small sample size and inconsistent application methods. Therefore, larger trials and standardized methodology are needed to reach more stronger and exact results.

Objective: This study evaluated the risk factors for tube feeding dependency of the patients with head and neck squamous cell carcinoma (HNSCC) who underwent an operation with curative intent. Methods: The medical records of patients with HNSCC who underwent operation with curative intent and who also had postoperative MBSS (modified barium swallow study) performed at a single institution were retrospectively reviewed between January 2013 and December 2018. The clinical and oncological characteristics along with the MBS findings and questionnaire results were retrieved. These were used to analyze the potential risk factors for tube feeding dependency after surgery. Univariate analysis of each factor was conducted and the odds ratios were calculated. Additionally, multivariate analysis was performed for the significant factors found on the univariate analysis. Results: 60 HNSCC patients (male:female=54:6) with four different primary sites of cancer and who had a mean age of 65.90±11.09 years-old were included in this study. 41 (68.3%) patients were T1-T2, 33 (55%) patients were N+, and 36 (60%) patients were advanced staged (III and IV). 30 (50%) patients received reconstruction with various flaps and 55 (91.7%) patients received neck dissection. Univariate analysis showed a prior history of radiation based therapy and chemoradiation along with silent aspiration, aspiration, pyriform sinus residue, pharyngeal weakness, and high PAS and SPS scores based on MBS showed a significant risk for feeding tube dependency. Multivariate analysis using these factors showed that only the prior history of radiation based therapy and a high SPS score were significant risk factors for feeding tube dependency. Conclusion Our study showed a 21.7% rate of feeding tube dependency after surgical treatment of HNSCC. A prior history of radiation based treatment and a higher swallowing performance scale score were the significant risk factors for tube feeding dependency.