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Reale M, Licci G, Orlando P, Matucci A, Trabalzini F, Maggiore G, Gallo O. Efficacy and safety of dupilumab in the treatment of CRSwNP in the real-life setting: a review of the literature. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08725-7. [PMID: 38762844 DOI: 10.1007/s00405-024-08725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION The recent approval of Dupilumab has profoundly revolutionized the management of patients affected by severe and recalcitrant Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). However, a review that summarizes the results of real-life studies and compares them to phase 3 studies SINUS-24 and 52 is still lacking. MATERIALS AND METHODS A search of all real-life studies published from 2019 to 2023 was performed. Patients characteristics at baseline and 6 and 12 months after starting Dupilumab were extracted and compared to those from phase 3 trials: age, sex, smoking habits, comorbid asthma and aspirin-exacerbated respiratory disease (AERD), previous endoscopic sinus surgery (ESS), hematic eosinophils and total IgE, NasalAQ2 Polyps Score (NPS), smell, SNOT-22, adverse events (AEs), and response to treatment. RESULTS 15 papers were included with an overall number of 1658 patients. A higher rate of comorbidities and previous ESS was found in patients from real-life studies. In addition, they had worse smell and SNOT-22 at baseline compared to patients from SINUS-24 and 52. Comorbid and post-ESS patients tended to have a faster NPS and SNOT-22 improvement, although the absolute values were not clinically relevant. A more extensive surgery and a number of ESS ≥ 2 were related to worse olfactory outcomes, probably due to iatrogenic damage. No correlation was found between hematic eosinophils and outcomes. AEs were reported by 12.4% of patients and 2.2% had to discontinue dupilumab. Weight gain was an emergent AE (0.8%), probably related to the restored sense of smell and taste. Non-responders were 3.5% and they were switched to systemic steroid, ESS, or another biologic. CONCLUSION Despite some differences in prescription criteria between countries, dupilumab was demonstrated to be effective even in the real-life scenario. However, emerging AEs and possible unknown long-term AEs of a likely lifelong therapy should be considered.
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Affiliation(s)
- Marella Reale
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giuseppe Licci
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Pietro Orlando
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Andrea Matucci
- Department of Immunology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Franco Trabalzini
- Department of Otorhinolaryngology, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Eckert MA, Benitez A, Soler ZM, Dubno JR, Schlosser RJ. Gray matter and episodic memory associations with olfaction in middle-aged to older adults. Int Forum Allergy Rhinol 2024; 14:961-971. [PMID: 37897207 PMCID: PMC11045322 DOI: 10.1002/alr.23290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Age-related declines in olfaction contribute to low quality of life and appear to occur with declines in cognitive function, including diminished episodic memory. We tested the hypothesis that low gray matter volume within cortical regions that support olfaction and episodic memory can explain age-related differences in olfactory and episodic memory functions. METHODS T1-weighted images, Sniffin' Sticks olfactory measures, and the NIH Toolbox-Cognition Battery were administered to 131 middle-aged to older adults (50-86 years; 66% female). Correlation was used to examine the associations between these measures. A network-based image processing approach was then used to examine the degree to which spatial patterns of gray matter variance were related to the olfactory and cognitive measures. Structural equation modeling was used to characterize the relative specificity of olfactory, cognitive, gray matter, and aging associations. RESULTS Olfactory threshold, discrimination, and identification exhibited small to medium effect size associations with episodic memory performance (rs = 0.27-0.42, ps < 0.002). Gray matter volume within medial temporal and orbitofrontal cortex was also related to olfactory (discrimination and identification) and episodic memory function (rs = 0.21-0.36, ps < 0.019). Age and episodic memory explained the same variance in olfaction that was explained by the medial temporal and orbitofrontal pattern of gray matter volume. CONCLUSIONS The results of this cross-sectional study suggest that identifying mechanisms contributing to differences in medial temporal and orbitofrontal cortex will advance our understanding of co-morbid olfactory and cognitive declines.
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Affiliation(s)
- Mark A. Eckert
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | | | - Zachary M. Soler
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | - Judy R. Dubno
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina
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Beswick DM, Han EJ, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Eshaghian PH, Getz AE, Hwang PH, Khanwalkar A, Kimple AJ, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel Z, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner G, Wang MB, Taylor-Cousar JL, Saavedra M. Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy. Int Forum Allergy Rhinol 2024; 14:807-818. [PMID: 37725072 DOI: 10.1002/alr.23270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with cystic fibrosis (PwCF). While highly effective modulator therapy improves quality-of-life and symptom severity, the impact of this intervention and other factors associated with pursuing endoscopic sinus surgery (ESS) remains understudied. METHODS Adult PwCF + CRS were enrolled into a prospective, observational, multi-institutional study. Participants completed validated outcome measures to evaluate respiratory symptom severity, depression, headache, and sleep quality, as well as nasal endoscopy, sinus computed tomography (CT), and olfactory testing. Bivariate comparisons and regression modeling evaluated treatment cofactors, disease characteristics, and outcome measures associated with pursuing ESS. RESULTS Sixty PwCF were analyzed, including 24 (40%) who elected ESS. Pursuing ESS was associated with worse SinoNasal Outcome Test (SNOT-22) total, rhinologic, psychological, and sleep dysfunction domain scores; worse Patient Health Questionnaire-9-Revised depression scores; worse Pittsburgh Sleep Quality Index total scores; worse weight, role, emotion, and eating domain scores on the Cystic Fibrosis Questionnaire-Revised; more severe disease on nasal endoscopy; and lack of modulator therapy (all p < 0.050). Multivariable regression identified that worse SNOT-22 total score was associated with electing ESS (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02-1.16, p = 0.015) and elexacaftor/tezacaftor/ivacaftor (ETI) treatment (OR 0.04, 95% CI 0.004-0.34, p = 0.004) was associated with pursing medical therapy. CONCLUSIONS Worse sinonasal symptom burden, lack of ETI treatment, sleep quality, depression, and nasal endoscopy scores were associated with electing ESS, while lung disease severity and sinus CT scores were not. ETI use was associated with lower odds of pursuing ESS independent of sinonasal symptom burden.
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Affiliation(s)
- Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Ethan J Han
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Zara Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Grant Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Milene Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
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Fan H, Han Z, Gong X, Wu Y, Fu Y, Zhu T, Li H. Prevalence and predictors of depression and anxiety in patients with chronic rhinosinusitis: a systematic review and meta-analysis. BMJ Open 2024; 14:e079273. [PMID: 38490652 PMCID: PMC10946353 DOI: 10.1136/bmjopen-2023-079273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a persistent inflammation of the sinuses. As a result of long-term discomfort, patients may experience symptoms of common mental disorders such as anxiety and depression. This may affect the quality of life and disease progression. However, there is still uncertainty about the extent of the problem. OBJECTIVE This meta-analysis aimed to determine the prevalence of depression and anxiety symptoms in patients with CRS. SEARCH STRATEGY We searched PubMed, Embase, Web of Science, Cochrane Library, and CBM databases for relevant studies published before 15 July 2022 in patients with CRS with concomitant depression and anxiety symptoms. DATA COLLECTION AND ANALYSIS Two authors independently performed screening and quality assessment using validated tools. Extraction of data using predefined standardised data collection spreadsheets. Heterogeneity and inconsistency were checked using the I² statistic. RESULTS The meta-analysis included 32 articles involving 56 933 patients. The prevalence of depression and anxiety symptoms was estimated at 24.7% (95% CI, 21.3% to 28. 1%) and 29.7% (95% CI, 19.3% to 40.2%). Subgroup analysis revealed the following: (1) CRS without nasal polyps (CRSsNP): 26.2% (95% CI, 21.9% to 30.5%), CRS with nasal polyps(CRSwNP): 20% (95% CI, 15.9% to 24%); (2) Female patients: 36. 1% (95% CI, 25.3% to 46.9%), male patients: 24.3% (95% CI, 12. 1% to 36.6%); and (3) The average age≤50 years patients: 29.8% (95% CI, 21.3% to 38.2%), the average age>50 years patients: 22. 1% (95% CI, 17.1% to 27%). CONCLUSION A significant proportion of people with CRS have symptoms of depression and anxiety, and early screening for depression and anxiety in people with CRS is critical. And, more attention needs to be given to females and patients with CRSsNP during screening. PROSPERO REGISTRATION NUMBER CRD42022345959).
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Affiliation(s)
- Hongli Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhoutong Han
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinru Gong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuqi Wu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yijie Fu
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Tianmin Zhu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Li
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
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Zhang B, Li X, Deng H, Tan P, He W, Huang S, Wang L, Xu H, Cao L, Nie G. The relationship of personality, alexithymia, anxiety symptoms, and odor awareness: a mediation analysis. BMC Psychiatry 2024; 24:185. [PMID: 38448836 PMCID: PMC10916267 DOI: 10.1186/s12888-024-05653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/01/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Personality, emotions, and olfaction exhibit partial anatomical overlap in the limbic system structure, establishing potential mechanisms between personality, affective disorders, and olfactory-related aspects. Thus, this study aims to investigate the associations among the Big Five personality traits, alexithymia, anxiety symptoms, and odor awareness. METHODS A total of 863 college participants were recruited for this study. All participants completed the Chinese Big Five Personality Inventory-15, the Odor Awareness Scale (OAS), the Toronto Alexithymia Scale-20, and the Generalized Anxiety Disorder Screener-7. Structural equation modeling was employed to examine the hypothesized mediated model. RESULTS The findings revealed the majority of significant intercorrelations among the dimensions of the Big Five personality traits, alexithymia, anxiety symptoms, and OAS (|r| = 0.072-0.567, p < 0.05). Alexithymia and anxiety symptoms exhibited a serial mediation effect between neuroticism and OAS (95%CI[0.001, 0.014]), conscientiousness and OAS (95%CI[-0.008, -0.001]), and extraversion and OAS (95%CI[-0.006, -0.001]). Anxiety symptoms mediated the relationship between agreeableness and OAS (95%CI[-0.023, -0.001]) and between openness and OAS (95%CI [0.004, 0.024]). CONCLUSION The mediating roles of alexithymia and anxiety symptoms between the Big Five personality traits and odor awareness support the idea of a certain level of association among personality, emotions, and olfaction, with the underlying role of the limbic system structure. This enhances our understanding of personality, emotions, and olfaction and provides insights for future intervention measures for affective disorders and olfactory dysfunctions.
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Affiliation(s)
- Binfeng Zhang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Xiuxia Li
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Hongzhen Deng
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Peixuan Tan
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Wanyong He
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Shuling Huang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Lu Wang
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Hao Xu
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Lei Cao
- Department of Psychology, Guangxi Medical University, Nanning, China
| | - Guanghui Nie
- Department of Psychology, Guangxi Medical University, Nanning, China.
- School of Public Health, Guangxi Medical University, Shuangyong Road 22, 530021, Nanning, Guangxi, China.
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Lundberg M, Maurer R, Tchekmedyian R, Mullur J, Bensko JC, Buchheit KM, Laidlaw TM. Validation of a questionnaire assessing smell loss in an international aspirin-exacerbated respiratory disease population. Allergy Asthma Proc 2024; 45:5-13. [PMID: 38151738 DOI: 10.2500/aap.2024.45.230079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Background: Olfactory dysfunction (OD) and smell loss affects aspects of patients' everyday life and lowers their quality of life. OD questionnaires are considered one of the core-outcome measures in chronic rhinosinusitis, but many existing smell loss questionnaires contained pandemic-prohibitive questions on social gatherings or restaurant visits, were too culture specific or gender specific, or were overly long and cumbersome. Objective: We aimed to develop a new brief questionnaire to assess the impact and consequences of smell loss and its burden on daily life. This study validates this new, short, multicultural, dichotomized questionnaire in an international population that has aspirin-exacerbated disease (AERD). Methods: The Consequences of Smell Loss (COSL) questionnaire was developed and content validity was assessed by experts and patients at Brigham and Women's Hospital. The questionnaire, along with other validated quality-of-life surveys, was answered by 853 patients with AERD. We evaluated the factor structure, reliability, validity, and discriminative ability of the COSL questionnaire. Results: The final version of the COSL questionnaire consisted of 13 items divided into three subdomains (emotional distress, food and safety, and physical health) through factor analysis. The Cronbach α for internal consistency was 0.82. Convergent and discriminant validity with the 22-item Sinonasal Outcome Test (SNOT-22), Healthy Days Core Module-4, Patient Health Questionnaire-4, and a specific question on taste and smell were high (p < 0.0001 for all). The COSL questionnaire score was associated with SNOT-22 categories (p < 0.001) and was categorized as follows: normal, 0-1 points; very few consequences, 2-3 points; few, 4 points; moderate, 5-6 points; and severe, 7-13 points. Conclusion: The COSL questionnaire is a new, brief, valid, reliable tool that can effectively screen for a high burden of OD in patients with AERD and has the potential to be used in other patient populations with OD as well.
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Affiliation(s)
- Marie Lundberg
- From the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raffi Tchekmedyian
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jyotsna Mullur
- From the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jillian C Bensko
- From the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathleen M Buchheit
- From the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tanya M Laidlaw
- From the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
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Wu D, Liu Z, Bleier BS, Huang X, Hong J. Olfactory cleft mucus eosinophil-derived neurotoxin better reflects olfactory loss than blood eosinophil counts in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2023; 13:2144-2155. [PMID: 37264735 DOI: 10.1002/alr.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Eosinophils are associated with olfactory dysfunction in chronic rhinosinusitis (CRS) and eosinophil-derived neurotoxin (EDN) is a sensitive marker of intense eosinophil activation. This study aimed to analyze olfactory cleft mucus and olfactory mucosa EDN levels and their association with olfactory dysfunction in CRS. METHODS We prospectively recruited 150 patients with CRS electing endoscopic sinus surgery and 25 healthy controls. Both superior turbinate biopsy specimens and olfactory cleft mucus were collected to analyze EDN levels. Sniffin' Sticks test scores, olfactory cleft computed tomography (CT) scores, and olfactory cleft endoscopy scale (OCES) were obtained. Multivariable logistic regression analysis was applied to analyze the predictability of EDN levels for olfactory dysfunction in CRS. RESULTS Chronic rhinosinusitis with olfactory dysfunction presented significantly higher olfactory mucosa (p = 0.016) and olfactory cleft mucus (p < 0.001) EDN levels than CRS without olfactory dysfunction. Mucus EDN levels were positively correlated with blood eosinophils (r = 0.625, p = 0.002), olfactory cleft CT scores (r = 0.738, p < 0.001), and OCES (r = 0.605, p = 0.004) in CRS. Furthermore, mucus EDN levels were significantly negatively correlated with threshold, discrimination, and identification (TDI) (r = -0.688), olfactory threshold (r = -0.606), olfactory discrimination (r = -0.608), and olfactory identification (r = -0.697) scores. After adjusting for patient demographics and comorbidities, mucus EDN levels were significantly associated with olfactory dysfunction in CRS (odds ratio = 2.162; p = 0.027). Mucus EDN levels showed a significantly better performance for predicting olfactory dysfunction than blood eosinophil counts (area under the curve, 0.873 vs. 0.764, p = 0.024). CONCLUSION Olfactory cleft mucus EDN level may be a better biomarker for predicting olfactory dysfunction in CRS than blood eosinophil counts.
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Affiliation(s)
- Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, PR China
| | - Zheng Liu
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Benjamin S Bleier
- The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical, School, Boston, Massachusetts, USA
| | - Xiaoxi Huang
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China
| | - Junsheng Hong
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
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Naimi BR, Hunter SR, Boateng K, Rawson NE, Garvey E, Dalton PH, Trachtman J, Murphy C, Joseph PV, Schrandt S, Silberman P, Duffy A, Nyquist GG. Patient Insights into the Diagnosis of Smell and Taste Disorders in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.20.23295861. [PMID: 37790453 PMCID: PMC10543242 DOI: 10.1101/2023.09.20.23295861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Diagnosis of smell/taste dysfunction is necessary for appropriate medical care. This study examines factors affecting testing and diagnosis of smell/taste disorders . METHODS The online USA Smell and Taste Patient Survey was made available to US patients with smell/taste disorders between April 6-20, 2022. 4,728 respondents were included. RESULTS 1,791 (38%) patients reported a documented diagnosis. Patients most often saw family practitioners (34%), otolaryngologists (20%), and Taste/Smell clinics (6%) for smell/taste dysfunction. 64% of patients who went to Taste/Smell clinics received smell testing, followed by 39% of patients who saw otolaryngologists, and 31% of patients who saw family practitioners. Factors associated with increased odds of diagnosis included age (25-39 years (OR 2.97, 95% CI [2.25, 3.95]), 40-60 (OR 3.3, 95% CI [2.56, 4.52]), and >60 (OR 4.25, 95% CI [3.21, 5.67]) vs. 18-24 years), male gender (OR 1.26, 95% CI [1.07, 1.48]), insurance status (private (OR 1.61, 95% CI [1.15, 2.30]) or public (OR 2.03, 95% CI [1.42, 2.95]) vs. uninsured), perception of their family practitioner to be knowledgeable (OR 2.12, 95% CI [1.16, 3.90]), otolaryngologic evaluation (OR 6.17, 95% CI [5.16, 7.38]), and psychophysical smell testing (OR 1.77, 95% CI [1.42, 2.22]). CONCLUSION Psychophysical testing, otolaryngologic evaluation, patient assessment of family practitioner knowledge level, insurance, age, and gender are significant factors in obtaining smell/taste dysfunction diagnosis. This study identifies barriers to diagnosis including lack of insurance or access to specialist evaluation and highlights the importance of educating family practitioners in diagnosis and management of patients with smell/taste disorders.
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Affiliation(s)
- Bita R Naimi
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia PA USA
| | | | - Katie Boateng
- Smell and Taste Association of North America, Philadelphia PA USA
| | | | - Emily Garvey
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia PA USA
| | | | | | - Claire Murphy
- Department of Psychology, San Diego State University, San Diego CA USA
| | - Paule V Joseph
- Smell and Taste Association of North America, Philadelphia PA USA
- National Institute of Alcohol Abuse and Alcoholism and National Institute of Nursing Research, Section of Sensory Science and Metabolism, Bethesda MD USA
| | | | - Pamela Silberman
- Smell and Taste Association of North America, Philadelphia PA USA
| | - Alexander Duffy
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia PA USA
| | - Gurston G Nyquist
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia PA USA
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Mitchell MB, Workman AD, Rathi VK, Bhattacharyya N. Smell and Taste Loss Associated with COVID-19 Infection. Laryngoscope 2023; 133:2357-2361. [PMID: 37265267 DOI: 10.1002/lary.30802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/31/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to quantify the impact of COVID-19 on olfactory and gustatory function in US adults. METHODS From the 2021 Adult National Health Interview Survey, demographic and survey-specific module data concerning COVID-19 diagnoses, testing and disease severity, and data quantifying disturbances and eventual recovery of smell and taste were extracted. Sample weights were applied to obtain nationally representative statistics. The overall rate of COVID-19 infection was determined, and those diagnosed with COVID-19 were analyzed with respect to disease severity, smell and taste disturbance, and respective recoveries. RESULTS In 2021, 35.8 million or 14% of the adult population (95% CI 13.5-14.7%; mean age, 43.9 years; 53.8% female) had been diagnosed with COVID-19. Among those, 60.5% (58.6-62.5%) and 58.2% (56.2-60.1%) reported accompanying losses in smell or taste, respectively; there was a significant association between overall COVID-19 symptom severity and smell (p < 0.001) and taste disturbance (p < 0.001). Following infection, 72.2% (69.9-74.3%), 24.1% (22.2-26.2%), and 3.7% (3.0-4.6%) of the patients experienced complete, partial, and no smell recovery, respectively. Recovery rates for gustatory function paralleled olfaction, with 76.8% (74.6-78.9%), 20.6% (18.7-22.7%), and 2.6 (1.9-3.4%) reporting complete, partial, and no recovery of taste, respectively. When sensory disturbance was present, severity of overall symptomatology was negatively associated with smell and taste recovery (p < 0.001 for each). CONCLUSION The majority of adults infected with COVID-19 in 2021 experienced olfactory or gustatory dysfunction with a non-negligible population reporting incomplete or no near-term sensory recovery. Our results are useful for providers counseling patients and suggest that interventions lessening overall COVID-19 symptom burden may prevent prolonged sensory dysfunction. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2357-2361, 2023.
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Affiliation(s)
- Margaret B Mitchell
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
| | - Alan D Workman
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
| | - Vinay K Rathi
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts, USA
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10
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Zhang B, Li X, Tan P, Liu Y, He W, Wang L, Huang S, Nie G. Factor structure and psychometric properties of the Chinese version of the Odor Awareness Scale. Front Psychiatry 2023; 14:1228179. [PMID: 37575563 PMCID: PMC10415028 DOI: 10.3389/fpsyt.2023.1228179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background The Odor Awareness Scale (OAS) is a questionnaire that assesses individual differences in awareness of odors in the surrounding environment, which has been shown to be associated with affective symptoms in recent researches. To further research, A Chinese version of the OAS needs to be introduced. Objective To investigate the factor structure and validate the psychometric properties of the OAS. Methods A total of 978 participants from college were randomly allocated into two groups for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Additionally, the study entailed item analysis and scrutinized internal consistency reliability, test-retest reliability, and concurrent validity. Test-retest reliability was assessed by having 214 participants complete the OAS twice at a one-week interval. Concurrent validity was measured using the Body Odor Sniffing Questionnaire (BOSQ), the Generalized Anxiety Disorder Scale (GAD-7), and the Toronto Alexithymia Scale (TAS-20). Results EFA identified three factors that best fit the data: odor sensitivity, odor impact, and odor attention. CFA validated a second-order factor model, yielding good fit indices: χ 2 / Df = 2.326, RMSEA = 0.052, CFI = 0.911, TLI = 0.900, SRMR = 0.053. The final version of the OAS comprised 27 items and exhibited a commendable internal consistency reliability (Cronbach's α = 0.913), and a good test-retest reliability, as evidenced by the high Pearson correlation coefficient (r = 0.940) and intraclass correlation coefficient (ICC = 0.940). The OAS was significantly correlated with BOSQ (r = 0.416), GAD-7 (r = 0.155), and TAS-20 (r = -0.081). Conclusion The Chinese version of the OAS demonstrated robust reliability and validity, rendering it a valuable instrument for evaluating odor awareness in the Chinese population.
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Affiliation(s)
| | | | | | | | | | | | | | - Guanghui Nie
- Department of Psychology, Guangxi Medical University, Nanning, China
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11
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Liu Z, Hong J, Huang X, Wu D. Olfactory cleft mucus galectin-10 predicts olfactory loss in chronic rhinosinusitis. Ann Allergy Asthma Immunol 2023; 130:317-324.e1. [PMID: 35870756 DOI: 10.1016/j.anai.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/03/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Eosinophils have been reported to be involved in the pathogenesis of olfactory fluctuation in chronic rhinosinusitis (CRS). Galectin-10 is more frequently associated with type 2 inflammation and potentially a sign of intense eosinophil activation. OBJECTIVE To explore olfactory cleft mucus and olfactory mucosa galectin-10 level and its association with olfactory dysfunction (OD) in CRS. METHODS We prospectively enrolled 50 patients with CRS and 15 healthy controls. Olfactory cleft mucus and superior turbinate biopsy specimens were collected to analyze galectin-10 levels and quantify tissue eosinophils. Psychophysical olfactory testing, olfactory cleft endoscopy scale, and olfactory cleft computed tomography scores were obtained. The predictability of galectin-10 levels for OD in patients with CRS was analyzed by multivariable logistic regression analysis. RESULTS Both olfactory cleft mucus and olfactory mucosa galectin-10 levels in patients with CRS with OD were significantly higher than those in patients with CRS without OD (all P < .001). Mucus galectin-10 levels were positively correlated with tissue eosinophils (r = 0.541, P = 0.002), olfactory cleft endoscopy scale (r = 0.498, P = 0.006), and olfactory cleft computed tomography scores (r = 0.432, P = 0.019) in patients with CRS. Mucus galectin-10 levels were negatively correlated threshold, discrimination, and identification (r = -0.589, P = 0.001), olfactory threshold (r = -0.522, P = 0.003), olfactory discrimination (r = -0.488, P = 0.007), and olfactory identification (r = -0.466, P = 0.011) scores. After adjusting for patient demographics and comorbidities, mucus galectin-10 levels were significantly associated with OD in patients with CRS (odds ratio, 1.299; P = .008). Mucus galectin-10 levels greater than 8.975 ng/mL were the best predictor of OD in CRS. CONCLUSION Olfactory cleft mucus galectin-10 is highly associated with OD in CRS.
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Affiliation(s)
- Zheng Liu
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junsheng Hong
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoxi Huang
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, People's Republic of China.
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12
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Mitchell MB, Workman AD, Lee SE. Clinically meaningful changes in efficacy outcomes in chronic rhinosinusitis with nasal polyposis. Curr Opin Allergy Clin Immunol 2023; 23:9-13. [PMID: 36539378 DOI: 10.1097/aci.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis with nasal polyps (CRSwNP) carries a high disease burden, and many studies have been done investigating the efficacy of various medical and surgical therapies. However, outcome metrics have varied across these studies, making it difficult to compare therapeutic efficacy on a large scale. In this article, we discuss various outcome metrics used across prior studies as well as the relationship between these measures. RECENT FINDINGS Outcome metrics in CRSwNP studies include both clinically assessed and patient-reported outcome measures (PROMs). The former includes olfaction testing, scoring systems based on imaging and endoscopic evaluation, and histopathological and immunohistochemical evaluation of sinus tissue, and the latter includes quality-of-life instruments, symptom severity scales, and disease-control instruments. Recent studies evaluating the efficacy of new biologics have used a combination of both types of metrics. SUMMARY Both clinical metrics and patient-reported outcomes provide utility in evaluating disease severity and control in patients with CRSwNP, although there are nuances when comparing therapies in this population as patients with CRSwNP are heterogeneous and may have symptoms across several domains. However, PROMs in conjunction with clinical metrics provide useful information to assess patient symptoms and response to interventions.
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Affiliation(s)
- Margaret B Mitchell
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alan D Workman
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stella E Lee
- Harvard Medical School
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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13
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Chang F, Hong J, Yuan F, Wu D. Association between cognition and olfaction-specific parameters in patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2023; 280:3249-3258. [PMID: 36689021 DOI: 10.1007/s00405-023-07853-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) have reported significantly cognitive and olfactory dysfunction. This study aimed to explore the relationship between cognitive function and olfaction-specific parameters in patients with CRS. METHODS A cross-sectional survey method was used to investigate 98 participants, including 75 patients with CRS and 23 healthy controls. Cognitive function and psychophysical olfactory tests were performed. Olfactory cleft endoscopy scale and olfactory cleft computed tomography (CT) scores were obtained. Multivariate logistic regression was used to analyze the risk factors of Mild Cognitive Impairment (MCI) in patients with CRS. RESULTS There are significant differences in age, Montreal Cognitive Assessment (MoCA) scores, number of MCI, Lund-Mackay olfactory cleft (LM-OC) score, and blood eosinophil count between CRS with and without olfactory dysfunction groups (all P < 0.05). Total MoCA scores were positively correlated with thresholds-discrimination-identification (TDI) score (r = 0.541, P < 0.001), olfactory threshold (OT) (r = 0.440, P < 0.001), olfactory discrimination (OD) (r = 0.541, P < 0.001), and olfactory identification (OI) (r = 0.382, P = 0.001) scores. Furthermore, total MoCA scores were negatively correlated with LM-OC scores (r = - 0.351, P = 0.002). After adjusting for patient demographics, only the OD score was an independent risk factor for MCI among patients with CRS (odds ratio = 0.792; P = 0.039). The OD scores less than 11.5 were the best predictor of MCI in patients with CRS. CONCLUSION Olfaction-specific clinical parameters were highly correlated with cognitive function in patients with CRS and the OD score was an independent risk factor for MCI in patients with CRS.
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Affiliation(s)
- Feifan Chang
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Junsheng Hong
- Department of Otolaryngology-Head and Neck Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Fan Yuan
- Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Haidian District, No. 49 Huayuan North Road, Beijing, 100191, People's Republic of China.
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14
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Dal Bò E, Gentili C, Castellani A, Tripodi C, Fischmeister FPS, Cecchetto C. Olfactory meta-cognition in individuals with depressive and anxiety symptoms: The differential role of common and social odors. J Affect Disord 2022; 308:259-267. [PMID: 35429542 DOI: 10.1016/j.jad.2022.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/21/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Diminished olfactory functioning has been reported in depression, whereas evidence in anxiety disorders is still controversial. Olfactory meta-cognitive abilities (i.e., olfactory awareness, imagery and reactivity, and the importance of odors) are essential in shaping olfaction. Few studies examined these meta-cognitive abilities in relation to depressive, anxiety, and social anxiety symptoms, and none of them considered the awareness of social odors (i.e., body odors). METHODS This pre-registered study examined the relationship between olfactory meta-cognitive abilities and symptoms of depression, general anxiety, and social anxiety in 429 individuals. Self-report measures of symptoms of depression, general anxiety, and social anxiety, along with self-report olfactory meta-cognitive scales, were collected using an online survey. RESULTS Linear regression analyses revealed that olfactory awareness and importance of common odors were significantly directly predicted by symptoms of general anxiety, while affective importance to odors was negatively predicted by symptoms of depression. Regarding social odors, higher symptoms of depression and lower symptoms of social anxiety predicted increased awareness. LIMITATIONS Higher prevalence of women and narrow age range of the participants. Depressive and anxiety symptoms were assessed only with self-report questionnaires. CONCLUSIONS Symptoms of anxiety seem to be associated with higher levels of common odor awareness, corroborating the importance of olfactory functions in anxiety. In addition, results on social odors seem to reflect dysfunctional social behaviour that characterized symptoms of depression and social anxiety. Hence, the assessment of meta-cognitive abilities may represent a useful tool in the prevention and assessment of depressive, anxiety, and social anxiety symptoms.
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Affiliation(s)
- Elisa Dal Bò
- Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy; Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy
| | - Claudio Gentili
- Padova Neuroscience Center (PNC), University of Padua, Via Orus 2/B, 35131 Padua, Italy; Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy
| | - Andrea Castellani
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy
| | - Carmen Tripodi
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy
| | - Florian Ph S Fischmeister
- Institute of Psychology, University of Graz, Graz, Austria; BioTechMed, Graz, Austria; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Cinzia Cecchetto
- Department of General Psychology, University of Padua, Via Venezia 8, 35131 Padua, Italy.
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15
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Total laryngectomy negatively impacts sinonasal and olfactory-specific quality of life. Am J Otolaryngol 2022; 43:103471. [PMID: 35636084 DOI: 10.1016/j.amjoto.2022.103471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study is to characterize deficits in olfactory-specific and sinonasal-specific QoL after total laryngectomy (TL) with validated patient reported outcome measures. METHODS Thirty patients who had a TL were prospectively enrolled. Patient demographics, as well as scores from the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and the Sino-nasal Outcome Test-22 (SNOT-22) were collected. Univariate analysis was performed to assess associations between patient characteristics and QoL scores. RESULTS The average QOD-NS score was 37.9 ± 11.4 (<38.5 is considered abnormal) and average SNOT-22 score was 32.0 ± 3.8 (>20 indicates a moderate/severe impact on QoL). The abnormal QOD-NS group had a greater percentage of former smokers compared to the normal group (77.8% vs. 58.1%; P = 0.56) and more median days from surgery compared to the normal group (904 vs. 477 days; P = 0.24). CONCLUSIONS Olfactory dysfunction associated with TL results in blunting of olfactory-specific QoL.
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16
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Predictive significance of the questionnaire of olfactory disorders-negative statements for olfactory loss in patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2022; 279:5253-5262. [PMID: 35718822 PMCID: PMC9206836 DOI: 10.1007/s00405-022-07438-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
Objectives The questionnaire of olfactory disorder-negative statements (QOD-NS) is a valid and reliable instrument for assessing the olfactory-specific quality of life. This study aimed to explore the association between the QOD-NS and objective olfactory metrics (including objective olfactory cleft assessment) and then evaluate the predictive significance of the QOD-NS for olfactory loss in Chinese patients with chronic rhinosinusitis (CRS). Methods A total of 70 patients with CRS were enrolled in the study. Olfaction was assessed with Sniffin’ Sticks. The olfactory cleft was assessed by the sinus CT scan and nasal endoscopy (the Lund–Mackay olfactory cleft scale, LM-OC and olfactory cleft endoscopy scale, OCES). The QOD-NS and its short version were utilized to assess the patient-reported olfaction. The predictors associated with olfactory loss were analyzed by the logistic regression analysis. The optimal cutoff points of the predictors were determined by the receiver-operating characteristic curves and the Youden index. Results The TDI score in patients with CRS significantly correlated with the QOD-NS (r = − 0.755, P < 0.001), OCES (r = − 0.520, P < 0.001), LM-OC (r = − 0.615, P < 0.001). After adjusting for patient demographics and comorbidities, QOD-NS was significantly associated with olfactory dysfunction [odds ratio (OR) = 1.243; P = 0.001] and anosmia in patients with CRS (OR = 1.838; P = 0.006). Furthermore, the QOD-NS significantly correlated with the LM-OC (r = 0.610, P < 0.001), and the OCES (r = 0.464, P < 0.001) in patients with CRS. The QOD-NS had the highest predictive value for olfactory dysfunction (optimal cutoff = 10.5; Youden index = 0.635; area under the curve = 0.861) and anosmia (optimal cutoff = 20.5; Youden index = 0.790; area under the curve = 0.928) in patients with CRS. Conclusion The QOD-NS showed high validity and correlated well with objective olfactory metrics and olfactory cleft assessment in patients with CRS. The QOD-NS was a reliable predictor for olfactory dysfunction and anosmia in patients with CRS, which may aid in the fast screening of olfactory loss in the clinic.
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17
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Hopkins C, Lee SE, Klimek L, Soler ZM. Clinical Assessment of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1406-1416. [PMID: 35183784 DOI: 10.1016/j.jaip.2022.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/15/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common disease that affects >10% of the adult population in Europe and the United States. It has been delineated phenotypically into CRS without nasal polyps and CRS with nasal polyps. Both have a high disease burden and an overlapping spectrum of symptoms such as nasal obstruction, olfactory dysfunction, facial pain, pressure, and nasal discharge. Primary assessment includes evaluation of patient symptoms and impact on quality of life, nasal endoscopic examination, and imaging. Significant progress has been made in the understanding of CRS pathophysiology. There is a move toward describing CRS in terms of the predominant endotype or inflammatory pattern pathomechanism rather than the traditional classification of patients with and without nasal polyps. An increased elucidation of the disease endotypes, as characterized by their inflammatory pathways and mediators, is leading to a tailored more personalized treatment approach to the different disease subtypes.
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Affiliation(s)
| | - Stella E Lee
- Division of Otolaryngology-Head & Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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18
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Liu DT, Prem B, Sharma G, Kaiser J, Besser G, Mueller CA. Depression Symptoms and Olfactory-related Quality of Life. Laryngoscope 2022; 132:1829-1834. [PMID: 35353380 PMCID: PMC9544892 DOI: 10.1002/lary.30122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 01/05/2023]
Abstract
Objectives Patients with olfactory dysfunction (OD) frequently report symptoms of depression. The objective of this study was to determine how clinical characteristics and olfactory‐related quality of life (QoL) measures associate with the likelihood for major depressive disorders (MDDs). Methods A total of 192 OD patients were included. Olfactory function was measured using all three subtests of the Sniffn' Sticks test. Olfactory‐related quality of life (QoL) was evaluated using the Questionnaires of Olfactory Dysfunction (QOD)‐negative (NS) and ‐positive statement (PS). The likelihood for MDD was assessed using the Patients Health Questionnaire‐2 (PHQ‐2). Demographics and disease‐specific variables (etiology and duration of OD) were collected. Univariate and multivariable analyses were used to associate disease‐specific variables and the QOD with the outcome of the PHQ‐2. Additionally, the predictive ability of the QOD‐NS to predict depressive symptoms was calculated. Results In univariate analysis, COVID‐19 related smell loss, the QOD‐NS, and the QOD‐PS were significantly associated with the PHQ‐2. In multivariable analyses adjusting for QoL measures, the QOD‐NS (ß = 0.532, p < 0.001) and sinonasal OD (compared with postinfectious OD) were significantly associated with the PHQ‐2 (ß = 0.146, p = 0.047). When omitting QoL measures from multivariable analyses, only COVID‐19 related OD (compared with postinfectious OD) was significantly associated with the PHQ‐2 (ß = 0.287, p = 0.009). A QOD‐NS score > 20.5 had 70.13% sensitivity and 76.32% specificity for detecting symptoms of depression. Conclusion Our results suggest that COVID‐19 related OD might be associated with a higher likelihood for MDD. Furthermore, we showed that the QOD‐NS score might be helpful to predict symptoms of depression in OD patients. Level of Evidence 4 Laryngoscope, 132:1829–1834, 2022
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Affiliation(s)
- David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Prem
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gunjan Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Kaiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian A Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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20
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Zou L, Haehner A, Menzel S, Gunder N, Hummel T. Reliability and validity of a brief version of the Questionnaire of Olfactory Disorders (brief QOD) in patients with olfactory dysfunction. Rhinology 2021; 60:56-62. [PMID: 34874020 DOI: 10.4193/rhin21.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to determine the reliability and validity of the brief version of Questionnaire of Olfactory Disorders (brief QOD). METHODS A total of 372 patients participated in this study. Olfactory function was examined using the Sniffin' Sticks test. The brief version of QOD, including 4 items concerning parosmia (QOD-P), 7 items concerning quality of life (QOD-QOL), and 3 visual analog scales to rate disease burden, awareness of the disorder and issues related to professional life (QOD-VAS), was used to assess subjective information on olfactory dysfunction. We evaluated the split-half reliability, internal consistency and validity of the brief QOD. RESULTS The split-half reliability was 0.60 (QOD-P), 0.87 (QOD-QOL), and 0.66 (QOD-VAS), respectively. The Cronbach's α coefficient was 0.63 (QOD-P), 0.87 (QOD-QOL), and 0.71 (QOD-VAS), respectively. Olfactory function was found to be associated with QOD-P, QOD-QOL and QOD-VAS. CONCLUSIONS The brief QOD is a suitable scale for the assessment of subjective severity of olfactory dysfunction for purposes such as treatment counseling, disability assessment, treatment control, and research in patients with olfactory disorder.
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Affiliation(s)
- L Zou
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany 2 Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China 3 Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - S Menzel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - N Gunder
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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21
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Martinec Nováková L, Kliková M, Miletínová E, Bušková J. Olfaction-Related Factors Affecting Chemosensory Dream Content in a Sleep Laboratory. Brain Sci 2021; 11:1225. [PMID: 34573245 PMCID: PMC8465492 DOI: 10.3390/brainsci11091225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
Mental activity in sleep often involves visual and auditory content. Chemosensory (olfactory and gustatory) experiences are less common and underexplored. The aim of the study was to identify olfaction-related factors that may affect the occurrence of chemosensory dream content. Specifically, we investigated the effects of all-night exposure to an ambient odour, participants' appraisal of their current olfactory environment, their general propensity to notice odours and act on them (i.e., odour awareness), and their olfactory acuity. Sixty pre-screened healthy young adults underwent olfactory assessment, completed a measure of odour awareness, and spent three nights in weekly intervals in a sleep laboratory. The purpose of the first visit was to adapt to the experimental setting. On the second visit, half of them were exposed to the smell of vanillin or thioglycolic acid and the other half to an odourless control condition. On the third visit, they received control or stimulation in a balanced order. On each visit, data were collected twice: once from the first rapid eye movement (REM) stage that occurred after 3 a.m., and then shortly before getting up, usually from a non-REM stage. Participants were asked to report the presence of sensory dream content and to assess their current olfactory environment. Neither exposure, nor participants' assessments of the ambient odour, or olfactory acuity affected reports of chemosensory dream content but they were more frequent in individuals with greater odour awareness. This finding may have implications for treatment when such experiences become unwanted or bothersome.
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Affiliation(s)
- Lenka Martinec Nováková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (M.K.); (E.M.); (J.B.)
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Pátkova 2137/5, 182 00 Prague 8-Libeň, Czech Republic
| | - Monika Kliková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (M.K.); (E.M.); (J.B.)
- Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10-Vinohrady, Czech Republic
| | - Eva Miletínová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (M.K.); (E.M.); (J.B.)
- Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10-Vinohrady, Czech Republic
| | - Jitka Bušková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic; (M.K.); (E.M.); (J.B.)
- Third Faculty of Medicine, Charles University, Ruská 87, 100 00 Prague 10-Vinohrady, Czech Republic
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22
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Khan AH, Abbe A, Falissard B, Carita P, Bachert C, Mullol J, Reaney M, Chao J, Mannent LP, Amin N, Mahajan P, Pirozzi G, Eckert L. Data Mining of Free-Text Responses: An Innovative Approach to Analyzing Patient Perspectives on Treatment for Chronic Rhinosinusitis with Nasal Polyps in a Phase IIa Proof-of-Concept Study for Dupilumab. Patient Prefer Adherence 2021; 15:2577-2586. [PMID: 34848949 PMCID: PMC8611726 DOI: 10.2147/ppa.s320242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient perspective is an important and increasingly sought-after complement to clinical assessment. The aim of this study was to transcribe individual patients' experience of treatment in a dupilumab clinical trial through free-text responses with analysis using natural language processing (NLP) to obtain the unique perspective of patients on disease impact and unmet needs with existing treatment to inform future trial design. PATIENTS AND METHODS Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who were enrolled in a Phase IIa randomized controlled trial comparing dupilumab with placebo (NCT01920893) were invited to complete a self-assessment of treatment (SAT) tool at the end of treatment, asking, "What is your opinion on the treatment you had during the trial? What did you like or dislike about the treatment?" Free-text responses were analyzed for the overall cohort and according to treatment assignment using natural language processing including sentiment scoring. In a mixed-methods approach, quantitative patient-reported outcome (PRO) results were utilized to complement the qualitative analysis of free-text responses. RESULTS Of 60 patients enrolled in the study, 43 (71.6%) completed the SAT and responses from 37 patients were analyzed (placebo, n = 16; dupilumab, n = 21). Word analyses showed that the most common words were "smell," "improve," "staff," "great," "time," and "good." Across the whole cohort, "smell" was the most common symptom-related word. The words "smell" and "experience" were more likely to occur in patients treated with dupilumab. Patients treated with dupilumab also had more positive sentiment in their SAT responses than those who received placebo. The results from this qualitative analysis were reflected in quantitative PRO results. CONCLUSION "Smell" was important to patients with CRSwNP, highlighting its importance as a patient-centric efficacy outcome measure in the context of clinical trials in CRSwNP. TRIAL REGISTRATION ClinicalTrials.gov, NCT01920893. Registered 12 August 2013, https://www.clinicaltrials.gov/ct2/show/NCT01920893.
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Affiliation(s)
- Asif H Khan
- Sanofi, Chilly-Mazarin, France
- Correspondence: Asif H Khan Sanofi, 1 Avenue Pierre Brossolette, Chilly-Mazarin, 91380, FranceTel +33 1 60 49 77 77 Email
| | | | - Bruno Falissard
- Centre de recherche en epidémiologie et santé des populations (CESP), INSERM U1018, Paris, France
| | | | - Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona; Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; and CIBERES, Barcelona, Catalonia, Spain
| | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Chiesa-Estomba CM, Lechien JR, Calvo-Henríquez C, Mayo M, Maldonado B, Maza J, Tucciarone M, Villareal I, Vaira LA, Izquierdo-Dominguez A, Alobid I. Translation and validation of the short version of the Questionnaire of Olfactory Disorders-Negative Statements to Spanish. Am J Otolaryngol 2021; 42:102775. [PMID: 33125905 DOI: 10.1016/j.amjoto.2020.102775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION There are more than 400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the olfaction of our patients is necessary. MATERIAL AND METHODS Validation and cross-cultural adaptation of the svQOD-NS questionnaire to the Spanish language. Internal consistency of svQOD-NS measured with Cronbach α. RESULTS 40 patients met the inclusion criteria. 41 ± 153 (range 21-82), and 32 (80%) were female. 20 patients (57,1%) were male and 15 (42,9%) were female. There was a normal distribution among patients included according to the Shapiro-Wilk test (p = 0.175). Internal consistency of svQOD-NS measured with Cronbach α was 0.861. The intraclass correlation coefficient was 0.849 (confidence interval [CI] 95%: 0.766-0.911). CONCLUSION The Spanish Language is the second most spoken language with regard to the number of native speakers and the svQOD-NS translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.
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24
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Yan X, Whitcroft KL, Hummel T. Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2020; 5:992-1002. [PMID: 33364387 PMCID: PMC7752087 DOI: 10.1002/lio2.485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/14/2020] [Accepted: 10/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Olfactory dysfunction has a high prevalence in chronic rhinosinusitis (CRS) patients and significantly affects quality of life. CRS is recognized as a complex disorder encompassing heterogeneous inflammatory processes in the nose and paranasal sinuses. Olfactory dysfunction in CRS patients is associated with the level of inflammatory mediators and the efficiency of inflammatory control. Learning about the association between CRS-related inflammation and olfactory function will provide clues to the pathogenesis of CRS. STRUCTURE The first section of this review describes the assessment of olfactory function using various measures, from ratings to MR based imaging. Then, we discuss the conductive and inflammatory mechanisms related to olfactory dysfunction in CRS: olfaction is associated with certain inflammatory patterns and is potentially a marker of CRS subtype. Finally, we review anti-inflammatory therapies including conservative and surgical approaches, and their effectiveness in olfactory dysfunction in CRS. CONCLUSION Assessment of olfactory function should be considered in the clinical evaluation of CRS patients, not only for detecting and quantifying patients' symptom, but also because it appears to be useful to objectively assess the efficacy of CRS treatment over time. In addition, olfaction can be expected to expand the library of CRS phenotypes and endotypes and, hence, pave the way for more precise, tailored treatment options.
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Affiliation(s)
- Xiaoguang Yan
- Smell and Taste Clinic, Department of OtorhinolaryngologyTU DresdenDresdenGermany
| | - Katherine Lisa Whitcroft
- Smell and Taste Clinic, Department of OtorhinolaryngologyTU DresdenDresdenGermany
- UCL Ear Institute, University College LondonLondonUK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of OtorhinolaryngologyTU DresdenDresdenGermany
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25
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Schlosser RJ, Smith TL, Mace JC, Alt J, Beswick DM, Mattos JL, Payne S, Ramakrishnan VR, Soler ZM. Factors driving olfactory loss in patients with chronic rhinosinusitis: a case control study. Int Forum Allergy Rhinol 2020; 10:7-14. [PMID: 31899859 DOI: 10.1002/alr.22445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/06/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) in chronic rhinosinusitis (CRS) is common. It is likely that numerous factors such as sex, race, age, allergies, asthma, smoking, and other comorbidities play a role in CRS-related OD. In order to determine which aspects of OD are due solely to CRS and which are associated with other confounders, control populations are needed to allow appropriate risk assessments. METHODS Prospective, multi-institutional enrollment of patients with CRS and control subjects without CRS was performed. Demographic information, comorbidities, and olfactory testing (Sniffin' Sticks) of threshold (T), discrimination (D), and identification (I) scores (TDI) was collected. RESULTS A total of 224 patients with CRS and 164 control subjects were enrolled. Olfaction was worse in CRS patients compared to controls (mean ± standard deviation (SD) TDI = 22.4 ± 9.5 vs 28.8 ± 7.0, respectively, p < 0.001). Only 27% of CRS patients were normosmic compared to 49% of controls (p < 0.001). When stratifying by nasal polyp (NP) status, CRSwNP patients had significant impairments in TDI, T, D, and I compared to controls with mean differences of 11.2, 3.3, 3.5, and 4.4 points, respectively (all p < 0.001). In contrast, CRSsNP patients only had impaired T when compared to controls with a mean difference of 2.2 points (p < 0.001). Multivariate modeling of TDI scoring showed that OD was driven by polyps, asthma, diabetes, and age. CRSsNP was not independently associated with worse TDI scores. CONCLUSION OD in CRS patients is multifactorial. Independent drivers appear to be polyp status, asthma, diabetes, and age. OD in patients with CRSsNP is similar to controls with the exception of impaired thresholds.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, OR
| | - Jeremiah Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, CO
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Spencer Payne
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, CO
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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26
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Oleszkiewicz A, Park D, Resler K, Draf J, Schulze A, Zang Y, Hähner A, Hummel T. Quality of Life in Patients With Olfactory Loss Is Better Predicted by Flavor Identification Than by Orthonasal Olfactory Function. Chem Senses 2020; 44:371-377. [PMID: 31046120 DOI: 10.1093/chemse/bjz027] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
To date, most studies on the relationship between chemosensory performance and quality of life have focused on orthonasal measures of olfactory function. In the current investigation, we examined the predictive value of orthonasal and flavor identification indices of olfactory function on a wide spectrum of health and sociopsychological factors, including quality of life, life satisfaction, overall health, and depressive symptoms. Participants were 178 ENT patients (Mage = 58 ± 1), representing various causes of olfactory loss: idiopathic smell loss (n = 51; Mage = 63 ± 2), sinunasal disease (n = 27; Mage = 56 ± 3), head trauma (n = 33; Mage = 51 ± 2), and infections of the upper respiratory tract (n = 67; Mage = 59 ± 2). They completed self-report questionnaires and underwent olfactory testing using Sniffin' Sticks (orthonasal olfactory testing) and "Taste Powder" (intraorally applied flavors for retronasal olfactory testing, additionally inducing taste sensation). Data were analyzed with hierarchical regression models wherein the first step included subjects' sex, age, and orthonasal olfaction score. In the second step, we included the "Taste Powder" score. Tested models revealed that the first step was not significantly predicting variables of interest; however, there was an improvement of the model's predictive value when the "Taste Powder" score was added. Results of this study suggest that flavor identification significantly improves predictions of health and sociopsychological functioning of ENT patients with various etiologies.
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Affiliation(s)
- Anna Oleszkiewicz
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany.,Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Dahae Park
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
| | - Katarzyna Resler
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Julia Draf
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
| | - Anja Schulze
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
| | - Yunpeng Zang
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
| | - Antje Hähner
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
| | - Thomas Hummel
- Smell and Taste Centre, Technische Universitat Dresden, Dresden, Germany
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27
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Desiato VM, Soler ZM, Nguyen SA, Salvador C, Hill JB, Lamira J, Rowan NR, Yoo F, Little RE, Matthews LJ, Dubno JR, Schlosser RJ. Evaluating the Relationship Between Olfactory Function and Loneliness in Community-Dwelling Individuals: A Cross-sectional Study. Am J Rhinol Allergy 2020; 35:334-340. [PMID: 32915652 DOI: 10.1177/1945892420958365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors. METHODS Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin' Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 - item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders. RESULTS In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = -0.03, p = 0.050), olfactory discrimination (β = -0.111, p = 0.005), QOD-NS (β = 0.058, p < 0.001) and olfactory-VAS (β = 0.032, p < 0.001). UCLA scores were significantly associated with QOD-NS (PR 1.061 [CI 1.018-1.107], p = 0.005) and olfactory-VAS scores (PR 1.027, [CI 1.007-1.049], p = 0.009). After controlling for confounders, the association between DJG and olfactory discrimination, as well as DJG and olfactory-VAS remained significant. CONCLUSIONS In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.
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Affiliation(s)
- Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, Pennsylvania
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Craig Salvador
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Hill
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jensine Lamira
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Ryan E Little
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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28
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Desiato VM, Levy DA, Byun YJ, Nguyen SA, Soler ZM, Schlosser RJ. The Prevalence of Olfactory Dysfunction in the General Population: A Systematic Review and Meta-analysis. Am J Rhinol Allergy 2020; 35:195-205. [PMID: 32746612 DOI: 10.1177/1945892420946254] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is common and has been reported as an early indicator of COVID-19. However, the reported prevalence of OD in the general population varies widely depending upon the metric used to assess olfaction.Methodology/Principal: To perform a systematic review and meta-analysis of the prevalence of OD in the healthy general population, review the various assessment metrics used, and compare pooled OD prevalence rates. RESULTS A total of 175,073 subjects were identified (mean age 63.5 years, range 18 to 101) with an overall OD prevalence of 22.2% (95% CI 14.8-30.6). OD prevalence was significantly greater using objective olfactory assessments, compared to subjective measures (28.8%, CI 20.3-38.2 versus 9.5%, CI 6.1-13.5, p < 0.001). The prevalence of OD was greater using expanded identification tests (>8 items) compared to brief test with ≤8 items (30.3%, CI 16.2-46.5 versus 21.2%, CI 12.3-31.8). Prevalence was higher in studies with a mean age greater than 55 years compared to those with a mean age of 55 years or less (34.5%, CI 23.4-46.5 versus 7.5%, CI 2.6-14.5, p < 0.001). CONCLUSIONS The reported prevalence of OD in the general population depends on the testing method and population age. OD prevalence was greater in studies using objective tests, expanded identification tests, and in those with older subjects.
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Affiliation(s)
- Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Dylan A Levy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Young Jae Byun
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Xie DX, Leland EM, Seal SM, Lin SY, Rowan NR. A Systematic Review and Meta-Analysis of Taste Dysfunction in Chronic Rhinosinusitis. Laryngoscope 2020; 131:482-489. [PMID: 32609889 DOI: 10.1002/lary.28827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Patients with chronic rhinosinusitis (CRS) often describe alterations in sense of taste. These complaints have historically been attributed to olfactory dysfunction; however, there is evidence of direct, objective, gustatory disturbances in the setting of CRS that are not thoroughly characterized. This study sought to investigate and summarize gustatory dysfunction experienced by patients with CRS. METHODS PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were reviewed following PRISMA guidelines. English language, original studies investigating objective taste in adult patients with CRS were included. A meta-analysis with inverse variance, random-effects model was performed. RESULTS Of 2750 studies screened, 11 articles with 471 unique patients were included. Patients with CRS exhibit worse gustatory function compared to healthy controls (standardized mean difference 0.94 [95% CI, 0.44-1.45]). Hypogeusia was identified in 32/95 (33.7%) patients from three studies that used methods with a validated definition of hypogeusia. Older age, male gender, and smoking history were associated with taste dysfunction, while objective gustatory and olfactory dysfunction were not correlated. Subjective taste and quality of life measures were also not associated with objective taste. The impact of sinus surgery on objective taste is unclear. CONCLUSION Approximately 34% of patients with CRS experience hypogeusia. Neither olfactory function nor subjective taste were associated with objective gustatory function. Given the substantial prevalence of taste dysfunction patients with CRS, there is significant potential for growth in understanding of pathogenesis, impact on quality of life, and potential treatment strategies of taste impairment in the CRS patient population. LEVEL OF EVIDENCE 1 Laryngoscope, 131:482-489, 2021.
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Affiliation(s)
- Deborah X Xie
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Evelyn M Leland
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Stella M Seal
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Abstract
PURPOSE OF REVIEW The aim of this article is to identify and describe the relationship between chronic rhinosinusitis (CRS) and comorbid depression, including the patient factors that may increase the risk of depression. The impact of comorbid depression on quality of life, response to treatment and healthcare utilization will also be assessed. RECENT FINDINGS CRS is associated with a significantly increased prevalence of depression, where 9-26% of patients with CRS will have physician-diagnosed depression. An additional 40% will have undiagnosed depression that can be identified through screening tools. Patients without polyps are more likely to experience comorbid depression, as are patients with significant sleep dysfunction, olfactory dysfunction, and pain. CRS symptoms do improve with medical and surgical therapy in depressed patients, though baseline and posttreatment scores are worse. A similar degree of benefit from therapy is seen in both depressed and nondepressed patients. CRS treatment does seem to improve depression, whereas the effect of depression specific therapy is unknown. Depressed patients have a significantly larger economic burden because of their increased healthcare utilization and productivity losses. SUMMARY Depression is a highly prevalent and impactful comorbidity in patients with CRS. Increased awareness of this relationship may improve patients' overall quality of care.
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Wu D, Li Y, Bleier BS, Wei Y. Superior turbinate eosinophilia predicts olfactory decline in patients with chronic rhinosinusitis. Ann Allergy Asthma Immunol 2020; 125:304-310.e1. [PMID: 32387168 DOI: 10.1016/j.anai.2020.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting postoperative olfactory decline in patients with chronic rhinosinusitis (CRS) remains a considerable challenge. OBJECTIVE To evaluate patterns of postoperative olfactory function in patients with CRS and explore potential predictors of postoperative olfactory decline. METHODS A total of 76 patients with CRS electing endoscopic sinus surgery (ESS) were enrolled in this prospective study. Olfaction was assessed with Sniffin' Sticks preoperatively and 3 months postoperatively. Preoperative peripheral venous blood and superior turbinate at surgery were collected for eosinophil quantification. Olfactory cleft was evaluated by computed tomography and endoscopy. Postoperative olfactory decline was defined by a decrease in threshold-discrimination-identification (TDI) score more than 0 point. Multivariable logistic regression analysis was conducted to identify potential predictors associated with postoperative olfactory decline in TDI score. RESULTS A total of 30.26% of patients with CRS (23/76) presented with olfactory decline 3 months post-ESS. Patients with CRS with olfactory decline showed significantly higher preoperative tissue eosinophils (P < .001), blood eosinophil count (P = .002), blood eosinophil percentage (P = .009), and preoperative TDI scores (P = .017) than patients with CRS without olfactory decline. After adjusting for patient demographics and comorbidities, the preoperative tissue eosinophilia was significantly associated with patients with CRS with postoperative olfactory decline (odds ratio = 1.103; P = .038). An absolute count of 23.5 eosinophils per high-power field in superior turbinate was the best predictor of olfactory decline with the highest area under the receiver operating characteristic curve of 0.901. CONCLUSION Superior turbinate eosinophilia is highly associated with olfactory decline in patients with CRS 3 months after ESS.
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Affiliation(s)
- Dawei Wu
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yi Li
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Yongxiang Wei
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
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Thomas AJ, Mace JC, Ramakrishnan VR, Alt JA, Mattos JL, Schlosser RJ, Soler ZM, Smith TL. Quality-of-life and olfaction changes observed with short-term medical management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 10:656-664. [PMID: 32017433 PMCID: PMC7220819 DOI: 10.1002/alr.22532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/15/2019] [Accepted: 01/12/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) commonly experience both reduced quality of life (QOL) and olfactory dysfunction (OD). Literature on the impacts of appropriate medical therapy (AMT) for CRS on QOL and OD is limited, and the focused design of these studies may limit their applicability to usual clinical practice. METHODS Adults with symptomatic CRS were prospectively enrolled (November 2016 to October 2018) into an observational, multi-institutional study. Individualized AMT was initiated using standard practice according to evidence-based guidelines. Endoscopy examination (Lund-Kennedy), olfactory function (Sniffin' Sticks) testing, and QOL survey responses (22-item Sino-Nasal Outcome Test [SNOT-22], Questionnaire of Olfactory Disorders-Negative Statements [QOD-NS]) were obtained at enrollment and follow-up. RESULTS Baseline measures demonstrated heterogeneity of QOL and OD. After an average of 7.8 weeks, within-subject median SNOT-22 total improved by 39.5% (n = 39, p < 0.001) relative to baseline, including 50% (p = 0.014) improvement for item #21, "Sense of smell/taste." QOD-NS improvement was also statistically significant (p = 0.044). Sniffin' Sticks score relative improvement of 10.9% (n = 33, p = 0.109) was not statistically significant and lacked correlation with SNOT-22 total scores (R = -0.247, p = 0.165) or QOD-NS total scores (R = -0.016, p = 0.930), but correlated moderately with endoscopy score (R = -0.436, p = 0.018). CONCLUSIONS Participants with varied impacts of CRS, treated with individualized short-term AMT, demonstrated significant improvements in CRS- and olfactory-specific QOL measures, without corresponding improvement in clinically measured olfactory function. Olfactory function changes moderately correlated with endoscopy score changes, but lacked an association with QOL measurements.
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Affiliation(s)
- Andrew J. Thomas
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health & Science University, Portland, Oregon
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health & Science University, Portland, Oregon
| | | | - Jeremiah A. Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology - Head and Neck Surgery, Department of Surgery; University of Utah, Salt Lake City, Utah
| | - Jose L. Mattos
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Endoscopic Sinus Surgery, University of Virginia, Charlottesville, Virginia
| | - Rodney J. Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Surgery, Ralph H. Johnson Veteran Affairs Medical Center, Charleston, South Carolina
| | - Zachary M. Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health & Science University, Portland, Oregon
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Chowdhury N, Smith TL, Beswick DM. Measuring Success in the Treatment of Patients with Chronic Rhinosinusitis. Immunol Allergy Clin North Am 2020; 40:265-279. [DOI: 10.1016/j.iac.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Schlosser RJ, Desiato VM, Storck KA, Nguyen SA, Hill JB, Washington BJ, Noonan TE, Lamira J, Mulligan JK, Rowan NR, Yoo F, Matthews LJ, Dubno JR, Soler ZM. A Community-Based Study on the Prevalence of Olfactory Dysfunction. Am J Rhinol Allergy 2020; 34:661-670. [PMID: 32345032 DOI: 10.1177/1945892420922771] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is common, affecting an estimated 13 million adults in the United States. Prior studies may underestimate OD prevalence due to use of brief smell identification tests or age-adjusted cutoff values, which concede that it is acceptable for older people to have a decreased sense of smell. OBJECTIVE To determine OD prevalence in the healthy community when the goal and expectation is ideal olfactory function, rather than age-based population norms. Secondary goals were to explore factors associated with OD. METHODS Subjects without otolaryngic complaints were recruited from the community surrounding the Medical University of South Carolina. Olfactory-specific information was collected, and olfactory function was assessed using the Sniffin' Sticks test (Burghardt, Wedel, Germany) to measure threshold, discrimination, and identification (TDI). OD was defined as a TDI score < 31. Bivariate analysis and linear regression were used to determine factors associated with OD. RESULTS In total, 176 subjects were included with mean age of 52 years (range: 20-93), 111 (63%) female, and 127 (72%) white. Mean TDI score was 28.8 (6.9) and OD was present in 94 (53%) subjects. Multivariate linear regression revealed that TDI decreased an average of 1 point every 5 years. TDI was also associated with Mini-Mental Status Examination (MMSE) score, asthma, and gastroesophageal reflux disease. Threshold was associated with age, heart problems, and gastroesophageal reflux disease. Discrimination was associated with age and MMSE scores. Identification was associated with age, heart problems, and anxiety. CONCLUSIONS In a community-based sample, OD affects greater than 50% of subjects. Aging impacts all aspects of olfaction, while the effects of factors such as asthma, MMSE scores, gastroesophageal reflux disease, heart problems, and anxiety may only be evident in specific olfactory subtests.
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Affiliation(s)
- Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Vincent M Desiato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Hill
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon J Washington
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Tegan E Noonan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jensine Lamira
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lois J Matthews
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Oleszkiewicz A, Kunkel F, Larsson M, Hummel T. Consequences of undetected olfactory loss for human chemosensory communication and well-being. Philos Trans R Soc Lond B Biol Sci 2020; 375:20190265. [PMID: 32306872 DOI: 10.1098/rstb.2019.0265] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Olfactory perception has implications for human chemosensory communication and in a broader context, it affects well-being. However, most of the studies investigating the consequences of olfactory loss have recruited patients who have already been categorized as having a dysfunctional sense of smell and sought help in an ENT clinic. We revisit these findings by distinguishing subjects with olfactory impairment from a group of subjects who all declared a normal sense of smell when enrolling for this study. In the initial sample of 203 individuals, we found 59 to have impaired olfaction and four with marginal olfactory performance, not useful in daily life. Interestingly, we found a significant between-group difference in cognitive functioning, further supporting the notion of the relationship between cognition and olfactory performance. However, their chemosensory communication and well-being appeared not to be different from subjects with normosmia. Impaired olfactory function certainly has a severe impact on daily life but more so in individuals who are bothered with it and decide to seek treatment. The limited-to-no olfactory perception in the fraction of subjects who neither complain about it nor seek help in ENT clinics does not seem to have a major effect on their social, cognitive, emotional and health functioning. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'.
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Affiliation(s)
- A Oleszkiewicz
- Smell and Taste Clinic, Technische Universität Dresden, 01307 Dresden, Germany.,Institute of Psychology, University of Wroclaw, 50527 Wroclaw, Poland
| | - F Kunkel
- Smell and Taste Clinic, Technische Universität Dresden, 01307 Dresden, Germany
| | - M Larsson
- Gösta Ekmans Laboratory, Stockholm University, 11419 Stockholm, Sweden
| | - T Hummel
- Smell and Taste Clinic, Technische Universität Dresden, 01307 Dresden, Germany
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Valsamidis K, Printza A, Constantinidis J, Triaridis S. The Impact of Olfactory Dysfunction on the Psychological Status and Quality of Life of Patients with Nasal Obstruction and Septal Deviation. Int Arch Otorhinolaryngol 2020; 24:e237-e246. [PMID: 32296471 PMCID: PMC7153923 DOI: 10.1055/s-0040-1701269] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/03/2019] [Indexed: 01/25/2023] Open
Abstract
Introduction
Olfactory dysfunction may be present in patients with nasal obstruction and septal deviation. The impact of olfactory dysfunction on the psychological profile and quality of life (QoL) of these patients remains unexplored.
Objective
The present study aimed to investigate the emotional status and QoL of patients with olfactory dysfunction and septal deviation and to identify predictors associated with clinically significant improvement of psychological status and QoL, focusing mainly on the role of olfactory recovery after septoplasty.
Methods
The olfactory function was quantitatively assessed using the ‘‘Sniffin’ sticks'' test (Burghart Messtechnik GmbH, Wedel, Germany) in 60 patients and 25 controls enrolled in this prospective study. The participants completed validated questionnaires specific for general health (Short Form-36), nasal-symptom related QoL (SinoNasal Outcome Test-22), olfaction-associated QoL (Questionnaire of Olfactory Deficits) and for assessing their psychological state (Short Anxiety Screening Test and Beck Depression Inventory) preoperatively and 6 months postoperatively. The patients used the Glasgow Benefit Inventory to evaluate their personal benefit after septoplasty with.
Results
Septoplasty led to significantly improved olfactory function. Patients with olfactory impairment had significantly lower nasal-symptom related QoL, higher stress levels, and more depressive mood compared with normosmics and controls before and after septoplasty. Postoperatively, personal benefit from surgery was higher in normosmic patients. Improvement of nasal-symptom related QoL was significantly associated with higher likelihood of clinically significant improvement of patients' psychological profile and more personal benefit from surgery. Olfactory dysfunction was negatively correlated with the emotional status of the patients.
Conclusion
Olfactory dysfunction appears to significantly affect the psychological status of patients with nasal obstruction, and olfactory recovery improves the patients' perception of personal benefit from septoplasty.
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Affiliation(s)
- Konstantinos Valsamidis
- 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Athanasia Printza
- 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Otolaryngology Department, Medical school, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
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Abstract
Olfactory dysfunction (OD) is one of the cardinal symptoms of chronic rhinosinusitis (CRS), and its prevalence ranges from 60% to 80% in patients with CRS. It is much more common in CRS with nasal polyposis patients compared to CRS without nasal polyposis. Decreased olfactory function is associated with significant decreases in patient-reported quality of life (QOL), and notably, depression and the enjoyment of food. Objective measures can help detail the degree of OD, whereas subjective measures can help to determine in the impact on patient. There is variable treatment response to OD with both medical and surgical therapies.
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Mattos JL, Edwards C, Schlosser RJ, Hyer M, Mace JC, Smith TL, Soler ZM. A brief version of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1144-1150. [PMID: 31430061 PMCID: PMC6773507 DOI: 10.1002/alr.22392] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/09/2019] [Accepted: 06/27/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) is a valuable instrument in the measurement of olfactory-specific quality of life (QOL). In the clinical setting, patients can be overwhelmed with the time required to complete questionnaires. Our objective was to develop a brief version of the QOD-NS to streamline clinical care and research. METHODS QOD-NS scores from 221 subjects were used to determine which subset of the 17 QOD-NS questions best correlated with total and subdomain QOD-NS scores. An initial pool of 11 questions was made by removing items with ρ < 0.80 to their respective subdomain scores. Next, 500 bootstrapped samples were taken. On each sampe, an all-subsets regression was performed with total QOD-NS scores and QOD-NS subdomain scores as the outcomes. From this, our "top" and "bottom" 10 subsets were identified based on mean r2 value, representation in bootstrap analysis, and number of items. RESULTS All of our top subsets had excellent correlation with total and subdomain QOD-NS scores (mean r2 > 0.90). Our top choice has 7 total questions, is representative of all subdomains, has a mean r2 = 0.92, and was represented in 323 of our 500 bootstrapped samples. The worst-performing subset has 5 items, mean r2 = 0.81, and was represented in only 1 bootstrapped sample. CONCLUSIONS Using less than half of the questions in the QOD-NS, excellent correlations with both total and domain-specific scores are achieved. A brief version of the QOD-NS may prove useful in future clinical and research settings.
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Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Virginia, Charlottesville, VA
- University of Virginia School of Medicine, Charlottesville VA
| | | | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, , USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Lamira JM, Soler ZM, Schlosser RJ. A Pilot Study of Olfactory Training in Older Hyposmic Adults. Am J Rhinol Allergy 2019; 33:650-656. [DOI: 10.1177/1945892419858793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Olfactory loss is a common problem that significantly impacts quality of life. Olfactory training (OT) has been used most commonly for viral and traumatic olfactory dysfunction (OD) in younger subjects with hopes of neural regeneration, improved olfactory function, and subjective well-being. The objective of this study was to investigate the impact of a novel form of OT using 12 odors in participants over 45 years of age with objective OD. Methods Twenty-nine participants underwent OT using 12 standardized odor pens for a duration of 6 months. Objective OT of Threshold, Discrimination, and Identification and patient-reported outcomes were assessed at baseline and after 6 months of OT. Results Of the 29 participants who entered the protocol, only 16 subjects completed all 6 months of OT. Significant improvements were seen in overall Threshold Discrimination Identification (TDI; mean 4.40 points, P = .007), Discrimination (mean 1.44 points, P = .019), and Identification (mean 2.02 points, P = .011). Forty-four percent of subjects who completed OT achieved a mean clinically important difference of at least 5.5 points on TDI. Conclusion There was no significant change in patient-reported outcome measures, and no baseline factors were associated with change in olfaction. In this study, OT with 12 odors improves objective olfaction in nearly half of the older adults with OD. Further investigation is necessary to determine the impact of improved olfaction on overall health outcomes.
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Affiliation(s)
- Jensine M. Lamira
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Zachary M. Soler
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J. Schlosser
- Department of Otolaryngology—Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Oleszkiewicz A, Hummel T. Whose nose does not know? Demographical characterization of people unaware of anosmia. Eur Arch Otorhinolaryngol 2019; 276:1849-1852. [PMID: 30989334 PMCID: PMC6529373 DOI: 10.1007/s00405-019-05414-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE For functionally anosmic subjects, the sense of smell is basically useless in daily activities-they are unlikely to detect the threatening smell of rotten food, gas or smoke, or to enjoy the flavor of food or the smell of perfumes. Although this appears very distressing, functionally anosmic subjects in our sample seemed not to be aware or bothered with impaired olfaction and enrolled for the study targeted to people with a normal sense of smell. METHODS In the large sample of 9139 subjects who declared themselves to have a normal sense of smell, we have retrospectively found a notable proportion of scores indicating functional anosmia. RESULTS When we look at the overall Sniffin' Sticks score, 0.45% of the sample was functionally anosmic and this fraction increased to 3.4% when the identification score of 8 points and below was used. We present demographical information of those subjects, who despite their inability to use smell in daily life, consider themselves healthy. CONCLUSIONS Data offer a new perspective on the importance of olfaction in daily life and supports the notion about the importance of using screening tools in clinical practice.
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Affiliation(s)
- Anna Oleszkiewicz
- Smell and Taste Center, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- Institute of Psychology, University of Wroclaw, ul. Dawda 1, 50527, Wroclaw, Poland.
| | - Thomas Hummel
- Smell and Taste Center, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Rowan NR, Soler ZM, Storck KA, Othieno F, Ganjaei KG, Smith TL, Schlosser RJ. Impaired eating-related quality of life in chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 9:240-247. [PMID: 30485716 DOI: 10.1002/alr.22242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the tremendous burden of smell and taste dysfunction in patients with chronic rhinosinusitis (CRS), objective measures of smell and taste fail to fully account for eating-related disruptions in CRS patient quality of life (QOL). In this study we sought to investigate the driving force behind impaired eating-related QOL in CRS patients. METHODS Adult CRS patients were prospectively enrolled and answered a series of surveys relating to smell, taste, overall sinus-specific QOL, and depression. Patients with both smell-related and taste-related eating complaints were considered to have impaired eating-related QOL. Clinical demographics, objective chemosensory scores, and endoscopy scores were collected. RESULTS Seventy patients were enrolled and 23% showed impaired eating-related QOL. In multivariable analyses, patients with aspirin-exacerbated respiratory disease (AERD) showed 10.7 times higher odds of impaired eating-related QOL (odds ratio [OR] 10.72; 95% confidence interval [CI], 1.09 to 105.09; p = 0.042); meanwhile, for every 1-point increase in depression scores, the odds of impaired eating-related QOL increased by 1.3 (OR 1.31; 95% CI, 1.10 to 1.57; p = 0.003). For every 1-point decrease in orthonasal olfactory threshold, the odds of impaired eating-related QOL increased by 1.9 times (OR 1.85; 95% CI, 1.14 to 3.00; p = 0.013). Symptom scores, polyp status, endoscopic scores, and other olfactory measures did not remain significant after adjusting for other variables in forward-selection multivariable modeling. CONCLUSION Disruptions in eating-related QOL cannot be fully explained by objective smell or taste testing alone. We identified AERD and depression as independent risk factors for greater odds of impaired eating-related QOL in CRS. Improved orthonasal threshold scores were independently associated with better eating-related QOL.
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Affiliation(s)
- Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Florence Othieno
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Kimia G Ganjaei
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC.,Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Oregon Health & Science University, Portland, OR
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC.,Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC
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Wu D, Bleier BS, Wei Y. Temporary olfactory improvement in chronic rhinosinusitis with nasal polyps after treatment. Eur Arch Otorhinolaryngol 2018; 275:2193-2202. [DOI: 10.1007/s00405-018-5066-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/13/2018] [Indexed: 01/04/2023]
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Mattos JL, Schlosser RJ, DeConde AS, Hyer M, Mace JC, Smith TL, Soler ZM. Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8:777-782. [PMID: 29633540 PMCID: PMC6035764 DOI: 10.1002/alr.22112] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD-NS differentially impact QOL. METHODS Patients with chronic rhinosinusitis (CRS) completed the QOD-NS, 22-item Sino-Nasal Outcome Test (SNOT-22), Medical Outcomes Study Short Form 6-D (SF-6D) health utility measure, and Patient Health Questionnaire-2 (PHQ-2) depression screen. Exploratory factor analysis of the QOD-NS was performed. Associations between QOD-NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS). RESULTS Outcomes were examined on 132 patients. The QOD-NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF-6D and SNOT-22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ-2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD-NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05). CONCLUSION The QOD-NS measures 4 distinct factors. Eating-related questions had the greatest improvement after ESS. Health utility and CRS-specific QOL improvement most strongly associated with factor 2, while PHQ-2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD-NS on varying aspects of QOL.
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Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Adam S. DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, CA, USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2017; 275:415-423. [PMID: 29204922 DOI: 10.1007/s00405-017-4831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/28/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS). MATERIALS AND METHODS Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0-20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses. RESULTS SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group. CONCLUSION SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.
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