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Lechien JR, Saussez S. Effectiveness of platelet-rich plasma in long-lasting post-viral olfactory dysfunction: a case-series. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08816-5. [PMID: 38992193 DOI: 10.1007/s00405-024-08816-5] [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: 05/13/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To investigate the platelet-rich plasma (PRP) effectiveness in patients with a long-lasting postviral olfactory dysfunction (LPOD). METHODS Forty-three consecutive patients with a long-lasting postviral OD were prospectively recruited. The injection of 1 mL of PRP was carried out in both olfactory clefts. The pre- to 6-month post-PRP injection change in olfaction was assessed with the olfactory disorder questionnaire (ODQ) and the threshold, discrimination, and identification (TDI) tests. RESULTS Forty-three patients received bilateral PRP injections (24 females). The mean age of patients was 58.9 ± 16.8 years. The mean duration of LPOD was 8.7 years. The pre to 6-month post-injection mean TDI significantly improved from 10.3 ± 10.2 to 20.12 ± 12.07 (p = 0.001). The mean ODQ significantly decreased from 29.8 ± 13.0 to 23.4 ± 11.3 (p = 0.013). The average change of the TDI and the ODQ were 9.8 and 6.4, respectively. Age was inversely associated with the 6-month threshold score. CONCLUSION PRP appears to be a promising therapeutic strategy for long-lasting postviral OD. Our findings support the conduction of controlled randomized trial in this population of patients.
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Affiliation(s)
- Jerome R Lechien
- Division of Laryngology and Broncho-esophagology, Department of Otolaryngology-Head Neck Surgery, UMONS Research Institute for Health Sciences and Technology, EpiCURA Hospital, University of Mons (UMons), Mons, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
- Polyclinique Elsan de Poitiers, Poitiers, France.
- Department of Anatomy, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, Avenue du Champ de mars, 6, Mons, B7000, Belgium.
| | - Sven Saussez
- Division of Laryngology and Broncho-esophagology, Department of Otolaryngology-Head Neck Surgery, UMONS Research Institute for Health Sciences and Technology, EpiCURA Hospital, University of Mons (UMons), Mons, Belgium
- Department of Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
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2
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Tharakan T, Kallogjeri D, Piccirillo JF. Clinical studies in COVID-related olfactory disorders: Review of an institutional experience. World J Otorhinolaryngol Head Neck Surg 2024; 10:129-136. [PMID: 38855285 PMCID: PMC11156682 DOI: 10.1002/wjo2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 06/11/2024] Open
Abstract
Objective To share a single institutional experience with clinical research on COVID-related olfactory dysfunction (OD). Data Source/Method Narrative review of published original data and ongoing clinical trials on COVID-related OD at Washington University from 2020 to 2023. Results There were three new diagnostic-/patient-reported outcome measures developed and tested. We report five clinical trials of interventions for COVID-related olfactory disorders: combined Visual-Olfactory Training (VOLT) with patient-preferred scents versus standard olfactory training (VOLT trial), oral gabapentin versus placebo (Gabapentin for the Relief of Acquired Chemosensory Experience trial), nasal theophylline irrigations versus placebo (Smell Changes and Efficacy of Nasal Theophylline trial), stellate ganglion block (single-arm), and mindfulness-based stress reduction (MBSR) versus lifestyle intervention (MBSR trial). Conclusions Initial intervention trials for COVID-related OD have shown potential for improving subjective and objective olfactory outcomes. However, there remains no gold standard treatment that definitively outperforms placebo in controlled trials. Therefore, continued investigation of novel therapeutic strategies for COVID-related OD is necessary to maximize olfactory outcomes for affected patients.
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Affiliation(s)
- Theresa Tharakan
- Department of Otolaryngology–Head and Neck Surgery, Clinical Outcomes Research Office, School of MedicineWashington University in St LouisSt LouisMissouriUSA
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck Surgery, Clinical Outcomes Research Office, School of MedicineWashington University in St LouisSt LouisMissouriUSA
| | - Jay F. Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Clinical Outcomes Research Office, School of MedicineWashington University in St LouisSt LouisMissouriUSA
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3
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Miller JE, Taylor-Cousar JL, Overdevest JB, Khatiwada A, Mace JC, Alt JA, Bodner TE, Chowdhury NI, DiMango EA, Eshaghian PH, Getz AE, Gudis DA, Han EJ, Hwang PH, Keating CL, Khanwalkar A, Kimple AJ, Lee JT, Li D, Markarian K, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Tervo JP, Turner GA, Wang MB, Saavedra MT, Beswick DM. Determining the minimal clinically important difference for the questionnaire of olfactory disorders in people with cystic fibrosis and factors associated with improvement after highly effective modulator therapy. Int Forum Allergy Rhinol 2024; 14:1079-1087. [PMID: 38145393 DOI: 10.1002/alr.23312] [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: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF). The Questionnaire of Olfactory Disorders (QOD) is a validated instrument that evaluates olfactory-specific quality-of-life. The QOD minimal clinically important difference (MCID) and factors associated with olfactory improvement after elexacaftor/tezacaftor/ivacaftor have not been determined for PwCF. METHODS Prospective observational data were pooled from three studies that enrolled adult PwCF with chronic rhinosinusitis (CRS). QOD scores and disease characteristics were assessed. To evaluate internal consistency and calculate the QOD MCID, Cronbach's alpha and four distribution-based methods were employed. For participants who enrolled prior to elexacaftor/tezacaftor/ivacaftor, QOD scores were obtained at baseline and after elexacaftor/tezacaftor/ivacaftor initiation. Multivariable regression was used to identify factors associated with QOD improvement. RESULTS Of 129 PwCF included, 65 had QOD scores before and 3-6 months after starting elexacaftor/tezacaftor/ivacaftor. Mean baseline QOD score was 6.5 ± 7.9. Mean Cronbach's alpha was ≥0.85. The MCID estimates were as follows: Cohen's effect size = 1.6, standard error of measurement = 2.5, ½ baseline standard deviation = 4.0, and minimal detectable change = 6.9. Mean MCID was 3.7. Of those with pre/post elexacaftor/tezacaftor/ivacaftor QOD scores, the mean change in QOD was -1.3 ± 5.4. After elexacaftor/tezacaftor/ivacaftor, QOD improvement surpassed the MCID in 22% of participants (14/65). Worse baseline QOD scores and nasal polyps were associated with improved QOD scores after elexacaftor/tezacaftor/ivacaftor (both p < 0.04). CONCLUSION The QOD MCID in PwCF was estimated to be 3.7. Elexacaftor/tezacaftor/ivacaftor led to qualitative but not clinically meaningful improvements in QOD score for most PwCF; PwCF with worse baseline QOD scores and nasal polyps improved in a clinically significant manner.
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Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-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
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, 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
| | - Emily A DiMango
- Department of Medicine, Columbia University, New York, New York, 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, Aurora, Colorado, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Ethan J Han
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Claire L Keating
- Department of Medicine, Columbia University, New York, New York, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, 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 Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Karolin Markarian
- David Geffen School of Medicine, University of California, CTSI, 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, Palo Alto, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, 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 Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jeremy P Tervo
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Grant A Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
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Hong J, Wang Z, Wu D. Patterns of Olfactory Impairment Among Patients with Uncontrolled Chronic Rhinosinusitis. Laryngoscope 2024; 134:2341-2348. [PMID: 38362947 DOI: 10.1002/lary.31344] [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: 11/16/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Self-reported olfactory dysfunction is an assessment component criterion for chronic rhinosinusitis (CRS) disease control of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). No studies have objectively explored olfactory function across different psychophysical olfactory domains among patients with uncontrolled CRS. We aimed to investigate the patterns of olfactory impairment in patients with uncontrolled CRS with Sniffin' Sticks test. METHODS A total of 79 patients with CRS were prospectively recruited and assessed for disease control based on the EPOS criteria. Sniffin' Sticks test scores, olfactory cleft computed tomography (CT) scores, olfactory cleft endoscopy scale (OCES), questionnaire of olfactory disorders-negative statements (QOD-NS), and sinonasal outcome test-22 (SNOT-22) were obtained. Multiple logistic regression was applied to explore risk factors of uncontrolled CRS. RESULTS Twenty-six percent of patients with CRS presented with uncontrolled status. The odor threshold (OT) (p = 0.005), odor identification (OI) (p = 0.041), and thresholds-discrimination-identification (TDI) (p = 0.029) scores were significantly lower in patients with uncontrolled CRS when compared with patients with controlled CRS. Furthermore, patients with uncontrolled CRS presented with a significantly increased percentage of anosmia (p = 0.014), olfactory cleft CT score (p = 0.038), OCES (p = 0.016), QOD-NS(p = 0.008), and SNOT-22 (p < 0.001) scores than patients with controlled CRS. After adjusting for patient demographics, as for the subdomain of olfaction, only the OT score was an independent risk factor for uncontrolled CRS (odds ratio = 0.604; p = 0.030). The OT scores less than 5.950 were the best predictor of uncontrolled CRS. CONCLUSION Patients with uncontrolled CRS demonstrated distinct patterns of olfactory impairment, and a reduced olfactory threshold was highly associated with uncontrolled CRS. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2341-2348, 2024.
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Affiliation(s)
- Junsheng Hong
- Department of Otolaryngology-Head and Neck Surgery, Xuanwu Hospital Capital Medical University, Beijing, People's Republic of China
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhenlin Wang
- Department of Otolaryngology-Head and Neck Surgery, Xuanwu 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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Tripathi SH, Min S, Cody AS, Shukla G, Houssein FA, Howard JS, Hu A, Previtera MJ, Phillips KM, Sedaghat AR. Variability in Minimal Clinically Important Difference Calculation and Reporting in the Otolaryngology Literature. Laryngoscope 2024; 134:2059-2069. [PMID: 37933798 DOI: 10.1002/lary.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/21/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Best practices for calculation of the minimal clinically important difference (MCID) of outcome measures include the use of complementary methodologies (broadly classified as anchor-based and distribution-based) and reporting of the MCID's predictive ability. We sought to determine MCID calculation and reporting patterns within the otolaryngology literature. METHODS A systematic search strategy of Embase, PubMed, and Web of Science databases was developed and implemented to identify studies reporting the determination of an MCID for an outcome measure. Studies specifically within the otolaryngology literature (defined as journals classified as "otorhinolaryngology" in the Journal Citation Reports database) were included. All those journals were additionally searched for relevant articles. RESULTS There were 35 articles that met the inclusion criteria. Of these studies, 88.6% reported MCID of a patient-reported outcome measure and the remainder were for objective outcome measurements. Anchor-based methods were used by 82.9% of studies and distribution-based methods were used by 68.6% of studies. Of all studies, 31.4% utilized anchor-based methods alone, 17.1% utilized distribution-based methods alone, and 51.4% used both methods. Only 25.7% of studies reported the sensitivity (median: 60.8%, range: 40.5%-86.7%) and specificity (median: 80.4%, range: 63.5%-88.0%) of the MCID to detect patients experiencing clinically important change. CONCLUSION Deviation from best practices in MCID calculation and reporting exists within the otolaryngology literature, with almost half of all studies only using one method of MCID calculation and almost three-quarters not reporting the predictive ability (sensitivity/specificity) of the calculated MCID. When predictive ability is reported, however, MCIDs appear to be more specific than sensitive. LEVEL OF EVIDENCE NA Laryngoscope, 134:2059-2069, 2024.
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Affiliation(s)
- Siddhant H Tripathi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Alexander S Cody
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Geet Shukla
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Firas A Houssein
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - John S Howard
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Alex Hu
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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6
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Beswick DM, Liu CM, Overdevest JB, Zemke A, Khatiwada A, Gudis DA, Miller JE, Kimple A, Tervo JP, DiMango E, Goralski JL, Keating C, Senior B, Stapleton AL, Eshaghian PH, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Getz AE, Hwang PH, Khanwalker A, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner GA, Wang MB, Saavedra MT, Taylor Cousar JL. Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis. Laryngoscope 2024. [PMID: 38634358 DOI: 10.1002/lary.31438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The 22-question SinoNasal Outcome Test (SNOT-22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT-22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT-22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF). METHODS Prospective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMT's impact on CRS. For participants enrolled prior to HEMT initiation, SNOT-22 scores were obtained at baseline and after 3-6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbach's alpha and four distribution-based methods were used to assess internal consistency and calculate the MCID of the SNOT-22. RESULTS A total of 184 PwCF participated with mean baseline SNOT-22 scores ranging from 18.1 to 56.7. Cronbach's alpha was ≥0.90 across sites. Participants at sites with pre- and post-HEMT data reported improvement in SNOT-22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT-22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02-1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14-18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39-20.11) were associated with greater SNOT-22 improvement. The mean MCID calculated via distribution-based methods was 8.5. CONCLUSION Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF is 8.5 points, similar to non-CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT-22 has strong internal consistency in PwCF. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Christine M Liu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Anna Zemke
- Division of Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, U.S.A
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Adam Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jeremy P Tervo
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Emily DiMango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Jennifer L Goralski
- Department of Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Claire Keating
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, U.S.A
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, U.S.A
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Ashoke Khanwalker
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Greenville, South Carolina, U.S.A
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Grant A Turner
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Jennifer L Taylor Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
- Department of Pediatrics, National Jewish Health, Denver, Colorado, U.S.A
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7
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Lechien JR, Saussez S, Vaira LA, De Riu G, Boscolo-Rizzo P, Tirelli G, Michel J, Radulesco T. Effectiveness of Platelet-Rich Plasma for COVID-19-Related Olfactory Dysfunction: A Controlled Study. Otolaryngol Head Neck Surg 2024; 170:84-91. [PMID: 37522295 DOI: 10.1002/ohn.460] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To investigate the effectiveness of platelet-rich plasma (PRP) injection into the olfactory clefts of coronavirus disease 2019 (COVID-19) patients with persistent olfactory dysfunction (OD). STUDY DESIGN Controlled study. SETTING Multicenter study. METHODS From March 2022 to November 2022, COVID-19 patients with persistent OD were recruited from three European hospitals to undergo PRP injections into the olfactory clefts. Olfactory function was evaluated at baseline and 10 weeks postinjection with the Olfactory Disorder Questionnaire (ODQ) and threshold, discrimination, and identification (TDI) test. Data were compared with a control group of untreated patients. RESULTS Eighty-one patients who underwent PRP injection and 78 controls were included. Sixty-five PRP patients (80.3%) experienced subjective smell improvement after a mean duration of 3.4 ± 1.9 weeks. The parosmia, life quality statement, and ODQ sub- and total scores significantly decreased from pre- to 10-week postinjection in the PRP group. The TDI sub- and total scores significantly increased 10 weeks postinjection. In controls, the ODQ score did not change over time, while the discrimination, identification, and total TDI scores significantly increase after 10 weeks of follow-up. The 10-week TDI and ODQ scores were significantly better in the PRP group compared with the controls. CONCLUSION Patients who underwent PRP injection reported better 10-week subjective and objective smell outcomes than controls. Future randomized-controlled studies using saline injection into the olfactory cleft of controls are needed to determine the superiority of PRP over placebo.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan, Poitiers, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Sven Saussez
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
| | - Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Justin Michel
- Department of Otorhinolaryngology and Head and Neck Surgery, APHM, IUSTI, CNRS, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - Thomas Radulesco
- Department of Otorhinolaryngology and Head and Neck Surgery, APHM, IUSTI, CNRS, La Conception University Hospital, Aix Marseille University, Marseille, France
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陈 靖, 陈 雯, 罗 新, 黄 雪, 张 雅, 杨 钦. [Artificial intelligence-assisted prediction of olfactory disorders in patients with chronic rhinosinusitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:871-877;885. [PMID: 38114440 PMCID: PMC10985657 DOI: 10.13201/j.issn.2096-7993.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Indexed: 12/21/2023]
Abstract
Objective:To analyze the influencing factors and perform the prediction of olfactory disorders in patients with chronic rhinosinusitis(CRS) based on artificial intelligence. Methods:The data of 75 patients with CRS who underwent nasal endoscopic surgery from October 2021 to February 2023 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. There were 53 males and 22 females enrolled in the study, with a median age of 42.0 years old. The CRS intelligent microscope interpretation system was used to calculate the proportion of area glands and blood vessels occupy in the pathological sections of each patient, and the absolute value and proportion of eosinophils, lymphocytes, plasma cells and neutrophils. The patients were grouped according to the results of the Sniffin' Sticks smell test, and the clinical baseline data, differences in nasal mucosal histopathological characteristics, laboratory test indicators and sinus CT were compared between the groups. Determine the independent influencing factors of olfactory disorders and receiver operating characteristic curves(ROC) were used to evaluate the performance of the prediction model. Statistical analysis was performed using SPSS 25.0 software. Results:Among the 75 CRS patients, 25 cases(33.3%) had normal olfaction and 50 cases(66.7%) had olfactory disorders. Multivariate Logistic regression analysis showed that tissue eosinophils percentage(OR=1.032, 95%CI 1.002-1.064, P=0.036), Questionnaire of olfactory disorders-Negative statement(QOD-NS)(OR=1.079, 95%CI 1.004-1.160, P=0.040) and Anterior olfactory cleft score(AOCS)(OR=2.672, 95%CI 1.480-4.827, P=0.001) were independent risk factors for olfactory disorders in CRS patients. Further research found that the area under the ROC curve(AUC) of the combined prediction model established by the tissue eosinophil percentage, QOD-NS and AOCS was 0.836(95%CI 0.748-0.924, P<0.001), which is better than the above single factor prediction model in predicting olfactory disorders in CRS. Conclusion:Based on pathological artificial intelligence, tissue eosinophil percentage, QOD-NS and AOCS are independent risk factors for olfactory disorders in CRS patients, and the combination of the three factors has a good predictive effect on CRS olfactory disorders.
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Affiliation(s)
- 靖媛 陈
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雯仪 陈
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 新 罗
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雪琨 黄
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 雅娜 张
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
| | - 钦泰 杨
- 中山大学附属第三医院耳鼻咽喉头颈外科(广州,510630)Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- 中山大学附属第三医院变态反应科Department of Allergy, the Third Affiliated Hospital of Sun Yat-sen University
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Schönherr MV, Hummel T. [Detection of disorders of the chemical senses-assessment of state of health by those affected]. HNO 2023; 71:566-571. [PMID: 37535151 DOI: 10.1007/s00106-023-01345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
Although hundreds of thousands of people seek medical help every year because of smell and taste disorders, the burden on patients is often underestimated by health care professionals. Numerous studies have demonstrated the impact of disorders of the chemical senses on quality of life. In clinical practice, the Questionnaire of Olfactory Disorders (QOD) has proven to be a good measure of the impact of olfactory loss on everyday life. Patient-reported outcome measures (PROMs) should therefore be used more frequently for better recording and assessing the needs of patients. In addition to education and treatment by specialized clinics, the provision and optimization of information platforms, support groups, and organizations should be promoted in Germany.
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Affiliation(s)
- Max-Vincent Schönherr
- Klinik- und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Thomas Hummel
- Klinik- und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Tuz‐Hrycyna N, Rzepakowska A, Niemczyk K. Reliability and validity of the Polish version of the Questionnaire of Olfactory Disorders. Laryngoscope Investig Otolaryngol 2023; 8:799-807. [PMID: 37621288 PMCID: PMC10446256 DOI: 10.1002/lio2.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 08/26/2023] Open
Abstract
Background The comprehensive counseling of patients with olfactory dysfunctions requires accurate diagnosis. The recommendations include subjective assessment. The Questionnaire of Olfactory Disorders (QOD) is a disease-specific questionnaire for the subjective evaluation of olfactory dysfunctions. Material The study included 54 patients with olfactory dysfunctions, who were recruited to the study group (SG). The other 47 patients without the history of olfactory dysfunction and nasal cavity pathology were voluntarily allocated to the control group (CG). The protocol of the study was introduced to each patient and included: olfactory testing with Sniffin' Stick test, fulfillment of the Polish version of World Health Organization Quality of Life brief questionnaire and completing of the Polish version of the QOD. All participants (101) were invited for refilling the QOD questionnaire after 2 weeks for the test-retest statistics. Results The Polish QOD statements were significantly correlated and met the requirement by having test-retest correlation larger than 0.7. We found that internal consistency of the test measured by Cronbach's alpha coefficient was very high. The mean scores of the QOD test in normosmic SG patients were compared with corresponding scores in normosmic CG patients using U Mann-Whitney test. The analysis revealed statistically significant differences on mean QOD scores for each domains except QOD-S between both groups. Conclusions The Polish version of the QOD demonstrated high rate of the validity and the reliability. This instrument may be widely used in research projects and clinical practice concerning olfactory disorders in Polish patients. Level of Evidence NA.
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Affiliation(s)
- Natalia Tuz‐Hrycyna
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of WarsawWarsawPoland
| | - Anna Rzepakowska
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of WarsawWarsawPoland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of WarsawWarsawPoland
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Wu X, Chen Y, Wan C, Yu L, Lei P, Sun X. Establishing minimal clinically important differences for the Quality of Life Instrument of Chronic Gastritis QLICD-CG(V2.0) based on distribution-based methods. BMC Gastroenterol 2023; 23:149. [PMID: 37173655 PMCID: PMC10182708 DOI: 10.1186/s12876-023-02777-5] [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: 06/09/2022] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND To establish the lowest score reflecting meaningful changes from the perspective of patients is very important for explaining the results of patient reports. The measurement scale of quality of life in patients with chronic gastritis has been used in clinical practice, but the minimal clinically important difference (MCID) has not been worked out. In this paper, we use a distribution-based method to calculate the MCID of the scale QLICD-CG (Quality of Life Instruments for Chronic Diseases- Chronic Gastritis) (V2.0). METHODS The QLICD-CG(V2.0) scale was used to evaluate the quality of life in patients with chronic gastritis. Since the methods for developing MCID were diverse and there was no uniform standard, we took MCID developed by anchor-based method as the gold standard, and compared the MCID of QLICD-CG(V2.0) scale developed by various distribution-based methods for selection. Standard deviation method (SD), effect size method (ES), standardized response mean method (SRM), standard error of measurement method (SEM) and reliable change index method (RCI) are given in the distribution-based methods. RESULTS A total of 163 patients, with an average age of (52.37 ± 12.96) years old, were calculated according to the various methods and formulas given by the distribution-based method, and the results were compared with the gold standard. It was suggested that the results of the SEM method at the moderate effect (1.96) should be taken as the preferred MCID of the distribution-based method. And thus the MCID of the physical domain, psychological domain, social domain, general module, specific module and total score of the QLICD-CG(V2.0) scale were 9.29, 13.59, 9.27, 8.29, 13.49 and 7.86, respectively. CONCLUSIONS With anchor-based method as the gold standard, each method in distribution-based method has its own advantages and disadvantages. In this paper, 1.96SEM was found to have a good effect on the minimum clinically significant difference of the QLICD-CG(V2.0) scale, and it is recommended as the preferred method to establish MCID.
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Affiliation(s)
- Xiaoyu Wu
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, 523808, China
| | - Ying Chen
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, 523808, China.
| | - Lei Yu
- Huadu District People's Hospital Affiliated to Southern Medical University, Guangzhou, 510800, China
| | - Pingguang Lei
- People's Hospital of Songgang, Baoan, Shenzhen, 518105, Guangdong, China
| | - Xiaoyuan Sun
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, 523808, China
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Peterson AM, Miller B, Ioerger P, Hentati F, Doering MM, Kallogjeri D, Piccirillo JF. Most-Cited Patient-Reported Outcome Measures Within Otolaryngology-Revisiting the Minimal Clinically Important Difference: A Review. JAMA Otolaryngol Head Neck Surg 2023; 149:261-276. [PMID: 36729451 PMCID: PMC10729312 DOI: 10.1001/jamaoto.2022.4703] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Patient-reported outcome measures (PROMs) allow clinicians and researchers to assess health-related information from a patient's perspective. These measures have been used more frequently over the last several decades, but an associated minimal clinically important difference (MCID) is needed to optimize their utility. This narrative review identified the top 100 most-cited otolaryngology-related PROM development and validation publications and assessed the presence and characteristics of the PROMs' associated MCID. Observations In this narrative review, a literature search in Scopus and Web of Science was conducted on June 29, 2022, using keywords related to PROM development and validation studies in otolaryngology and reference lists. Studies that met the definition of a PROM and assessed an otolaryngologic disorder or study population were included for full-text review. After full-text review of 188 articles, the top 100 most-cited PROM development and validation publications, resulting in 106 total PROMs, were chosen for review. A total of 39 (37%) of the identified PROMs had an associated MCID. Of those reporting an MCID, 14 (35.9%) used an anchor-based method, 12 (30.8%) used a distribution-based method, 10 (25.6%) used both, and 3 (7.7%) did not specify or used neither method. Rhinology had the greatest number of PROMs with an associated MCID (16 of 24, 66%), and pediatrics had the fewest (1 of 13, 7.7%). The median number of citations of PROMs with an MCID was higher than those without an MCID. Conclusions and Relevance The majority of the most-cited PROMs in otolaryngology lack an associated MCID. These data indicated that there are a multitude of PROMs that have been cited hundreds of times and used for decades without the ability to identify whether a particular change in score on the instrument is clinically meaningful. There is a need to determine and validate MCIDs for commonly used PROMs to aid clinical research and trial interpretation.
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Affiliation(s)
- Andrew M. Peterson
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Brevin Miller
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Patrick Ioerger
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- University of Kansas Medical Center, Kansas City, Kansas
| | - Firas Hentati
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Case Western Reserve University, Cleveland, Ohio
| | - Michelle M. Doering
- Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jay F. Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Investigations and Outcomes for Olfactory Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022; 10:377-384. [PMCID: PMC9707095 DOI: 10.1007/s40136-022-00438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review To provide a detailed overview of the investigations and core outcome measures for olfactory disorders. Recent Findings Olfactory disorders can have a detrimental impact to the quality of life of patients. There are a wide range of causes of olfactory loss including sinonasal conditions, idiopathic, post-head trauma or infection. This review highlights the key investigations and reasoning for their use to clinically assess and research patients with olfactory disorders. In addition, this review outlines the core outcome measures for olfaction that will help inform future research in olfactory disorders. Summary A systematic approach with history taking and examination particularly with nasal endoscopy can determine the cause of the olfactory disorder in most cases. Specific olfactory disorder questionnaires can demonstrate the impact on quality of life, while psychophysical testing can objectively assess and monitor olfaction over time. Olfactory-evoked potentials and functional MRI are reserved for research, whereas CT and MRI imaging are used depending on history and examination. A core outcome set for olfaction has been developed that will help standardise the outcome measures used in olfaction and olfactory disorders research.
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2022; 9:CD013876. [PMID: 36062970 PMCID: PMC9443431 DOI: 10.1002/14651858.cd013876.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Olfactory dysfunction is a common consequence of COVID-19 infection and persistent symptoms can have a profound impact on quality of life. At present there is little guidance on how best to treat this condition. A variety of interventions have been suggested to promote recovery, including medication and olfactory training. However, it is uncertain whether any intervention is of benefit. This is an update of the 2021 review with one additional study added. OBJECTIVES: 1) To evaluate the benefits and harms of any intervention versus no treatment for people with persisting olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance that had persisted for at least four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included two studies with 30 participants. The studies evaluated the following interventions: systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant and palmitoylethanolamide plus luteolin. Systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant compared to no intervention We included a single RCT with 18 participants who had anosmia for at least 30 days following COVID-19 infection. Participants received a 15-day course of oral corticosteroids combined with nasal irrigation (consisting of an intranasal corticosteroid/mucolytic/decongestant solution) or no intervention. Psychophysical testing was used to assess olfactory function at 40 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. Palmitoylethanolamide plus luteolin compared to no intervention We included a single RCT with 12 participants who had anosmia or hyposmia for at least 90 days following COVID-19 infection. Participants received a 30-day course of palmitoylethanolamide and luteolin or no intervention. Psychophysical testing was used to assess olfactory function at 30 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2022; 9:CD013877. [PMID: 36063364 PMCID: PMC9443936 DOI: 10.1002/14651858.cd013877.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Loss of olfactory function is well recognised as a symptom of COVID-19 infection, and the pandemic has resulted in a large number of individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority the symptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recovery and prevent persisting olfactory disturbance. This is an update of the 2021 review with four studies added. OBJECTIVES 1) To evaluate the benefits and harms of any intervention versus no treatment for people with acute olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance, which had been present for less than four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia, change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included five studies with 691 participants. The studies evaluated the following interventions: intranasal corticosteroid sprays, intranasal corticosteroid drops, intranasal hypertonic saline and zinc sulphate. Intranasal corticosteroid spray compared to no intervention/placebo We included three studies with 288 participants who had olfactory dysfunction for less than four weeks following COVID-19. Presence of normal olfactory function The evidence is very uncertain about the effect of intranasal corticosteroid spray on both self-rated recovery of olfactory function and recovery of olfactory function using psychophysical tests at up to four weeks follow-up (self-rated: risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; psychophysical testing: RR 2.3, 95% CI 1.16 to 4.63; 1 study; 77 participants; very low-certainty evidence). Change in sense of smell The evidence is also very uncertain about the effect of intranasal corticosteroid spray on self-rated change in the sense of smell (at less than 4 weeks: mean difference (MD) 0.5 points lower, 95% CI 1.38 lower to 0.38 higher; 1 study; 77 participants; at > 4 weeks to 3 months: MD 2.4 points higher, 95% CI 1.32 higher to 3.48 higher; 1 study; 100 participants; very low-certainty evidence, rated on a scale of 1 to 10, higher scores mean better olfactory function). Intranasal corticosteroids may make little or no difference to the change in sense of smell when assessed with psychophysical testing (MD 0.2 points, 95% CI 2.06 points lower to 2.06 points higher; 1 study; 77 participants; low-certainty evidence, 0- to 24-point scale, higher scores mean better olfactory function). Serious adverse effects The authors of one study reported no adverse effects, but their intention to collect these data was not pre-specified so we are uncertain if these were systematically sought and identified. The remaining two studies did not report on adverse effects. Intranasal corticosteroid drops compared to no intervention/placebo We included one study with 248 participants who had olfactory dysfunction for ≤ 15 days following COVID-19. Presence of normal olfactory function Intranasal corticosteroid drops may make little or no difference to self-rated recovery at > 4 weeks to 3 months (RR 1.00, 95% CI 0.89 to 1.11; 1 study; 248 participants; low-certainty evidence). No other outcomes were assessed by this study. Data on the use of hypertonic saline nasal irrigation and the use of zinc sulphate to prevent persistent olfactory dysfunction are included in the full text of the review. AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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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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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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18
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Lee JJ, Peterson AM, Kallogjeri D, Jiramongkolchai P, Kukuljan S, Schneider JS, Klatt-Cromwell CN, Drescher AJ, Brunworth JD, Piccirillo JF. Smell Changes and Efficacy of Nasal Theophylline (SCENT) irrigation: A randomized controlled trial for treatment of post-viral olfactory dysfunction. Am J Otolaryngol 2022; 43:103299. [PMID: 34894449 PMCID: PMC9057210 DOI: 10.1016/j.amjoto.2021.103299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/28/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of intranasal theophylline saline irrigation on olfactory recovery in patients with post-viral olfactory dysfunction (PVOD). METHODS Between May 2019 and April 2020, we conducted a double-blinded, placebo-controlled randomized clinical trial of adults with 6-36 months of PVOD. Patients were randomized to nasal theophylline saline irrigation or placebo saline irrigation twice a day for 6 weeks. The primary outcome was the Global Rating of Smell Change. Secondary outcomes were changes in the University of Pennsylvania Smell Identification Test (UPSIT) and Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS). RESULTS Twenty-two patients (n = 12, theophylline; n = 10, placebo) completed the study. Slightly more patients in the theophylline group (33%) reported improved smell compared to the placebo group (30%, difference 3.3%, 95% CI -35.6% to 42.3%). The median differences in pre- and post-treatment UPSIT and QOD-NS change between the two groups were 1 (95% CI -3 to 5) and -10 (95% CI -15 to -4), respectively in favor of theophylline. Three patients receiving theophylline and 2 receiving placebo had clinically meaningful improvements on the UPSIT (difference 5%, 95% CI -30% to 40%). There were no adverse events, and serum theophylline levels were undetectable in 10/10 patients. CONCLUSIONS While safe, there were no clinically meaningful differences in olfactory change between the two groups except for olfaction-related quality of life, which was better with theophylline. The imprecise estimates suggest future trials will need substantially larger sample sizes or treatment modifications, such as increasing the theophylline dose, to observe larger treatment effects.
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Affiliation(s)
- Jake J Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Andrew M Peterson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Pawina Jiramongkolchai
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sara Kukuljan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Cristine N Klatt-Cromwell
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew J Drescher
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph D Brunworth
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
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19
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Wei G, Gu J, Gu Z, Du C, Huang X, Xing H, Li L, Zhang A, Hu X, Huo J. Olfactory Dysfunction in Patients With Coronavirus Disease 2019: A Review. Front Neurol 2022; 12:783249. [PMID: 35115994 PMCID: PMC8805677 DOI: 10.3389/fneur.2021.783249] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/14/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on public-health and economic systems worldwide. Among the several neurological symptoms of patients with COVID-19 reported in clinical practice, olfactory dysfunction (OD) is the most common. OD occurs as the earliest or the only clinical manifestation in some patients. Increasing research attention has focused on OD, which is listed as one of the main diagnostic symptoms of severe acute respiratory syndrome-coronavirus-2 infection. Multiple clinical and basic-science studies on COVID-19-induced OD are underway to clarify the underlying mechanism of action. In this review, we summarize the clinical characteristics, mechanisms, evaluation methods, prognosis, and treatment options of COVID-19-induced OD. In this way, we hope to improve the understanding of COVID-19-induced OD to aid early identification and precise intervention.
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Affiliation(s)
- Guoli Wei
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
- Department of Oncology, Yangzhou University Medical College, Yangzhou, China
| | - Jialin Gu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- The Third Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhancheng Gu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- The Third Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Du
- Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofei Huang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- The Third Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haiyan Xing
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Lingchang Li
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Aiping Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xingxing Hu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
- Department of Oncology, Yangzhou University Medical College, Yangzhou, China
- *Correspondence: Xingxing Hu
| | - Jiege Huo
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Jiege Huo
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20
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Mao F, Sun Y, Wang J, Huang Y, Lu Y, Cao F. Sensitivity to change and minimal clinically important difference of Edinburgh postnatal depression scale. Asian J Psychiatr 2021; 66:102873. [PMID: 34624746 DOI: 10.1016/j.ajp.2021.102873] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Edinburgh Postnatal Depression Scale (EPDS) was widely used in measuring depression symptoms among pregnant women. However, it is still unclear about the sensitivity to change and minimal clinically important difference (MCID) for EPDS. METHODS Based on data from an eight-week smartphone-based mindfulness intervention, scores of EPDS, 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder (GAD-7) before and after the intervention were collected. Three self-appraisal questions were collected after the intervention. The sensitivity to change of EPDS was determined by correlations between changes in PHQ-9, GAD-7, and EPDS. MCID for EPDS was determined by distribution-based method (0.5 standard deviation and standard error of the measurement) and anchor-based method (PHQ-9, GAD-7, and participants' self-appraisal served as anchors). The final MCID value for EPDS was calculated by average scores of the two methods. 117 women with pre-post assessments were included in the analysis. RESULTS EPDS score changes from baseline to post-intervention were correlated with pre-post change in PHQ-9 and GAD-7 (r = 0.540, P < 0.001). The average MCID for EPDS score was found to be 4 points (ranging from -1.45 to -6.5 points) for improvement and 3 points for worsening (ranging from 1.45 to 3.5 points). CONCLUSION The EPDS is sensitive to detect the changes in maternal depressive symptoms during pregnancy through a mindfulness course of interventions. Four points for improvement and three points for worsening are recommended as MCID for EPDS.
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Affiliation(s)
- Fangxiang Mao
- School of Nursing and Rehabilitation, Shandong University, China
| | - Yaoyao Sun
- School of Nursing and Rehabilitation, Shandong University, China
| | - Juan Wang
- School of Nursing and Rehabilitation, Shandong University, China
| | - Yongqi Huang
- School of Nursing and Rehabilitation, Shandong University, China
| | - Yane Lu
- School of Nursing and Rehabilitation, Shandong University, China
| | - Fenglin Cao
- School of Nursing and Rehabilitation, Shandong University, China.
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21
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Beswick DM, Humphries SM, Balkissoon CD, Strand M, Vladar EK, Ramakrishnan VR, Taylor-Cousar JL. Olfactory dysfunction in cystic fibrosis: Impact of CFTR modulator therapy. J Cyst Fibros 2021; 21:e141-e147. [PMID: 34598881 DOI: 10.1016/j.jcf.2021.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/03/2021] [Accepted: 09/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Elexacaftor-tezacaftor-ivacaftor (ETI) improves pulmonary health and chronic rhinosinusitis (CRS) for people with cystic fibrosis (PwCF), however its impact on olfaction has not been investigated. Olfactory dysfunction impairs quality-of-life (QOL). This study evaluated the impact of ETI on multiple olfactory metrics. METHODS Adult PwCF/CRS with CF transmembrane conductance regulator genotype F508del/F508del or F508del/minimal function who clinically initiated ETI participated in a prospective, observational study. Endpoints included changes after 6 months of ETI in quantitative olfactory function (Smell Identification Test, SIT), olfactory QOL (Questionnaire of Olfactory Disorders, QOD) and percent olfactory cleft opacification (%OCO), representing superior nasal cavity inflammation where afferent olfactory neurons are concentrated. RESULTS 30 PwCF/CRS met inclusion criteria; 25 completed the study. Mean ETI adherence was 93%. At baseline, participants were hyposmic (mean SIT 31.3), had significant %OCO (mean 65.6%), yet reported non-impaired olfactory QOL (mean QOD 6.1). At follow-up, mean SIT worsened mildly (p=0.009), mean %OCO remained stable (p=0.46), and mean QOD improved modestly (p=0.008). No outcomes were impacted by prior modulator use, genotype, nasal polyps, or CF-related diabetes. Prior sinus surgery was associated with QOD improvement (p=0.04). Increased (worse) baseline QOD scores and %OCO were associated with greater improvements (p<0.003), but not SIT (p=0.44). CONCLUSIONS ETI was not associated with improvement in quantitative olfaction or olfactory cleft opacification after 6 months. PwCF/CRS have hyposmia but do not report impairment in olfactory QOL. Further study to investigate mechanisms explaining olfactory dysfunction and whether olfaction improves with greater duration of ETI or in younger age groups is warranted.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, CA, USA; Department of Academic Affairs, National Jewish Health, Denver, CO, USA.
| | | | | | - Matthew Strand
- Division of Biostatistics, National Jewish Health, Denver, CO, USA
| | - Eszter K Vladar
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, Aurora, CO, USA; Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO, USA
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22
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Leong S, Sharma RK, Safi C, DiMango E, Keating C, Gudis DA, Overdevest JB. Association of Quality of Life Measures and Otolaryngologic Care in Cystic Fibrosis Patients. Ann Otol Rhinol Laryngol 2021; 131:817-823. [PMID: 34514873 DOI: 10.1177/00034894211045636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Appropriate management of chronic rhinosinusitis (CRS) among patients with cystic fibrosis (CF) is important in improving quality of life. Otolaryngologists play a critical role in reducing CRS symptom burden. This study seeks to evaluate the role of patient-reported quality-of-life measures in guiding interventions for CF-related sinus disease. METHODS We performed a prospective, cross-sectional study of 105 patients presenting to a CF-accredited clinic between July and September 2018. Demographic data and sinus surgery history were collected, in addition to Sino-Nasal Outcome Test (SNOT-22) and Questionnaire of Olfactory Disorders (QOD-NS) scores. Statistical analysis was conducted using correlation and non-parametric Mann-Whitney U tests. RESULTS Baseline well-care visits accounted for 71.4% of all clinical evaluations. Prior otolaryngology intervention was noted in 69 (66%) patients, where the majority of these patients (63/69; 91%) underwent endoscopic sinus surgery (ESS). Patients with a history of otolaryngology intervention had an average SNOT-22 score of 33.2 (SD = 20.6) compared to 24.9 (SD = 18.5) for patients without prior intervention (P = .048). The average QOD-NS score was 5.5 (SD = 6.4) among patients referred to otolaryngologists and 3.1 (SD = 5.7) for non-referred patients (P = .012). SNOT-22 and QOD-NS scores were modestly correlated (R of .43). CONCLUSION CF patients with symptoms resulting in worse quality-of-life assessments were more likely to have established coordinated care with an otolaryngologist. Further validation of the utility of SNOT-22 and QOD-NS questionnaires as care coordination metrics is necessary in the CF population.
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Affiliation(s)
- Stephen Leong
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Rahul K Sharma
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Chetan Safi
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Emily DiMango
- Department of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Claire Keating
- Department of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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23
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Li J, Bur AM, Villwock MR, Shankar S, Palmer G, Sykes KJ, Villwock JA. Olfactory Phenotypes Differentiate Cognitively Unimpaired Seniors from Alzheimer's Disease and Mild Cognitive Impairment: A Combined Machine Learning and Traditional Statistical Approach. J Alzheimers Dis 2021; 81:641-650. [PMID: 33843686 DOI: 10.3233/jad-210175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is an early symptom of Alzheimer's disease (AD). However, olfactory testing is not commonly performed to test OD in the setting of AD. OBJECTIVE This work investigates objective OD as a non-invasive biomarker for accurately classifying subjects as cognitively unimpaired (CU), mild cognitive impairment (MCI), and AD. METHODS Patients with MCI (n = 24) and AD (n = 24), and CU (n = 33) controls completed two objective tests of olfaction (Affordable, Rapid, Olfactory Measurement Array -AROMA; Sniffin' Sticks Screening 12 Test -SST12). Demographic and subjective sinonasal and olfaction symptom information was also obtained. Analyses utilized traditional statistics and machine learning to determine olfactory variables, and combinations of variables, of importance for differentiating normal and disease states. RESULTS Inability to correctly identify a scent after detection was a hallmark of MCI/AD. AROMA was superior to SST12 for differentiating MCI from AD. Performance on the clove scent was significantly different between all three groups. AROMA regression modeling yielded six scents with AUC of the ROC of 0.890 (p < 0.001). Random forest model machine learning algorithms considering AROMA olfactory data successfully predicted MCI versus AD disease state. Considering only AROMA data, machine learning algorithms were 87.5%accurate (95%CI 0.4735, 0.9968). Sensitivity and specificity were 100%and 75%, respectively with ROC of 0.875. When considering AROMA and subject demographic and subjective data, the AUC of the ROC increased to 0.9375. CONCLUSION OD differentiates CUs from those with MCI and AD and can accurately predict MCI versus AD. Leveraging OD data may meaningfully guide management and research decisions.
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Affiliation(s)
- Jennifer Li
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Andres M Bur
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Mark R Villwock
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Suraj Shankar
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Gracie Palmer
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Kevin J Sykes
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
| | - Jennifer A Villwock
- University of Kansas Medical Center, Department of Otolaryngology - Head and Neck Surgery, Kansas City, KS, USA
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Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013877. [PMID: 34291812 PMCID: PMC8406518 DOI: 10.1002/14651858.cd013877.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loss of olfactory function is well recognised as a cardinal symptom of COVID-19 infection, and the ongoing pandemic has resulted in a large number of affected individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority the symptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recovery and prevent persisting olfactory disturbance. OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to prevent persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Individuals who had symptoms for less than four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Our primary outcomes were the presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia, change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study of 100 participants, which compared an intranasal steroid spray to no intervention. Participants in both groups were also advised to undertake olfactory training for the duration of the trial. Data were identified for only two of the prespecified outcomes for this review, and no data were available for the primary outcome of serious adverse effects. Intranasal corticosteroids compared to no intervention (all using olfactory training) Presence of normal olfactory function after three weeks of treatment was self-assessed by the participants, using a visual analogue scale (range 0 to 10, higher scores = better). A score of 10 represented "completely normal smell sensation". The evidence is very uncertain about the effect of intranasal corticosteroids on self-rated recovery of sense of smell (estimated absolute effect 619 per 1000 compared to 520 per 1000, risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; very low-certainty evidence). Change in sense of smell was not reported, but the self-rated score for sense of smell was reported at the endpoint of the study with the same visual analogue scale (after three weeks of treatment). The median scores at endpoint were 10 (interquartile range (IQR) 9 to 10) for the group receiving intranasal corticosteroids, and 10 (IQR 5 to 10) for the group receiving no intervention (1 study; 100 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence regarding the efficacy of different interventions at preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a small number of additional ongoing studies in this area. As this is a living systematic review, the evidence will be updated regularly to incorporate new data from these, and other relevant studies, as they become available. For this (first) version of the living review, we identified a single study of intranasal corticosteroids to include in this review, which provided data for only two of our prespecified outcomes. The evidence was of very low certainty, therefore we were unable to determine whether intranasal corticosteroids may have a beneficial or harmful effect.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013876. [PMID: 34291813 PMCID: PMC8406942 DOI: 10.1002/14651858.cd013876.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Olfactory dysfunction is an early and sensitive marker of COVID-19 infection. Although self-limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post-COVID-19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post-viral anosmia (such as medication or olfactory training). OBJECTIVES To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included one study with 18 participants, which compared the use of a 15-day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low-certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low-certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post-COVID-19 olfactory dysfunction is very uncertain.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Flavor Enhancement in Daily Life of Patients with Olfactory Dysfunction. CHEMOSENS PERCEPT 2021. [DOI: 10.1007/s12078-021-09289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Introduction
Patients with olfactory dysfunction report deterioration of taste due to loss of flavor, leading to less food enjoyment, alterations in dietary behaviors and stress. The aim of this study was to introduce flavor enhancement to investigate its acceptance and possible effects on quality of life.
Methods
In this prospective, controlled, randomized, single-blinded, cross-over pilot study, we recruited 30 olfactory dysfunction patients, of which 16 were hyposmic and 14 anosmic. After single-blinded triangle flavor discrimination test, flavor drops were randomized either in high or low concentration for 14 days and vice versa for another 14 days. Records included a daily diary and the questionnaire of olfactory disorders.
Results
Usage rates were excellent with 82.2% of all days, while drops were mainly used for breakfast (44.6%, p < 0.05). Hyposmics used flavor enhancement on significantly more days (median = 14) compared to anosmics (median = 11, p = 0.0094). QOD improved in 12 patients to a meaningful extent.
Conclusions
In this pilot study, we show that flavor enhancement is feasible accompanied by high compliance and acceptance in olfactory dysfunction patients. Flavor drops were used regardless of low or high concentrations with no adverse events noted.
Implications
Our findings give rise to further studies illuminating the possible advantages of flavor enhancement in patients with olfactory disorders.
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Pruijssers B, van der Vaart L, Milani F, Roovers JP, Vollebregt A, van der Vaart H. Minimal Clinically Important Difference (MCID) for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire - IUGA Revised (PISQ-IR). J Sex Med 2021; 18:1265-1270. [PMID: 37057419 DOI: 10.1016/j.jsxm.2021.04.005] [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: 10/29/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND To put statistically significant changes in patient reported outcome measurement (PROM) questionnaires into a clinical perspective, the concept of the minimal clinically important difference (MCID) can be used. AIM To determine the MCID for the summary score for sexually active (SA) women of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), a validated instrument which assesses sexual functioning (SF) for patients suffering from a symptomatic pelvic floor disorder. METHODS Patients participating in a multicentre prospective cohort study comparing pessary therapy with surgery for a symptomatic pelvic organ prolapse (POP) filled in the PISQ-IR at baseline and 12 months' follow-up. We used both an anchor-based as well as a distribution-based method to calculate the MCID for both treatment groups. The Patient Global Impression of Improvement (PGI-I) questionnaire and PISQ-IR question 19a about satisfaction with sexual functioning were used as anchors. For the distribution-based approach we used the effect size (ES). OUTCOMES MCID for the SA summary score of the PISQ-IR. RESULTS Data of 243 women were used to calculate the MCID. In the pessary group, Kendall's tau-b correlation coefficients between the PISQ-IR summary score and both anchors were below the cut-off of 0.21, which implies the anchors cannot be used to calculate an MCID. In our surgery group, the PISQ-IR question 19a met the anchor criteria and 0.31 points increase in the PISQ-IR summary score was equal to an improvement of 1 point on question 19a about satisfaction with sexual functioning. CLINICAL IMPLICATIONS Future research on this subject should focus on clinical relevance of results rather than statistical significance only. STRENGTHS & LIMITATIONS Our main strength is the fact that we used both anchor-based and distribution-based methods to determine our MCID. Secondly, we set out to determine an MCID for both treatment groups separately, which relatively enhances the generalisability of our results. A limitation is that we were not able to estimate an MCID for the pessary group. Pruijssers B, van der Vaart L, Milani F, et al. Minimal Clinically Important Difference (MCID) for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire - IUGA Revised (PISQ-IR). J Sex Med 2021;18:1265-1270. CONCLUSION We estimated the MCID for the PISQ-IR SA summary score to be 0.31 in our surgery group.
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Affiliation(s)
- Bente Pruijssers
- Department of Obstetrics and Gynecology, University Medical Center, , Utrecht, The Netherlands
| | - Lisa van der Vaart
- Department of Gynecology and Obstetrics, Amsterdam University Medical Center, , Amsterdam, The Netherlands
| | - Fred Milani
- Department of Obstetrics & Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Jan-Paul Roovers
- Department of Gynecology and Obstetrics, Amsterdam University Medical Center, , Amsterdam, The Netherlands
| | - Astrid Vollebregt
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Center, , Utrecht, The Netherlands
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Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Hippokratia 2021. [DOI: 10.1002/14651858.cd013877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Katie E Webster
- Cochrane ENT; Nuffield Department of Surgical Sciences, University of Oxford; Oxford UK
| | | | - Carl Philpott
- Department of Medicine; Norwich Medical School, University of East Anglia; Norwich UK
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Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021. [DOI: 10.1002/14651858.cd013876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Katie E Webster
- Cochrane ENT; Nuffield Department of Surgical Sciences, University of Oxford; Oxford UK
| | | | - Carl Philpott
- Department of Medicine; Norwich Medical School, University of East Anglia; Norwich UK
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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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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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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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Zhao R, Chen K, Tang Y. Olfactory changes after endoscopic sinus surgery for chronic rhinosinusitis: A meta-analysis. Clin Otolaryngol 2020; 46:41-51. [PMID: 32865350 DOI: 10.1111/coa.13639] [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] [Received: 05/22/2020] [Revised: 08/02/2020] [Accepted: 08/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is an important treatment modality for chronic rhinosinusitis (CRS). However, its effect on olfaction remains controversial. OBJECTIVE OF REVIEW To assess the olfactory impact of ESS in patients with CRS. TYPE OF REVIEW A meta-analysis. SEARCH STRATEGY A systematic literature search in the PubMed, EMBASE and Cochrane Library databases was conducted to identify studies that assessed change in olfaction after ESS in patients with CRS. Search terms were related to paranasal sinus diseases, smell and endoscopy. EVALUATION METHOD The extracted data included authors, publication year, study type, age, sex, diagnostic criteria, surgical mode, sample size, follow-up time, olfaction measurement tool and outcome. We analysed the olfactory changes as continuous variables. RESULTS Thirty-five studies including 3164 patients with CRS were eligible for the meta-analysis. Among patients having CRS with nasal polyps, olfactory dysfunction improved, as assessed by the Sniffin' Sticks total score (P = .000), Sniffin' Sticks discrimination score (P = .023), Sniffin' Sticks identification score (P = .005), University of Pennsylvania Smell Identification Test (P = .046) and Visual Analogue Scale (P = .000). However, the threshold score of the Sniffin' Sticks test did not improve significantly (P = .361). Olfactory dysfunction did not improve in patients having CRS without nasal polyps according to the University of Pennsylvania Smell Identification Test (P = .404). In non-classified CRS patients, improvement in olfactory dysfunction was observed according to the University of Pennsylvania Smell Identification Test (P = .000), Visual Analogue Scale (P = .001) and Questionnaire of Olfactory Disorders-Negative Statements (P = .001). However, there were no significant improvements according to the Brief Smell Identification Test (P = .325), Sniffin' Sticks threshold score (P = .160) and Sniffin' Sticks identification score (P = .079). CONCLUSION Endoscopic sinus surgery may be beneficial for improvement in olfactory conditions in patients with CRS. Further thorough and comprehensive studies need to be conducted.
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Affiliation(s)
- Rui Zhao
- Department of Otorhinolaryngology, West China Hospital of Sichuan University, Chengdu, China.,Otorhinolaryngology-Head and Neck Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kai Chen
- Department of Otorhinolaryngology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuedi Tang
- Department of Otorhinolaryngology, West China Hospital of Sichuan University, Chengdu, China
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Xu Z, Luo X, Xu L, Deng J, Gao W, Jiang L, Huang Z, Shi J, Lai Y. Effect of short-course glucocorticoid application on patients with chronic rhinosinusitis with nasal polyps. World Allergy Organ J 2020; 13:100131. [PMID: 32566071 PMCID: PMC7300158 DOI: 10.1016/j.waojou.2020.100131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Local and systemic glucocorticoids are mainstay therapies for chronic rhinosinusitis. With respect to local glucocorticoids, nasal spray is used extensively, but some patients do not benefit from short-course treatment. Recently, some clinicians have focused on the effects of high-dose local glucocorticoids in chronic rhinosinusitis with nasal polyps (CRSwNP), such as treatment using nasal irrigation, transnasal nebulization, and nose-dripping therapy (nasal drop) with high-dose budesonide. However, there are little data comparing the effect of short-course high-dose local glucocorticoids with regular nasal spray and oral steroids in the treatment of preoperative CRSwNP patients. Furthermore, the appropriate use of different types of glucocorticoids in different endotypes of CRSwNP remains unclear. METHODS This randomized controlled clinical research study was performed at a single academic center. Patients who satisfied the criteria of chronic rhinosinusitis with bilateral nasal polyps were randomly assigned in a 1:1:1 ratio to receive oral methylprednisolone, 24 mg/d and budesonide nasal spray, 256 μg/d, or intranasal budesonide suspension, 1 mg/d and budesonide nasal spray, 256 μg/d, or budesonide nasal spray, 256 μg/d for one week. Symptoms, endoscopic scores, and tissue and blood inflammatory cells were recorded before and after the study. Adverse events were recorded by clinicians. RESULTS A total of 127 patients with CRSwNP underwent randomization. The total nasal symptoms scores (TNSS) decreased significantly in all groups compared to those at baseline. The assessment of the reduction in TNSS demonstrated that the change was significantly greater in the nasal drop group than in the nasal spray group (-7.47 vs -4.10, P = 0.032), and it was also greater in the oral steroid group than in the nasal spray group (-7.30 vs -4.10, P = 0.039). A similar trend also appeared in the reduction in Sinonasal-Outcome Test 22 (SNOT-22). After treatment, a significantly reduction in NP score was observed in the nasal drop group (-0.82) and oral steroid group (-0.85) compared with that in the nasal spray group (-0.10), and there was no significant difference between the nasal drop and oral steroid groups (P = 0.98). While calculating the percentage of patients who were sensitive to glucocorticoid treatment, there was 10.26% in the nasal spray group, 47.37% in the nasal drop group, and 52.50% in the oral steroid group that were sensitive to glucocorticoid treatment. The reduction in NP score was more significant in patients with eosinophilic CRSwNP in the nasal drop group and oral steroid group than in the nasal spray group. However, in patients with non-eosinophilic CRSwNP, the change in NP size was similar in the different treatment groups. CONCLUSION Budesonide suspension nasal drop can significantly improve the quality of life and reduce the endoscopic score following short-course treatment, and the treatment effect of nasal drop was better than that of regular nasal spray. Budesonide nasal suspension can be used as a regular treatment for eosinophilic CRSwNP and can be an alternative choice for patients with a high percentage of tissue eosinophil infiltration who cannot use oral glucocorticoids.
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Key Words
- Budesonide
- CONSORT, Consolidated standards of reporting trials
- CRS, Chronic Rhinosinusitis
- CRSsNP, Chronic Rhinosinusitis without Nasal Polyps
- CRSwNP, Chronic Rhinosinusitis with Nasal Polyps
- Chronic rhinosinusitis with nasal polyps
- EPOS 2012, European position paper on rhinosinusitis and nasal polyps 2012 guidelines
- Eos, Eosinophil
- Glucocorticoid
- H&E, Hematoxylin-eosin
- HPA, Hypothalamic-pituitary-adrenal
- MCID, Minimal Clinical Important Differences
- NP, nasal polyp
- Nasal drop
- Nasal spray
- Oral steroid
- SD, Standard Deviation
- SEM, Standard Error of Measurement
- SNOT 22, Sinonasal-Outcome Test 22
- TNSS, Total nasal symptom score
- VAS, Visual Analogue Scale
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Affiliation(s)
- Zhaofeng Xu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Xin Luo
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Lei Xu
- Department of Otorhinolaryngology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Nanjing Medical University, Changzhou, 213003, PR China
| | - Jie Deng
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Wenxiang Gao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Lijie Jiang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Zhaoqi Huang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Jianbo Shi
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
| | - Yinyan Lai
- Department of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR China
- Guangzhou Key Laboratory of Otorhinolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University. Guangzhou, 510080, PR 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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Yoo F, Schlosser RJ, Storck KA, Ganjaei KG, Rowan NR, Soler ZM. Effects of endoscopic sinus surgery on objective and subjective measures of cognitive dysfunction in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1135-1143. [DOI: 10.1002/alr.22406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Frederick Yoo
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Department of SurgeryRalph H. Johnson VA Medical Center Charleston SC
| | - Kristina A. Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
| | - Kimia G. Ganjaei
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
- Rutgers: Robert Wood Johnson Medical School Piscataway NJ
| | - Nicholas R. Rowan
- Department of Otolaryngology‒Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore MD
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology‒Head and Neck SurgeryMedical University of South Carolina Charleston SC
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Beswick DM, Mace JC, Rudmik L, Soler ZM, Alt JA, Smith KA, Detwiller KY, Smith TL. Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 9:231-239. [PMID: 30548212 DOI: 10.1002/alr.22256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Healthcare disparities related to socioeconomic factors may adversely impact disease states and treatment outcomes. Among patients with chronic rhinosinusitis (CRS), the impact of socioeconomic factors on outcomes following endoscopic sinus surgery (ESS) remains uncertain. METHODS Adult patients with refractory CRS were prospectively enrolled into an observational, multi-institutional cohort study between March 2011 and June 2015. Socioeconomic factors analyzed included household income, insurance status, years of education completed, race, age, and ethnicity. Income was stratified according to the Thompson and Hickey model. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Brief Smell Identification Test (BSIT) were completed preoperatively and postoperatively. RESULTS A total of 392 patients met inclusion criteria. Higher age and male gender were associated with better mean preoperative SNOT-22 scores (both p < 0.02), whereas Medicare insurance status and male gender were associated with worse preoperative mean BSIT scores (both p < 0.02). Postoperatively, higher household income ($100,001+/year) and lower age were associated with a greater likelihood of improving at least 1 minimal clinically important difference (MCID) on SNOT-22 scores (OR = 2.40 and 1.03, respectively, both p < 0.05), while no factors were associated with increased odds of achieving a MCID on BSIT scores. CONCLUSIONS Preoperative olfactory function and postoperative quality of life (QOL) improvement were associated with metrics of socioeconomic status in patients with CRS electing ESS. The odds of experiencing a clinically meaningful QOL improvement were more than twice as likely for patients with the highest household income level compared to other income tiers. Further investigation is warranted to identify barriers to postoperative improvement.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology, University of Colorado, Aurora, CO
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - 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, UT
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kara Y Detwiller
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
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