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Gunder N, Hummel T. Parosmia in patients with post-infectious olfactory dysfunction in the era of COVID-19-associated olfactory impairment. HNO 2024:10.1007/s00106-024-01470-7. [PMID: 38935276 DOI: 10.1007/s00106-024-01470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES A large number of patients with olfactory impairment are affected by parosmia or phantosmia. This study aimed to examine the demographic and clinical characteristics of parosmia. METHODS We performed a retrospective data analysis of patients consulting at our Smell and Taste Outpatient Clinic. A total of 297 patients were included (203 women, mean age 44.4 ± 13.7 years). Olfactory function was quantified using the "Sniffin' Sticks" composite TDI (odor threshold, determination, and identification) score. The presence of qualitative olfactory impairment was assessed trough medical history and a parosmia questionnaire. RESULTS Most of the patients showed olfactory impairment after an infection with SARS-CoV‑2 (84%) and were diagnosed with parosmia (49%). Patients with parosmia (PAR) (n = 201) were significantly younger compared to the group without parosmia (noPAR; n = 92) (PAR 43.2 ± 13 years vs. noPAR 47 ± 15.1 years, p = 0.03) and had a slightly shorter duration of disease, without reaching statistical significance (PAR 10.3 ± 4.9 months, noPAR 13.6 ± 37.6 months, p = 0.23). They also had higher TDI scores (PAR 24.3 ± 7 points, noPAR 21.4 ± 8.2 points, p = 0.003). CONCLUSIONS Patients affected by parosmia were younger and had a better olfactory function compared to patients without parosmia.
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Affiliation(s)
- Nadine Gunder
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Thomas Hummel
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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2
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Menger NS, Tognetti A, Farruggia MC, Mucignat C, Bhutani S, Cooper KW, Rohlfs Domínguez P, Heinbockel T, Shields VDC, D'Errico A, Pereda-Loth V, Pierron D, Koyama S, Croijmans I. Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports. JMIR Public Health Surveill 2024; 10:e47064. [PMID: 38728069 PMCID: PMC11127136 DOI: 10.2196/47064] [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: 03/09/2023] [Revised: 10/26/2023] [Accepted: 03/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Smell disorders are commonly reported with COVID-19 infection. The smell-related issues associated with COVID-19 may be prolonged, even after the respiratory symptoms are resolved. These smell dysfunctions can range from anosmia (complete loss of smell) or hyposmia (reduced sense of smell) to parosmia (smells perceived differently) or phantosmia (smells perceived without an odor source being present). Similar to the difficulty that people experience when talking about their smell experiences, patients find it difficult to express or label the symptoms they experience, thereby complicating diagnosis. The complexity of these symptoms can be an additional burden for patients and health care providers and thus needs further investigation. OBJECTIVE This study aims to explore the smell disorder concerns of patients and to provide an overview for each specific smell disorder by using the longitudinal survey conducted in 2020 by the Global Consortium for Chemosensory Research, an international research group that has been created ad hoc for studying chemosensory dysfunctions. We aimed to extend the existing knowledge on smell disorders related to COVID-19 by analyzing a large data set of self-reported descriptive comments by using methods from natural language processing. METHODS We included self-reported data on the description of changes in smell provided by 1560 participants at 2 timepoints (second survey completed between 23 and 291 days). Text data from participants who still had smell disorders at the second timepoint (long-haulers) were compared with the text data of those who did not (non-long-haulers). Specifically, 3 aims were pursued in this study. The first aim was to classify smell disorders based on the participants' self-reports. The second aim was to classify the sentiment of each self-report by using a machine learning approach, and the third aim was to find particular food and nonfood keywords that were more salient among long-haulers than those among non-long-haulers. RESULTS We found that parosmia (odds ratio [OR] 1.78, 95% CI 1.35-2.37; P<.001) as well as hyposmia (OR 1.74, 95% CI 1.34-2.26; P<.001) were more frequently reported in long-haulers than in non-long-haulers. Furthermore, a significant relationship was found between long-hauler status and sentiment of self-report (P<.001). Finally, we found specific keywords that were more typical for long-haulers than those for non-long-haulers, for example, fire, gas, wine, and vinegar. CONCLUSIONS Our work shows consistent findings with those of previous studies, which indicate that self-reports, which can easily be extracted online, may offer valuable information to health care and understanding of smell disorders. At the same time, our study on self-reports provides new insights for future studies investigating smell disorders.
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Affiliation(s)
- Nick S Menger
- Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Arnaud Tognetti
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Centre d'Economie de l'Environnement Montpellier, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture l'Alimentation et l'Environnement, Institut Agro, Université de Montpellier, Montpellier, France
| | - Michael C Farruggia
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT, United States
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Keiland W Cooper
- Department of Neurobiology and Behavior, University of California, Irvine, CA, United States
| | - Paloma Rohlfs Domínguez
- Department of Developmental and Educational Psychology, University of Basque Country, Leioa, Spain
| | - Thomas Heinbockel
- Department of Anatomy, Howard University College of Medicine, Washington, DC, United States
| | - Vonnie D C Shields
- Biological Sciences Department, Fisher College of Science and Mathematics, Towson University, Towson, MD, United States
| | - Anna D'Errico
- Goethe University of Frankfurt, Frankfurt am Main, Germany
| | | | - Denis Pierron
- Laboratoire Évolution et Santé Orale, Université Toulouse III, Toulouse, France
| | - Sachiko Koyama
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Ilja Croijmans
- Language and Communication Department, Faculty of Arts, Radboud University, Nijmegen, Netherlands
- Centre for Language Studies, Radboud University, Nijmegen, Netherlands
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Ioakeim-Ioannidou M, Daartz J, Erfani P, Urell T, Lalonde A, Berv J, Leahy S, Fullerton B, Bolton R, Yock T, Tarbell N, Yeap B, MacDonald SM. Phantosmia during proton radiation and differences in frequency of phantosmia rates based on proton craniospinal irradiation technique for pediatric brain tumor patients. Pediatr Blood Cancer 2024; 71:e30927. [PMID: 38421306 DOI: 10.1002/pbc.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Unusual olfactory perception, often referred to as "phantosmia" or "cacosmia" has been reported during brain radiotherapy (RT), but is infrequent and does not typically interfere with the ability to deliver treatment. We seek to determine the rate of phantosmia for patients treated with proton craniospinal irradiation (CSI) and identify any potential clinical or treatment-related associations. METHODS We performed a retrospective review of 127 pediatric patients treated with CSI, followed by a boost to the brain for primary brain tumors in a single institution between 2016 and 2021. Proton CSI was delivered with passive scattering (PS) proton technique (n = 53) or pencil beam scanning technique (PBS) (n = 74). Within the PBS group, treatment delivery to the CSI utilized a single posterior (PA) field (n = 24) or two posterior oblique fields (n = 50). We collected data on phantom smell, nausea/vomiting, and the use of medical intervention. RESULTS Our cohort included 80 males and 47 females. The median age of patients was 10 years (range: 3-21). Seventy-one patients (56%) received concurrent chemotherapy. During RT, 104 patients (82%) developed worsening nausea, while 63 patients (50%) reported episodes of emesis. Of those patients who were awake during CSI (n = 59), 17 (29%) reported phantosmia. In the non-sedated group, we found a higher rate of phantosmia in patients treated with PBS (n = 16, 42%) than PS (n = 1, 4.7%) (p = .002). Seventy-eight patients (61%) required medical intervention after developing nausea/vomiting or phantosmia during RT. Two patients required sedation due to the malodorous smell during CSI. We did not find any significant difference in nausea/vomiting based on treatment technique. CONCLUSION Proton technique significantly influenced olfactory perception with greater rates of phantosmia with PBS compared to PS. Prospective studies should be performed to determine the cause of these findings and determine techniques to minimize phantosmia during radiation therapy.
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Affiliation(s)
- Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parsa Erfani
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Urell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Lalonde
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Julia Berv
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shannon Leahy
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Fullerton
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Bolton
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torunn Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Beow Yeap
- Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Liu ZY, Vaira LA, Boscolo-Rizzo P, Walker A, Hopkins C. Post-viral olfactory loss and parosmia. BMJ MEDICINE 2023; 2:e000382. [PMID: 37841969 PMCID: PMC10568123 DOI: 10.1136/bmjmed-2022-000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/26/2023] [Indexed: 10/17/2023]
Abstract
The emergence of SARS-CoV-2 has brought olfactory dysfunction to the forefront of public awareness, because up to half of infected individuals could develop olfactory dysfunction. Loss of smell-which can be partial or total-in itself is debilitating, but the distortion of sense of smell (parosmia) that can occur as a consequence of a viral upper respiratory tract infection (either alongside a reduction in sense of smell or as a solo symptom) can be very distressing for patients. Incidence of olfactory loss after SARS-CoV-2 infection has been estimated by meta-analysis to be around 50%, with more than one in three who will subsequently report parosmia. While early loss of sense of smell is thought to be due to infection of the supporting cells of the olfactory epithelium, the underlying mechanisms of persistant loss and parosmia remain less clear. Depletion of olfactory sensory neurones, chronic inflammatory infiltrates, and downregulation of receptor expression are thought to contribute. There are few effective therapeutic options, so support and olfactory training are essential. Further research is required before strong recommendations can be made to support treatment with steroids, supplements, or interventions applied topically or injected into the olfactory epithelium in terms of improving recovery of quantitative olfactory function. It is not yet known whether these treatments will also achieve comparable improvements in parosmia. This article aims to contextualise parosmia in the setting of post-viral olfactory dysfunction, explore some of the putative molecular mechanisms, and review some of the treatment options available.
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Affiliation(s)
- Zhen Yu Liu
- Department of ENT Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luigi Angelo Vaira
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Sardegna, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Abigail Walker
- Department of ENT, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Hernandez AK, Landis BN, Altundag A, Fjaeldstad AW, Gane S, Holbrook EH, Huart C, Konstantinidis I, Lechner M, Macchi A, Portillo Mazal P, Miwa T, Philpott CM, Pinto JM, Poletti SC, Vodicka J, Welge-Luessen A, Whitcroft KL, Hummel T. Olfactory Nomenclature: An Orchestrated Effort to Clarify Terms and Definitions of Dysosmia, Anosmia, Hyposmia, Normosmia, Hyperosmia, Olfactory Intolerance, Parosmia, and Phantosmia/Olfactory Hallucination. ORL J Otorhinolaryngol Relat Spec 2023; 85:312-320. [PMID: 37062268 PMCID: PMC10711772 DOI: 10.1159/000530211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/10/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Definitions are essential for effective communication and discourse, particularly in science. They allow the shared understanding of a thought or idea, generalization of knowledge, and comparison across scientific investigation. The current terms describing olfactory dysfunction are vague and overlapping. SUMMARY As a group of clinical olfactory researchers, we propose the standardization of the terms "dysosmia," "anosmia," "hyposmia," "normosmia," "hyperosmia," "olfactory intolerance," "parosmia," and "phantosmia" (or "olfactory hallucination") in olfaction-related communication, with specific definitions in this text. KEY MESSAGES The words included in this paper were determined as those which are most frequently used in the context of olfactory function and dysfunction, in both clinical and research settings. Despite widespread use in publications, however, there still exists some disagreement in the literature regarding the definitions of terms related to olfaction. Multiple overlapping and imprecise terms that are currently in use are confusing and hinder clarity and universal understanding of these concepts. There is a pressing need to have a unified agreement on the definitions of these olfactory terms by researchers working in the field of chemosensory sciences. With the increased interest in olfaction, precise use of these terms will improve the ability to integrate and advance knowledge in this field.
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Affiliation(s)
- Anna Kristina Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Otolaryngology – Head and Neck Surgery, Philippine General Hospital, University of the Philippines – Manila, Manila, Philippines
- Department of Otolaryngology – Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
| | - Basile N. Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospital of Geneva, Geneva, Switzerland
| | - Aytug Altundag
- Department of Otolaryngology, Head and Neck Surgery, Biruni University Medical School, Istanbul, Turkey
| | - Alexander Wieck Fjaeldstad
- Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
- Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Simon Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Eric H. Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Iordanis Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matt Lechner
- Division of Surgery and Interventional Science, University College London, London, UK
- UCL Cancer Institute, University College London, London, UK
- ENT Department, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alberto Macchi
- ENT Clinic, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Patricia Portillo Mazal
- Servicio de Otorrinolaringología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Takaki Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Japan
| | - Carl M. Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- The Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Sophia C. Poletti
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Antje Welge-Luessen
- Department of Otorhinolaryngology, University Hospital Basel, Basel, Switzerland
| | - Katherine L. Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Hummel T, T. Liu D, A. Müller C, A. Stuck B, Welge-Lüssen A, Hähner A. Olfactory Dysfunction: Etiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:146-154. [PMID: 36647581 PMCID: PMC10198165 DOI: 10.3238/arztebl.m2022.0411] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/03/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Disorders of the sense of smell have received greater attention because of the frequency with which they occur as a symptom of SARS-CoV-2 infection. Olfactory dysfunction can lead to profound reduction in quality of life and may arise from many different causes. METHODS A selective literature review was conducted with consideration of the current version of the guideline issued by the Association of the Scientific Medical Societies in Germany. RESULTS The cornerstones of diagnosis are the relevant medical history and psychophysical testing of olfactory function using standardized validated tests. Modern treatment strategies are oriented on the cause of the dysfunction. While treatment of the underlying inflammation takes precedence in patients with sinunasal dysosmia, olfactory training is the primary treatment option for other forms of the disorder. The prognosis is determined not only by the cause of the olfactory dysfunction and the patient's age, but also by the olfactory performance as measured at the time of diagnosis. CONCLUSION Options for the treatment of olfactory dysfunction are available but limited, depending on the cause. It is therefore important to carry out a detailed diagnostic work-up and keep the patient informed of the expected course and prognosis.
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Affiliation(s)
- Thomas Hummel
- Interdisciplinary Center for Smell and Taste, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - David T. Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna General Hospital, Austria
| | - Christian A. Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna General Hospital, Austria
| | - Boris A. Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, Giessen and Marburg University Hospital Ltd., Marburg
| | - Antje Welge-Lüssen
- Interdisciplinary Center for Smell and Taste, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Antje Hähner
- Department of Otorhinolaryngology, Basel University Hospital, Switzerland
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Garden EM, Kumaresan K, Clark A, Philpott CM. Olfactory Disorders Questionnaire: Scaling severity of quality-of-life impact. Clin Otolaryngol 2023; 48:206-212. [PMID: 36537763 DOI: 10.1111/coa.14017] [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: 08/26/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Olfactory Disorders Questionnaire (ODQ) is widely used for patients suffering from olfactory disorders to depict the impact on quality of life. The aim of this study was to scale and produce reference values for patients ODQ score according to Becks Depression Inventory (BDI) severity. METHODS In this prospective study, a cross-sectional anonymous survey was created, which combined EQ-5D-5L, BDI and ODQ. Correlation was calculated between the three questionnaires. Receiver operator characteristic curves were created to produce cut-off values for ODQ scores based on three BDI categories (mild, borderline clinical and moderate-to-severe depression). RESULTS Of the 578 who responded to the survey, 445 completed all sections and were included in the study. Majority were female (n = 327,73.5%), median age group 55-70 years (n = 193,43.4%). There was a strong correlation between BDI score and total ODQ score. There was a clear gradient in total ODQ score for each BDI classification; those with mild depression had the lowest mean ODQ score (101.8, range 39-168), those with moderate-to-severe depression had the highest (138.24, range 74-177). Due to overlapping of confidence intervals we were unable to grade the ODQ score. CONCLUSION The study was unable to generate reference values for the ODQ due to lower numbers of patients with borderline clinical to extreme depression. However, we were able to appreciate the general trend, that the higher the ODQ score, the higher the risk of depression. These findings should guide clinical practice to ensure appropriate care and support is provided for those with olfactory dysfunction.
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Affiliation(s)
- Elizabeth Mairenn Garden
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - Kala Kumaresan
- Norwich Medical School, University of East Anglia, Norwich, UK.,The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Carl Martin Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.,The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norwich, UK.,Fifth Sense, Barrow-in-Furness, UK
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8
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Magnetic resonance imaging findings in patients with idiopathic olfactory dysfunction and normal findings on nasoendoscopy. J Laryngol Otol 2023; 137:85-88. [PMID: 35445651 PMCID: PMC9834702 DOI: 10.1017/s0022215122000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In presentations of anosmia or dysosmia, magnetic resonance imaging may be required to screen for intracranial pathology such as olfactory neuroblastomas and other intracranial masses impacting on the olfactory pathway. This study aimed to establish positive magnetic resonance imaging findings of anosmia or dysosmia for scans performed before the coronavirus disease 2019 pandemic. METHODS The study examined the outcome of patients who presented with isolated olfactory dysfunction and who underwent magnetic resonance imaging between 2015 and 2019. RESULTS Of the 131 patients, 41 (31.3 per cent) had normal scan findings, 50 (38.2 per cent) had insignificant paranasal mucosal disease and 6 (4.6 per cent) had mucosal thickening significant enough to require additional intervention. These interventions included repeat nasoendoscopy or commencement of intranasal or oral steroids. No patients had olfactory neuroblastoma. CONCLUSION Only 4.6 per cent of the magnetic resonance imaging scans revealed abnormal findings related to anosmia or dysosmia, and none required ENT surgical intervention. None of the magnetic resonance imaging scans identified an olfactory neuroblastoma or intracranial masses impacting on the olfactory pathway.
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Carlisle TC, Birlea M, Restrepo D, Filley CM. Headache-Associated Phantosmia as a Harbinger of Lewy Body Dementia. J Neuropsychiatry Clin Neurosci 2022; 35:92-97. [PMID: 35989571 PMCID: PMC11022529 DOI: 10.1176/appi.neuropsych.21110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Olfactory hallucinations, or phantosmias, can occur in many neurological, psychiatric, and medical conditions, but no widely used standardized approach exists to comprehensively assess qualitative olfactory dysfunction in the clinical setting. Additionally, medical professionals, patients, and their family members may not recognize phantosmia as a potentially neurological problem. Given the many possible etiologies for symptomatic phantosmia, it is important to recognize this unusual presentation and elicit a meaningful history to explore the potential underlying cause. We describe a 77-year-old gentleman with a two-year history of headaches accompanied by smelling a foul odor and discuss the differential diagnosis for new onset and persistent phantosmia. This unusual case ultimately manifested features consistent with Lewy body dementia, highlighting the varied clinical presentations that are possible with this neurodegenerative disorder. We discuss the possible pathophysiology of phantosmia in Lewy body disorders, including a proposed mechanism for olfactory hallucinations arising prior to the typical well-formed hallucinations in Lewy body dementia.
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Affiliation(s)
- Tara C Carlisle
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Marius Birlea
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Diego Restrepo
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Christopher M Filley
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
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10
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Olfactory and gustatory disorders in COVID-19. ALLERGO JOURNAL INTERNATIONAL 2022; 31:243-250. [PMID: 35755859 PMCID: PMC9208356 DOI: 10.1007/s40629-022-00216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/28/2022] [Indexed: 12/05/2022]
Abstract
Loss of olfaction is one of the symptoms most commonly reported by patients with coronavirus disease 2019 (COVID-19). Although the spontaneous recovery rate is high, recent studies have shown that up to 7% of patients remain anosmic for more than 12 months after the onset of infection, leaving millions of people worldwide suffering from severe olfactory impairment. Olfactory training remains the first recommended treatment. With the continued lack of approved drug treatments, new therapeutic options are being explored. This article reviews the current state of science on COVID-19-related olfactory disorders, focusing on epidemiology, pathophysiology, cure rates, currently available treatment options, and research on new treatments.
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Insights into the molecular triggers of parosmia based on gas chromatography olfactometry. COMMUNICATIONS MEDICINE 2022; 2:58. [PMID: 35647609 PMCID: PMC9130211 DOI: 10.1038/s43856-022-00112-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Parosmia is a debilitating condition in which familiar smells become distorted and disgusting, with consequences for diet and mental health. It is a feature of post-infectious olfactory loss, particularly resulting from COVID-19. There is currently little understanding of its pathophysiology, and the prevailing hypothesis for the underlying mechanism is aberrant growth of regenerating olfactory sensory neurons after damage. Methods We use gas-chromatograph olfactometry to individually present components of a complex olfactory mixture as a rapid screening tool for assessment of both quantitative and qualitative olfactory dysfunction in those with and without parosmia. This allows them to report the associated sensory effects and to identify those molecules which are altered or parosmic in nature. Results Here we show 15 different molecular triggers of this symptom. These trigger molecules are common to many in the parosmic volunteer group and share certain characteristics such as extremely low olfactory threshold and common molecular structure Conclusions We posit that specific highly odour-active molecules are the cause of the parosmic symptom in most cases and initiate the sense of disgust, suggesting that parosmia is, at least in part, a receptor-level phenomenon. Parker et al. determine the aroma compounds responsible for the distortions experienced by those with the olfactory disorder parosmia, by applying a technique normally used in flavour chemistry, GC-Olfactometry. The authors show that a group of 15 highly odour-active compounds are common triggers of distortion and individually elicit the perception of disgust. During the recovery from smell loss, caused by infection or injury, sometimes certain smells can become revolting – a condition called parosmia. We used a technique that separates out the chemicals that make up the smell of instant coffee and let several people with parosmia after infection smell them one at a time. Most of these people picked out the same chemicals as smelling disgusting and setting off their parosmia. These chemicals are known to have strong smells to humans and can be grouped into four classes based on their chemical shape and the elements they contain. These findings help in the understanding of what chemical compounds trigger parosmia, which may help in developing diagnostics and therapies for this condition in the future.
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12
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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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Jiang X, Yuan Y, Li Z, Ou Y, Li Z. First-episode olfactory hallucination in a patient with anxiety disorder: A case report. Front Psychiatry 2022; 13:990341. [PMID: 36203838 PMCID: PMC9530368 DOI: 10.3389/fpsyt.2022.990341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Olfactory hallucination refers to olfactory perception in the absence of chemical stimuli. Although it has been associated with many neurological and psychotic disorders, it has rarely been reported as the first and only symptom in patients with anxiety disorder, and its treatment remains inadequate. CASE SUMMARY A 66-year-old woman who had been experiencing gradually worsening olfactory hallucinations for almost 4 years was diagnosed with generalized anxiety disorder. Olfactory hallucination disappeared after treatment with anti-anxiety drugs. CONCLUSION Olfactory hallucination can be the first and only symptom in patients with anxiety disorder and may be effectively treated with anti-anxiety medication. In fact, it can precede the diagnosis of anxiety disorder by several years.
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Affiliation(s)
- Xingmei Jiang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yiwen Yuan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Ying Ou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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14
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Klimek L, Hagemann J, Döge J, Koll L, Cuevas M, Klimek F, Hummel T. Störungen des Riech- und Schmeckvermögens bei COVID-19. ALLERGO JOURNAL 2022; 31:35-43. [PMCID: PMC9618349 DOI: 10.1007/s15007-022-5602-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] [Indexed: 11/06/2022]
Abstract
Der Verlust des Riechvermögens ist eines der Symptome, die von Patienten mit COVID-19 mit am häufigsten angegeben werden. Obwohl die Spontanheilungsrate hoch ist, haben neuere Studien gezeigt, dass bis zu 7 % der Patienten mehr als zwölf Monate nach Beginn der Infektion anosmisch bleiben, sodass weltweit Millionen von Menschen unter schweren Riechstörungen leiden. Riechtraining ist nach wie vor die erste empfohlene Behandlungsform. Angesichts weiterhin fehlender zugelassener medikamentöser Behandlungsmöglichkeiten werden neue therapeutische Optionen erforscht. Dieser Artikel gibt einen Überblick über den aktuellen Stand der Wissenschaft zu COVID-19-bedingten Riechstörungen, wobei der Schwerpunkt auf der Epidemiologie, der Pathophysiologie, den Heilungsraten, den derzeit verfügbaren Behandlungsmöglichkeiten und der Forschung zu neuen Behandlungsmethoden liegt. Zitierweise: Klimek L, Hagemann J, Döge J, Freudelsperger L, Cuevas M, Klimek F, Hummel T. Olfactory and gustatory disorders in COVID-19. Allergo J Int 2022;31:243-50 https://doi.org/10.1007/s40629-022-00216-7
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Affiliation(s)
- Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Jan Hagemann
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Julia Döge
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Laura Koll
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| | - Mandy Cuevas
- Klinik u. Poliklinik für Hals- Nasen- und Ohrenheilkunde, Univ.-Klinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Felix Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Thomas Hummel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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15
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Allensworth JJ, Schlosser RJ, Smith TL, Mace JC, Soler ZM. Use of the diet history questionnaire III to determine the impact of dysosmia on dietary quality. Int Forum Allergy Rhinol 2021; 12:849-858. [PMID: 34762776 DOI: 10.1002/alr.22926] [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: 08/27/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysosmia could alter dietary quality through mechanisms including changes in appetite, food choice, and subsequent nutritional intake. However, there are few studies which directly assess olfactory performance and dietary quality. In this pilot study, we aimed to measure dietary quality in dysosmic subjects compared with normosmic controls. METHODS Community dwelling adult subjects prospectively underwent olfactory testing using the Sniffin' Sticks Test from which composite threshold, discrimination and identification (TDI) scores were used to identify dysosmic subjects (TDI < 31) and normosmic controls (TDI ≥31). Subjects completed the Diet History Questionnaire III (DHQIII), a standardized and validated tool for nutritional assessment developed by the National Institutes of Health. The Healthy Eating Index (HEI) was calculated to determine compliance with the United States Dietary Guidelines for Americans. RESULTS Sixty patients were enrolled, including 29 dysosmic subjects and 31 normosmic controls with no difference in age or gender across groups. A significant correlation between TDI score and HEI component score was seen for protein (r = 0.256; p = 0.048), dairy (r = 0.285; p = 0.027), and saturated fat scores (r = -0.262; p = 0.043). Compared with normosmic controls, dysosmic subjects were found to have less total protein and total dairy intake, as well as less total saturated fat intake. CONCLUSIONS This study found significantly altered nutritional quality in subjects with reduced olfactory function, including decreased intake of protein, dairy and saturated fats. These findings are relevant given the high prevalence of dysosmia in the aging population and previous studies showing associations with mortality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jordan J Allensworth
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR
| | - Zachary M Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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16
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Ivona JA, Cortés Vega Y. COVID-19-Associated Parosmia and Dysgeusia: A Case Series. Cureus 2021; 13:e17584. [PMID: 34646638 PMCID: PMC8481294 DOI: 10.7759/cureus.17584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
Impairment of the chemical senses - smell, taste, and chemesthesis - has been pinpointed as one of the main clinical presentations of coronavirus disease 2019 (COVID-19). Chemosensory dysfunction can be quantitative, involving reduction or loss of perception (e.g., hyposmia, anosmia, hypogeusia), and qualitative, involving distortion of perception (parosmia and dysgeusia). Quantitative chemosensory dysfunction is reported more often among COVID-19 patients than qualitative dysfunction. The following report details four patients with a laboratory-assisted diagnosis of COVID-19 who experienced qualitative chemosensory dysfunction. A discussion of these symptoms in the broader context of upper respiratory tract infections is included, with an emphasis on olfactory dysfunction.
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17
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Olfactory hallucinations in a population-based sample. Psychiatry Res 2021; 304:114117. [PMID: 34391204 DOI: 10.1016/j.psychres.2021.114117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Olfactory hallucinations referring to olfactory perceptions in the absence of chemical stimuli, occur in non-clinical and clinical populations. Few studies have investigated their prevalence in the general population and little is known about factors triggering and maintaining them such as substance use, severe life events, and mood. We analyzed self-report data from 2500 community dwelling Norwegians, aged 18-96 years, for occurrence of olfactory hallucinations and co-occurring hallucinations in other modalities (auditory, visual, tactile). Analyses included age, sex, self-reported symptoms of depression and anxiety, mental health status, and experience of severe life-events. The results show that 4.2% (95% CI 3.5-5.1%) reported having experienced olfactory hallucinations, and 56% of individuals experiencing olfactory hallucinations also reported these in combination with hallucinations in other modalities. Prevalence varied significantly in terms of age and sex, in that olfactory hallucinations were most frequently reported by young individuals and females. Self-reported symptoms of anxiety and experience of stressful life events were significantly associated with olfactory hallucinations, suggesting that experiencing olfactory hallucinations may negatively affect functioning and may increase the likelihood of developing psychopathology. Findings underline the need to continue to examine olfactory hallucinations albeit with a more comprehensive assessment in order to increase knowledge on this experience.
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Philpott C, Dixon J, Boak D. Qualitative Olfactory Disorders: Patient Experiences and Self-Management. ALLERGY & RHINOLOGY 2021; 12:21526567211004251. [PMID: 34589267 PMCID: PMC8474348 DOI: 10.1177/21526567211004251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Qualitative olfactory disorders in the form of parosmia and phantosmia are
very subjective and cannot be measured at present. They pose an unpleasant
experience for patients and a therapeutic challenge for clinicians. Objective This study aimed to characterise the specific experiences of patients
affected by the qualitative symptoms of parosmia and phantosmia including
both triggers for symptoms and self-help measures they have tried. Methods A cross-sectional survey questionnaire was developed with the input of
patient experts within the charity Fifth Sense. The survey was then open
online for 3 months to charity members complaining of qualitative symptoms.
The survey captured the frequency and impact of symptoms and self-management
undertaken. Reflective feedback was also captured from a patient
workshop. Results There were 100 participants; 61% female, age range 13-88. Common
self-reported aetiology included sinonasal disease (17%), idiopathic (33%)
and post-viral olfactory loss (26%) and post-traumatic olfactory loss (23%).
Parosmia was reported as a daily symptom in 67% compared to 31% for
phantosmia; 36% complained of suffering with both symptoms. Only 4% of
respondents reported having received any successful treatment for their
qualitative symptoms and 58% reported having received no treatment
whatsoever. Olfactory training was the most common self-management method
reported. Conclusion This study illustrates that qualitative disturbances remain problematic for
those who experience them due to the duration of symptoms, the relative lack
of experience or knowledge amongst medical professionals and the lack of
therapeutic options. In future, consideration needs to be given to
adaptation and coping strategies to help patients deal with these
symptoms.
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Affiliation(s)
- Carl Philpott
- The Norfolk Smell & Taste Clinic, James Paget University Hospital, Gorleston, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,Fifth Sense, Barrow-on-Furness, Cumbria, UK
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19
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Pellegrino R, Mainland JD, Kelly CE, Parker JK, Hummel T. Prevalence and correlates of parosmia and phantosmia among smell disorders. Chem Senses 2021; 46:bjab046. [PMID: 34698820 PMCID: PMC8633731 DOI: 10.1093/chemse/bjab046] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Among those many individuals who experience a reduced odor sensitivity (hyposmia/anosmia), some individuals also have disorders that lead to odor distortion, such as parosmia (i.e. distorted odor with a known source), or odor phantoms (i.e. odor sensation without an odor source). We surveyed a large population with at least one olfactory disorder (N = 2031) and found that odor distortions were common (46%), with respondents reporting either parosmia (19%), phantosmia (11%), or both (16%). In comparison to respondents with hyposmia or anosmia, respondents with parosmia were more likely to be female, young, and suffering from post-viral olfactory loss (P < 0.001), while respondents with phantosmia were more likely to be middle-aged (P < 0.01) and experiencing symptoms caused by head trauma (P < 0.01). In addition, parosmia, compared to phantosmia or anosmia/hyposmia, was most prevalent 3 months to a year after olfactory symptom onset (P < 0.001), which coincides with the timeline of physiological recovery. Finally, we observed that the frequency and duration of distortions negatively affects the quality of life, with parosmia showing a higher range of severity than phantosmia (P < 0.001). Previous research often grouped these distortions together, but our results show that they have distinct patterns of demographics, medical history, and loss in quality of life.
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Affiliation(s)
- Robert Pellegrino
- Monell Chemical Senses Center, Philadelphia, PA, USA
- Department of Food Science, University of Tennessee, Knoxville, TN, USA
| | - Joel D Mainland
- Monell Chemical Senses Center, Philadelphia, PA, USA
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jane K Parker
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, UK
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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20
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Ciurleo R, De Salvo S, Bonanno L, Marino S, Bramanti P, Caminiti F. Parosmia and Neurological Disorders: A Neglected Association. Front Neurol 2020; 11:543275. [PMID: 33240192 PMCID: PMC7681001 DOI: 10.3389/fneur.2020.543275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
Parosmia is a distorted olfactory sensation in the presence of an odor. This olfactory disorder can affect the quality of life of most patients who experience it. Qualitative olfactory dysfunctions, such as parosmia and phantosmia, may be clinical conditions secondary to neurological diseases. The incidence of parosmia is underestimated, as well as its association with neurological diseases, due to poor self-reporting of patients and lack of objective methods for its measure. In this paper, we show selected clinical cases of parosmia associated with neurological disorders, such as traumatic brain injury and multiple sclerosis. These clinical cases show how the correct diagnosis of parosmia can represent the tip of the iceberg of important underlying neurological disorders and be a good prognostic indicator of their progression or recovery.
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Affiliation(s)
- Rosella Ciurleo
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Simona De Salvo
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Lilla Bonanno
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Silvia Marino
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Placido Bramanti
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Fabrizia Caminiti
- Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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21
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Assessment of odor hedonic perception: the Sniffin' sticks parosmia test (SSParoT). Sci Rep 2020; 10:18019. [PMID: 33093474 PMCID: PMC7581750 DOI: 10.1038/s41598-020-74967-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
Qualitative olfactory dysfunction is characterized as distorted odor perception and can have a profound effect on quality of life of affected individuals. Parosmia and phantosmia represent the two main subgroups of qualitative impairment and are currently diagnosed based on patient history only. We have developed a test method which measures qualitative olfactory function based on the odors of the Sniffin’ Sticks Identification subtest. The newly developed test is called Sniffin’ Sticks Parosmia Test (SSParoT). SSParoT uses hedonic estimates of two oppositely valenced odors (pleasant and unpleasant) to assess hedonic range (HR) and hedonic direction (HD), which represent qualitative olfactory perception. HR is defined as the perceivable hedonic distance between two oppositely valenced odors, while HD serves as an indicator for overall hedonic perception of odors. This multicenter study enrolled a total of 162 normosmic subjects in four consecutive experiments. Cluster analysis was used to group odors from the 16-item Sniffin’ Sticks Identification test and 24-additional odors into clusters with distinct hedonic properties. Eleven odor pairs were found to be suitable for estimation of HR and HD. Analysis showed agreement between test–retest sessions for all odor pairs. SSparoT might emerge as a valuable tool to assess qualitative olfactory function in health and disease.
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22
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Parma V, Ohla K, Veldhuizen MG, Niv MY, Kelly CE, Bakke AJ, Cooper KW, Bouysset C, Pirastu N, Dibattista M, Kaur R, Liuzza MT, Pepino MY, Schöpf V, Pereda-Loth V, Olsson SB, Gerkin RC, Rohlfs Domínguez P, Albayay J, Farruggia MC, Bhutani S, Fjaeldstad AW, Kumar R, Menini A, Bensafi M, Sandell M, Konstantinidis I, Di Pizio A, Genovese F, Öztürk L, Thomas-Danguin T, Frasnelli J, Boesveldt S, Saatci Ö, Saraiva LR, Lin C, Golebiowski J, Hwang LD, Ozdener MH, Guàrdia MD, Laudamiel C, Ritchie M, Havlícek J, Pierron D, Roura E, Navarro M, Nolden AA, Lim J, Whitcroft KL, Colquitt LR, Ferdenzi C, Brindha EV, Altundag A, Macchi A, Nunez-Parra A, Patel ZM, Fiorucci S, Philpott CM, Smith BC, Lundström JN, Mucignat C, Parker JK, van den Brink M, Schmuker M, Fischmeister FPS, Heinbockel T, Shields VDC, Faraji F, Santamaría E, Fredborg WEA, Morini G, Olofsson JK, Jalessi M, Karni N, D'Errico A, Alizadeh R, Pellegrino R, Meyer P, Huart C, Chen B, Soler GM, Alwashahi MK, Welge-Lüssen A, Freiherr J, de Groot JHB, Klein H, Okamoto M, Singh PB, Hsieh JW, Reed DR, Hummel T, Munger SD, Hayes JE. More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis. Chem Senses 2020; 45:609-622. [PMID: 32564071 PMCID: PMC7337664 DOI: 10.1093/chemse/bjaa041] [Citation(s) in RCA: 317] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± SD), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.
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Affiliation(s)
- Valentina Parma
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Kathrin Ohla
- Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Wilhelm-Johnen-Straße, Jülich, Germany
| | - Maria G Veldhuizen
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Masha Y Niv
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Alyssa J Bakke
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
| | - Keiland W Cooper
- Center for the Neurobiology of Learning and Memory, University of California and Qureshey Research Laboratory, Irvine, CA, USA
| | - Cédric Bouysset
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK
| | - Michele Dibattista
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, Università degli Studi di Bari A. Moro, P.zza G. Cesare, Bari, Italy
| | - Rishemjit Kaur
- CSIR-Central Scientific Instruments Organisation, Chandigarh, India
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Marta Y Pepino
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel, Vienna, Austria
| | - Veronica Pereda-Loth
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthese, UMR 5288 CNRS, Universitéde Toulouse, Toulouse, France
| | - Shannon B Olsson
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, GKVK Campus, Bengaluru, India
| | - Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Paloma Rohlfs Domínguez
- Department of Psychology and Anthropology, University of Extremadura, Avenida de la Universidad, s/n, Cáceres, Spain
| | - Javier Albayay
- Department of General Psychology, University of Padova, Via Venezia, Padova, Italy
| | - Michael C Farruggia
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego State University, San Diego, CA, USA
| | - Alexander W Fjaeldstad
- Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Central Denmark Region, Laegaardvej, Holstebro, Denmark
| | - Ritesh Kumar
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Anna Menini
- Neuroscience Area, International School for Advanced Studies, SISSA, Via Bonomea, Trieste, Italy
| | - Moustafa Bensafi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Mari Sandell
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.,Functional Foods Forum, University of Turku, Turku, Finland
| | | | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, Lise-Meitner-Str., Freising, Germany
| | | | - Lina Öztürk
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Thierry Thomas-Danguin
- CSGA-Centre for Taste and Feeding Behavior, INRAE, CNRS, AgroSup Dijon, Université Bourgogne Franche-Comté, 17 rue Sully, Dijon, France
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, boul. des Forges, Trois-Rivières, QC, Canada
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, the Netherlands
| | - Özlem Saatci
- Department of Otorhinolaryngology, Medical Science University, Emek, Sancaktepe-İstanbul, Turkey
| | - Luis R Saraiva
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Sidra Medicine, Out Patient Clinic, Doha, Qatar
| | - Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Jérôme Golebiowski
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Liang-Dar Hwang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | | | - Maria Dolors Guàrdia
- IRTA-Food Technology Programme, IRTA, Finca Camps i Armet, Monells, Girona, Spain
| | | | - Marina Ritchie
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Jan Havlícek
- Department of Zoology, Charles University, Viničná, Nové Město, Czechia
| | - Denis Pierron
- Équipe de Médecine Evolutive, UMR5288 CNRS/Université Toulouse III, faculté de chirurgie dentaire, 3 Chemin des Maraîchers, Toulouse, France
| | - Eugeni Roura
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Marta Navarro
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Alissa A Nolden
- Department of Food Science, University of Massachusetts, Holdsworth Way, Amherst, MA, USA
| | - Juyun Lim
- Department of Food Science and Technology, Oregon State University, Corvallis, OR, USA
| | | | | | - Camille Ferdenzi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Evelyn V Brindha
- Department of Electrical and Electronics Engineering, Karunya Institute of Technology and Sciences, Karunya Nagar, Coimbatore, Tamilnadu, India
| | - Aytug Altundag
- Otorhinolaryngology Department, Biruni University, Protokol Yolu, Topkapı, Zeytinburnu, Istanbul, Turkey
| | - Alberto Macchi
- Italian Academy of Rhinology Asst Settelaghi-University of Insubriae, via Guicciardini, Varese, Italy
| | - Alexia Nunez-Parra
- Department of Biology, Universidad de Chile, Las Palmeras, Santiago, Chile
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sébastien Fiorucci
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Carl M Philpott
- The Norfolk Smell and Taste Clinic, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Barry C Smith
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Johan N Lundström
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg, Stockholm, Sweden
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, via Marzolo, Padova, Italy
| | - Jane K Parker
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, UK
| | - Mirjam van den Brink
- Laboratory of Behavioural Gastronomy, Maastricht University Campus Venlo, Nassaustraat, BV Venlo, the Netherlands
| | - Michael Schmuker
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | | | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, N.W., Washington, DC, USA
| | - Vonnie D C Shields
- Biological Sciences Department, Fisher College of Science and Mathematics, Towson University, Towson, MD USA
| | - Farhoud Faraji
- Division of Otolaryngology, Head & Neck Surgery, University of California San Diego Health, MC La Jolla, CA, USA
| | - Enrique Santamaría
- Clinical Neuroproteomics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Proteored-ISCIII, Pamplona, Spain
| | - William E A Fredborg
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Gabriella Morini
- University of Gastronomic Sciences, Piazza Vittorio Emanuele II 9, Bra, Pollenzo, CN, Italy
| | - Jonas K Olofsson
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Rasoul Akram Hospital, Sattarkhan Ave., Tehran, Iran
| | - Noam Karni
- Internal Medicine Department, Hadassah Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Anna D'Errico
- Department of Molecular and Cellular Neurobiology, Goethe Universität Frankfurt, Goethe Universität Frankfurt, Max von Laue Strasse, Frankfurt am Main, Germany
| | - Rafieh Alizadeh
- ENT and Head and Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, Iran
| | - Robert Pellegrino
- Food Science Department, University of Tennessee, Knoxville, TN, USA
| | - Pablo Meyer
- Health Care and Life Sciences, IBM T. J. Watson Research Center, Yorktown Heights, NY, USA
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Ben Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Liwan District, Guangzhou City, China
| | - Graciela M Soler
- Department of Otorhinolaringology, Buenos Aires University and GEOG (Grupo de Estudio de Olfato y Gusto), Calle Paraguay, Piso 3. CABA (Ciudad Autónoma de Buenos Aires), Argentina
| | - Mohammed K Alwashahi
- Surgery Department, ENT Division, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Jessica Freiherr
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage, Erlangen, Germany
| | - Jasper H B de Groot
- Department of Psychology, Utrecht University, Heidelberglaan 1, CS Utrecht, The Netherlands
| | - Hadar Klein
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Masako Okamoto
- Department of Applied Biological Chemistry, The University of Tokyo, Yayoi, Bunkyo-ku, Tokyo, Japan
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Blindern, Oslo, Norway
| | - Julien W Hsieh
- Rhinology-Olfactology Unit, ENT Department, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | | | | | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Helmholtzstr., Dresden, Germany
| | - Steven D Munger
- Center for Smell and Taste, University of Florida, , Rm LG-101D, Gainesville, FL, USA.,Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - John E Hayes
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
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23
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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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24
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Lecuyer Giguere F, Jobin B, Robert J, Bastien L, Giguère JF, De Beaumont L, de Guise E, Frasnelli J. Early parosmia signs and affective states predicts depression and anxiety symptoms six months after a mild Traumatic Brain Injury. Chem Senses 2020; 45:bjaa037. [PMID: 32516412 DOI: 10.1093/chemse/bjaa037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Indexed: 02/28/2024] Open
Abstract
This longitudinal study aimed to evaluate qualitative (parosmia) and quantitative (hyposmia/anosmia) olfaction 2-4 weeks (baseline) and six months (follow-up) after a mild traumatic brain injury (mTBI). We further evaluated the predictive value of baseline depression, anxiety and olfaction scores on depression and anxiety at follow-up. At baseline, olfactory function and affective state were assessed in 107 participants (53 patients with mild TBI; 54 healthy controls). At follow-up, data were collected on 71 participants (32 patients, 39 controls). Both at baseline and follow-up, patients with mild TBI showed more signs of parosmia, depression and anxiety, compared to controls. However, patients did not, neither at baseline nor follow-up, show quantitative olfactory impairment. Moreover, while baseline scores of depression and anxiety helped predict the development of symptoms of depression and anxiety at follow up, adding parosmia scores to the prediction model significantly increased the amount of explained variances. Clinicians should implement affective and olfactory evaluation to predict patients' affective outcome.
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Affiliation(s)
- Fanny Lecuyer Giguere
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Québec, Canada
- Research Center, (CIUSSS-NIM), Montréal, Québec, Canada
| | - Benoit Jobin
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
- Research Center, (CIUSSS-NIM), Montréal, Québec, Canada
| | - Joëlle Robert
- Department of Psychology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Laurianne Bastien
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
- Research Center, (CIUSSS-NIM), Montréal, Québec, Canada
| | | | - Louis De Beaumont
- Research Center, (CIUSSS-NIM), Montréal, Québec, Canada
- Department of Surgery, University of Montréal, Montréal, Québec, Canada
| | - Elaine de Guise
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Québec, Canada
- Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
| | - Johannes Frasnelli
- Department of Psychology, University of Montréal, Montréal, Québec, Canada
- Research Center, (CIUSSS-NIM), Montréal, Québec, Canada
- Department of Anatomy, University of Québec in Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada
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25
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Pellegrino R, Cooper KW, Di Pizio A, Joseph PV, Bhutani S, Parma V. Corona Viruses and the Chemical Senses: Past, Present, and Future. Chem Senses 2020; 45:bjaa031. [PMID: 32407464 PMCID: PMC7239211 DOI: 10.1093/chemse/bjaa031] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
A wealth of rapidly evolving reports suggests that olfaction and taste disturbances may be manifestations of the novel COVID-19 pandemic. While otolaryngological societies worldwide have started to consider chemosensory evaluation as a screening tool for COVID-19 infection, the true nature of the relationship between the changes in chemosensory ability and COVID-19 is unclear. Our goal with this review is to provide a brief overview of published and archived literature, as well as the anecdotal reports and social trends related to this topic up to April 29, 2020. We also aim to draw parallels between the clinical/chemosensory symptomology reported in association to past coronavirus pandemics (such as SARS and MERS) and the novel COVID-19. This review also highlights current evidence on persistent chemosensory disturbances after the infection has resolved. Overall, our analysis pinpoints the need for further studies: 1) to better quantify olfaction and taste disturbances associated with SARS-CoV-2 infection, compared to those of other viral and respiratory infections, 2) to understand the relation between smell, taste, and chemesthesis disturbances in COVID-19, and 3) to understand how persistent are these disturbances after the infection has resolved.
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Affiliation(s)
- Robert Pellegrino
- Department of Food Science, Institute of Agriculture, University of Tennessee, Knoxville, TN, USA
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Keiland W Cooper
- Interdepartmental Neuroscience Program, University of California Irvine, Irvine (CA), USA
| | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, 85354 Freising, Germany
| | - Paule V Joseph
- Division of Intramural Research, National Institute of Nursing Research (NINR) & National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institutes of Health, Bethesda, MD, 20892, USA
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
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26
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Drareni K, Hummel T, Bensafi M, Serex CA, Hugentobler M, Rimmer J, Friedrich H, Voruz F, Terzic A, Landis BN. Olfactory and Gustatory Function in Patients With Different Types of Maxillofacial Trauma. Laryngoscope 2020; 131:E331-E337. [PMID: 32352171 DOI: 10.1002/lary.28701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate olfactory and gustatory function in patients with maxillofacial trauma and associated fractures. STUDY DESIGN Retrospective cohort study. METHODS Olfactory and gustatory function was assessed psychophysically in 124 patients who had sustained maxillofacial trauma with an associated fracture. Five groups were defined based on the fracture type: Le Fort, mandibular, nasal, orbital, and zygomatic. Olfaction was measured with Sniffin' Sticks (threshold, discrimination, identification [TDI] score) and gustation with the taste spray method. Patients self-rated olfactory and gustatory function on a visual analog scale prior to formal testing. RESULTS Ten out of 124 patients were found to be anosmic (8%), with half of them found in the Le Fort (skull base) group. The Le Fort fracture group had significantly lower olfactory function than other fracture types (TDI score = 22.4 ± 10.7; P = .01; possible range = 1-48). The mean gustatory spray test score was 3.82 ± 0.4 (possible range = 0-4) without any intergroup differences. Self-rated olfactory function showed a correlation with the measured scores (r = 0.61, P < .001) across all groups. CONCLUSIONS The present data show a significant effect of maxillofacial fracture type on the development of anosmia. Maxillofacial fractures involving the skull base, such as Le Fort fractures, are more likely to cause permanent smell loss, whereas the other fracture types are rarely associated with anosmia. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E331-E337, 2021.
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Affiliation(s)
- Kenza Drareni
- Smell and Taste Clinic, Department of Otorhinolaryngology, University Hospital Dresden, Dresden, Germany.,Lyon Neuroscience Research Center, French National Centre for Scientific Research, Joint Research Unit and University of Lyon I, Lyon, France
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, University Hospital Dresden, Dresden, Germany
| | - Moustafa Bensafi
- Lyon Neuroscience Research Center, French National Centre for Scientific Research, Joint Research Unit and University of Lyon I, Lyon, France
| | - Charles-Arnaud Serex
- Service of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva Medical School, Geneva, Switzerland.,Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Marianne Hugentobler
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Joanne Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Hergen Friedrich
- Division of Pediatric Otolaryngology, University Children's Hospital, Zurich, Switzerland
| | - François Voruz
- Service of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva Medical School, Geneva, Switzerland.,Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Andrej Terzic
- Service of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva Medical School, Geneva, Switzerland
| | - Basile N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospitals, Geneva, Switzerland
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Bainbridge KE, Byrd-Clark D, Leopold D. Factors Associated With Phantom Odor Perception Among US Adults: Findings From the National Health and Nutrition Examination Survey. JAMA Otolaryngol Head Neck Surg 2019; 144:807-814. [PMID: 30128498 DOI: 10.1001/jamaoto.2018.1446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data. Objective To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition. Design, Setting, and Participants In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey. Exposures Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status. Main Outcomes and Measures Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists. Results Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51). Conclusions and Relevance An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.
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Affiliation(s)
- Kathleen E Bainbridge
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
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Bainbridge KE, Byrd-Clark D. Phantom odor perception and vascular conditions among adults in the United States: National Health and Nutrition Examination Survey 2011-2014. Laryngoscope 2019; 130:332-337. [PMID: 30908686 DOI: 10.1002/lary.27936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Phantom odor perception has been correlated with burden of vascular risk among older adults. We evaluated associations between vascular conditions and phantom odor perception among adults in the United States. STUDY DESIGN Cross-sectional analysis. METHODS Cross-sectional data were collected as part of the 2011 to 2014 National Health and Nutrition Examination Survey, yielding a nationally representative sample of 7,417 adults aged 40 years and older. Phantom odor perception was defined as report of an unpleasant, bad, or burning odor when nothing is there. Participants reported on vascular conditions including history of stroke. Total cholesterol and glycated hemoglobinwere measured. High blood pressure was ascertained during an examination. RESULTS Stroke was associated with a 76% greater likelihood of phantom odor perception. Congestive heart failure and angina were associated with three times and 2.8 times the odds of phantom odor perception among adults 40 to 59 years and 60 years and older, respectively. Adults with diagnosed, but controlled, high cholesterol reported phantom odors more frequently than those without high cholesterol. Adults with diagnosed, but controlled, high blood pressure reported phantom odors more frequently than those without high blood pressure. We observed a threefold greater odds of phantom odor perception among adults aged 60 years and older with diabetes, but only among those who use both insulin and oral medications. CONCLUSIONS Stroke, angina, congestive heart failure, well-managed high blood pressure, and well-managed high cholesterol are associated with phantom odor perception. Vascular or metabolic conditions or their treatments may contribute to reporting of phantom odor perception. LEVEL OF EVIDENCE NA Laryngoscope, 130:332-337, 2020.
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Affiliation(s)
- Kathleen E Bainbridge
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
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29
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Schofield PW, Doty RL. The influence of head injury on olfactory and gustatory function. HANDBOOK OF CLINICAL NEUROLOGY 2019; 164:409-429. [PMID: 31604560 DOI: 10.1016/b978-0-444-63855-7.00023-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head injury, particularly that resulting in brain injury, is a significant public health concern. For example, annual incidence rates of traumatic brain injury, a common consequence of head injury, range from 54 to 60 million people worldwide, including 2.2-3.6 million people whose trauma is moderate to severe. Trauma to the face and brain, including blast injuries common in modern warfare, can result in alterations in the ability to both smell and taste. In the case of smell, these include total loss of function (anosmia), decreased sensitivity (hyposmia), alterations in odor quality (dysosmia), and hallucination (phantosmia). Although taste dysfunction, i.e., altered perception of such basic taste-bud-mediated sensations as sweet, sour, bitter, salty, and savory (umami), can be similarly influenced by head trauma, the effects are typically more subtle and less studied. The present review provides an up-to-date assessment of what is known about the impact of head injury on quantitative measures of taste and smell function, including the influences of severity, type of injury, location of insults, prognosis, and approaches to therapy.
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Affiliation(s)
- Peter W Schofield
- Neuropsychiatry Service, Hunter New England Local Health District and Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Richard L Doty
- Smell and Taste Center and Department of Otorhinolaryngology: Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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30
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Magliulo G, De Vincentiis M, Iannella G, Ciofalo A, Pasquariello B, Manno A, Angeletti D, Polimeni A. Olfactory evaluation in obstructive sleep apnoea patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:338-345. [PMID: 30197425 PMCID: PMC6146584 DOI: 10.14639/0392-100x-1981] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Abstract
The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin' Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition.
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Affiliation(s)
- G. Magliulo
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | | | - G. Iannella
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Ciofalo
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - B. Pasquariello
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Manno
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - D. Angeletti
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Polimeni
- Department of Oral and Maxillo Facial Sciences, University Sapienza, Rome, Italy
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31
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Doğan A, Bayar Muluk N, Şahan MH, Asal N, Inal M, Ergün U. Olfactory bulbus volume and olfactory sulcus depth in migraine patients: an MRI evaluation. Eur Arch Otorhinolaryngol 2018; 275:2005-2011. [DOI: 10.1007/s00405-018-5029-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/02/2018] [Indexed: 02/07/2023]
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32
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Saltagi MZ, Rabbani CC, Ting JY, Higgins TS. Management of long-lasting phantosmia: a systematic review. Int Forum Allergy Rhinol 2018; 8:790-796. [PMID: 29485754 DOI: 10.1002/alr.22108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Interest in the pathophysiology and management of phantom smells has increased rapidly over the last decade. A PubMed search for the term "phantosmia" demonstrated a near-doubling of articles published on phantosmia within the past 7 years. We aimed to systematically review the literature on the management of phantosmia. METHODS The PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990, using terms combined with pertinent Boolean search operators. We included articles evaluating management of phantosmia written in the English language, with original data and a minimum of 6 months of follow-up, on at least 2 patients and with well-defined and measurable outcomes. RESULTS A total of 2151 unique titles were returned upon the initial search. Of these, 146 abstracts were examined, yielding 7 articles meeting the inclusion criteria. All articles were predominantly level 4 evidence. One prospective level 3 study was included. The studies included a total of 96 patients, with follow-up ranging from 6 months to 11 years. Endpoints were primarily based on subjective patient responses. Management options included observation and medical and surgical therapy. Olfactory mucosa excision was the only surgical intervention studied, with short-term symptomatic improvement in 10 of 11 patients. Forty-one patients were treated medically, which included antipsychotic, antimigraine, and antiseizure medications, transcranial stimulation, and topical cocaine application. CONCLUSION Despite increasing interest in the treatment of phantosmia and reports of successful therapies, there remains a paucity of data and lack of consensus regarding optimal management of this difficult condition.
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Affiliation(s)
| | - Cyrus C Rabbani
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY.,Kentuckiana Ear, Nose & Throat, Louisville, KY
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33
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Ciofalo A, De Vincentiis M, Iannella G, Zambetti G, Giacomello P, Altissimi G, Greco A, Fusconi M, Pasquariello B, Magliulo G. Mild traumatic brain injury: evaluation of olfactory dysfunction and clinical–neurological characteristics. Brain Inj 2018; 32:550-556. [DOI: 10.1080/02699052.2018.1432074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrea Ciofalo
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Marco De Vincentiis
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Giannicola Iannella
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Giampietro Zambetti
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Paola Giacomello
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Giancarlo Altissimi
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Antonio Greco
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Massimo Fusconi
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Benedetta Pasquariello
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
- Department of Social Sciences and Economics, University “ Sapienza”, Rome, Italy
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34
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Sjölund S, Larsson M, Olofsson JK, Seubert J, Laukka EJ. Phantom Smells: Prevalence and Correlates in a Population-Based Sample of Older Adults. Chem Senses 2017; 42:309-318. [PMID: 28334095 PMCID: PMC5863552 DOI: 10.1093/chemse/bjx006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Loss of olfactory function is common in old age, but evidence regarding qualitative olfactory dysfunction in the general older population is scarce. The current study investigates the prevalence and correlates of phantom smell experiences (phantosmia) in a population-based study (Swedish National Study on Aging and Care in Kungsholmen [SNAC-K]) of Swedish adults (n = 2569) aged between 60 and 90 years. Phantosmia was assessed through a standardized interview and defined as reporting having experienced an odor percept in the absence of any stimuli in the surrounding environment that could emit the odor. The relationships between phantosmia and demographic, genetic, health-related, and behavioral variables were analyzed with hierarchical logistic regression analyses. The overall prevalence of phantom smells was 4.9%, and was associated with female gender, carrying the met allele of the BDNF gene, higher vascular risk burden, and reporting distorted smell sensations (parosmia). Olfactory dysfunction was, however, not related to phantosmia. The most frequently reported phantom smell was smoky/burnt. A novel finding was that some individuals reported phantom smells with an autobiographical connotation. The results from this study indicate that the prevalence of phantosmia in the general older population is not negligible and that some factors that are beneficial for preserved olfactory function, such as female gender and the BDNF met allele, are also associated with the occurrence of phantom smells.
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Affiliation(s)
- Sara Sjölund
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Maria Larsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Jonas K Olofsson
- Gösta Ekman's Laboratory, Department of Psychology, Stockholm University, Frescati Hagväg 9 A, 10691 Stockholm, Sweden
| | - Janina Seubert
- Department of Clinical Neuroscience, Psychology Division, Karolinska Institutet, Nobels väg 9, 17165 Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330 Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330 Stockholm, Sweden
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35
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Abstract
Olfactory loss is frequent. However, in public not many people complain of that, or they are even not (fully) aware of it. This indicates that it is possible to live a life without a sense of smell, albeit it is more dangerous, less pleasant, and food tastes much less interesting. Most common causes for smell loss are sinunasal disease (chronic rhinosinusitis with and without nasal polyps), acute infections of the upper airways, head trauma, and neurodegenerative disorders. In many people smell loss seems to be due to the aging process. Before treatment olfactory disorders are diagnosed according to cause with the medical history being a big portion of the diagnostic process. Olfactory disorders are in principle reversible, with a relatively high degree of spontaneous improvement in olfactory loss following infections of the upper respiratory tract. Medical treatment is according to cause. It also involves surgical approaches as well as conservative treatments including the use of corticosteroids, antibiotics, or smell training. Because today olfactory dysfunction seems to receive more attention than in previous years it can be expected that tomorrow we will have more specific and effective treatment options available.
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36
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Jion YI, Grosberg BM, Evans RW. Phantosmia and Migraine With and Without Headache. Headache 2016; 56:1494-1502. [DOI: 10.1111/head.12890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/03/2023]
Affiliation(s)
| | - Brian M. Grosberg
- Hartford Healthcare Headache Center; Wethersfield CT USA (B.M. Grosberg)
| | - Randolph W. Evans
- Department of Neurology; Baylor College of Medicine; Houston TX USA (R.W. Evans)
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37
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Caminiti F, De Salvo S, Nunnari D, Bramanti P, Ciurleo R, Granata F, Marino S. Effect of the antiepileptic therapy on olfactory disorders associated with mesial temporal sclerosis. Neurocase 2016; 22:357-61. [PMID: 27347726 DOI: 10.1080/13554794.2016.1176203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parosmia has been described in neurological disorders, including temporal epilepsy. We reported a case of parosmia associated with unilateral hyposmia and mesial temporal sclerosis. We assessed the olfactory function by using Sniffin' sticks test and olfactory event-related potentials (OERPs). The findings of unilateral deficit of identification associated with parosmia only in the side ipsilateral to mesial temporal sclerosis area, that involves temporal olfactory regions responsible for higher level of smell processing, suggest a central genesis of olfactory disorders. The administration of levetiracetam restored olfactory function, OERP N1-P2 amplitude, and mesial temporal sclerosis-related electroencephalographic findings.
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Affiliation(s)
| | | | | | | | | | - Francesca Granata
- b Department of Biomedical Sciences and Morphological and Functional Imaging , University of Messina , Messina , Italy
| | - Silvia Marino
- a IRCCS Centro Neurolesi "Bonino-Pulejo" , Messina , Italy.,b Department of Biomedical Sciences and Morphological and Functional Imaging , University of Messina , Messina , Italy
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38
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Abstract
Insights into risk factors for olfactory decline are needed, because knowledge about its origin is limited. This impairment has important implications for human health. Several epidemiologic studies of olfaction provide insight into the prevalence of olfactory disorders. Here, we review the major population studies carried out on this topic to date. Our purpose is to characterize knowledge about olfactory disorders from human studies. We also describe the existing methods for measuring the sense of smell in population studies, present recent insights into the epidemiology of smell disorders, and discuss the risk factors identified to date. Synthesis of these data shows that olfactory dysfunction increases as people age and is worse in men. Further study of olfaction is warranted for gaining better information on the etiologies affecting its impairment, research that will have a large public health impact.
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Affiliation(s)
- Jingpu Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin Province, 130041, China
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC1035, Chicago, IL 60637
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39
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40
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Rowe TB, Shepherd GM. Role of ortho-retronasal olfaction in mammalian cortical evolution. J Comp Neurol 2016; 524:471-95. [PMID: 25975561 PMCID: PMC4898483 DOI: 10.1002/cne.23802] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/16/2015] [Accepted: 04/29/2015] [Indexed: 02/02/2023]
Abstract
Fossils of mammals and their extinct relatives among cynodonts give evidence of correlated transformations affecting olfaction as well as mastication, head movement, and ventilation, and suggest evolutionary coupling of these seemingly separate anatomical regions into a larger integrated system of ortho-retronasal olfaction. Evidence from paleontology and physiology suggests that ortho-retronasal olfaction played a critical role at three stages of mammalian cortical evolution: early mammalian brain development was driven in part by ortho-retronasal olfaction; the bauplan for neocortex had higher-level association functions derived from olfactory cortex; and human cortical evolution was enhanced by ortho-retronasal smell.
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Affiliation(s)
- Timothy B. Rowe
- Jackson School of Geosciences, The University of Texas at Austin, Austin, TX, 78712 USA
| | - Gordon M. Shepherd
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, 06510 USA
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41
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Frasnelli J, Laguë-Beauvais M, LeBlanc J, Alturki A, Champoux M, Couturier C, Anderson K, Lamoureux J, Marcoux J, Tinawi S, Dagher J, Maleki M, Feyz M, de Guise E. Olfactory function in acute traumatic brain injury. Clin Neurol Neurosurg 2016; 140:68-72. [DOI: 10.1016/j.clineuro.2015.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 11/16/2015] [Accepted: 11/21/2015] [Indexed: 12/16/2022]
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Morrissey DK, Pratap U, Brown C, Wormald PJ. The role of surgery in the management of phantosmia. Laryngoscope 2015; 126:575-8. [PMID: 26422113 DOI: 10.1002/lary.25647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/19/2015] [Accepted: 08/10/2015] [Indexed: 11/05/2022]
Affiliation(s)
- David K Morrissey
- School of Medicine, The University of Queensland, Brisbane, Queensland.,The Queen Elizabeth Hospital, Woodville, South Australia
| | - Upasna Pratap
- The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria
| | | | - Peter-John Wormald
- The Queen Elizabeth Hospital, Woodville, South Australia.,Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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43
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Abstract
Olfactory disorders are common and affect about one-fifth of the general population. The main causes of olfactory loss are post viral upper respiratory infection, nasal/sinus disease, and head trauma and are therefore very frequent among patients in ear, nose, and throat clinics. We have systematically reviewed the impact of quantitative, qualitative, and congenital olfactory disorders on daily life domains as well as on general quality of life and depression. From the extensive body of literature, it can be concluded that loss of the sense of smell leads to disturbances in important areas, mainly in food enjoyment, detecting harmful food and smoke, and to some extent in social situations and working life. Most patients seem to deal well and manage those restrictions. However, a smaller proportion has considerable problems and expresses a noticeable reduction in general quality of life and enhanced depression. The impact of coping strategies is discussed.
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Affiliation(s)
- Ilona Croy
- Occupational and Environmental Medicine, Medicinaregatan 16, University of Gothenburg, Box 414, 40530 Göteborg, Sweden.
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44
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Affiliation(s)
- I Croy
- Department of Psychosomatic Medicine and Psychotherapy, University of Dresden Medical School, Germany
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45
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Leopold DA, Hornung DE. Olfactory cocainization is not an effective long-term treatment for phantosmia. Chem Senses 2013; 38:803-6. [PMID: 24122320 DOI: 10.1093/chemse/bjt047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Phantosmia, the perception of an odor when there are no odorants in the environment, can be a very debilitating symptom. In the 1960s, Zilstorff reported olfactory distortions could be treated by the topical application of a cocaine solution to the olfactory epithelium. In evaluating this treatment, we observed no long-term benefit using cocaine on 6 patients with phantosmia. Based on our observations, the patient's olfactory ability was not a determining factor in the initiation or quality of their phantosmia. Following topical cocainization, we observed a remarkable delay of hours to days in the return of olfactory ability, and when cocaine was applied to only 1 nostril, there was a decreased olfactory ability on the noncocainized side. These results may suggest the possibility that phantosmia is related to a central processing problem.
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Affiliation(s)
- Donald A Leopold
- Department of Surgery ENT division, University of Vermont, Burlington, VT 05401, USA.
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46
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Keller A, Malaspina D. Hidden consequences of olfactory dysfunction: a patient report series. BMC EAR, NOSE, AND THROAT DISORDERS 2013; 13:8. [PMID: 23875929 PMCID: PMC3733708 DOI: 10.1186/1472-6815-13-8] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND The negative consequences of olfactory dysfunction for the quality of life are not widely appreciated and the condition is therefore often ignored or trivialized. METHODS 1,000 patients with olfactory dysfunction participated in an online study by submitting accounts of their subjective experiences of how they have been affected by their condition. In addition, they were given the chance to answer 43 specific questions about the consequences of their olfactory dysfunction. RESULTS Although there are less practical problems associated with impaired or distorted odor perception than with impairments in visual or auditory perception, many affected individuals report experiencing olfactory dysfunction as a debilitating condition. Smell loss-induced social isolation and smell loss-induced anhedonia can severely affect quality of life. CONCLUSIONS Olfactory dysfunction is a serious condition for those affected by it and it deserves more attention from doctors who treat affected patients as well as from scientist who research treatment options.
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Affiliation(s)
- Andreas Keller
- Laboratory of Neurogenetics and Behavior, Rockefeller University, New York, NY, USA
| | - Dolores Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Creedmoor Psychiatric Center, New York State Office of Mental Health, New York, NY, USA
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Abstract
Phantosmia is an infrequently reported and poorly understood qualitative olfactory disorder characterized by the perception of a frequently unpleasant odor in the absence of an odorant stimulus. Peripheral phantosmia is hypothesized to involve abnormally active olfactory receptor neurons while central phantosmia is theorized to be the result of hyperactive neurons in the cortex. The authors present a case report that describes 2 patients with incomparable tumors and radiation fields who both experienced phantosmia featuring a halitosis-like odor during their courses of radiation therapy. Both the 6-year-old with diffuse intrinsic pontine glioma and the 15-year-old with World Health Organization grade II-III astrocytoma in the bifrontal lobes experienced significant distress and decreased quality of life during treatment because of the phantosmia, which resolved after completion of radiation therapy. To the best of the authors' knowledge, these are the first descriptions of phantosmia during focal or whole-brain radiation therapy.
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Affiliation(s)
- Joanna C Yang
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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48
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Fark T, Hummel C, Hähner A, Nin T, Hummel T. Characteristics of taste disorders. Eur Arch Otorhinolaryngol 2012; 270:1855-60. [DOI: 10.1007/s00405-012-2310-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 11/30/2012] [Indexed: 12/13/2022]
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Abstract
Qualitative olfactory disorders such as parosmia and phantosmia are not well investigated. In particular, the causes and treatment options for phantosmia are largely unknown. We report a case of long lasting phantosmia that disappeared under anti-depressive treatment, raising the question to what extent certain forms of qualitative olfactory disorders are an early symptom of depression.
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Affiliation(s)
- Basile N Landis
- Smell & Taste Clinic, Department of Otorhinolaryngology, University of Dresden Medical School ('Technische Universität Dresden'), Dresden, Germany.
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Gopinath B, Sue CM, Kifley A, Mitchell P. The association between olfactory impairment and total mortality in older adults. J Gerontol A Biol Sci Med Sci 2011; 67:204-9. [PMID: 22080501 DOI: 10.1093/gerona/glr165] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Population-based data on the relationship between impaired olfaction and risk of mortality among older adults are lacking. We used a representative cohort of adults aged 60 years or older to assess whether olfactory loss is a predictor of mortality, independent of potential confounders. METHODS Olfaction was measured by the San Diego Odor Identification Test (SDOIT) among 1,636 participants enrolled in the Blue Mountains Eye Study (2002-2004). Five-year all-cause mortality was confirmed using the Australian National Death Index. RESULTS More than one in five participants (21.8%) with olfactory impairment had died over the 5 years compared with less than 10% of participants without olfactory loss. Moderate olfactory loss (SDOIT score ≤3) was associated with a 68% increased risk of all-cause mortality (multivariable-adjusted hazard ratio, 1.68; 95% confidence interval, 1.10-2.56). This association did not persist after further adjustment for cognitive impairment. The association between olfactory loss and all-cause mortality was more marked among older participants (≥70 years) than younger participants (<70 years) with olfactory impairment (multivariable-adjusted hazard ratio, 1.48; 95% confidence interval, 1.02-2.15). However, adjusting for cognitive impairment diminished this association. CONCLUSIONS Older adults with moderately impaired olfaction compared with those with normal olfaction had a higher risk of dying 5 years later. The relationship between olfaction and mortality, however, may be largely mediated by cognitive impairment in these older adults. Our findings highlight the value of identifying olfactory loss in the preclinical stage in the older patient before the development of related comorbidities.
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Affiliation(s)
- Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Westmead, NSW 2145, Australia
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