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Dias M, Shaida Z, Haloob N, Hopkins C. Recovery rates and long-term olfactory dysfunction following COVID-19 infection. World J Otorhinolaryngol Head Neck Surg 2024; 10:121-128. [PMID: 38855291 PMCID: PMC11156684 DOI: 10.1002/wjo2.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives Olfactory dysfunction is one of the most recognized symptoms of COVID-19, significantly impacting quality of life, particularly in cases where recovery is prolonged. This review aims to explore patterns of olfactory recovery post-COVID-19 infection, with particular focus on delayed recovery. Data Sources Published literature in the English language, including senior author's own work, online and social media platforms, and patients' anecdotal reports. Method A comprehensive review of the literature was undertaken by the authors with guidance from the senior author with expertise in the field of olfaction. Results Based on self-report, an estimated 95% of patients recover their olfactory function within 6 months post-COVID-19 infection. However, psychophysical testing detects higher rates of persistent olfactory dysfunction. Recovery has been found to continue for at least 2 years postinfection; negative prognostic indicators include severe olfactory loss in the acute phase, female sex, and older age. Variability in quantitative and qualitative disturbance in prolonged cases likely reflects both peripheral and central pathophysiological mechanisms. Limitations of many of the reviewed studies reflect lack of psychophysical testing and baseline olfactory assessment. Conclusions Post-COVID-19 olfactory dysfunction remains a significant health and psychosocial burden. Emerging evidence is improving awareness and knowledge among clinicians to better support patients through their olfactory rehabilitation, with hope of recovery after several months or years. Further research is needed to better understand the underlying pathogenesis of delayed recovery, identify at risk individuals earlier in the disease course, and develop therapeutic targets.
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Hummel T, Power Guerra N, Gunder N, Hähner A, Menzel S. Olfactory Function and Olfactory Disorders. Laryngorhinootologie 2023; 102:S67-S92. [PMID: 37130532 PMCID: PMC10184680 DOI: 10.1055/a-1957-3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.
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Affiliation(s)
- T Hummel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - N Power Guerra
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Medizinische Universität Rostock, Rostock
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden
| | - A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - S Menzel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
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Kelly CE. Parosmia and altered taste in patients recovering from Covid 19. CLINICAL NUTRITION OPEN SCIENCE 2023; 48:1-10. [PMID: 36514442 PMCID: PMC9731923 DOI: 10.1016/j.nutos.2022.11.008] [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: 09/27/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Parosmia is a well-documented consequence of smell loss associated with Covid 19. Those who experience this qualitative olfactory disorder during recovery find that the odour of common foods and household items is distorted, and the experience can range from merely altered to profoundly disgusting. This can lead to a greatly altered relationship with food, including the physical symptoms of loss of appetite, nausea, vomiting, as well as wider reaching issues such as withdrawal from social situations, emotional distancing from others in their close social circles, and anhedonia. There is at present no known cure or intervention to mitigate the condition. The AbScent Parosmia and Phantosmia support group on Facebook became an important resource for patients with this condition during the early part of the pandemic, and the crowd-sourcing of experiences, tips and peer-to-peer advice became a valuable source of information for the community as well as researchers trying to understand the condition. Using protocols described in earlier literature on the use of social media for qualitative research, this paper provides information on the management of parosmia based on the experiences of over 30k patients in the AbScent Parosmia and Phantosmia group on Facebook and 6k member of the AbScent Network.
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Sequeria Rodriguez P, Santana Ortiz R, Ortiz-Hernández E. Late onset and persistent parosmia and dysgeusia as neurosensorial complication by the SARS virus COV 2. OTOLARYNGOLOGY CASE REPORTS 2023; 26:100510. [PMID: 36691459 PMCID: PMC9850639 DOI: 10.1016/j.xocr.2023.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
About the neurological manifestations of COVID-19, smell impairment with some distortion or parosmia is currently one of the longest-lasting post-covid sequelae affecting many young adults around the world, we present a case of a 25yo patient that after the COVID-19 infection initiates with anosmia and dysgeusia of difficult control and some weeks later begins with parosmia associated to general discomfort and vomiting preceded by nausea, accompanied by poor oral intake, generating weight loss in 3 weeks, and depression probably related to the clinical profile and the confinement due to the pandemic. She was treated with prednisone, gabapentin, nasal irrigations and olfactory rehabilitation, with mild improvement, which was greater after the second dose of covid-19 vaccine.
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Affiliation(s)
- Patricia Sequeria Rodriguez
- Servicio de Otorrinolaringología, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico
| | | | - Enrique Ortiz-Hernández
- Servicio de Otorrinolaringología, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico,Corresponding author. Servicio de Otorrinolaringología, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Coronel Calderon 777, Guadalajara, 44280, Jalisco, Mexico
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Gary JB, Gallagher L, Joseph PV, Reed D, Gudis DA, Overdevest JB. Qualitative Olfactory Dysfunction and COVID-19: An Evidence-Based Review with Recommendations for the Clinician. Am J Rhinol Allergy 2023; 37:95-101. [PMID: 35957578 PMCID: PMC9379596 DOI: 10.1177/19458924221120117] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nearly 40% of patients who experience smell loss during SARS-CoV-2 infection may develop qualitative olfactory dysfunction, most commonly parosmia. Our evidence-based review summarizes the evolving literature and offers recommendations for the clinician on the management of patients experiencing parosmia associated with COVID-19. METHODS We performed a systematic search using independent queries in PubMed, Embase, Ovid, and Cochrane databases, then categorized articles according to themes that emerged regarding epidemiology, effect on quality of life, disease progression, prognosis, pathophysiology, diagnosis, and treatment of parosmia. RESULTS We identified 123 unique references meeting eligibility and performed title and abstract review with 2 independent reviewers, with 74 articles undergoing full-text review. An inductive approach to thematic development provided 7 central themes regarding qualitative olfactory dysfunction following COVID-19. CONCLUSIONS While other respiratory viruses are known to cause qualitative olfactory disturbances, the incidence of parosmia following COVID-19 is notable, and correlates negatively with age. The presence of parosmia predicts persistent quantitative olfactory dysfunction. Onset can occur months after infection, and symptoms may persist for well over 7 months. Affected patients report increased anxiety and decreased quality of life. Structured olfactory training with essential oils is the preferred treatment, where parosmia predicts recovery of aspects of quantitative smell loss when undergoing training. There is limited evidence that nasal corticosteroids may accelerate recovery of olfactory function. Patients should be prepared for the possibility that symptoms may persist for years, and providers should guide them to resources for coping with their psychosocial burden.
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Affiliation(s)
- Joseph B. Gary
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
| | - Liam Gallagher
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
| | - Paule V. Joseph
- National Institute on Alcohol Abuse and
Alcoholism, Bethesda, MD, USA
- National Institute of Nursing Research,
Bethesda, MD, USA
| | - Danielle Reed
- Monell Chemical Senses
Center, Philadelphia, PA, USA
| | - David A. Gudis
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology–Head and
Neck Surgery, Columbia University Irving Medical
Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Jonathan B. Overdevest
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology–Head and
Neck Surgery, Columbia University Irving Medical
Center, New York–Presbyterian Hospital, New York, NY, USA
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Association of anosmia and neutralizing antibody production in adolescents with SARS-CoV-2. Int J Pediatr Otorhinolaryngol 2023; 164:111403. [PMID: 36463663 PMCID: PMC9694343 DOI: 10.1016/j.ijporl.2022.111403] [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: 08/05/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To monitor olfactory/gustatory dysfunction and its relationship to SARS-CoV-2 IgG antibody responses in an adolescent population. METHODS Adolescents with changes in olfactory/gustatory functions were enrolled in a 15-month study. The patients were evaluated with 1) SNOT-22, 2) pediatric smell wheel, and 3) SARS-CoV-2 antibody testing. The relationship between these scores and length of anosmia, and the amount of SARS-CoV-2 IgG antibodies were assessed. A brain MRI was performed in cases of persistent special sensory symptoms. RESULTS Eighteen patients were identified with smell and/or taste complaints. Most of the patients were female (67%) and median age was 15 years (range 11-17). Twelve patients had prior SARS-CoV-2 PCR testing, with only five patients with a positive result. The median SNOT-22 score was 16 (range 0-52) and the median smell wheel score was 6.5 (range 1-11). Patients with taste difficulty were more likely to have a score less than eight. 78% of the patients tested positive for antibodies and there was a strong negative correlation between smell wheel score and antibody level (Spearman, ρ = -0.798, p = 0.002). Five patients underwent MRI scan, and all resulted as normal olfactory bulb structures. 66% received nasal corticosteroids. 11 patients presented in follow up. CONCLUSIONS Adolescents presenting to a pediatric ENT clinic during the SARS-CoV-2 pandemic were likely to have prolonged (>6 weeks) symptoms of SARS-CoV-2. The majority do not report positive PCR testing result but do report systemic symptoms including anosmia. This suggests that anosmia may be both a late and prolonged symptom of SARS-CoV-2.
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Altundag A. Parosmia and Phantosmia: Managing Quality Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:19-26. [PMID: 36721659 PMCID: PMC9880375 DOI: 10.1007/s40136-023-00441-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/28/2023]
Abstract
Purpose of Review The purpose of this review was to summarize the current knowledge on parosmia and phantosmia and introduce support and treatment algorithms for the two qualitative olfactory disorders. Recent Findings Recent literature regarding parosmia has revealed that patients with the disorder are mainly triggered by certain substances, including thiols and pyrazines. In 2015, the existing "olfactory training" regimen was improved to more effectively treat post-infectious olfactory loss and was named "modified olfactory training" (MOT). It was also found in 2022 that MOT is also effective against COVID-19-induced parosmia. Summary Parosmia, the distortion of smells, is a symptom in qualitative olfactory disorders that severely affects patients' mental well-being and enjoyment of their everyday lives. The condition was first documented in 1895 and can affect up to 5% of the general population. Etiologies of parosmia include sinonasal diseases, viruses, surgeries, traumatic brain injury, neurological and psychiatric conditions, toxic chemicals, and medications. Parosmia has seen a surge in cases since the onset of the COVID-19 pandemic and is linked to changes in brain structure following an infection. The evaluation of the symptom is done using surveys, smell identification tests, fMRI, MRI, PET/CT, and gas chromatography. Treatment for parosmia can vary in duration, which makes it essential to focus not only on helping the patients regain normosmia, but also on supporting the patient through the recovery journey. Parosmia should not be confused with phantosmia, in which the distortion of smells occurs in the absence of olfactory stimuli. The etiology of phantosmia can vary from infections and traumatic brain injury to psychiatric disorders like schizophrenia. Unlike parosmia, the treatment of phantosmia is less straightforward, with an emphasis on determining the etiology and providing symptomatic relief.
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Affiliation(s)
- Aytug Altundag
- Otorhinolaryngology Department, Biruni University School of Medicine, Istanbul, Turkey
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Said M, Luong T, Jang SS, Davis ME, DeConde AS, Yan CH. Clinical factors associated with lower health scores in COVID-19-related persistent olfactory dysfunction. Int Forum Allergy Rhinol 2022; 12:1242-1253. [PMID: 35032409 PMCID: PMC9011709 DOI: 10.1002/alr.22978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with persistent COVID-19 olfactory dysfunction (OD) commonly report parosmia. Understanding the impact of COVID-19 OD and parosmia is critical to prioritizing research and interventions. In this study we investigate the impact of parosmia and other clinical and disease characteristics on health state utility values (HUVs) for those with persistent COVID-19 OD. METHODS Patients with a history of COVID-19 diagnosis and persistent OD were recruited from a tertiary medical center and a social media support forum for chemosensory dysfunction. Clinical characteristics and disease-specific symptoms were obtained along with self-reported history of smell function and presence of parosmia. HUVs were calculated using indirect (EuroQol 5-Dimension [EQ-5D]) and direct (VAS) measures. RESULTS Our study included 286 subjects (75.52% women) with persistent COVID-19-related OD. Results (mean ± standard deviation) of HUVs based on EQ-5D and VAS were 0.81 ± 0.14 and 0.73 ± 0.21, respectively. Mean self-reported smell function (on a 0-10 scale) was 9.67 ± 1.25 pre-COVID-19, 0.93 ± 2.34 at diagnosis, and 3.39 ± 2.32 at most current assessment. A total of 89.16% of the subjects reported parosmia and 24.13% sought medical care for anosmia. Seeing an MD for OD (p < 0.001), female gender (EQ-5D only, p = 0.002), a history of chronic pain (p < 0.05) and depression/anxiety (EQ-5D only, p < 0.001) predicted worse health. Parosmia and persistent symptoms, such as shortness of breath, were associated with lower EQ-5D and VAS scores, but did not independently predict poorer health scores on multivariable analysis. CONCLUSION Persistent COVID-19 OD results in health states comparable to other chronic diseases.
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Affiliation(s)
- Mena Said
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
| | - Thanh Luong
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
- School of MedicineUniversity of California San DiegoSan DiegoCA
| | - Sophie S Jang
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
| | - Morgan E. Davis
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
| | - Adam S. DeConde
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
| | - Carol H. Yan
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San DiegoSan DiegoCA
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Bousquet C, Bouchoucha K, Bensafi M, Ferdenzi C. Phantom smells: a prevalent COVID-19 symptom that progressively sets in. Eur Arch Otorhinolaryngol 2022; 280:1219-1229. [PMID: 36173444 PMCID: PMC9521006 DOI: 10.1007/s00405-022-07649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE One of the long-term symptoms of COVID-19 is phantosmia, a type of Olfactory Disorder (OD) that has deleterious impacts on patients' quality of life. The aim of this article was to study how this poorly understood qualitative OD manifests itself in the COVID-19. METHODS 4691 patients with COVID-19 responded to our online questionnaire focusing on COVID-19-related OD. We first analyzed the prevalence of phantosmia in this population. Then, with the help of Natural Language Processing techniques, we investigated the qualitative descriptions of phantom smells by the 1723 respondents who reported phantosmia. RESULTS The prevalence of phantosmia was of 37%. Women were more likely to report phantosmia than men, as well as respondents for whom OD was described as fluctuating rather than permanent, lasted longer, was partial rather than total and appeared progressively rather than suddenly. The relationship between OD duration and phantosmia followed a logarithmic function, with a prevalence of phantosmia increasing strongly during the first 2 months of the disease before reaching a plateau and no decrease over the 15 months considered in this study. Qualitative analyses of phantosmia descriptions with a sentiment analysis revealed that the descriptions were negatively valenced for 78% of the respondents. Reference to "tobacco" was more frequent in non-smokers. Source names and odor characteristics were used differently according to age and OD duration. CONCLUSION The results of this descriptive study of phantosmia contribute to the current efforts of the medical community to better understand and treat this rapidly increasing COVID-19-related OD.
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Affiliation(s)
- Christophe Bousquet
- Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, University Claude Bernard Lyon 1, CH Le Vinatier, Bât. 462 Neurocampus, 95 boulevard Pinel, 69675 Bron Cedex, France
| | - Kamar Bouchoucha
- Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, University Claude Bernard Lyon 1, CH Le Vinatier, Bât. 462 Neurocampus, 95 boulevard Pinel, 69675 Bron Cedex, France
| | - Moustafa Bensafi
- Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, University Claude Bernard Lyon 1, CH Le Vinatier, Bât. 462 Neurocampus, 95 boulevard Pinel, 69675 Bron Cedex, France
| | - Camille Ferdenzi
- Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028, University Claude Bernard Lyon 1, CH Le Vinatier, Bât. 462 Neurocampus, 95 boulevard Pinel, 69675 Bron Cedex, France
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Analysis of Prevalence and Predictive Factors of Long-Lasting Olfactory and Gustatory Dysfunction in COVID-19 Patients. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081256. [PMID: 36013436 PMCID: PMC9410278 DOI: 10.3390/life12081256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022]
Abstract
Background: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infection, the predictive factors leading to long-lasting chemosensory dysfunction are still poorly understood. Methods: 102 out of 421 (24.2%) mildly symptomatic COVID-19 patients completed a second questionnaire about the evolution of their symptoms one year after the infection using visual analog scales (VAS). A subgroup of 69 patients also underwent psychophysical evaluation of olfactory function through UPSIT. Results: The prevalence of chemosensory dysfunction decreased from 82.4% to 45.1% after 12 months, with 46.1% of patients reporting a complete recovery. Patients older than 40 years (OR = 0.20; 95% CI: [0.07, 0.56]) and with a duration of loss of smell longer than four weeks saw a lower odds ratio for recovery (OR = 0.27; 95% CI: [0.10, 0.76]). In addition, 28 patients (35.9%) reported suffering from parosmia, which was associated with moderate to severe taste dysfunction at the baseline (OR = 7.80; 95% CI: [1.70, 35.8]). Among the 69 subjects who underwent the UPSIT, 57 (82.6%) presented some degree of smell dysfunction, showing a moderate correlation with self-reported VAS (r = −0.36, p = 0.0027). Conclusion: A clinically relevant number of subjects reported persistent chemosensory dysfunction and parosmia one year after COVID-19 infection, with a moderate correlation with psychophysical olfactory tests.
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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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Abstract
PURPOSE OF REVIEW This article reviews the literature on COVID-19 related anosmia, focusing on the epidemiology, pathophysiology recovery rates, current available treatment options, and research regarding novel treatments. RECENT FINDINGS Loss of sense of smell is one of the most prevalent symptoms reported by patients after COVID-19 infection. Even though there is a high self-reported recovery rate, recent studies have demonstrated that up to 7% of the patients remain anosmic more than 12 months after onset, leaving millions worldwide with severe olfactory dysfunction. Olfactory training remains the first line recommended treatment. Given the paucity of effective medical treatments options researchers are exploring novel therapeutic options. SUMMARY Olfactory dysfunction remains a significant and persistent legacy of the COVID-19 pandemic, but heightened awareness may stimulate research that leads to the development of much-needed treatment options.
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Affiliation(s)
- Katerina Karamali
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Michael Elliott
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Claire Hopkins
- Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
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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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Schambeck SE, Crowell CS, Wagner KI, D’Ippolito E, Burrell T, Mijočević H, Protzer U, Busch DH, Gerhard M, Poppert H, Beyer H. Phantosmia, Parosmia, and Dysgeusia Are Prolonged and Late-Onset Symptoms of COVID-19. J Clin Med 2021; 10:jcm10225266. [PMID: 34830550 PMCID: PMC8618742 DOI: 10.3390/jcm10225266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/28/2022] Open
Abstract
Deficiencies in smell and taste are common symptoms of COVID-19. Quantitative losses are well surveyed. This study focuses on qualitative changes such as phantosmia (hallucination of smell), parosmia (alteration of smell), and dysgeusia (alteration of taste) and possible connections with the adaptive immune system. Subjective experience of deficiency in taste and smell was assessed by two different questionnaires after a median of 100 and 244 days after first positive RT-PCR test. SARS-CoV-2-specific antibody levels were measured with the iFlash-SARS-CoV-2 assay. After 100 days a psychophysical screening test for olfactory and gustatory dysfunction was administered. 30 of 44 (68.2%) participants reported a chemosensory dysfunction (14 quantitative, 6 qualitative, 10 quantitative, and qualitative) during COVID-19, eleven (25.0%) participants (1 quantitative, 7 qualitative, 3 quantitative, and quantity) after 100 days, and 14 (31.8%) participants (1 quantitative, 10 qualitative, 3 quantitative and qualitative) after 244 days. Four (9.1%) participants, who were symptom-free after 100 days reported now recently arisen qualitative changes. Serological and T-cell analysis showed no correlation with impairment of taste and smell. In conclusion, qualitative changes can persist for several months and occur as late-onset symptoms months after full recovery from COVID-19-induced quantitative losses in taste and smell.
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Affiliation(s)
- Sophia E. Schambeck
- Helios Klinikum München West, Steinerweg 5, 81241 München, Germany; (H.P.); (H.B.)
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
- Correspondence:
| | - Claudia S. Crowell
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany;
| | - Karolin I. Wagner
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
| | - Elvira D’Ippolito
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
| | - Teresa Burrell
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
| | - Hrvoje Mijočević
- Institute of Virology, School of Medicine, Technical University of Munich, Trogerstr. 30, 81675 München, Germany;
| | - Ulrike Protzer
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany;
- Institute of Virology, School of Medicine, Technical University of Munich, Trogerstr. 30, 81675 München, Germany;
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany;
| | - Markus Gerhard
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Trogerstr. 30, 81675 München, Germany; (C.S.C.); (K.I.W.); (E.D.); (T.B.); (D.H.B.); (M.G.)
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany;
| | - Holger Poppert
- Helios Klinikum München West, Steinerweg 5, 81241 München, Germany; (H.P.); (H.B.)
- Klinik und Poliklinik für Neurologie im Neuro-Kopf-Zentrum, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 München, Germany
| | - Henriette Beyer
- Helios Klinikum München West, Steinerweg 5, 81241 München, Germany; (H.P.); (H.B.)
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15
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Bastola A, Nepal R, Shrestha B, Maharjan K, Shrestha S, Chalise BS, Neupane J. Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal. Trop Med Infect Dis 2021; 6:113. [PMID: 34203115 PMCID: PMC8293320 DOI: 10.3390/tropicalmed6030113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.
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Affiliation(s)
- Anup Bastola
- Department of Tropical Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal;
| | - Richa Nepal
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
| | - Bikesh Shrestha
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
| | - Kijan Maharjan
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
| | - Sanjay Shrestha
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
| | - Bimal Sharma Chalise
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
| | - Jenish Neupane
- Department of Internal Medicine, Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal; (B.S.); (K.M.); (S.S.); (B.S.C.); (J.N.)
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16
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Duyan M, Ozturan IU. Acute Psychosis in COVID-19: Is It Due to Favipiravir Treatment or Acute Viral Illness? ACTA ACUST UNITED AC 2021; 3:1627-1629. [PMID: 33997622 PMCID: PMC8106544 DOI: 10.1007/s42399-021-00952-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 01/10/2023]
Abstract
In this report, we present a case of acute psychosis that occurred after the loading dose of favipiravir, one of the most prescribed antiviral drugs in many countries, in a patient with COVID-19. A 31-year-old female was readmitted to the emergency department after 3 days of sleep disturbance, intermittent paranoid delusions, auditory hallucinations, and agitation that started after the favipiravir treatment was initiated. A physical examination revealed disorganized speech, distorted orientation, and agitation. All laboratory tests, including drug screening and cerebrospinal fluid analysis, were normal. After excluding all the other causes of acute psychosis, favipiravir treatment was discontinued, antipsychotic treatment was started, and the patient was admitted to the psychiatric ward. The symptoms resolved on the second day of hospitalization. Although acute viral illness does seldomly cause psychosis in patients with increased inflammatory response, in the presented case, none of the inflammatory markers were positive, and acute psychosis was attributed to the loading dose of favipiravir. In conclusion, clinicians should be aware of this rare adverse effect and prescribe cautiously to patients at a high risk of psychosis.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
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