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Feit NZ, Kloosterman N, LaPointe KA, Pitiranggon C, Finnegan IE, Smith CD, Gregoski MJ, Rowan NR, Soler ZM, Schlosser RJ. Intranasal Trigeminal Function in Aging Adults. Am J Rhinol Allergy 2024:19458924241274973. [PMID: 39169723 DOI: 10.1177/19458924241274973] [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: 08/23/2024]
Abstract
BACKGROUND Intranasal trigeminal function is important in detecting environmental stimuli. The impact of age-associated chemosensory dysfunction upon taste and olfaction is well described, but an understanding of trigeminal loss (chemesthesis) is lacking. OBJECTIVE The goal of this study was to characterize trigeminal function in a cohort of older adults and explore potential impacts. METHODS Twenty-eight participants over 50 years of age were recruited from the community as part of an aging cohort study. This nested cohort completed chemosensory questionnaires, patient-reported outcome measures (PROMs), and psychophysical testing for taste (taste strips), olfaction (Sniffin' Sticks), and trigeminal function (eucalyptol lateralization). Data were analyzed for associations between trigeminal function, olfactory, and taste psychophysical performance, patient-reported metrics, and demographic risk factors. RESULTS Patient-reported trigeminal impairment is less severe than other chemosensory loss, with mean visual analog scores (VAS, rated 0-100 from least to most severe) for smell (32.9 ± 34.2), taste (20.6 ± 28.4), and trigeminal sensation (9.5 ± 12.8). Despite low VAS scores, psychophysical trigeminal dysfunction was present in 10 (35.7%) subjects. Psychophysical olfactory and taste dysfunction were present in 16 (57.1%) and eight (28.6%) participants respectively. Hypercholesterolemia was associated with psychophysical trigeminal dysfunction (mean lateralization performance in hypercholesterolemia 57.7% ± 17.1 vs. 74.1% ± 10.4, p = .008). CONCLUSION Intranasal trigeminal impairment is present in nearly one-third of aging adults when assessed by psychophysical methods but is under-recognized. Hyperlipidemia may be associated with trigeminal impairment. Future inquiries should better characterize these findings in larger and prospective cohorts.
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Affiliation(s)
- Noah Z Feit
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicole Kloosterman
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kristina A LaPointe
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Charn Pitiranggon
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Isabel E Finnegan
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Carter D Smith
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mathew J Gregoski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Zachary M Soler
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Forestell CA. Does Maternal Diet Influence Future Infant Taste and Odor Preferences? A Critical Analysis. Annu Rev Nutr 2024; 44:313-337. [PMID: 38724030 DOI: 10.1146/annurev-nutr-121222-101404] [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] [Indexed: 08/30/2024]
Abstract
The dietary choices a mother makes during pregnancy offer her developing fetus its earliest exposure to the family's culinary preferences. This comprehensive literature review synthesizes five decades of research, which has provided valuable insights into fetal flavor learning. Converging evidence across various species supports the functionality of fetal chemoreceptive systems by the end of gestation, enabling the detection of an extensive array of chemosensory cues derived from the maternal diet and transmitted to the amniotic fluid. The fetus effectively encodes these flavors, resulting in their enhanced acceptance after birth. While existing studies predominantly concentrate on fetal learning about odor volatiles, limited evidence suggests a capacity for learning about gustatory (i.e., taste) properties. Examining whether these prenatal odor, taste, and flavor experiences translate into enduring shifts in dietary behaviors beyond weaning remains a crucial avenue for further investigation.
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Dekeyser A, Huart C, Hummel T, Hox V. Olfactory Loss in Rhinosinusitis: Mechanisms of Loss and Recovery. Int J Mol Sci 2024; 25:4460. [PMID: 38674045 PMCID: PMC11050448 DOI: 10.3390/ijms25084460] [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: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Chronic rhinosinusitis (CRS) is a highly prevalent disease and up to 83% of CRS patients suffer from olfactory dysfunction (OD). Because OD is specifically seen in those CRS patients that present with a type 2 eosinophilic inflammation, it is believed that type 2 inflammatory mediators at the level of the olfactory epithelium are involved in the development of this olfactory loss. However, due to the difficulties in obtaining tissue from the olfactory epithelium, little is known about the true mechanisms of inflammatory OD. Thanks to the COVID-19 pandemic, interest in olfaction has been growing rapidly and several studies have been focusing on disease mechanisms of OD in inflammatory conditions. In this paper, we summarize the most recent data exploring the pathophysiological mechanisms underlying OD in CRS. We also review what is known about the potential capacity of olfactory recovery of the currently available treatments in those patients.
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Affiliation(s)
- Agnès Dekeyser
- Laboratory of Pneumology, ENT (Airways) and Dermatology (Skin) (LUNS), Institute of Experimental and Clinical Research (IREC), UCLouvain, 1200 Brussels, Belgium; (A.D.); (C.H.)
| | - Caroline Huart
- Laboratory of Pneumology, ENT (Airways) and Dermatology (Skin) (LUNS), Institute of Experimental and Clinical Research (IREC), UCLouvain, 1200 Brussels, Belgium; (A.D.); (C.H.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany;
| | - Valérie Hox
- Laboratory of Pneumology, ENT (Airways) and Dermatology (Skin) (LUNS), Institute of Experimental and Clinical Research (IREC), UCLouvain, 1200 Brussels, Belgium; (A.D.); (C.H.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Taha E, Shetta A, Nour SA, Naguib MJ, Mamdouh W. Versatile Nanoparticulate Systems as a Prosperous Platform for Targeted Nose-Brain Drug Delivery. Mol Pharm 2024; 21:999-1014. [PMID: 38329097 DOI: 10.1021/acs.molpharmaceut.3c00588] [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] [Indexed: 02/09/2024]
Abstract
The intranasal route has proven to be a reliable and promising route for delivering therapeutics to the central nervous system (CNS), averting the blood-brain barrier (BBB) and avoiding extensive first-pass metabolism of some drugs, with minimal systemic exposure. This is considered to be the main problem associated with other routes of drug delivery such as oral, parenteral, and transdermal, among other administration methods. The intranasal route maximizes drug bioavailability, particularly those susceptible to enzymatic degradation such as peptides and proteins. This review will stipulate an overview of the intranasal route as a channel for drug delivery, including its benefits and drawbacks, as well as different mechanisms of CNS drug targeting using nanoparticulate drug delivery systems devices; it also focuses on pharmaceutical dosage forms such as drops, sprays, or gels via the nasal route comprising different polymers, absorption promoters, CNS ligands, and permeation enhancers.
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Affiliation(s)
- Esraa Taha
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Amro Shetta
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo (AUC), AUC Avenue, P.O. Box 74, New Cairo 11835, Egypt
| | - Samia A Nour
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Marianne J Naguib
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Wael Mamdouh
- Department of Chemistry, School of Sciences and Engineering, The American University in Cairo (AUC), AUC Avenue, P.O. Box 74, New Cairo 11835, Egypt
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Kleinbeck S, Wolkoff P. Exposure limits for indoor volatile substances concerning the general population: The role of population-based differences in sensory irritation of the eyes and airways for assessment factors. Arch Toxicol 2024; 98:617-662. [PMID: 38243103 PMCID: PMC10861400 DOI: 10.1007/s00204-023-03642-w] [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: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 01/21/2024]
Abstract
Assessment factors (AFs) are essential in the derivation of occupational exposure limits (OELs) and indoor air quality guidelines. The factors shall accommodate differences in sensitivity between subgroups, i.e., workers, healthy and sick people, and occupational exposure versus life-long exposure for the general population. Derivation of AFs itself is based on empirical knowledge from human and animal exposure studies with immanent uncertainty in the empirical evidence due to knowledge gaps and experimental reliability. Sensory irritation in the eyes and airways constitute about 30-40% of OELs and is an abundant symptom in non-industrial buildings characterizing the indoor air quality and general health. Intraspecies differences between subgroups of the general population should be quantified for the proposal of more 'empirical' based AFs. In this review, we focus on sensitivity differences in sensory irritation about gender, age, health status, and vulnerability in people, based solely on human exposure studies. Females are more sensitive to sensory irritation than males for few volatile substances. Older people appear less sensitive than younger ones. However, impaired defense mechanisms may increase vulnerability in the long term. Empirical evidence of sensory irritation in children is rare and limited to children down to the age of six years. Studies of the nervous system in children compared to adults suggest a higher sensitivity in children; however, some defense mechanisms are more efficient in children than in adults. Usually, exposure studies are performed with healthy subjects. Exposure studies with sick people are not representative due to the deselection of subjects with moderate or severe eye or airway diseases, which likely underestimates the sensitivity of the group of people with diseases. Psychological characterization like personality factors shows that concentrations of volatile substances far below their sensory irritation thresholds may influence the sensitivity, in part biased by odor perception. Thus, the protection of people with extreme personality traits is not feasible by an AF and other mitigation strategies are required. The available empirical evidence comprising age, lifestyle, and health supports an AF of not greater than up to 2 for sensory irritation. Further, general AFs are discouraged for derivation, rather substance-specific derivation of AFs is recommended based on the risk assessment of empirical data, deposition in the airways depending on the substance's water solubility and compensating for knowledge and experimental gaps. Modeling of sensory irritation would be a better 'empirical' starting point for derivation of AFs for children, older, and sick people, as human exposure studies are not possible (due to ethical reasons) or not generalizable (due to self-selection). Dedicated AFs may be derived for environments where dry air, high room temperature, and visually demanding tasks aggravate the eyes or airways than for places in which the workload is balanced, while indoor playgrounds might need other AFs due to physical workload and affected groups of the general population.
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Affiliation(s)
- Stefan Kleinbeck
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Garefis K, Markou D, Chatziavramidis A, Nikolaidis V, Markou K, Konstantinidis I. Assessment of Intranasal Function of the Trigeminal Nerve in Daily Clinical Practice. ORL J Otorhinolaryngol Relat Spec 2024; 86:55-64. [PMID: 38330928 DOI: 10.1159/000536645] [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: 09/18/2022] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The trigeminal nerve is a mixed cranial nerve responsible for the motor innervation of the masticatory muscles and the sensory innervation of the face, including the nasal cavities. Through its nasal innervation, we perceive sensations, such as cooling, tingling, and burning, while the trigeminal system mediates the perception of airflow. However, the intranasal trigeminal system has received little attention in the clinical evaluation of patients with nasal pathology. SUMMARY Testing methods that enable the clinical assessment of intranasal trigeminal function have recently been developed. This study aims to present the current clinical methods that can be utilised in everyday practice, as described in the literature. These methods include four assessment techniques: (1) the quick screening test of trigeminal sensitivity involves patients rating the intensity of ammonium vapour presented in a lipstick-like container. (2) The lateralisation test requires subjects to identify which nasal cavity is being stimulated by a trigeminal stimulus, such as eucalyptol or menthol, while the other side receives an odourless stimulus. (3) The trigeminal sticks test evaluates the trigeminal function similarly to the olfactory function using sticks filled with trigeminal stimulant liquids. (4) The automated CO2 stimulation device is used for measuring trigeminal pain thresholds, utilising intranasal CO2 stimuli to define the pain threshold. KEY MESSAGES Assessing intranasal trigeminal function clinically may prove useful in evaluating rhinology patients, particularly those who encounter nasal obstruction without anatomical blockage and those experiencing olfactory disorders with suspected trigeminal dysfunction. Despite their limitations, the presented methods may provide useful information about nasal patency, chemosensitivity, and pain sensation in the daily clinical practice of such patients, leading to better therapeutic decisions.
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Affiliation(s)
- Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dimitrios Markou
- School of Electrical and Computer Engineering Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Chatziavramidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Vasilios Nikolaidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Durrant FG, Chen T, Poupore NS, Nguyen SA, Chapurin N, Schlosser RJ. Unique Measurements of Intranasal Trigeminal Function: A Pilot Study. Otolaryngol Head Neck Surg 2023; 169:1048-1054. [PMID: 37162025 DOI: 10.1002/ohn.369] [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: 01/26/2023] [Revised: 03/14/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To investigate novel methods of measuring intranasal trigeminal function and correlate to validated measures of trigeminal function. STUDY DESIGN Prospective cohort study. SETTING Tertiary medical center. METHODS Forty-one subjects without nasal congestion were assessed. The trigeminal temperature function of the cool/warmth detection threshold and cold/heat pain threshold was measured with the Thermal Sensory Analyzer (TSA) device, as previously validated at buccal mucosa and infraorbital skin. Identical temperature sensory function was assessed at the anterior septum and inferior turbinate. Lateralization of trigeminal odorants eucalyptol, isothiocyanate, and acetic acid was conducted. Visual analog scales (VAS) of trigeminal function were collected. RESULTS Extraoral cheek site and oral site thermal measures were moderately correlated, suggesting consistent assessment of trigeminal function. Nearly all intranasal thermal measures correlated between the septum and turbinate (significant correlations [ρ] ranged from .3 to .8). Oral and extraoral cheek sites had modest correlations to intranasal cold and heat pain (ρ = .4-.5). The oral site had modest correlations of cold and heat detection to intranasal sites, with turbinate appearing to have the most correlations. Isothiocyanate lateralization was the most closely correlated to intranasal thermal scores for cold and heat pain. Turbinate thermal measures had weak correlations with trigeminal VAS scores (ρ = .3-.4). CONCLUSION Intranasal trigeminal measures of thermal function correlate to validated extraoral and intraoral thermal measures. The turbinate appears to have stronger correlations to the septum than found in the mouth and face. TSA testing might provide a rapid, novel method of intranasal trigeminal function assessment.
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Affiliation(s)
- Frederick G Durrant
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tiffany Chen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicolas S Poupore
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nikita Chapurin
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Hernandez AK, Walke A, Haehner A, Cuevas M, Hummel T. Correlations between gustatory, trigeminal, and olfactory functions and nasal airflow. Eur Arch Otorhinolaryngol 2023; 280:4101-4109. [PMID: 37129608 PMCID: PMC10153028 DOI: 10.1007/s00405-023-07962-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To determine the relationship of chemosensory screening and nasal airflow tests among the same set of participants, and to determine other factors that are related to the outcomes of these tests. METHODS Participants had no chemosensory complaints. Structured medical history was taken. Participants underwent 5 screening tests: q-sticks (orthonasal olfaction), q-powders (retronasal olfaction), trigeminal lateralization test, taste sprays, and peak nasal inspiratory flow (PNIF). Ratings of smell/taste ability and nasal airflow were obtained using visual analogue scales (VAS). Composite sinusitis symptoms and significance of olfaction questionnaire scores were also determined. RESULTS Four hundred participants were included in the study, 156 men, 244 women; aged 18-82 years (mean: 46). The q-powders and taste spray scores were weakly positively correlated with all the other chemosensory tests and PNIF. However, chemosensory test scores were not correlated with VAS, composite sinusitis symptoms, and significance of olfaction questionnaire scores. Various tests showed significant decrease starting at specific ages (in years, PNIF and trigeminal lateralization: 40, q-powders: 60, and q-sticks: 70). CONCLUSION Chemosensory screening tests and self-rated chemosensory function showed no correlation in participants without chemosensory complaints. In addition, gustatory function appeared to be correlated with olfactory and trigeminal function but also with nasal airflow, and nasal airflow was related not only to olfactory but also to trigeminal and taste function. Over all, the results suggest that chemosensory functions (orthonasal olfactory, trigeminal, retronasal olfactory, gustatory) and nasal airflow are correlated with each other, which we propose may be possibly mediated, at least in part, through central nervous system interactions.
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Affiliation(s)
- Anna Kristina Hernandez
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, 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.
| | - Antje Walke
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Mandy Cuevas
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
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Shusterman D. Trigeminal Function in Sino-Nasal Health and Disease. Biomedicines 2023; 11:1778. [PMID: 37509418 PMCID: PMC10376906 DOI: 10.3390/biomedicines11071778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
The upper airway (nasal passages, paranasal sinuses, pharynx, and glottis) provides the sentinel portion of the human respiratory tract, with the combined senses of olfaction (cranial nerve I) and trigeminal sensation (cranial nerve V) signaling the quality of inspired air. Trigeminal function also complements the sense of taste (in turn mediated by cranial nerves VII, IX and X), and participates in the genesis of taste aversions. The ability of trigeminal stimulation in the upper aero-digestive tract to trigger a variety of respiratory and behavioral reflexes has long been recognized. In this context, the last three decades has seen a proliferation of observations at a molecular level regarding the mechanisms of olfaction, irritation, and gustation. Concurrently, an ever-widening network of physiological interactions between olfaction, taste, and trigeminal function has been uncovered. The objective of this review is to summarize the relatively recent expansion of research in this sub-field of sensory science, and to explore the clinical and therapeutic implications thereof.
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Affiliation(s)
- Dennis Shusterman
- Division of Occupational, Environmental and Climate Medicine, University of California, San Francisco, CA 94143-0843, USA
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10
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Burghardt GKL, Cuevas M, Sekine R, Hummel T. Trigeminal Sensitivity in Patients With Allergic Rhinitis and Chronic Rhinosinusitis. Laryngoscope 2023; 133:654-660. [PMID: 36504410 DOI: 10.1002/lary.30512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are of high importance in otorhinolaryngology. Some of their symptoms are related to changes in the nasal trigeminal sensitivity. The aim of this study was to compare nasal trigeminal sensitivity in patients with AR, CRSwNP, and healthy controls (HC). METHODS A total of 75 individuals participated (age 19-78 years; 34 AR, 10 CRSwNP and 31 HC). Olfactory function was determined using the extended Sniffin' Sticks test battery. Trigeminal sensitivity was assessed with CO2 detection thresholds. Trigeminal negative mucosal potentials (NMP) and EEG-derived event-related potentials (ERP) were recorded in response to selective olfactory (phenylethyl alcohol) and trigeminal (CO2 ) stimuli using high-precision air-dilution olfactometry. RESULTS In comparison to HC, AR patients had lower CO2 thresholds, also reflected in shorter peak latencies in NMP and trigeminal ERP measurements. CRSwNP patients had a decreased sensitivity for trigeminal stimuli, also reflected in prolonged trigeminal ERP latencies, and reduced olfactory function compared to HC. CONCLUSION AR patients seemed to be more sensitive to trigeminal stimuli than CRSwNP patients. Importantly, the differences could be shown on psychophysical and electrophysiological levels. The changes in trigeminal sensitivity appear to be present already at the level of the respiratory epithelium. The differences between the two groups may depend on the specific inflammatory changes accompanying each disorder, the degree of inflammatory activity, or duration of the inflammatory disorder. However, because the sample sizes are relatively small, these results need to be confirmed in the future studies with larger groups. LEVEL OF EVIDENCE 4 Laryngoscope, 133:654-660, 2023.
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Affiliation(s)
| | - Mandy Cuevas
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Rumi Sekine
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.,Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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11
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Li Y, Tan Z, Wang J, Cai Y, Wang M, Zhou W, Wang L. Responses of Chemosensory Perception to Stimulation of the Human Brain. Ann Neurol 2023; 93:175-183. [PMID: 36218015 DOI: 10.1002/ana.26532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Significant advances have been made in our understanding of the neural substrates of human chemosensory processing, involving the piriform cortex, insula, and orbitofrontal cortex. However, the important and challenging issues are to localize the brain regions with high anatomic precision that can causally produce chemosensory perception and further delineate the topography of different classifications of chemosensory perception. METHODS We quantitatively measured subjective responses of chemosensory perception to intracranial electrical stimulation over the brain in neurosurgical patients (n = 302) with medically refractory epilepsy. RESULTS The chemosensory perceptions including olfaction, gustation, and chemesthesis were elicited in 21 of 302 patients (7%). Chemosensory responses were evoked in 53 (0.2%) of 21,661 stimulated sites. The highest response rate (1.8%) was in the insula (37/2,051 stimulated sites from 15/163 patients). The chemosensory perception emerged predominantly during stimulation of the insula along the central sulcus axis. Notably, there existed a distinct pattern that the anteroventral insula predominately represented orthonasal olfaction, whereas different chemosensory modalities converged in the mid-dorsal insula. INTERPRETATION This study provided a detailed characterization of chemosensory perception across the brain, especially in the insula. These results suggest that the cortex along the banks of the central sulcus of the insula may play a role in producing the supramodal sensation of flavor. It also indicates that dysfunction of the central insula should be considered during the evaluation of chemosensory-related epileptic seizures. ANN NEUROL 2023;93:175-183.
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Affiliation(s)
- Yanyan Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zheng Tan
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jing Wang
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yufei Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Mengyang Wang
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Wen Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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12
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Respiratory influence on brain dynamics: the preponderant role of the nasal pathway and deep slow regime. Pflugers Arch 2023; 475:23-35. [PMID: 35768698 DOI: 10.1007/s00424-022-02722-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/31/2023]
Abstract
As a possible body signal influencing brain dynamics, respiration is fundamental for perception, cognition, and emotion. The olfactory system has recently acquired its credentials by proving to be crucial in the transmission of respiratory influence on the brain via the sensitivity to nasal airflow of its receptor cells. Here, we present recent findings evidencing respiration-related activities in the brain. Then, we review the data explaining the fact that breathing is (i) nasal and (ii) being slow and deep is crucial in its ability to stimulate the olfactory system and consequently influence the brain. In conclusion, we propose a possible scenario explaining how this optimal respiratory regime can promote changes in brain dynamics of an olfacto-limbic-respiratory circuit, providing a possibility to induce calm and relaxation by coordinating breathing regime and brain state.
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13
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Thaploo D, Joshi A, Georgiopoulos C, Warr J, Hummel T. Tractography indicates lateralized differences between trigeminal and olfactory pathways. Neuroimage 2022; 261:119518. [PMID: 35926760 DOI: 10.1016/j.neuroimage.2022.119518] [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: 11/04/2021] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 11/15/2022] Open
Abstract
Odorous sensations are based on trigeminal and olfactory perceptions. Both trigeminal and olfactory stimuli generate overlapping as well as distinctive activations in the olfactory cortex including the piriform cortex. Orbitofrontal cortex (OFC), an integrative center for all senses, is directly activated in the presence of olfactory stimulations. In contrast, the thalamus, a very important midbrain structure, is not directly activated in the presence of odors, but rather acts as a relay for portions of olfactory information between primary olfactory cortex and higher-order processing centers. The aims of the study were (1) to examine the number of streamlines between the piriform cortex and the OFC and also between the piriform cortex and the thalamus and (2) to explore potential correlations between these streamlines and trigeminal and olfactory chemosensory perceptions. Thirty-eight healthy subjects were recruited for the study and underwent diffusion MRI using a 3T MRI scanner with 67 diffusion directions. ROIs were adapted from two studies looking into olfaction in terms of functional and structural properties of the olfactory system. The "waytotal number" was used which corresponds to number of streamlines between two regions of interests. We found the number of streamlines between the piriform cortex and the thalamus to be higher in the left hemisphere, whereas the number of streamlines between the piriform cortex and the OFC were higher in the right hemisphere. We also found streamlines between the piriform cortex and the thalamus to be positively correlated with the intensity of irritating (trigeminal) odors. On the other hand, streamlines between the piriform cortex and the OFC were correlated with the threshold scores for these trigeminal odors. This is the first studying the correlations between streamlines and olfactory scores using tractography. Results suggest that different chemosensory stimuli are processed through different networks in the chemosensory system involving the thalamus.
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Affiliation(s)
- Divesh Thaploo
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Haus 5, Fetscherstraße 74, Dresden 01307, Germany.
| | - Akshita Joshi
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Haus 5, Fetscherstraße 74, Dresden 01307, Germany
| | - Charalampos Georgiopoulos
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Haus 5, Fetscherstraße 74, Dresden 01307, Germany; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Haus 5, Fetscherstraße 74, Dresden 01307, Germany
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14
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Zigrand C, Jobin B, Lecuyer Giguère F, Giguère JF, Boller B, Frasnelli J. Olfactory perception in patients with a mild traumatic brain injury: a longitudinal study. Brain Inj 2022; 36:985-990. [PMID: 35946141 DOI: 10.1080/02699052.2022.2109734] [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: 11/02/2022]
Abstract
OBJECTIVE This longitudinal study aimed to evaluate olfactory perception in patients with first time mild traumatic brain injury (mTBI) 2-4 weeks (baseline) and 6 months (follow-up) following their trauma. METHODS At baseline, we enrolled 107 participants (54 healthy controls; 53 patients with mTBI). Thirty-nine healthy controls and 32 patients with mTBI returned for follow-up. We assessed odor detection (yes/no paradigm) and odor perception with a self-reported evaluation of intensity and pleasantness of four common odorants, by using an olfactometer, i.e., a computer controlled automated odor presentation device. RESULTS At baseline, patients with mTBI showed significantly more difficulty detecting odors; however, they perceived them as more intense and less pleasant. These effects vanished at follow-up. CONCLUSION These results suggest that patients with mTBI suffer from altered olfactory detection and perception in the first weeks following their trauma. This may have an impact on eating behavior and quality of life. Further, our data suggest recovery of olfactory function within the first six months following a head trauma.
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Affiliation(s)
- Coline Zigrand
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada.,Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Research Center of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Benoit Jobin
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada.,Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada.,Research Center of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Fanny Lecuyer Giguère
- Research Center of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | | | - Benjamin Boller
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada.,Research Center of the Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Johannes Frasnelli
- Research Center of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
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15
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Sorting of Odor Dilutions Is a Meaningful Addition to Assessments of Olfactory Function as Suggested by Machine-Learning-Based Analyses. J Clin Med 2022; 11:jcm11144012. [PMID: 35887775 PMCID: PMC9317381 DOI: 10.3390/jcm11144012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The categorization of individuals as normosmic, hyposmic, or anosmic from test results of odor threshold, discrimination, and identification may provide a limited view of the sense of smell. The purpose of this study was to expand the clinical diagnostic repertoire by including additional tests. Methods: A random cohort of n = 135 individuals (83 women and 52 men, aged 21 to 94 years) was tested for odor threshold, discrimination, and identification, plus a distance test, in which the odor of peanut butter is perceived, a sorting task of odor dilutions for phenylethyl alcohol and eugenol, a discrimination test for odorant enantiomers, a lateralization test with eucalyptol, a threshold assessment after 10 min of exposure to phenylethyl alcohol, and a questionnaire on the importance of olfaction. Unsupervised methods were used to detect structure in the olfaction-related data, followed by supervised feature selection methods from statistics and machine learning to identify relevant variables. Results: The structure in the olfaction-related data divided the cohort into two distinct clusters with n = 80 and 55 subjects. Odor threshold, discrimination, and identification did not play a relevant role for cluster assignment, which, on the other hand, depended on performance in the two odor dilution sorting tasks, from which cluster assignment was possible with a median 100-fold cross-validated balanced accuracy of 77–88%. Conclusions: The addition of an odor sorting task with the two proposed odor dilutions to the odor test battery expands the phenotype of olfaction and fits seamlessly into the sensory focus of standard test batteries.
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16
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Riech- und Schmeckstörungen. DGNEUROLOGIE 2022. [PMCID: PMC9007254 DOI: 10.1007/s42451-022-00434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ziel der vorliegenden Übersicht ist es, einen Überblick über die Ätiologie und Diagnostik von Riech- und Schmeckstörungen zu geben. Da etwa 5 % der Allgemeinbevölkerung betroffen sind, ist es ein häufiges Krankheitsbild. Riechen und Schmecken erhielten v. a. zuletzt Aufmerksamkeit während des Aufkommens der SARS-CoV-2-Pandemie, wobei eine plötzlich aufgetretene Riech- und/oder Schmeckstörung zu den typischen Symptomen zählt. Daneben sind Riechstörungen in der Frühdiagnostik neurodegenerativer Erkrankungen von Bedeutung. Häufig zeigen Patienten mit Riechstörungen Zeichen einer Depression. Die Auswirkungen von Riech‑/Schmeckstörungen sind also umfangreich, die Therapiemöglichkeiten aktuell begrenzt. Nach einem Einblick in die Ätiologie werden Diagnostik und Therapiemöglichkeiten auf dem aktuellen Stand der Literatur erörtert. Auch zukunftsweisende Behandlungsvorstellungen, wie z. B. autologe Schleimhauttransplantationen oder olfaktorische Implantate, werden angesprochen.
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17
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Caretta A, Mucignat-Caretta C. Not Only COVID-19: Involvement of Multiple Chemosensory Systems in Human Diseases. Front Neural Circuits 2022; 16:862005. [PMID: 35547642 PMCID: PMC9081982 DOI: 10.3389/fncir.2022.862005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Chemosensory systems are deemed marginal in human pathology. In appraising their role, we aim at suggesting a paradigm shift based on the available clinical and experimental data that will be discussed. Taste and olfaction are polymodal sensory systems, providing inputs to many brain structures that regulate crucial visceral functions, including metabolism but also endocrine, cardiovascular, respiratory, and immune systems. Moreover, other visceral chemosensory systems monitor different essential chemical parameters of “milieu intérieur,” transmitting their data to the brain areas receiving taste and olfactory inputs; hence, they participate in regulating the same vital functions. These chemosensory cells share many molecular features with olfactory or taste receptor cells, thus they may be affected by the same pathological events. In most COVID-19 patients, taste and olfaction are disturbed. This may represent only a small portion of a broadly diffuse chemosensory incapacitation. Indeed, many COVID-19 peculiar symptoms may be explained by the impairment of visceral chemosensory systems, for example, silent hypoxia, diarrhea, and the “cytokine storm”. Dysregulation of chemosensory systems may underlie the much higher mortality rate of COVID-19 Acute Respiratory Distress Syndrome (ARDS) compared to ARDSs of different origins. In chronic non-infectious diseases like hypertension, diabetes, or cancer, the impairment of taste and/or olfaction has been consistently reported. This may signal diffuse chemosensory failure, possibly worsening the prognosis of these patients. Incapacitation of one or few chemosensory systems has negligible effects on survival under ordinary life conditions but, under stress, like metabolic imbalance or COVID-19 pneumonia, the impairment of multiple chemosensory systems may lead to dire consequences during the course of the disease.
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Affiliation(s)
- Antonio Caretta
- National Institute for Biostructures and Biosystems (NIBB), Rome, Italy
- Department of Food and Drug Science, University of Parma, Parma, Italy
| | - Carla Mucignat-Caretta
- National Institute for Biostructures and Biosystems (NIBB), Rome, Italy
- Department of Molecular Medicine, University of Padova, Padua, Italy
- *Correspondence: Carla Mucignat-Caretta,
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18
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Sekine R, Hähner A, Laudien M, Mori E, Hummel T. Ratings of trigeminal stimulation in patients with olfactory loss. Rhinology 2022; 60:313-315. [PMID: 35243484 DOI: 10.4193/rhin21.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R Sekine
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.,Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - A Hähner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - M Laudien
- Department of Otorhinolaryngology, University of Kiel, Kiel, Germany
| | - E Mori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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19
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Abstract
Ziel der vorliegenden Übersicht ist es, einen Überblick über die Ätiologie und Diagnostik von Riech- und Schmeckstörungen zu geben. Da etwa 5 % der Allgemeinbevölkerung betroffen sind, ist es ein häufiges Krankheitsbild. Riechen und Schmecken erhielten v. a. zuletzt Aufmerksamkeit während des Aufkommens der SARS-CoV-2-Pandemie, wobei eine plötzlich aufgetretene Riech- und/oder Schmeckstörung zu den typischen Symptomen zählt. Daneben sind Riechstörungen in der Frühdiagnostik neurodegenerativer Erkrankungen von Bedeutung. Häufig zeigen Patienten mit Riechstörungen Zeichen einer Depression. Die Auswirkungen von Riech‑/Schmeckstörungen sind also umfangreich, die Therapiemöglichkeiten aktuell begrenzt. Nach einem Einblick in die Ätiologie werden Diagnostik und Therapiemöglichkeiten auf dem aktuellen Stand der Literatur erörtert. Auch zukunftsweisende Behandlungsvorstellungen, wie z. B. autologe Schleimhauttransplantationen oder olfaktorische Implantate, werden angesprochen.
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Affiliation(s)
- M M Speth
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Hals- und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Schweiz.
| | - U S Speth
- Klinik für Mund‑, Kiefer-, und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - T Hummel
- Universitäts-HNO Klinik, TU Dresden, Dresden, Deutschland
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20
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Zucco GM, Doty RL. Multiple Chemical Sensitivity. Brain Sci 2021; 12:46. [PMID: 35053790 PMCID: PMC8773480 DOI: 10.3390/brainsci12010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Multiple Chemical Sensitivity (MCS), a condition also known as Chemical Sensitivity (CS), Chemical Intolerance (CI), Idiopathic Environmental Illness (IEI) and Toxicant Induced Loss of Tolerance (TILT), is an acquired multifactorial syndrome characterized by a recurrent set of debilitating symptoms. The symptoms of this controversial disorder are reported to be induced by environmental chemicals at doses far below those usually harmful to most persons. They involve a large spectrum of organ systems and typically disappear when the environmental chemicals are removed. However, no clear link has emerged among self-reported MCS symptoms and widely accepted objective measures of physiological dysfunction, and no clear dose-response relationship between exposure and symptom reactions has been observed. In addition, the underlying etiology and pathogenic processes of the disorder remain unknown and disputed, although biologic and psychologic hypotheses abound. It is currently debated whether MCS should be considered a clinical entity at all. Nevertheless, in the last few decades MCS has received considerable scientific and governmental attention in light of the many persons reporting this illness. In this review, we provide a general overview of the history, definition, demographics, prevalence, and etiologic challenges in defining and understanding MCS.
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Affiliation(s)
- Gesualdo M Zucco
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35100 Padova, Italy
| | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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21
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Olfactory stimulation Inhibits Nociceptive Signal Processing at the Input Stage of the Central Trigeminal System. Neuroscience 2021; 479:35-47. [PMID: 34695536 DOI: 10.1016/j.neuroscience.2021.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023]
Abstract
The spinal trigeminal nucleus caudalis (SpVc) in the mammalian brainstem serves a pivotal function in pain processing. As the main relay center for nociceptive signals, SpVc conducts pain-related signals from various regions of the head toward higher levels of central processing such as the thalamus. SpVc also receives modulatory signals from other brain areas, which can alleviate the perception of headache. We studied the impact of olfactory co-stimulation on pain-related behavior and SpVc neural activity in mice. Using the TRPA1 agonist allyl isothiocyanate (AITC) as noxious stimulus, we quantified the aversive response and the perceived pain intensity by evaluating explorative running and the mouse grimace scale, respectively. We found that the floral odorants phenylethyl alcohol (PEA) and lavender oil mitigated the aversive response to AITC. Consistent with this finding, a newly developed, automated quantification of c-Fos expression in SpVc revealed that co-stimulation with PEA or lavender profoundly reduced network activity in the presence of AITC. These results demonstrated a substantial analgesic potential of odor stimulation in the trigeminal system and provide an explanation for the palliative effect of odors in the treatment of headache.
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22
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Tremblay C, Iravani B, Aubry Lafontaine É, Steffener J, Fischmeister FPS, Lundström JN, Frasnelli J. Parkinson's Disease Affects Functional Connectivity within the Olfactory-Trigeminal Network. JOURNAL OF PARKINSONS DISEASE 2021; 10:1587-1600. [PMID: 32597818 DOI: 10.3233/jpd-202062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Olfactory dysfunction (OD) is a frequent symptom of Parkinson's disease (PD) that appears years prior to diagnosis. Previous studies suggest that PD-related OD is different from non-parkinsonian forms of olfactory dysfunction (NPOD) as PD patients maintain trigeminal sensitivity as opposed to patients with NPOD who typically exhibit reduced trigeminal sensitivity. We hypothesize the presence of a specific alteration of functional connectivity between trigeminal and olfactory processing areas in PD. OBJECTIVE We aimed to assess potential differences in functional connectivity within the chemosensory network in 15 PD patients and compared them to 15 NPOD patients, and to 15 controls. METHODS Functional MRI scanning session included resting-state and task-related scans where participants carried out an olfactory and a trigeminal task. We compared functional connectivity, using a seed-based correlation approach, and brain network modularity of the chemosensory network. RESULTS PD patients had impaired functional connectivity within the chemosensory network while no such changes were observed for NPOD patients. No group differences we found in modularity of the identified networks. Both patient groups exhibited impaired connectivity when executing an olfactory task, while network modularity was significantly weaker for PD patients than both other groups. When performing a trigeminal task, no changes were found for PD patients, but NPOD patients exhibited impaired connectivity. Conversely, PD patients exhibited a significantly higher network modularity than both other groups. CONCLUSION In summary, the specific pattern of functional connectivity and chemosensory network recruitment in PD-related OD may explain distinct behavioral chemosensory features in PD when compared to NPOD patients and healthy controls.
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Affiliation(s)
- Cécilia Tremblay
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Behzad Iravani
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Émilie Aubry Lafontaine
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jason Steffener
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Johan N Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.,Research Center, Sacré-Coeur Hospital of Montrealéal, Québec, Canada
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23
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Bogdanov V, Reinhard J, McGlone F, Haehner A, Simons CT, Hummel T. Oral Somatosensory Sensitivity in Patients With Taste Disturbance. Laryngoscope 2021; 131:2572-2577. [PMID: 34435674 DOI: 10.1002/lary.29843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The significance of the human sense of taste is typically underestimated until it is altered or even lost. Hypogeusia, a diminished capacity to taste, has an adverse influence on a patient's quality of life. Similar to interactions between the oral senses and between olfaction and intranasal trigeminal sensitivity, taste disturbance may also affect the mechanosensitivity of the tongue. In this study, we investigated the lingual tactile sensitivity of patients with subjective taste disturbance and people with normogeusia. STUDY DESIGN Prospective case-control study. METHODS Forty-six patients with subjective taste disturbance (mean age 60 years) and 43 participants with normogeusia (mean age 55 years) were enrolled and underwent a stereognostic test of edge and point sensitivity based on 3D-printed letters sized from 2 to 8 mm. Gustatory function and salivary production were also tested. RESULTS Patients with dysgeusia needed significantly bigger letters to recognize them compared with controls (P = .01). Apart from this, patients with dysgeusia had no significant association between gustatory function and salivary production. Duration of dysgeusia and age were not associated with the presently obtained measures of gustatory or oral mechanosensory function. CONCLUSIONS The results of this study indicate that taste dysfunction has a negative impact on oral mechanosensitivity and hence possibly on oral texture perception. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2572-2577, 2021.
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Affiliation(s)
- Vasyl Bogdanov
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany
| | - Jule Reinhard
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Francis McGlone
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Antje Haehner
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Chris T Simons
- CFAES Department of Food Science & Technology, Columbus, Ohio, U.S.A
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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24
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Otte MS, Bork ML, Zimmermann PH, Klußmann JP, Lüers JC. Patients with COVID-19-associated olfactory impairment also show impaired trigeminal function. Auris Nasus Larynx 2021; 49:147-151. [PMID: 34366241 PMCID: PMC8310725 DOI: 10.1016/j.anl.2021.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Objective Next to olfactory function, the nose can also perceive chemestetic sensations mediated by the trigeminal nerve. While olfactory dysfunction as a symptom of COVID-19 is well described, there has been little research on the limitation of other nasal sensory inputs due to SARS-CoV-2 infection. The aim of this study was to determine possible limitations of nasal chemesthesis after COVID-19 infection by a psychophysiological diagnostic tool. Methods In 65 patients with a PCR-confirmed, former COVID-19 disease, olfaction was tested by means of a sniffin' sticks test, tasting by taste sprays and chemesthesis with a menthol dilution series. The subjective self-assessment of the patients was recorded via a questionnaire. Results We found a restriction of nasal chemesthesis and the extent correlated with the loss of smell, as well as with the values of the taste score, but not with subjective self-assessment. Conclusion Not only the ability to smell and taste, but also nasal chemesthesis is affected by COVID-19.
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Affiliation(s)
- Martin Sylvester Otte
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne 50924, Germany.
| | - Marie-Luise Bork
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne 50924, Germany
| | - Philipp Heinrich Zimmermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne 50924, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne 50924, Germany; Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan-Christoffer Lüers
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne 50924, Germany
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25
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Joshi A, Thaploo D, Yan X, Zang Y, Warr J, Hummel T. Habitual Exposure to Trigeminal Stimuli and Its Effects on the Processing of Chemosensory Stimuli. Neuroscience 2021; 470:70-77. [PMID: 34274425 DOI: 10.1016/j.neuroscience.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to compare brain responses to trigeminal and olfactory stimuli in frequent and non-frequent gum chewers in order to explore whether habitual exposure to trigeminal stimuli affects their central-nervous processing. In healthy subjects, fMRI brain scans were obtained for 20 frequent gum chewers (GC) and 20 non-frequent gum chewers (N'GC), in response to four odorous stimuli; 2 'trigeminal' (peppermint and spearmint) and 2 non-trigeminal or 'olfactory' (cherry and strawberry). During measurements, subjects reported intensity and pleasantness ratings for all stimuli. In addition, a test for general trigeminal sensitivity test (lateralization test) and an odor threshold test was performed. Brain activations in response to individual odors were investigated for the total study population followed by group wise (GC and N'GC) analysis separately for responses to trigeminal (peppermint + spearmint) and olfactory (cherry + strawberry) odors. (1) The GC group exhibited higher trigeminal sensitivity compared to the N'GC group. (2) Olfactory odors activated bilateral insular cortex and amygdala. Apart from olfactory areas (amygdala, insular cortex), trigeminal odors also produced activations in right thalamus and right substantia nigra. (3) In the GC group, olfactory odors produced higher bilateral insular cortex activation than in N'GC group, but no such differences were observed for trigeminal odors. GC subjects appeared to be more responsive to trigeminal chemosensory stimuli. However, this did not directly translate into differences in central-nervous activations to trigeminal stimuli; instead, the use of chewing gum was associated with stronger brain activation towards olfactory stimuli.
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Affiliation(s)
- A Joshi
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.
| | - D Thaploo
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - X Yan
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Y Zang
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - J Warr
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Takasago, Paris, France
| | - T Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Migneault-Bouchard C, Boselie FJM, Hugentobler M, Landis BN, Frasnelli J. Trigeminal impairment in treatment-refractory chronic nasal obstruction. Rhinology 2021; 59:312-318. [PMID: 33847326 DOI: 10.4193/rhin20.510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with anatomically unexplained, chronic nasal obstruction (CNO) that is refractory to medical treatment pose a challenge for clinicians. A surgical solution, addressing mechanical obstacles, is unsuited for these patients. CNO may result from disrupted airflow perception due to activation of the intranasal trigeminal system; therefore, aim of this study is to evaluate if intranasal trigeminal function of these CNO patients is decreased. METHODS In this retrospective cross-sectional study, we compared 143 CNO patients and 58 healthy volunteers, between 18 to 80 years old. We assessed nasal patency by means of rhinomanometry (RM) and measured susceptibility of intranasal trigeminal system by the trigeminal lateralization task (TLT). RESULTS TLT scores were significantly lower in CNO patients compared to controls (p less than 0.001), but RM scores were not different between groups. Accordingly, TLT allowed to identify CNO patients with an accuracy of the area under the curve (AUC) of 0.78, while the value for RM was at chance (AUC=0.47). CNO patients showed normal reaction to vasoconstrictive agents with significantly lower RM values after Xylomethazoline application. CONCLUSION Results suggest that reported nasal obstruction in CNO patients without any obvious anatomical obstacle and resistant to medical treatment may be linked to decreased perception of nasal airflow rather than physical obstruction. In this sub-set of CNO patients, trigeminal testing more adequately reflects the reported obstruction than nasal resistance assessment does. In future studies, the relation of the trigeminal status and the subjective sensation of nasal obstruction needs to be addressed with validated patient rated outcome measures (PROMs).
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Affiliation(s)
- C Migneault-Bouchard
- Department of Anatomy, Universite du Quebec a Trois-Rivieres (UQTR), Trois-Rivieres, QC, Canada
| | - F J M Boselie
- Head and Neck Surgery Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - M Hugentobler
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - B N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology â€" Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - J Frasnelli
- Department of Anatomy, Universite du Quebec a Trois-Rivieres (UQTR), Trois-Rivieres, QC, Canada; Research Center of the Sacre-Coeur Hospital, Montreal, QC, Canada
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27
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Pellegrino R, Mignot C, Georgiopoulos C, Haehner A, Hummel T. Consequences of gaining olfactory function after lifelong anosmia. Neurocase 2021; 27:238-242. [PMID: 34003718 DOI: 10.1080/13554794.2021.1921221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present a rare case in which a patient has gained her smell after lifelong anosmia. The patient was objectively tested and diagnosed with functional anosmia at age 13 and reported they were experiencing a new sensation of smell at age 22. Our results show an electrophysiological signal for two unimodal odorants. The patient had a retronasal score in the hyposmic range and self-reported the ability to smell non-trigeminal odors, but reported being disturbed by the presence of the new sense and co-occurrence of phantosmia. We discuss our case in routes of neurogenesis and non-forming memory association with odors.
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Affiliation(s)
- Robert Pellegrino
- Department of Otorhinolaryngology, Smell & Taste Clinic, University of Dresden Medical School, Dresden, Germany
| | - Coralie Mignot
- Department of Otorhinolaryngology, Smell & Taste Clinic, University of Dresden Medical School, Dresden, Germany
| | - Charalampos Georgiopoulos
- Department of Otorhinolaryngology, Smell & Taste Clinic, University of Dresden Medical School, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell & Taste Clinic, University of Dresden Medical School, Dresden, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell & Taste Clinic, University of Dresden Medical School, Dresden, Germany
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28
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Glezer I, Bruni‐Cardoso A, Schechtman D, Malnic B. Viral infection and smell loss: The case of COVID-19. J Neurochem 2021; 157:930-943. [PMID: 32970861 PMCID: PMC7537178 DOI: 10.1111/jnc.15197] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022]
Abstract
Olfactory disorders have been increasingly reported in individuals infected with SARS-CoV-2, the virus causing the coronavirus disease 2019 (COVID-19). Losing the sense of smell has a strong impact on the quality of life, since it may lead to malnutrition, weight loss, food poisoning, depression, and exposure to dangerous chemicals. Individuals who suffer from anosmia (inability to smell) also cannot sense the flavor of food, which is a combination of taste and smell. Interestingly, infected individuals have reported sudden loss of smell with no congested nose, as is frequently observed in common colds or other upper respiratory tract infections. These observations suggest that SARS-CoV-2 infection leads to olfactory loss through a distinct mechanism, which is still unclear. This article provides an overview of olfactory loss and the recent findings relating to COVID-19. Possible mechanisms of SARS-CoV-2-induced olfactory loss are also discussed.
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Affiliation(s)
- Isaias Glezer
- Department of BiochemistryUNIFESPEscola Paulista de MedicinaUniversidade Federal de São PauloRua Tres de MaioSão PauloBrazil
| | | | | | - Bettina Malnic
- Department of BiochemistryUniversity of São PauloSão PauloBrazil
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Han P, Seo H, Klockow M, Yan X, Hähner A, Hummel T. Oral irritation in patients with chemosensory dysfunction. FLAVOUR FRAG J 2021. [DOI: 10.1002/ffj.3660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Pengfei Han
- Smell and Taste Clinic, Department of Otorhinolaryngology Technische Universität Dresden Dresden Germany
- Faculty of Psychology Southwest University Chongqing China
| | - Han‐Seok Seo
- Department of Food Science University of Arkansas Fayetteville AR USA
| | - Marie Klockow
- Smell and Taste Clinic, Department of Otorhinolaryngology Technische Universität Dresden Dresden Germany
| | - Xiaoguang Yan
- Smell and Taste Clinic, Department of Otorhinolaryngology Technische Universität Dresden Dresden Germany
| | - Antje Hähner
- Smell and Taste Clinic, Department of Otorhinolaryngology Technische Universität Dresden Dresden Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology Technische Universität Dresden Dresden Germany
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30
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Ferreli F, Di Bari M, Gaino F, Albanese A, Politi LS, Spriano G, Mercante G. Trigeminal features in COVID-19 patients with smell impairment. Int Forum Allergy Rhinol 2021; 11:1253-1255. [PMID: 33728825 PMCID: PMC8251376 DOI: 10.1002/alr.22796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
| | - Matteo Di Bari
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
| | - Francesca Gaino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
| | - Alberto Albanese
- Department of Neurology, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy.,Department of Neuroscience, Catholic University, Milan, Italy
| | - Letterio S Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Neuroradiology, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Milan, Italy
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Abstract
Approximately 5% of the general population is affected by functional anosmia with approximately additional 15% exhibiting decreased olfactory function. Many of these individuals ask for help. Because the subjective rating of olfactory function is biased, assessment of olfactory function is important. Olfactory measurements are needed for patient counseling and the tracking of changes in the sense of smell over time. The present review provides an overview of frequently used psychophysical tests for olfactory function, discusses differences between threshold and suprathreshold aspects of olfactory function, and gives examples on how to apply psychophysical tests.
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Affiliation(s)
- Thomas Hummel
- Department of Otorhinolaryngology, Smell & Taste Clinic, "Technische Universität Dresden", Dresden, Germany
| | - Dino Podlesek
- Department of Neurosurgery, "Technische Universität Dresden", Dresden, Germany
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32
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Thomas DC, Baddireddy SM, Kohli D. Anosmia: A review in the context of coronavirus disease 2019 and orofacial pain. J Am Dent Assoc 2020; 151:696-702. [PMID: 32854871 PMCID: PMC7328601 DOI: 10.1016/j.adaj.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/23/2022]
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Le Bon SD, Pisarski N, Verbeke J, Prunier L, Cavelier G, Thill MP, Rodriguez A, Dequanter D, Lechien JR, Le Bon O, Hummel T, Horoi M. Psychophysical evaluation of chemosensory functions 5 weeks after olfactory loss due to COVID-19: a prospective cohort study on 72 patients. Eur Arch Otorhinolaryngol 2020; 278:101-108. [PMID: 32754871 PMCID: PMC7402072 DOI: 10.1007/s00405-020-06267-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/31/2020] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate the evolution of chemosensation via extended psychophysical testing in patients who suffered from sudden chemosensory loss due to coronavirus disease 2019 (COVID-19). Additionally, this study sought to determine whether odor threshold testing provided additional information on olfactory loss due to COVID-19 compared to the more common odor identification testing. Methods Prospective cohort study of patients with sudden chemosensory loss since February 2020 and confirmed COVID-19 infection via RT-PCR or serology testing. Olfactory function was tested extensively using the “Sniffin Sticks” test battery. In addition, we screened gustatory perception and nasal cooling sensations using psychophysical tests. Results Seventy-two patients completed the study. After a mean of 37 days, 37% of patients showed olfactory dysfunction, 7% were dysgeusic, and 48% showed signs of low sensitivity for cooling sensation. A longer duration of anosmia before smell improvement was correlated with lower olfactory function at 5 weeks. Odor threshold detection was more affected by COVID-19 compared to odor identification. Conclusion Five weeks after developing sudden chemosensory loss due to COVID-19, a high proportion of patients were dysosmic and showed signs of low nasal cooling sensitivity, whereas most of them had normal taste function. SARS-CoV-2 affected mainly odor thresholds, possibly suggesting that the major cause of loss of smell lies at the level of the olfactory neuroepithelium, rather than in the central nervous system.
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Affiliation(s)
- Serge-Daniel Le Bon
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium.
| | - Nathalie Pisarski
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Justine Verbeke
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Léa Prunier
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Gaëtan Cavelier
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Marie-Paule Thill
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Didier Dequanter
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Jérôme R Lechien
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
| | - Olivier Le Bon
- Department of Psychiatry and Laboratory of Psychiatric Research (ULB 266), Cliniques universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Mihaela Horoi
- Department of Otorhinolaryngology, CHU Saint-Pierre, 129 Boulevard de Waterloo, 1000, Brussels, Belgium
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34
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Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID-19 patients. Eur Arch Otorhinolaryngol 2020; 277:2783-2792. [PMID: 32583183 PMCID: PMC7312102 DOI: 10.1007/s00405-020-06131-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
Abstract
Objective COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive, reliable and easy-to-perform olfactory test for the screening of suspected COVID-19 patients. Study design Phase I was a case–control study and Phase II a transversal descriptive study. Subjects and methods Olfaction was assessed with the ethyl alcohol threshold test and symptoms with visual analogue scales. The study was designed in two phases: In Phase I, we compared confirmed COVID-19 patients and healthy controls. In Phase II, patients with suspected COVID-19 infection referred for testing were studied. Results 275 participants were included in Phase I, 135 in Phase II. The ROC curve showed an AUC of 0.749 in Phase I, 0.737 in Phase II. The cutoff value which offered the highest amount of correctly classified patients was ≥ 2 (10% alcohol) for all age intervals. The odds ratio was 8.19 in Phase I, 6.56 in Phase II with a 75% sensitivity. When cases report normal sense of smell (VAS < 4), it misdiagnoses 57.89% of patients detected by the alcohol threshold test. Conclusion The olfactory loss assessed with the alcohol threshold test has shown high sensitivity and odds ratio in both patients with confirmed COVID-19 illness and participants with suspected SARS-CoV-2 infection.
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