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Imbs S, Deyrail B, Nguyen DT, Hossu G, Blum A, Gondim Teixeira PA, Rumeau C, Jankowski R, Gillet R. Olfactory cleft stenosis and obstruction on paranasal sinus CT scan in pre-septo-rhinoplasty patients: normal variants or pathologic findings? Eur Radiol 2024; 34:5339-5348. [PMID: 38206402 DOI: 10.1007/s00330-023-10564-9] [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: 08/27/2023] [Revised: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE(S) To determine the frequency of olfactory cleft (OC) stenosis and obstruction on paranasal sinus CT scans in pre-septorhinoplasty of patients who had septal deviation, septopyramidal deformation or nasal obstruction without other sinonasal conditions. METHODS This retrospective study included patients referred to our institution between December 2013 and December 2021 for septorhinoplasty due to nasal obstruction without other sinonasal or neurological conditions. All patients underwent preoperative paranasal sinus CT scan and olfactory testing. OC stenosis was quoted as none, partial, or total (less than 1/3 contact between nasal septum and ethmoid turbinates, 1/3-2/3, more than 2/3, respectively), as well as OC obstruction as none, partial, or complete (obstruction of less than 1/3 of OC, 1/3-2/3, more than 2/3, respectively). Radiologic evaluation was validated by near perfect interobserver agreement. RESULTS A total of 75 patients (32 women, 43 men) with a mean age of 44.2 ± 15.64 (23-74) years were included, of which 36 were normosmic and 39 hyposmic. OC stenosis was partial in 58.7% (n = 44) of the patients, absent in 28% (n = 21), and total in 13.3% (n = 10), without difference between normosmic and hyposmic patients (p = .66). OC obstruction was absent in 52% (n = 39) and partial in 46.7% (n = 35), without difference between normosmic and hyposmic patients (p = .51). Only one normosmic patient had complete OC obstruction. CONCLUSION OC partial stenosis and partial obstruction were frequent findings in pre-septorhinoplasty patients without respiratory mucosa disease and did not influence their olfactory status. Total stenosis and complete obstruction were rarer and require further investigation. CLINICAL RELEVANCE STATEMENT Isolated partial olfactory cleft stenosis and obstruction should be considered normal variants, whereas the impact of complete olfactory cleft stenosis and obstruction on patient's olfactory status remains to be determined. KEY POINTS • The incidence of olfactory cleft stenosis and obstruction in asymptomatic patients remains unknown, even though it is encountered in clinical practice. • Partial and total olfactory cleft stenosis occurred in 58.7% and 13.3% of the patients; partial obstruction occurred in half of the cases, but complete obstruction was extremely rare. • There are frequent findings of partial olfactory cleft obstruction and stenosis, but complete obstruction and total stenosis should be further investigated.
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Affiliation(s)
- Sara Imbs
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
| | - Baptiste Deyrail
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Duc Trung Nguyen
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Rumeau
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Roger Jankowski
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Marechal de Lattre de Tassigny, Nancy, 54000, France.
- Université de Lorraine, INSERM, IADI, Nancy, France.
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France.
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Kikuta S, Nagayama S, Hasegawa-Ishii S. Structures and functions of the normal and injured human olfactory epithelium. Front Neural Circuits 2024; 18:1406218. [PMID: 38903957 PMCID: PMC11188711 DOI: 10.3389/fncir.2024.1406218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
The olfactory epithelium (OE) is directly exposed to environmental agents entering the nasal cavity, leaving OSNs prone to injury and degeneration. The causes of olfactory dysfunction are diverse and include head trauma, neurodegenerative diseases, and aging, but the main causes are chronic rhinosinusitis (CRS) and viral infections. In CRS and viral infections, reduced airflow due to local inflammation, inflammatory cytokine production, release of degranulated proteins from eosinophils, and cell injury lead to decreased olfactory function. It is well known that injury-induced loss of mature OSNs in the adult OE causes massive regeneration of new OSNs within a few months through the proliferation and differentiation of progenitor basal cells that are subsequently incorporated into olfactory neural circuits. Although normal olfactory function returns after injury in most cases, prolonged olfactory impairment and lack of improvement in olfactory function in some cases poses a major clinical problem. Persistent inflammation or severe injury in the OE results in morphological changes in the OE and respiratory epithelium and decreases the number of mature OSNs, resulting in irreversible loss of olfactory function. In this review, we discuss the histological structure and distribution of the human OE, and the pathogenesis of olfactory dysfunction associated with CRS and viral infection.
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Affiliation(s)
- Shu Kikuta
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Nihon University, Tokyo, Japan
| | - Shin Nagayama
- Department of Neurobiology and Anatomy, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
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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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4
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Clijsters M, Khan M, Backaert W, Jorissen M, Speleman K, Van Bulck P, Van Den Bogaert W, Vandenbriele C, Mombaerts P, Van Gerven L. Protocol for postmortem bedside endoscopic procedure to sample human respiratory and olfactory cleft mucosa, olfactory bulbs, and frontal lobe. STAR Protoc 2024; 5:102831. [PMID: 38277268 PMCID: PMC10837096 DOI: 10.1016/j.xpro.2023.102831] [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: 10/05/2023] [Revised: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
We present a protocol for the rapid postmortem bedside procurement of selected tissue samples using an endoscopic endonasal surgical technique that we adapted from skull base surgery. We describe steps for the postmortem collection of blood, cerebrospinal fluid, a nasopharyngeal swab, and tissue samples; the clean-up procedure; and the initial processing and storage of the samples. This protocol was validated with tissue samples procured postmortem from COVID-19 patients and can be applied in another emerging infectious disease. For complete details on the use and execution of this protocol, please refer to Khan et al. (2021)1 and Khan et al. (2022).2.
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Affiliation(s)
- Marnick Clijsters
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, 3000 Leuven, Belgium
| | - Mona Khan
- Max Planck Research Unit for Neurogenetics, 60438 Frankfurt, Germany
| | - Wout Backaert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, 3000 Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Kato Speleman
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, 8000 Bruges, Belgium
| | - Pauline Van Bulck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Wouter Van Den Bogaert
- Department of Imaging & Pathology, Forensic Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium; Department of Forensic Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, 60438 Frankfurt, Germany
| | - Laura Van Gerven
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, 3000 Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, 3000 Leuven, Belgium.
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Kai N, Nishida N, Aoishi K, Takagi T, Hato N. Effect of intranasal administration of concentrated growth factors on regeneration of the olfactory epithelium in an olfactory dysfunction-induced rat model. PLoS One 2024; 19:e0298640. [PMID: 38416730 PMCID: PMC10901354 DOI: 10.1371/journal.pone.0298640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/26/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE The development of treatments that promote the regenerative capacity of the olfactory epithelium (OE) is desirable. This study aimed to evaluate the effects of intranasal administration of concentrated growth factors (CGFs) in a rat model of olfactory dysfunction. STUDY DESIGN Animal study. METHODS Nineteen male rats were used. Fourteen olfactory dysfunction models were created by intraperitoneal administration of 3-methylindole. We randomly divided the rats from the olfactory dysfunction model after 1 week into the CGF or saline group; CGFs were administered to seven animals and saline to seven animals. Behavioral assessments using the avoidance test were conducted until day 28 after CGF/saline administration. On day 28, histological evaluation was conducted to determine olfactory epithelial thickness and the olfactory marker protein (OMP)-positive cell count. Five animals were intraperitoneally injected with saline as the control group. RESULTS The avoidance rate remained decreased until 28 days after CGF/saline administration, and there was no significant difference between the two groups. Olfactory epithelial thicknesses on day 28 were 38.64 ± 3.17 μm and 32.84 ± 4.50 μm in the CGF and saline groups, respectively. OE thickness was significantly thicker in the CGF group than in the saline group (P = 0.013). The numbers of OMP-positive cells were 40.29 ± 9.77/1.0 × 104 μm2 and 31.00 ± 3.69/1.0 × 104 μm2 in the CGF and saline groups, respectively. The number of OMP+ cells in the CGF group was significantly increased compared with that in the saline group (P = 0.009). Both groups showed no improvement compared with the control group (OE thickness: 54.08 ± 3.36 μm; OMP+ cell count: 56.90 ± 9.91/1.0 × 104 μm2). CONCLUSIONS The CGF group showed improved olfactory epithelial thickness and OMP-positive cell numbers compared with that in the saline group.
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Affiliation(s)
- Naruhiko Kai
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naoya Nishida
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
- Department of Otolaryngology, Ehime Prefectural Niihama Hospital, Niihama, Japan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Santillán-Morales V, Rodriguez-Espinosa N, Muñoz-Estrada J, Alarcón-Elizalde S, Acebes Á, Benítez-King G. Biomarkers in Alzheimer's Disease: Are Olfactory Neuronal Precursors Useful for Antemortem Biomarker Research? Brain Sci 2024; 14:46. [PMID: 38248261 PMCID: PMC10813897 DOI: 10.3390/brainsci14010046] [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: 11/16/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Alzheimer's disease (AD), as the main cause of dementia, affects millions of people around the world, whose diagnosis is based mainly on clinical criteria. Unfortunately, the diagnosis is obtained very late, when the neurodegenerative damage is significant for most patients. Therefore, the exhaustive study of biomarkers is indispensable for diagnostic, prognostic, and even follow-up support. AD is a multifactorial disease, and knowing its underlying pathological mechanisms is crucial to propose new and valuable biomarkers. In this review, we summarize some of the main biomarkers described in AD, which have been evaluated mainly by imaging studies in cerebrospinal fluid and blood samples. Furthermore, we describe and propose neuronal precursors derived from the olfactory neuroepithelium as a potential resource to evaluate some of the widely known biomarkers of AD and to gear toward searching for new biomarkers. These neuronal lineage cells, which can be obtained directly from patients through a non-invasive and outpatient procedure, display several characteristics that validate them as a surrogate model to study the central nervous system, allowing the analysis of AD pathophysiological processes. Moreover, the ease of obtaining and harvesting endows them as an accessible and powerful resource to evaluate biomarkers in clinical practice.
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Affiliation(s)
- Valeria Santillán-Morales
- Laboratory of Neuropharmacology, Clinical Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; (V.S.-M.); (S.A.-E.)
| | - Norberto Rodriguez-Espinosa
- Department of Neurology, University Hospital Nuestra Señora de Candelaria, 38010 Tenerife, Spain;
- Department of Internal Medicine, Dermatology and Psychiatry, Faculty of Health Sciences, University of La Laguna (ULL), 38200 Tenerife, Spain
| | - Jesús Muñoz-Estrada
- Department of Computational Biomedicine, Cedars Sinai Medical Center, Los Angeles, CA 90069, USA;
| | - Salvador Alarcón-Elizalde
- Laboratory of Neuropharmacology, Clinical Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; (V.S.-M.); (S.A.-E.)
| | - Ángel Acebes
- Department of Basic Medical Sciences, Institute of Biomedical Technologies (ITB), University of La Laguna (ULL), 38200 Tenerife, Spain
| | - Gloria Benítez-King
- Laboratory of Neuropharmacology, Clinical Research, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico; (V.S.-M.); (S.A.-E.)
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Bauer L, Benavides FFW, Veldhuis Kroeze EJB, de Wit E, van Riel D. The neuropathogenesis of highly pathogenic avian influenza H5Nx viruses in mammalian species including humans. Trends Neurosci 2023; 46:953-970. [PMID: 37684136 PMCID: PMC10591965 DOI: 10.1016/j.tins.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023]
Abstract
Circulation of highly pathogenic avian influenza (HPAI) H5Nx viruses of the A/Goose/Guangdong/1/96 lineage in birds regularly causes infections of mammals, including humans. In many mammalian species, infections are associated with severe neurological disease, a unique feature of HPAI H5Nx viruses compared with other influenza A viruses. Here, we provide an overview of the neuropathogenesis of HPAI H5Nx virus infection in mammals, centered on three aspects: neuroinvasion, neurotropism, and neurovirulence. We focus on in vitro studies, as well as studies on naturally or experimentally infected mammals. Additionally, we discuss the contribution of viral factors to the neuropathogenesis of HPAI H5Nx virus infections and the efficacy of intervention strategies to prevent neuroinvasion or the development of neurological disease.
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Affiliation(s)
- Lisa Bauer
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Emmie de Wit
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Debby van Riel
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
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Kumaresan K, Bengtsson S, Sami S, Clark A, Hummel T, Boardman J, High J, Sobhan R, Philpott C. A double-blinded randomised controlled trial of vitamin A drops to treat post-viral olfactory loss: study protocol for a proof-of-concept study for vitamin A nasal drops in post-viral olfactory loss (APOLLO). Pilot Feasibility Stud 2023; 9:174. [PMID: 37828592 PMCID: PMC10568902 DOI: 10.1186/s40814-023-01402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Smell loss is a common problem with an estimated 5% of the population having no functioning sense of smell. Viral causes of smell loss are the second most common cause and the coronavirus (COVID-19) pandemic is estimated to have caused 20,000 more people this year to have a lasting loss of smell. Isolation, depression, anxiety, and risk of danger from hazards such as toxic gas and spoiled food are all negative impacts. It also affects appetite with weight loss/gain in two-thirds of those affected. Phantosmia or smell distortion can also occur making most foods seem unpalatable. Smell training has been tried with good results in the immediate post-viral phase. Evidence behind treatment with steroids has not shown to have proven effectiveness. With this, a key problem for patients and their clinicians is the lack of proven effective therapeutic treatment options. Based on previous studies, there is some evidence supporting the regenerative potential of retinoic acid, the metabolically active form of vitamin A in the regeneration of olfactory receptor neurons. It is based on this concept that we have chosen vitamin A as our study comparator. AIM To undertake a two-arm randomised trial of intranasally delivered vitamin A vs no intervention to determine proof of concept. METHODS/DESIGN The study will compare 10,000 IU once daily Vitamin A self-administered intranasal drops versus peanut oil drops (placebo) delivered over 12 weeks in patients with post-viral olfactory loss. Potentially eligible patients will be recruited from the Smell & Taste Clinic and via the charity Fifth Sense. They will be invited to attend the Brain Imaging Centre at the University of East Anglia on two occasions, 3 months apart. If they meet the eligibility criteria, they will be consented to enter the study and randomised to receive vitamin A drops or no treatment in a 2:1 ratio. MRI scanning will enable volumetric measurement of the OB and ROS; fMRI will then be conducted using an olfactometer to deliver pulsed odours-phenethylalcohol (rose-like) and hydrogen sulphide (rotten eggs). Participants will also perform a standard smell test at both visits as well as complete a quality-of-life questionnaire. Change in OB volume will be the primary outcome measure. DISCUSSION We expect the outputs of this study to enable a subsequent randomised controlled trial of Vitamin A versus placebo. With PPI input we will make the outputs publicly available using journals, conferences, and social media via Fifth Sense. We have already prepared a draft RCT proposal in partnership with the Norwich Clinical Trials Unit and plan to develop this further in light of the findings. TRIAL REGISTRATION ISRCTN registry 39523. Date of registration in the primary registry: 23rd February 2021.
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Affiliation(s)
- Kala Kumaresan
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk & Waveney ENT Service, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| | - Sara Bengtsson
- School of Psychology, University of East Anglia, Norwich, UK
| | - Saber Sami
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Juliet High
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Rashed Sobhan
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Carl Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK.
- Norfolk & Waveney ENT Service, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK.
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Gupta A, Shrivastav K, Agrawal A, Purohit A, Chanchlani R. Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review. Osong Public Health Res Perspect 2023; 14:388-417. [PMID: 37920896 PMCID: PMC10626325 DOI: 10.24171/j.phrp.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/09/2023] [Accepted: 07/10/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. METHODS An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant. RESULTS In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. CONCLUSION COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.
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Affiliation(s)
- Ankita Gupta
- Department of Public Health Dentistry, Rishiraj College of Dental Sciences, Bhopal, India
| | - Kriti Shrivastav
- Department of Oral Medicine and Radiology, Rishiraj College of Dental Sciences, Bhopal, India
| | - Amit Agrawal
- Department of Pediatrics, Gandhi Medical College and Hamidia Hospital, Bhopal, India
| | - Abhishek Purohit
- Department of Dentistry, Regional Training Center for Oral Health Promotion, All India Institute of Medical Sciences, Bhopal, India
| | - Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, India
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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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11
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Debbaneh P, McKinnon L, Haidari M, Liang J. Drug-induced olfactory and gustatory dysfunction: Analysis of FDA adverse events reporting system. Auris Nasus Larynx 2023:S0385-8146(22)00240-1. [PMID: 36682949 DOI: 10.1016/j.anl.2022.12.012] [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: 11/03/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES With the COVID-19 pandemic, there is growing interest and research in olfactory and gustatory dysfunction (OGD). Drug-induced dysfunction is an often overlooked etiology. While several medications include smell or taste disturbance as a side effect, there are no publications describing which medications are most frequently implicated. We aim to describe the patterns of these adverse drug reactions (ADRs) using the FDA Adverse Events Reporting System (FAERS). METHODS The FAERS database was queried from 2011 to 2021 for terms describing ADRs related to OGD. Terms included anosmia, hyposmia, olfactory test abnormal, olfactory nerve disorder, hallucination olfactory, parosmia, ageusia, hypogeusia, dysgeusia, and taste disorder. We identified the top reported medications associated with general smell dysfunction, general taste dysfunction, reduced smell, and altered smell. RESULTS From 2011 to 2021, 16,091 ADRs were reported with OGD, of which13,641 (84.8%) and 2,450 (15.2%) were associated with gustatory and olfactory reactions, respectively. Zinc products (370 reports) and fluticasone propionate (214) were most commonly associated with olfactory dysfunction, specifically reduced olfaction. Varenicline (24) and fluticasone propionate (23) were most commonly associated with altered smell. Lenalidomide (490) and sunitinib (468) were most commonly associated with gustatory dysfunction. Antineoplastic and immunomodulating medications accounted for 21.6% and 36.3% of olfactory and gustatory ADRs, respectively. Among this category, immunoglobulin drugs were the most commonly associated with OGD ADRs. CONCLUSION Gustatory dysfunction is more commonly reported ADR compared with olfactory dysfunction. Immunologic/rheumatologic medications are the leading culprit of reported OGD. With increasing numbers of patients presenting to otolaryngologists for OGD, it is important to consider drug-induced etiology. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter Debbaneh
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA.
| | | | - Muhib Haidari
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
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12
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Is congenital anosmia protective for Parkinson’s disease triggered by pathogenic entrance through the nose? NPJ Parkinsons Dis 2022; 8:152. [DOI: 10.1038/s41531-022-00425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
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13
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Fahmy M, Whitcroft K. Psychophysical Testing in Chemosensory Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022; 10:393-404. [PMID: 36120187 PMCID: PMC9468236 DOI: 10.1007/s40136-022-00429-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review To provide an overview of psychophysical testing in olfaction and gustation. Recent Findings Subjective patient report correlates poorly with objective assessment of olfaction and gustation. It is therefore important that clinicians and researchers perform psychophysical testing during chemosensory assessment. There are several validated psychophysical tests of olfaction and gustation, with ongoing developments accelerated by the COVID-19 pandemic. These tests have been culturally and linguistically adapted globally. Screening tests have been developed with careful consideration to distinguish normosmics from those with olfactory dysfunction. Summary Validated chemosensory tools are available for use by the clinician to support screening, diagnosis, or monitoring. There are promising advances in self-assessment and screening that provide avenues for the development of a standardised pathway for identification and formal assessment of patients with smell and taste disorders.
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Affiliation(s)
- Miriam Fahmy
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospital NHS Trust, Wakefield, UK
- Wrexham, UK
| | - Katherine Whitcroft
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospital NHS Trust, Wakefield, UK
- UCL Ear Institute, London, UK
- Centre for Olfactory Research Applications, Institute of Philosophy, School of Advanced Study, London, UK
- Smell and Taste Clinic, Techniche Universität Dresden, Dresden, Germany
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14
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Hosseinpoor M, Kabiri M, Rajati Haghi M, Ghadam Soltani T, Rezaei A, Faghfouri A, Poustchian Gholkhatmi Z, Bakhshaee M. Intranasal Corticosteroid Treatment on Recovery of Long‐Term Olfactory Dysfunction Due to
COVID
‐19. Laryngoscope 2022; 132:2209-2216. [PMID: 36054369 PMCID: PMC9538270 DOI: 10.1002/lary.30353] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Masoumeh Hosseinpoor
- Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
| | - Mona Kabiri
- Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mohsen Rajati Haghi
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
| | | | - Alireza Rezaei
- Department of Pathology, Mashhad Branch Islamic Azad University of Medical Sciences Mashhad Iran
| | - Atiyeh Faghfouri
- Student Research Committee, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | | | - Mehdi Bakhshaee
- Department of Otorhinolaryngology, Sinus and Surgical Endoscopic Research Center Mashhad University of Medical Sciences Mashhad Iran
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15
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Ogawa T, Matsumoto K, Tojima I, Kikuoka H, Hira D, Shimizu T. Therapeutic Potential of Valproic Acid for Postviral Olfactory Dysfunction: A Single-Arm Pilot Study. Ann Otol Rhinol Laryngol 2022; 132:709-714. [PMID: 35833237 DOI: 10.1177/00034894221111245] [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: 11/17/2022]
Abstract
OBJECTIVES Although some patients with postviral olfactory dysfunction (PVOD) recover spontaneously, many others are left with the degree of smell loss and there are no established drugs for the treatment of patients with PVOD. Valproic acid (VPA) has been widely used for the treatment of epilepsy. Its potential neuroregenerative effects have been shown via animal studies. This is the first study to treat PVOD patients with VPA. This open-label, single-arm, phase II study was conducted to investigate the effects of VPA in patients with PVOD. METHODS The patients received oral tablets of VPA 200 mg twice a day for 24 weeks. In total, 11 patients with PVOD were recruited. Oder scores of recognition and detection threshold (measured with a T&T olfactometer), and visual analog scale were examined during the treatment. RESULTS All odor scores significantly improved over time. Although the mean duration of olfactory dysfunction in this study was 11.5 months, both odor recognition threshold and odor detection threshold scores significantly improved 4 weeks after treatment initiation compared to the pre-treatment threshold scores. The olfactory recovery rates in patients treated with VPA were clearly better than those we previously reported in PVOD patients who received Toki-shakuyaku-san, the traditional treatment in Japan. The olfactory recovery rates of patients with PVOD at 12 weeks and 24 weeks of VPA treatment were both 77.8%, and the olfactory cure rates at 12 weeks and 24 weeks of VPA treatment were 33.3% and 44.4%, respectively. No serious adverse events were observed. CONCLUSIONS VPA seems to be a safe treatment option in patients with PVOD. The effects of VPA treatment for PVOD patients should be studied with a controlled study design in the future.
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Affiliation(s)
- Takao Ogawa
- Department of Otorhinolaryngology, Shiga University of Medical Science, Shiga, Japan
| | - Koji Matsumoto
- Department of Otorhinolaryngology, Shiga University of Medical Science, Shiga, Japan
| | - Ichiro Tojima
- Department of Otorhinolaryngology, Shiga University of Medical Science, Shiga, Japan
| | - Hirotaka Kikuoka
- Department of Otorhinolaryngology, Shiga University of Medical Science, Shiga, Japan
| | - Daiki Hira
- Department of Pharmacy, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology, Shiga University of Medical Science, Shiga, Japan
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16
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Ye P, He S, Tang S, Xie X, Duan C, Zhang L, Steinke J, Borish L, Li X, Feng X. Improvement of Subjective Olfactory Dysfunction in Chronic Rhinosinusitis With Nasal Polyps After Endoscopic Sinus Surgery. Front Surg 2022; 9:870682. [PMID: 35784922 PMCID: PMC9240462 DOI: 10.3389/fsurg.2022.870682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Olfactory impairment is a common complaint in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), but the influence of endoscopic sinus surgery (ESS) on olfaction and the factors predicting olfactory impairment are not fully understood. This study aimed to assess the effect of ESS on improving olfactory dysfunction in patients with CRSwNP and to identify factors that predict prognosis. Methods A total of 56 patients with CRSwNP reported their self-evaluated olfactory dysfunction score preoperatively and 1 month, 3 months, and 12 months after ESS. Preoperative clinical characteristics, computed tomography (CT) scan, and sinonasal endoscopy examination results were collected before surgery. Additionally, factors that predicted olfactory loss and affected the improvement of olfaction after ESS were evaluated. Results Olfactory improvement can be observed 1 month after ESS. A total of 73.2% (41/56) subjects experienced sustained recovery of subjective olfaction with the self-evaluated olfactory dysfunction score improving from 2.04 to 0.64 (P < 0.001) after 12 months. The Lund–Mackay scores (r = 0.593, P < 0.001) and Lund–Kennedy scores (r = 0.265, P < 0.05) correlated with the preoperative olfactory dysfunction score. Multivariate logistic regression analysis revealed that longer duration of olfactory dysfunction, blood eosinophilia, lower Lund–Mackay scores, and peripheral distribution of CT opacification were risk factors that adversely affected the recovery of olfactory function (P < 0.05). Conclusion ESS improved self-evaluated olfactory function in patients with CRSwNP. Lund–Mackay scores and Lund–Kennedy scores were correlated with olfactory function prior to surgery, while a longer course of the disease, higher blood eosinophilia, lower Lund–Mackay scores, and peripheral distribution of CT opacification were risk factors for poor olfactory prognosis.
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Affiliation(s)
- Ping Ye
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Shaojuan He
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Shuangmei Tang
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Xinyu Xie
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Chen Duan
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Liqiang Zhang
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - John W. Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States
- Department of Microbiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Xuezhong Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
- Correspondence: Xin Feng Xuezhong Li
| | - Xin Feng
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, National Health Commission Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
- Correspondence: Xin Feng Xuezhong Li
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17
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Ho CY, Salimian M, Hegert J, O’Brien J, Choi SG, Ames H, Morris M, Papadimitriou JC, Mininni J, Niehaus P, Burke A, Canbeldek L, Jacobs J, LaRocque A, Patel K, Rice K, Li L, Johnson R, LeFevre A, Blanchard T, Shaver CM, Moyer A, Drachenberg C. Postmortem Assessment of Olfactory Tissue Degeneration and Microvasculopathy in Patients With COVID-19. JAMA Neurol 2022; 79:544-553. [PMID: 35404378 PMCID: PMC9002725 DOI: 10.1001/jamaneurol.2022.0154] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Loss of smell is an early and common presentation of COVID-19 infection. Although it has been speculated that viral infection of olfactory neurons may be the culprit, it is unclear whether viral infection causes injuries in the olfactory bulb region. Objective To characterize the olfactory pathology associated with COVID-19 infection in a postmortem study. Design, Setting, and Participants This multicenter postmortem cohort study was conducted from April 7, 2020, to September 11, 2021. Deceased patients with COVID-19 and control individuals were included in the cohort. One infant with congenital anomalies was excluded. Olfactory bulb and tract tissue was collected from deceased patients with COVID-19 and appropriate controls. Histopathology, electron microscopy, droplet digital polymerase chain reaction, and immunofluorescence/immunohistochemistry studies were performed. Data analysis was conducted from February 7 to October 19, 2021. Main Outcomes and Measures (1) Severity of degeneration, (2) losses of olfactory axons, and (3) severity of microvasculopathy in olfactory tissue. Results Olfactory tissue from 23 deceased patients with COVID-19 (median [IQR] age, 62 [49-69] years; 14 men [60.9%]) and 14 control individuals (median [IQR] age, 53.5 [33.25-65] years; 7 men [50%]) was included in the analysis. The mean (SD) axon pathology score (range, 1-3) was 1.921 (0.569) in patients with COVID-19 and 1.198 (0.208) in controls (P < .001), whereas axon density was 2.973 (0.963) × 104/mm2 in patients with COVID-19 and 3.867 (0.670) × 104/mm2 in controls (P = .002). Concomitant endothelial injury of the microvasculature was also noted in olfactory tissue. The mean (SD) microvasculopathy score (range, 1-3) was 1.907 (0.490) in patients with COVID-19 and 1.405 (0.233) in control individuals (P < .001). Both the axon and microvascular pathology was worse in patients with COVID-19 with smell alterations than those with intact smell (mean [SD] axon pathology score, 2.260 [0.457] vs 1.63 [0.426]; P = .002; mean [SD] microvasculopathy score, 2.154 [0.528] vs 1.694 [0.329]; P = .02) but was not associated with clinical severity, timing of infection, or presence of virus. Conclusions and Relevance This study found that COVID-19 infection is associated with axon injuries and microvasculopathy in olfactory tissue. The striking axonal pathology in some cases indicates that olfactory dysfunction in COVID-19 infection may be severe and permanent.
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Affiliation(s)
- Cheng-Ying Ho
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Pathology, University of Maryland School of Medicine, Baltimore
| | | | - Julia Hegert
- Department of Pathology, Orlando Health, Orlando, Florida
| | - Jennifer O’Brien
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Sun Gyeong Choi
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Heather Ames
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Meaghan Morris
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Joseph Mininni
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Peter Niehaus
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Allen Burke
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Leyla Canbeldek
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Jonathan Jacobs
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Autumn LaRocque
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Kavi Patel
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Kathryn Rice
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Ling Li
- Office of the Chief Medical Examiner, Baltimore, Maryland
| | - Robert Johnson
- University of Maryland Brain and Tissue Bank, Baltimore,Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Alexandra LeFevre
- University of Maryland Brain and Tissue Bank, Baltimore,Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Thomas Blanchard
- University of Maryland Brain and Tissue Bank, Baltimore,Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Ciara M. Shaver
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ann Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Cinthia Drachenberg
- Department of Pathology, University of Maryland School of Medicine, Baltimore
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18
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Collins A, Bear RA, Mallikarjun A, Kane SA, Essler JL, Kaynaroglu P, Feuer R, Smith JG, Otto CM. Effects of Intranasal and Oral Bordetella bronchiseptica Vaccination on the Behavioral and Olfactory Capabilities of Detection Dogs. Front Vet Sci 2022; 9:882424. [PMID: 35664843 PMCID: PMC9159271 DOI: 10.3389/fvets.2022.882424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
The bacterium Bordetella bronchiseptica is responsible for serious respiratory disease in dogs, most often associated with ‘kennel cough’ (canine infectious tracheobronchitis). It is recommended that dogs are vaccinated against the bacterium every 6–12 months, either by oral or intranasal administration. Any impairment of dogs' olfactory capabilities due to medical treatments may impact their efficiency and accuracy in their jobs. This study examined (1) the effect of intranasal and oral vaccines on the olfactory capabilities of detection dogs; as well as (1) effects of the vaccines on canine behavior. Dogs that were vaccinated initially with the oral and 28 days later with intranasal B. bronchiseptica were generally slower to find the target odor than the dogs that were assigned intranasal then oral vaccine. This result prompted a second between-subjects study to further investigate any impact of intranasal administration of the B. bronchiseptica vaccine on the olfactory capabilities of dogs. The intranasal vaccine was of particular interest due to its prevalent use and potential for nasal inflammation leading to decreased olfactory capabilities. Neither odor threshold nor time spent searching for odor were affected by the intranasal vaccine. Behavioral analyses showed that behaviors associated with the dogs' positive and negative motivation affected their time spent finding the target odor; this suggests that behavior should be considered in future studies of olfactory performance.
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Affiliation(s)
- Amanda Collins
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel A. Bear
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Amritha Mallikarjun
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah A. Kane
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer L. Essler
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Patricia Kaynaroglu
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Feuer
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jordan G. Smith
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Cynthia M. Otto
- Penn Vet Working Dog Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Clinical Science and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Cynthia M. Otto
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19
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Abstract
Olfactory loss is associated with symptoms of depression. The present study, conducted on a large cohort of mostly dysosmic patients, aimed to investigate whether improvement in olfactory performance would correspond with a decrease in depression severity. In 171 participants (157 dysosmic), we assessed olfactory function and severity of depression before and after an average interval of 11 months, with many patients showing improvement in olfactory function. Separate analyses were conducted for (a) the whole group of patients and (b) the group of dysosmic patients using both classic and Bayesian approaches. For odor identification, Student t test demonstrated that the whole sample improved consistently, especially within the group of dysosmic patients. The dysosmic group also improved in odor threshold and overall olfactory function. Pearson correlation showed that an increase in olfactory function was associated with a decrease in depression severity, particularly in dysosmic patients. To conclude, the present results indicate that symptoms of depression change with olfactory function in general and odor identification in particular.
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20
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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21
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Tan CJW, Tan BKJ, Tan XY, Liu HT, Teo CB, See A, Xu S, Toh ST, Kheok SW, Charn TC, Teo NWY. Neuroradiological Basis of COVID-19 Olfactory Dysfunction: A Systematic Review and Meta-Analysis. Laryngoscope 2022; 132:1260-1274. [PMID: 35318656 PMCID: PMC9088641 DOI: 10.1002/lary.30078] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
Objective Olfactory dysfunction (OD) is a common presenting symptom of COVID‐19 infection. Radiological imaging of the olfactory structures in patients with COVID‐19 and OD can potentially shed light on its pathogenesis, and guide clinicians in prognostication and intervention. Methods PubMed, Embase, Cochrane, SCOPUS were searched from inception to August 1, 2021. Three reviewers selected observational studies, case series, and case reports reporting radiological changes in the olfactory structures, detected on magnetic resonance imaging, computed tomography, or other imaging modalities, in patients aged ≥18 years with COVID‐19 infection and OD, following preferred reporting items for systematic reviews and meta‐analyses guidelines and a PROSPERO‐registered protocol (CRD42021275211). We described the proportion of radiological outcomes, and used random‐effects meta‐analyses to pool the prevalence of olfactory cleft opacification, olfactory bulb signal abnormalities, and olfactory mucosa abnormalities in patients with and without COVID‐19‐associated OD. Results We included 7 case–control studies (N = 353), 11 case series (N = 154), and 12 case reports (N = 12). The pooled prevalence of olfactory cleft opacification in patients with COVID‐19 infection and OD (63%, 95% CI = 0.38–0.82) was significantly higher than that in controls (4%, 95% CI = 0.01–0.13). Conversely, similar proportions of cases and controls demonstrated olfactory bulb signal abnormalities (88% and 94%) and olfactory mucosa abnormalities (2% and 0%). Descriptive analysis found that 55.6% and 43.5% of patients with COVID‐19 infection and OD had morphological abnormalities of the olfactory bulb and olfactory nerve, respectively, while 60.0% had abnormal olfactory bulb volumes. Conclusion Our findings implicate a conductive mechanism of OD, localized to the olfactory cleft, in approximately half of the affected COVID‐19 patients. Laryngoscope, 132:1260–1274, 2022
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Affiliation(s)
- Claire Jing-Wen Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Xin Yan Tan
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Hui Ting Liu
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Chong Boon Teo
- Department of Undergraduate Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore.,Departments of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital (SKH), Singapore, Singapore
| | - Shuhui Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
| | - Si Wei Kheok
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore.,Departments of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital (SKH), Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital (SGH), Singapore, Singapore
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22
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Kagoya R, Toma-Hirano M, Yamagishi J, Matsumoto N, Kondo K, Ito K. Immunological status of the olfactory bulb in a murine model of Toll-like receptor 3-mediated upper respiratory tract inflammation. J Neuroinflammation 2022; 19:13. [PMID: 35012562 PMCID: PMC8744287 DOI: 10.1186/s12974-022-02378-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postviral olfactory dysfunction (PVOD) following a viral upper respiratory tract infection (URI) is one of the most common causes of olfactory disorders, often lasting for over a year. To date, the molecular pathology of PVOD has not been elucidated. METHODS A murine model of Toll-like receptor 3 (TLR3)-mediated upper respiratory tract inflammation was used to investigate the impact of URIs on the olfactory system. Inflammation was induced via the intranasal administration of polyinosinic-polycytidylic acid (poly(I:C), a TLR3 ligand) to the right nostril for 3 days. Peripheral olfactory sensory neurons (OSNs), immune cells in the olfactory mucosa, and glial cells in the olfactory bulb (OB) were analyzed histologically. Proinflammatory cytokines in the nasal tissue and OB were evaluated using the quantitative real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS In the treated mice, OSNs were markedly reduced in the olfactory mucosa, and T cell and neutrophil infiltration therein was observed 1 day after the end of poly(I:C) administration. Moreover, there was a considerable increase in microglial cells and slight increase in activated astrocytes in the OB. In addition, qPCR and ELISA revealed the elevated expression of interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and interferon-gamma both in the OB and nasal tissue. CONCLUSIONS Taken together, the decreased peripheral OSNs, OB microgliosis, and elevated proinflammatory cytokines suggest that immunological changes in the OB may be involved in the pathogenesis of PVOD.
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Affiliation(s)
- Ryoji Kagoya
- Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. .,Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Makiko Toma-Hirano
- Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Junya Yamagishi
- Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Naoyuki Matsumoto
- Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.,Department of Otolaryngology and Head and Neck Surgery, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, 296-8602, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ken Ito
- Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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23
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Yildirim D, Kandemirli SG, Tekcan Sanli DE, Akinci O, Altundag A. A Comparative Olfactory MRI, DTI and fMRI Study of COVID-19 Related Anosmia and Post Viral Olfactory Dysfunction. Acad Radiol 2022; 29:31-41. [PMID: 34810059 PMCID: PMC8549400 DOI: 10.1016/j.acra.2021.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/24/2022]
Abstract
Rationale and Objective To evaluate how COVID-19 anosmia imaging findings resembled and differed from postinfectious olfactory dysfunction (OD). Material and Methods A total of 31 patients presenting with persistent COVID-19 related OD and 97 patients with post-infectious OD were included. Olfactory bulb MRI, DTI and olfactory fMRI findings in both groups were retrospectively assessed. Results All COVID-19 related OD cases were anosmic, 18.6% of post-infectious OD patients were hyposmic and remaining 81.4% were anosmic. Mean interval between onset of OD and imaging was 1.5 months for COVID-19 related OD and 6 months for post-infectious OD. Olfactory bulb volumes were significantly higher in COVID-19 related OD than post-infectious OD. Deformed bulb morphology and increased olfactory bulb signal intensity was seen in 58.1% and 51.6% with COVID-19 related OD; and 63.9% – 46.4% with post-infectious OD; without significant difference. Significantly higher rate of olfactory nerve clumping and higher QA values at orbitofrontal and entorhinal regions were observed in COVID-19 related OD than post-infectious OD. Absence of orbitofrontal and entorhinal activity showed no statistically significant difference between COVID-19 related OD and post-infectious OD, however trigeminosensory activity was more robust in COVID-19 related OD cases. Conclusion Olfactory bulb damage may play a central role in persistent COVID-19 related anosmia. Though there is decreased olfactory bulb volume and decreased white matter tract integrity of olfactory regions in COVID-19 related anosmia, this is not as pronounced as in other post-infectious OD. Trigeminosensory activity was more robust in COVID-19 related OD. These findings may reflect better preserved central olfactory system in COVID-19 related OD compared to COVID-19 related OD.
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Affiliation(s)
- Duzgun Yildirim
- Acibadem University, Department of Medical Imaging, Istanbul, Turkey
| | - Sedat Giray Kandemirli
- University of Iowa, Hospital and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IA 52242.
| | | | - Ozlem Akinci
- Sancaktepe Sehit Prof Dr Ilhan Varank Research and Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Aytug Altundag
- Acibadem Taksim Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
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24
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Lakshmanan HG, Miller E, White-Canale A, McCluskey LP. Immune responses in the injured olfactory and gustatory systems: a role in olfactory receptor neuron and taste bud regeneration? Chem Senses 2022; 47:bjac024. [PMID: 36152297 PMCID: PMC9508897 DOI: 10.1093/chemse/bjac024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sensory cells that specialize in transducing olfactory and gustatory stimuli are renewed throughout life and can regenerate after injury unlike their counterparts in the mammalian retina and auditory epithelium. This uncommon capacity for regeneration offers an opportunity to understand mechanisms that promote the recovery of sensory function after taste and smell loss. Immune responses appear to influence degeneration and later regeneration of olfactory sensory neurons and taste receptor cells. Here we review surgical, chemical, and inflammatory injury models and evidence that immune responses promote or deter chemosensory cell regeneration. Macrophage and neutrophil responses to chemosensory receptor injury have been the most widely studied without consensus on their net effects on regeneration. We discuss possible technical and biological reasons for the discrepancy, such as the difference between peripheral and central structures, and suggest directions for progress in understanding immune regulation of chemosensory regeneration. Our mechanistic understanding of immune-chemosensory cell interactions must be expanded before therapies can be developed for recovering the sensation of taste and smell after head injury from traumatic nerve damage and infection. Chemosensory loss leads to decreased quality of life, depression, nutritional challenges, and exposure to environmental dangers highlighting the need for further studies in this area.
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Affiliation(s)
- Hari G Lakshmanan
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Elayna Miller
- Department of Medical Illustration, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - AnnElizabeth White-Canale
- Department of Medical Illustration, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Lynnette P McCluskey
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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25
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Khan N, Alimova Y, Clark SJ, Vekaria H, Walsh AE, Williams HC, Hawk GS, Sullivan P, Johnson LA, McClintock TS. Human APOE ɛ3 and APOE ɛ4 Alleles Have Differential Effects on Mouse Olfactory Epithelium. J Alzheimers Dis 2021; 85:1481-1494. [PMID: 34958025 DOI: 10.3233/jad-215152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive age-dependent disorder whose risk is affected by genetic factors. Better models for investigating early effects of risk factors such as apolipoprotein E (APOE) genotype are needed. OBJECTIVE To determine whether APOE genotype produces neuropathologies in an AD-susceptible neural system, we compared effects of human APOE ɛ3 (E3) and APOE ɛ4 (E4) alleles on the mouse olfactory epithelium. METHODS RNA-Seq using the STAR aligner and DESeq2, immunohistochemistry for activated caspase-3 and phosphorylated histone H3, glucose uptake after oral gavage of 2-[1,2-3H (N)]-deoxy-D-glucose, and Seahorse Mito Stress tests on dissociated olfactory mucosal cells. RESULTS E3 and E4 olfactory mucosae show 121 differentially abundant mRNAs at age 6 months. These do not indicate differences in cell type proportions, but effects on 17 odorant receptor mRNAs suggest small differences in tissue development. Ten oxidoreductases mRNAs important for cellular metabolism and mitochondria are less abundant in E4 olfactory mucosae but this does not translate into differences in cellular respiration. E4 olfactory mucosae show lower glucose uptake, characteristic of AD susceptibility and consistent with greater expression of the glucose-sensitive gene, Asns. Olfactory sensory neuron apoptosis is unaffected at age 6 months but is greater in E4 mice at 10 months. CONCLUSION Effects of human APOE alleles on mouse olfactory epithelium phenotype are apparent in early adulthood, and neuronal loss begins to increase by middle age (10 months). The olfactory epithelium is an appropriate model for the ability of human APOE alleles to modulate age-dependent effects associated with the progression of AD.
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Affiliation(s)
- Naazneen Khan
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Yelena Alimova
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Sophie J Clark
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Hemendra Vekaria
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA
| | - Adeline E Walsh
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Holden C Williams
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - Patrick Sullivan
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY, USA.,Department of Neuroscience, University of Kentucky, Lexington, KY, USA.,Lexington Veterans' Affairs Healthcare System, Lexington, KY, USA
| | - Lance A Johnson
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Sanders Brown Center on Aging, University of Kentucky, Lexington, KY, USA
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26
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COVID-19 Anosmia: High Prevalence, Plural Neuropathogenic Mechanisms, and Scarce Neurotropism of SARS-CoV-2? Viruses 2021; 13:v13112225. [PMID: 34835030 PMCID: PMC8625547 DOI: 10.3390/v13112225] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of coronavirus disease 2019 (COVID-19). It is known as a respiratory virus, but SARS-CoV-2 appears equally, or even more, infectious for the olfactory epithelium (OE) than for the respiratory epithelium in the nasal cavity. In light of the small area of the OE relative to the respiratory epithelium, the high prevalence of olfactory dysfunctions (ODs) in COVID-19 has been bewildering and has attracted much attention. This review aims to first examine the cytological and molecular biological characteristics of the OE, especially the microvillous apical surfaces of sustentacular cells and the abundant SARS-CoV-2 receptor molecules thereof, that may underlie the high susceptibility of this neuroepithelium to SARS-CoV-2 infection and damages. The possibility of SARS-CoV-2 neurotropism, or the lack of it, is then analyzed with regard to the expression of the receptor (angiotensin-converting enzyme 2) or priming protease (transmembrane serine protease 2), and cellular targets of infection. Neuropathology of COVID-19 in the OE, olfactory bulb, and other related neural structures are also reviewed. Toward the end, we present our perspectives regarding possible mechanisms of SARS-CoV-2 neuropathogenesis and ODs, in the absence of substantial viral infection of neurons. Plausible causes for persistent ODs in some COVID-19 convalescents are also examined.
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27
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Olfactory and Taste Dysfunction in Coronavirus Disease 2019 Pandemic. Indian J Otolaryngol Head Neck Surg 2021; 74:3159-3166. [PMID: 34631493 PMCID: PMC8487225 DOI: 10.1007/s12070-021-02871-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
This study is done to raise awareness of olfactory and taste dysfunction association in coronavirus disease, urging early detection and isolation of coronavirus positive patients thus breaking the chain of transmission of disease. This is a retrospective observational study done in outpatient department of tertiary care hospital in Mumbai, west India from 1st May 2020 to 1st August 2020 on patients who were confirmed positive for COVID-19 by real-time reverse transcription polymerase chain reaction (rRT-PCR) and having olfactory dysfunction and/or taste disorders. In study population, anosmia and ageusia occurred in 88% and 83.33% respectively. In control population, anosmia and ageusia occurred in 93% and 85.71% respectively. The mean duration of anosmia was around 2 weeks and 3 weeks for study and control group respectively. In study population 94.6% recovered from anosmia, whereas in control population 64.3% recovered from anosmia. Anosmia gradually improved to hyposmia. In the study population 94.3% hyposmia patients showed recovery, while in control population 85.2% showed recovery. Ageusia collaborated with the duration of anosmia. Recovery from taste dysfunction was 88.6% and 63.9% in study and control population respectively. Olfactory and taste dysfunction are very important clinical features of coronavirus positive patients with anosmia being the most prominent symptom. All patients presenting with smell and or taste dysfunction should be screened for coronavirus disease, helping in early detection in asymptomatic patients.
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28
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Altunisik E, Baykan AH, Sahin S, Aydin E, Erturk SM. Quantitative Analysis of the Olfactory System in COVID-19: An MR Imaging Study. AJNR Am J Neuroradiol 2021; 42:2207-2214. [PMID: 34556477 DOI: 10.3174/ajnr.a7278] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Anosmia or hyposmia, often accompanied by changes in taste, is recognized as a common symptom that can assist in the diagnosis of coronavirus disease 2019 (COVID-19). The pathogenesis of olfactory dysfunction in COVID-19 is not yet fully understood. MR imaging represents a useful anatomic imaging method for the evaluation of olfactory dysfunction associated with varying etiologies, including viral infection, trauma, and neurodegenerative processes. This case-control study was conducted to compare quantitative measurements of olfactory anatomic structures between patients diagnosed with COVID-19 associated with persistent olfactory dysfunction and healthy controls. MATERIALS AND METHODS This study has a retrospective design. Cranial MR imaging was performed on all participants in both the patient and control groups. The bilateral olfactory bulb volume, olfactory tract length, and olfactory sulcus depth were measured in all patients. RESULTS A total of 116 people aged 18-60 years, including 36 patients diagnosed with COVID-19 and 80 controls, were included in the study. All measured values were compared between the patient and control groups. The right, left, and total olfactory bulb volume values were significantly lower in the patient group than in the control group. The patient group also had significantly lower right and left olfactory sulcus depth and olfactory tract length values compared with those in the control group. CONCLUSIONS MR imaging findings can be used to demonstrate olfactory injury in patients with COVID-19. The olfactory pathway may represent an alternative route for virus entry into the central nervous system.
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Affiliation(s)
- E Altunisik
- From the Department of Neurology (E. Altunisik)
| | - A H Baykan
- Radiology (A.H.B.), Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - S Sahin
- Department of Radiology (S.S.), Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - E Aydin
- Department of Radiology (E. Aydin), Baskent University Faculty of Medicine, Izmir, Turkey
| | - S M Erturk
- Department of Radiology (S.M.E), Istanbul University Faculty of Medicine, Istanbul, Turkey
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29
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Omura K, Han B, Nishijima H, Aoki S, Ebihara T, Kondo K, Otori N, Kojima H, Yamasoba T, Kikuta S. Heterogeneous distribution of mature olfactory sensory neurons in human olfactory epithelium. Int Forum Allergy Rhinol 2021; 12:266-277. [PMID: 34538025 DOI: 10.1002/alr.22885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The olfactory cleft (OC) comprising the olfactory epithelium (OE) is the most important anatomical location for olfactory function. Endoscopic sinus surgery (ESS) is used to treat diseases related to the OC and improve olfactory dysfunction. However, iatrogenic OE injury occasionally occurs. Comprehensive knowledge of the olfactory region is required to avoid damage to the OE during endoscopic procedures. METHODS Immunohistochemistry was performed on olfactory mucosa obtained from the unaffected side of olfactory neuroblastoma surgical specimens. The OE was defined as the epithelium containing mature olfactory sensory neurons (OSNs). The distribution and cell kinetics of the OE were examined. RESULTS The OE was selectively localized to the anterior two-thirds of the superior turbinate (ST) and in the nasal septum (NS) just opposite to the ST; the OE was not detected within the mucosa of the superior meatus. The density of mature OSNs was high at the ethmoid tegmen but gradually decreased with distance from the ethmoid tegmen. The extent of cell death and proliferation was relatively even across the OE. Analysis of airflow profiles revealed that resection of inferior ST does not decrease airflow to the OC. CONCLUSION The results indicate that the distribution and degree of differentiation of mature OSNs are heterogenous throughout the OE. Epithelial resection of the anterior or superior ST has the potential to damage olfactory function. Resection of the inferior or posterior ST or widening of the superior meatus is a safer alternative that does not damage mature OSNs or alter airflow to the OC.
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Affiliation(s)
- Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Bing Han
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hironobu Nishijima
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Aoki
- Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Teru Ebihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shu Kikuta
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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30
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Koyama S, Kondo K, Ueha R, Kashiwadani H, Heinbockel T. Possible Use of Phytochemicals for Recovery from COVID-19-Induced Anosmia and Ageusia. Int J Mol Sci 2021; 22:8912. [PMID: 34445619 PMCID: PMC8396277 DOI: 10.3390/ijms22168912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
The year 2020 became the year of the outbreak of coronavirus, SARS-CoV-2, which escalated into a worldwide pandemic and continued into 2021. One of the unique symptoms of the SARS-CoV-2 disease, COVID-19, is the loss of chemical senses, i.e., smell and taste. Smell training is one of the methods used in facilitating recovery of the olfactory sense, and it uses essential oils of lemon, rose, clove, and eucalyptus. These essential oils were not selected based on their chemical constituents. Although scientific studies have shown that they improve recovery, there may be better combinations for facilitating recovery. Many phytochemicals have bioactive properties with anti-inflammatory and anti-viral effects. In this review, we describe the chemical compounds with anti- inflammatory and anti-viral effects, and we list the plants that contain these chemical compounds. We expand the review from terpenes to the less volatile flavonoids in order to propose a combination of essential oils and diets that can be used to develop a new taste training method, as there has been no taste training so far. Finally, we discuss the possible use of these in clinical settings.
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Affiliation(s)
- Sachiko Koyama
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Kenji Kondo
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Rumi Ueha
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideki Kashiwadani
- Department of Physiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, Washington, DC 20059, USA
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31
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Takayama S, Arita R, Ono R, Saito N, Suzuki S, Kikuchi A, Ohsawa M, Tadano Y, Akaishi T, Tanaka J, Kanno T, Abe M, Onodera K, Ishii T. Treatment of COVID-19-Related Olfactory Disorder Promoted by Kakkontokasenkyushin'i: A Case Series. TOHOKU J EXP MED 2021; 254:71-80. [PMID: 34108344 DOI: 10.1620/tjem.254.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Olfactory disorders are one of the characteristic symptoms of the coronavirus disease of 2019 (COVID-19), which causes infection and inflammation of the upper and lower respiratory tract. To our knowledge, there are no treatments for COVID-19-related olfactory disorder. Here, we report five olfactory disorder cases in COVID-19, treated using the Japanese traditional (Kampo) medicine, kakkontokasenkyushin'i. We treated five patients with mild COVID-19 at an isolation facility using Kampo medicine, depending on their symptoms. Patients with the olfactory disorder presented with a blocked nose, nasal discharge or taste impairment. Physical examination using Kampo medicine showed similar findings, such as a red tongue with red spots and sublingual vein congestion, which presented as blood stasis and inflammation; thus, we prescribed the Kampo medicine, kakkontokasenkyushin'i. After administration, the numeric rating scale scores of the smell impairment improved within 3 days from 9 to 3 in case 1, from 10 to 0 in case 2, from 9 to 0 in case 3, from 5 to 0 in case 4, and from 9 to 0 within 5 days in case 5. Following the treatment, other common cold symptoms were also alleviated. Kakkontokasenkyushin'i can be used for treating nasal congestion, rhinitis, and inflammation in the nasal mucosa. The olfactory disorder in COVID-19 has been reportedly associated with inflammation and congestion, especially in the olfactory bulb and olfactory cleft. Kakkontokasenkyushin'i may be one of the treatment alternatives for the olfactory disorder with rhinitis in patients with COVID-19.
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Affiliation(s)
- Shin Takayama
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine
| | - Ryutaro Arita
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Rie Ono
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Natsumi Saito
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Satoko Suzuki
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Akiko Kikuchi
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine
| | - Minoru Ohsawa
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine
| | - Yasunori Tadano
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Junichi Tanaka
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Takeshi Kanno
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Ko Onodera
- Department of Education and Support for Regional Medicine, Tohoku University Hospital
| | - Tadashi Ishii
- Department of Kampo Medicine, Tohoku University Hospital.,Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine
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Genetzaki S, Tsakiropoulou E, Nikolaidis V, Markou K, Konstantinidis I. Postinfectious Olfactory Dysfunction: Oral Steroids and Olfactory Training versus Olfactory Training Alone: Is There any Benefit from Steroids? ORL J Otorhinolaryngol Relat Spec 2021; 83:387-394. [PMID: 34107478 DOI: 10.1159/000516316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are limited treatment options for postinfectious olfactory dysfunction (PIOD). Olfactory training has recently been used in clinical practice, but no medical treatment is widely accepted. Although there is weak evidence for their value, some physicians use oral corticosteroids as first-line treatment. The aim of this study was to compare combined oral methylprednisolone and olfactory training with olfactory training alone in the management of PIOD. METHODS This prospective cohort study included 131 patients with PIOD over a 2-year period before the COVID-19 pandemic. Seventy-eight patients who were treated with oral methylprednisolone and olfactory training (group A) were compared with 53 patients who were treated with olfactory training only (group B). Olfactory function was evaluated with "Sniffin' Sticks" at baseline and 2, 8, and 16 weeks after initial assessment. Patients who improved after steroid treatment underwent magnetic resonance imaging of the paranasal sinuses, skin prick tests, lung spirometry, and sputum eosinophil assessment. RESULTS Oral steroids improved 19.23% of patients (n = 15) of group A. History, clinical evaluation, imaging, and laboratory tests identified an inflammatory background in half of them (n = 8). The remaining 7 had no findings of nasal inflammation, and all had a short history of olfactory dysfunction. Both groups significantly improved in olfactory testing results at the end of the olfactory training scheme without significant difference between them. CONCLUSIONS The percentage of improved patients after oral methylprednisolone was relatively low to suggest it as first-line treatment. Half of the improved patients had an underlying upper airway inflammatory condition not related to the infection that caused the acute loss of olfactory function.
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Affiliation(s)
- Sotiria Genetzaki
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Evangelia Tsakiropoulou
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Vasilios Nikolaidis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
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Zugaj M, van Ditzhuijzen NS, Golebski K, Fokkens WJ. The effect of coronaviruses on olfaction: systematic review. Rhinology 2021; 59:226-235. [PMID: 34091654 DOI: 10.4193/rhin20.610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Unlike other respiratory viruses, SARS-CoV-2 causes anosmia without sinonasal inflammation. Here we systematically review the effects of the 7 known human coronaviruses on olfaction to determine if SARS-CoV-2 distinctly affects the olfactory system. METHOD PubMed, EMBASE, Web of Science, bioRxiv, medRxiv and DOAJ were searched for studies describing pathophysiological, immunohistochemical, cytological and clinical data. RESULTS 49 studies were included. Common cold coronaviruses lead to sinonasal inflammation which can cause transient and chronic loss of smell. MERS-CoV entry receptors were not found in the nasal mucosa and it did not impair olfaction. SARS-CoV-1 had low affinity for its receptor ACE2, limiting olfactory effects. Anosmia is frequent in SARS-CoV-2 infections. SARS-CoV-2’s entry factors ACE2 and TMPRSS2 are expressed in the nasal respiratory epithelium and olfactory supporting cells. SARS-CoV-2 appeared to target the olfactory cleft while diffuse nasal inflammation was not observed. Damage of the olfactory epithelium was observed in animal models. Alternative receptors such as furin and neuropilin-1 and the similarity of viral proteins to odourant receptors could amplify olfactory impairment in SARS-CoV-2 infection. CONCLUSIONS The pathophysiology of anosmia in SARS-CoV-2 infection is distinct from other coronaviruses due to preferentially targeting olfactory supporting cells. However, SARS-CoV-2 does not cause sinonasal inflammation in spite of preferred entry factor expression in the nasal respiratory epithelium. This raises doubts about the attention given to ACE2. Alternative receptors, odourant receptor mimicry and other as yet unknown mechanisms may be crucial in the pathogenesis of anosmia in SARS-CoV-2 infection. Further studies are warranted to investigate infection mechanisms beyond ACE2.
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Affiliation(s)
- M Zugaj
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - N S van Ditzhuijzen
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - K Golebski
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Location AMC, Amsterdam, The Netherlands
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
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Wee C, Younis J, Xia T, Guyuron B. Delayed Septal Perforation as a Complication of COVID-19: A Case Report. Aesthetic Plast Surg 2021; 45:1197-1200. [PMID: 33403422 PMCID: PMC7785033 DOI: 10.1007/s00266-020-02078-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/26/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are increasing reports of the effects of SARS-CoV-2 on olfactory function, with a significant number of patients reporting anosmia as a symptom. However, our knowledge and understanding of the virus's complete impact on the nose remains poor. This report describes a unique patient case to demonstrate how COVID-19 may be associated with rhinoplasty complications such as septal perforation. CASE REPORT This is a case report of a previously healthy patient who underwent septorhinoplasty in 2018. She had frequent follow-up including intranasal examinations without evidence of the septal perforation for the 2 years following her operation. In March 2020, the patient was noted to have symptoms suggestive of COVID-19, but testing was not recommended by the pediatrician. Soon after her symptoms resolved, she experienced a sudden onset of whistling and physical examination revealed a perforation in the septum which rapidly enlarged over the ensuing weeks. She tested positive for the COVID-19 antibody. After confirming that she no longer had an active infection via antigen testing, she underwent repair of her septal perforation without complications. CONCLUSION This case report illustrates a septorhinoplasty complication that may be associated with COVID-19. Further study into this virus's impact on vascularity and wound healing, specifically in the nose, is recommended. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Corinne Wee
- Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH, USA.
| | - Joseph Younis
- Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas Xia
- Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH, USA
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Samimi Ardestani SH, Mohammadi Ardehali M, Rabbani Anari M, Rahmaty B, Erfanian R, Akbari M, Motedayen Z, Samimi Niya F, Aminloo R, Farahbakhsh F, Hosseininasab A, Hassanlouei B, Rezaian N, Mokhtari Z. The coronavirus disease 2019: the prevalence, prognosis, and recovery from olfactory dysfunction (OD). Acta Otolaryngol 2021; 141:171-180. [PMID: 33176530 PMCID: PMC7678411 DOI: 10.1080/00016489.2020.1836397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many patients with coronavirus disease 2019 (COVID-19) complain from olfactory dysfunction (OD). Aims/objectives: To evaluate the prevalence, prognosis, and recovery from OD in COVID-19 patients. MATERIAL AND METHODS In this study, patients with COVID-19 symptoms who were referred to six different tertiary referral centres were recruited after positive results for COVID-19. All patients were assessed for a one-month follow-up after the initial diagnosis of COVID-19. RESULTS Three hundred and eleven patients with COVID-19 were recruited in the present study. Two hundred and seven patients (66.6%) had a recent history of OD. One hundred and seventy-eight patients had experienced OD as a primary symptom intercurrent to other COVID-19 symptoms or solely. Sixty-nine patients had OD at the time of presentation to referral centres. Headache and nasal obstruction had significant relationships with recovery from OD in this subgroup, and the platelet count was the most important predictor for the recovery from OD. One hundred seventy-nine (86.4%) patients were nearly or fully recovered from OD approximately a month after the onset of OD. CONCLUSION Headache, nasal obstruction, and platelet count may have specific roles as prognostic factors in the recovery from OD.
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Affiliation(s)
- Seyed Hadi Samimi Ardestani
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mohammadi Ardehali
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rabbani Anari
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Akbari
- Department of Otolaryngology – Head and Neck Surgery, Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zohre Motedayen
- Otorhinolaryngology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fahimeh Samimi Niya
- Otorhinolaryngology Research Center, Yazd University of Medical Sciences, Yazd, Iran
| | - Radmehr Aminloo
- Department of Internal Medicine, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farbod Farahbakhsh
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseininasab
- Infectious and Tropical Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Babak Hassanlouei
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Naime Rezaian
- Otorhinolaryngology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Mokhtari
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Due to the rapid spread of the SARS-CoV-2 virus, many health systems worldwide are overwhelmed, leading to the triggering of the scarcity of medical resources. The identification of indicators that require hospital admission help in the efficient allocation of medical resources. Olfactory impairment is also one of the indicators of COVID-19 infection. Many studies have analyzed olfactory dysfunction in COVID-19 with a variable prevalence rate but underreporting of this problem is very much likely as the problem is considered benign. Many scientific societies have stated that olfactory dysfunction is a frequent symptom of COVID-19 and have published recommendations for it.
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Addison AB, Wong B, Ahmed T, Macchi A, Konstantinidis I, Huart C, Frasnelli J, Fjaeldstad AW, Ramakrishnan VR, Rombaux P, Whitcroft KL, Holbrook EH, Poletti SC, Hsieh JW, Landis BN, Boardman J, Welge-Lüssen A, Maru D, Hummel T, Philpott CM. Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction. J Allergy Clin Immunol 2021; 147:1704-1719. [PMID: 33453291 DOI: 10.1016/j.jaci.2020.12.641] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Respiratory tract viruses are the second most common cause of olfactory dysfunction. As we learn more about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the recognition that olfactory dysfunction is a key symptom of this disease process, there is a greater need than ever for evidence-based management of postinfectious olfactory dysfunction (PIOD). OBJECTIVE Our aim was to provide an evidence-based practical guide to the management of PIOD (including post-coronavirus 2019 cases) for both primary care practitioners and hospital specialists. METHODS A systematic review of the treatment options available for the management of PIOD was performed. The written systematic review was then circulated among the members of the Clinical Olfactory Working Group for their perusal before roundtable expert discussion of the treatment options. The group also undertook a survey to determine their current clinical practice with regard to treatment of PIOD. RESULTS The search resulted in 467 citations, of which 107 articles were fully reviewed and analyzed for eligibility; 40 citations fulfilled the inclusion criteria, 11 of which were randomized controlled trials. In total, 15 of the articles specifically looked at PIOD whereas the other 25 included other etiologies for olfactory dysfunction. CONCLUSIONS The Clinical Olfactory Working Group members made an overwhelming recommendation for olfactory training; none recommended monocycline antibiotics. The diagnostic role of oral steroids was discussed; some group members were in favor of vitamin A drops. Further research is needed to confirm the place of other therapeutic options.
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Affiliation(s)
- Alfred B Addison
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Billy Wong
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Tanzime Ahmed
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Alberto Macchi
- ENT University of Insubria, Italian Academy of Rhinology, Varese, Italy
| | - Iordanis Konstantinidis
- Smell and Taste Clinic, 2nd ORL University Department, Aristotle University, Thessaloniki, Greece
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Research Center, Sacré-Coeur Hospital Montréal, Montréal, Québec, Canada
| | - Alexander W Fjaeldstad
- Flavour Clinic, ENT Department, Regional Hospital West Jutland, Holstebro, Denmark; Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, Colo; Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Philippe Rombaux
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Katherine L Whitcroft
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, London, United Kingdom; South Yorkshire Deanery, Yorkshire and Humber School of Surgery, Yorkshire, United Kingdom
| | - Eric H Holbrook
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Sophia C Poletti
- Department of Otorhinolaryngology - Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julien W Hsieh
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospitals of Geneva, Geneva, Switzerland
| | - Basile N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Devina Maru
- Royal College of General Practitioners, London, United Kingdom
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Carl M Philpott
- Fifth Sense, Barrow-in-Furness, United Kingdom; Norfolk Smell and Taste Clinic, James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
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38
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Saniasiaya J, Islam MA, Abdullah B. Prevalence of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID-19): A Meta-analysis of 27,492 Patients. Laryngoscope 2020; 131:865-878. [PMID: 33219539 PMCID: PMC7753439 DOI: 10.1002/lary.29286] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/26/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
Objectives/Hypothesis Olfactory dysfunction has been observed as one of the clinical manifestations in COVID‐19 patients. We aimed to conduct a systematic review and meta‐analysis to estimate the overall pooled prevalence of olfactory dysfunction in COVID‐19 patients. Study Design Systematic review and meta‐analyses. Methods PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between 1 December 2019 and 23 July 2020. We used random‐effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Robustness of the pooled estimates was checked by different subgroup and sensitivity analyses This study is registered with PROSPERO (CRD42020183768). Results We identified 1162 studies, of which 83 studies (n = 27492, 61.4% female) were included in the meta‐analysis. Overall, the pooled prevalence of olfactory dysfunction in COVID‐19 patients was 47.85% [95% CI: 41.20–54.50]. We observed olfactory dysfunction in 54.40% European, 51.11% North American, 31.39% Asian, and 10.71% Australian COVID‐19 patients. Anosmia, hyposmia, and dysosmia were observed in 35.39%, 36.15%, and 2.53% of the patients, respectively. There were discrepancies in the results of studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations. The discrepancy might be due to false‐negative reporting observed in self‐reported health measures. Conclusions The prevalence of olfactory dysfunction in COVID‐19 patients was found to be 47.85% based on high‐quality evidence. Due to the subjective measures of most studies pooled in the analysis, further studies with objective measures are advocated to confirm the finding. Level of Evidence 2 Laryngoscope, 131:865–878, 2021
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan University, Kuala Lumpur, Malaysia
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Vaira LA, Hopkins C, Sandison A, Manca A, Machouchas N, Turilli D, Lechien JR, Barillari MR, Salzano G, Cossu A, Saussez S, De Riu G. Olfactory epithelium histopathological findings in long-term coronavirus disease 2019 related anosmia. J Laryngol Otol 2020; 134:1123-1127. [PMID: 33190655 PMCID: PMC7729153 DOI: 10.1017/s0022215120002455] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Olfactory dysfunction represents one of the most frequent symptoms of coronavirus disease 2019, affecting about 70 per cent of patients. However, the pathogenesis of the olfactory dysfunction in coronavirus disease 2019 has not yet been elucidated. CASE REPORT This report presents the radiological and histopathological findings of a patient who presented with anosmia persisting for more than three months after infection with severe acute respiratory syndrome coronavirus-2. CONCLUSION The biopsy demonstrated significant disruption of the olfactory epithelium. This shifts the focus away from invasion of the olfactory bulb and encourages further studies of treatments targeted at the surface epithelium.
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Affiliation(s)
- L A Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
- Biomedical Science Department, University of Sassari, Italy
| | - C Hopkins
- Department of ENT, King's College, London, UK
| | - A Sandison
- Department of Histopathology, Charing Cross Hospital and Imperial College Healthcare NHS Trust, London, UK
| | - A Manca
- Histopathology Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - N Machouchas
- Otorhinolaryngology Operative Unit, University Hospital of Sassari, Italy
| | - D Turilli
- Radiology Operative Unit, University Hospital of Sassari, Italy
| | - J R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (‘YO-IFOS’), Belgium
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (‘UMons’), Belgium
| | - M R Barillari
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University, Naples, Italy
| | - G Salzano
- Maxillofacial Surgery Unit, University Hospital of Naples ‘Federico II’, Italy
| | - A Cossu
- Histopathology Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - S Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (‘YO-IFOS’), Belgium
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (‘UMons’), Belgium
| | - G De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
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40
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Liu DT, Pellegrino R, Sabha M, Altundag A, Damm M, Poletti SC, Croy I, Hähner A, Oleszkiewicz A, Cuevas M, Hummel T. Factors associated with relevant olfactory recovery after olfactory training: a retrospective study including 601 participants. Rhinology 2020; 0:2651. [PMID: 32901616 DOI: 10.4193/rhin20.262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory training (OT) represents a therapeutic option for multiple etiologies of olfactory dysfunction (OD) that also benefits normosmic subjects. In this retrospective study, we report the effectiveness of OT and factors associated with relevant changes in olfactory function (OF) in large groups of normosmic participants and patients with OD, including a control group that performed no training. METHODS This was a retrospective pooled analysis including 2 treatment cohorts of 8 previously published studies. Adult partici- pants that either presented with the major complaint of quantitative OD or normosmic volunteers were recruited at various ENT clinics and received OT or no training. The outcome was based on changes in objective olfactory test scores after OT. RESULTS A total of 601 patients with OD or normosmic subjects were included. OT was more effective compared to no training. No interaction was found between OT and OF. In multivariate analysis, higher baseline OF (adjusted odds ratio, aOR, 0.93) and posttraumatic (aOR, 0.29) or idiopathic OD (aOR, 0.18) compared to postinfectious causes were significantly associated with lower odds of relevant improvements in patients with OD receiving OT. Subgroup analysis of normosmic participants receiving OT further revealed a significant association of age and baseline olfactory function with improvements of overall OF. CONCLUSIONS This study demonstrated that OT was more effective than no training in patients with various causes of OD. Additi- onally, baseline olfactory performance and etiology of OD were identified as important factors associated with relevant improve- ments after OT.
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Affiliation(s)
- D T Liu
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - R Pellegrino
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
- Department of Food Science, Institute of Agriculture, University of Tennessee, Knoxville, Tennessee, U.S.A
| | - M Sabha
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - A Altundag
- Department of Otorhinolaryngology, Biruni University Medicine Faculty, Istanbul, Turkey
| | - M Damm
- ENT-Medicine Cologne (HNO-Heilkunde Köln) and University Hospitals of Cologne, Cologne, Germany
| | - S C Poletti
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - I Croy
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - A Hähner
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - A Oleszkiewicz
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
| | - M Cuevas
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Medical Faculty Carl-Gustav Carus, Technical University of Dresden, Dresden, Germany
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41
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Meng X, Deng Y, Dai Z, Meng Z. COVID-19 and anosmia: A review based on up-to-date knowledge. Am J Otolaryngol 2020; 41:102581. [PMID: 32563019 PMCID: PMC7265845 DOI: 10.1016/j.amjoto.2020.102581] [Citation(s) in RCA: 235] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of Coronavirus Disease 2019 (COVID-19) has caused a vast disaster throughout the world. There is increasing evidence that olfactory dysfunction can present in COVID-19 patients. Anosmia can occur alone or can be accompanied by other symptoms of COVID-19, such as a dry cough. However, the pathogenic mechanism of olfactory dysfunction and its clinical characteristics in patients with COVID-19 remains unclear. Multiple cross-sectional studies have demonstrated that the incidence rate of olfactory dysfunction in COVID-19 patients varies from 33.9-68% with female dominance. Anosmia and dysgeusia are often comorbid in COVID-19 patients. Otolaryngologists should be mindful of the symptom of anosmia in outpatients so as not to delay the diagnosis of COVID-19. In this paper, we have reviewed the relevant knowledge based on up-to-date literature.
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Affiliation(s)
- Xiangming Meng
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China.
| | - Yanzhong Deng
- Department of Anesthesiology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Zhiyong Dai
- Department of Otolaryngology, Wuxi Huishan District People's Hospital, 2 Zhanqian North Road, Luoshe Town, Huishan District, Wuxi 214187, PR China
| | - Zhisheng Meng
- Faculty of Information Engineering and Automation, Kunming University of Science and Technology, No.727 South Jingming Road, Chenggong District, Kunming 650500, PR China
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Iran-Pour E, Tavabi AA, Seifi A. Presentation with Anosmia and Ageusia: Possible Hidden Carriers of COVID-19. South Med J 2020; 113:399-400. [PMID: 32747969 PMCID: PMC8055087 DOI: 10.14423/smj.0000000000001123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Elham Iran-Pour
- From the Department of Neurosurgery, and Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio
| | - Amir Ali Tavabi
- From the Department of Neurosurgery, and Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio
| | - Ali Seifi
- From the Department of Neurosurgery, and Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio
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43
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Eliezer M, Hautefort C. MRI Evaluation of the Olfactory Clefts in Patients with SARS-CoV-2 Infection Revealed an Unexpected Mechanism for Olfactory Function Loss. Acad Radiol 2020; 27:1191. [PMID: 32425479 PMCID: PMC7229929 DOI: 10.1016/j.acra.2020.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France.
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
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44
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Armocida D, Pesce A, Raponi I, Pugliese F, Valentini V, Santoro A, Berra LV. Letter: Anosmia in COVID-19: Severe Acute Respiratory Syndrome Coronavirus 2 Through the Nasoliary Epithelium and a Possible Spreading Way to the Central Nervous System-A Purpose to Study. Neurosurgery 2020; 87:E246-E247. [PMID: 32379311 PMCID: PMC7239107 DOI: 10.1093/neuros/nyaa204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Daniele Armocida
- A.U.O. "Policlinico Umberto I" Neurosurgery Division Human Neurosciences Department Sapienza University of Rome Rome, Italy
| | - Alessandro Pesce
- A.U.O. "Policlinico Umberto I" Neurosurgery Division Human Neurosciences Department Sapienza University of Rome Rome, Italy
- IRCCS "Neuromed" Pozzilli (IS), Italy
| | - Ingrid Raponi
- Odontostomatological Science and Maxillo-facial Surgery Department Sapienza University of Rome Policlinico Umberto I Rome, Italy
| | - Francesco Pugliese
- Department of Anaesthesia and Intensive Care University La Sapienza Rome, Italy
| | - Valentino Valentini
- Odontostomatological Science and Maxillo-facial Surgery Department Sapienza University of Rome Policlinico Umberto I Rome, Italy
| | | | - Luigi Valentino Berra
- A.U.O. "Policlinico Umberto I" Neurosurgery Division Human Neurosciences Department Sapienza University of Rome Rome, Italy
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45
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Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T. Age-Related Olfactory Dysfunction: Epidemiology, Pathophysiology, and Clinical Management. Front Aging Neurosci 2020; 12:208. [PMID: 32733233 PMCID: PMC7358644 DOI: 10.3389/fnagi.2020.00208] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022] Open
Abstract
Like other sensory systems, olfactory function deteriorates with age. Epidemiological studies have revealed that the incidence of olfactory dysfunction increases at the age of 60 and older and males are more affected than females. Moreover, smoking, heavy alcohol use, sinonasal diseases, and Down’s syndrome are associated with an increased incidence of olfactory dysfunction. Although the pathophysiology of olfactory dysfunction in humans remains largely unknown, studies in laboratory animals have demonstrated that both the peripheral and central olfactory nervous systems are affected by aging. Aged olfactory neuroepithelium in the nasal cavity shows the loss of mature olfactory neurons, replacement of olfactory neuroepithelium by respiratory epithelium, and a decrease in basal cell proliferation both in the normal state and after injury. In the central olfactory pathway, a decrease in the turnover of interneurons in the olfactory bulb (OB) and reduced activity in the olfactory cortex under olfactory stimulation is observed. Recently, the association between olfactory impairment and neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), has gained attention. Evidence-based pharmacotherapy to suppress or improve age-related olfactory dysfunction has not yet been established, but preliminary results suggest that olfactory training using odorants may be useful to improve some aspects of age-related olfactory impairment.
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Affiliation(s)
- Kenji Kondo
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keigo Suzukawa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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46
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Bagheri SH, Asghari A, Farhadi M, Shamshiri AR, Kabir A, Kamrava SK, Jalessi M, Mohebbi A, Alizadeh R, Honarmand AA, Ghalehbaghi B, Salimi A, Dehghani Firouzabadi F. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran 2020; 34:62. [PMID: 32974228 PMCID: PMC7500422 DOI: 10.34171/mjiri.34.62] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The occurrence of anosmia/hyposmia during novel Coronavirus disease 2019 (COVID-19) may indicate a relationship between coincidence of olfactory dysfunction and coronavirus disease 2019 (COVID-19). This study aimed to assess the frequency of self-reported anosmia/hyposmia during COVID-19 epidemic in Iran. Methods: This population-based cross sectional study was performed through an online questionnaire from March 12 to 17, 2020. Cases from all provinces of Iran voluntarily participated in this study. Patients completed a 33-item patient-reported online questionnaire, including smell and taste dysfunction and their comorbidities, along with their basic characteristics and past medical histories. The inclusion criteria were self-reported anosmia/hyposmia during the past 4 weeks, from the start of COVID-19 epidemic in Iran. Results: A total of 10 069 participants aged 32.5±8.6 (7-78) years took part in this study, of them 71.13% women and 81.68% nonsmokers completed the online questionnaire. The correlation between the number of olfactory disorders and reported COVID-19 patients in all provinces up to March 17, 2020 was highly significant (Spearman correlation coefficient = 0.87, P< 0.001). A sudden onset of olfactory dysfunction was reported in 76.24% of the participations and persistent anosmia in 60.90% from the start of COVID19 epidemic. In addition, 80.38% of participants reported concomitant olfactory and gustatory dysfunctions. Conclusion: An outbreak of olfactory dysfunction occurred in Iran during the COVID-19 epidemic. The exact mechanisms by which anosmia/hyposmia occurred in patients with COVID-19 call for further investigations.
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Affiliation(s)
- Seyed Hamidreza Bagheri
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alimohamad Asghari
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kamran Kamrava
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Rafieh Alizadeh
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Babak Ghalehbaghi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Salimi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
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47
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Ogawa T, Nakamura K, Yamamoto S, Tojima I, Shimizu T. Recovery Over Time and Prognostic Factors in Treated Patients with Post-Infectious Olfactory Dysfunction: A Retrospective Study. Ann Otol Rhinol Laryngol 2020; 129:977-982. [DOI: 10.1177/0003489420922563] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: The aims of the present study were to clarify the time-course of olfactory recovery and the prognostic factors in PIOD patients treated with Toki-shakuyaku-san (TSS). Methods: A retrospective cohort study of patients with PIOD was conducted by reviewing patients’ medical records. This study included patients who received TSS or a combination of TSS and zinc sulfate. Olfactory function was examined by T&T olfactometer at each 3-monthly follow-up visit. Patients with normal and mild olfactory dysfunction were excluded. Gender, age, treatment, duration of disease until the first visit and olfactory function scores of the T&T olfactometer at the first visit were analyzed as candidate clinical predictors of recovery. Results: A total of 82 PIOD patients with ages ranging from 16 to 79 years were included. The mean duration of follow-up was 14.5 months (range 3-45 months). The number of patients with olfactory recovery increased for 24 months and the cumulative recovery rate was 77.3%. In about 60% of patients, olfactory recovery occurred within 6 months. Multivariate analysis showed that younger age (<65 years) and residual olfactory function were significantly associated with good olfactory recovery. Conclusions: We revealed recovery rates over time in patients with PIOD. The recovery of olfactory function often occurred during the early period (≤6 months). However, the number of patients with olfactory recovery increased for a long-term of 24 months after the first visit. Residual olfactory function and younger age were prognostic factors exactly. TSS may be a useful therapeutic agent for patients with PIOD. We believe that these results provide important information that is useful for counseling patients with PIOD.
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Affiliation(s)
- Takao Ogawa
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Keigo Nakamura
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Sayuri Yamamoto
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Tojima
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
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48
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Pellegrino R, Cooper KW, Di Pizio A, Joseph PV, Bhutani S, Parma V. Corona Viruses and the Chemical Senses: Past, Present, and Future. Chem Senses 2020; 45:bjaa031. [PMID: 32407464 PMCID: PMC7239211 DOI: 10.1093/chemse/bjaa031] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
A wealth of rapidly evolving reports suggests that olfaction and taste disturbances may be manifestations of the novel COVID-19 pandemic. While otolaryngological societies worldwide have started to consider chemosensory evaluation as a screening tool for COVID-19 infection, the true nature of the relationship between the changes in chemosensory ability and COVID-19 is unclear. Our goal with this review is to provide a brief overview of published and archived literature, as well as the anecdotal reports and social trends related to this topic up to April 29, 2020. We also aim to draw parallels between the clinical/chemosensory symptomology reported in association to past coronavirus pandemics (such as SARS and MERS) and the novel COVID-19. This review also highlights current evidence on persistent chemosensory disturbances after the infection has resolved. Overall, our analysis pinpoints the need for further studies: 1) to better quantify olfaction and taste disturbances associated with SARS-CoV-2 infection, compared to those of other viral and respiratory infections, 2) to understand the relation between smell, taste, and chemesthesis disturbances in COVID-19, and 3) to understand how persistent are these disturbances after the infection has resolved.
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Affiliation(s)
- Robert Pellegrino
- Department of Food Science, Institute of Agriculture, University of Tennessee, Knoxville, TN, USA
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Keiland W Cooper
- Interdepartmental Neuroscience Program, University of California Irvine, Irvine (CA), USA
| | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, 85354 Freising, Germany
| | - Paule V Joseph
- Division of Intramural Research, National Institute of Nursing Research (NINR) & National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institutes of Health, Bethesda, MD, 20892, USA
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
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Sundar S, Battistoni C, McNulty R, Morales F, Gorky J, Foley H, Dhurjati P. An agent-based model to investigate microbial initiation of Alzheimer's via the olfactory system. Theor Biol Med Model 2020; 17:5. [PMID: 32290858 PMCID: PMC7158140 DOI: 10.1186/s12976-020-00123-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a degenerative brain disease. A novel agent-based modelling framework was developed in NetLogo 3D to provide fundamental insights into the potential mechanisms by which a microbe (eg. Chlamydia pneumoniae) may play a role in late-onset AD. The objective of our initial model is to simulate one possible spatial and temporal pathway of bacterial propagation via the olfactory system, which may then lead to AD symptoms. The model maps the bacteria infecting cells from the nasal cavity and the olfactory epithelium, through the olfactory bulb and into the olfactory cortex and hippocampus regions of the brain. RESULTS Based on the set of biological rules, simulated randomized infection by the microbe led to the formation of beta-amyloid (Aβ) plaque and neurofibrillary (NF) tangles as well as caused immune responses. Our initial simulations demonstrated that breathing in C. pneumoniae can result in infection propagation and significant buildup of Aβ plaque and NF tangles in the olfactory cortex and hippocampus. Our model also indicated how mucosal and neural immunity can play a significant role in the pathway considered. Lower immunities, correlated with elderly individuals, had quicker and more Aβ plaque and NF tangle formation counts. In contrast, higher immunities, correlated with younger individuals, demonstrated little to no such formation. CONCLUSION The modelling framework provides an organized visual representation of how AD progression may occur via the olfactory system to better understand disease pathogenesis. The model confirms current conclusions in available research but can be easily adjusted to match future evidence and be used by researchers for their own individual purposes. The goal of our initial model is to ultimately guide further hypothesis refinement and experimental testing to better understand the dynamic system interactions present in the etiology and pathogenesis of AD.
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Affiliation(s)
- Shalini Sundar
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA
| | - Carly Battistoni
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA
| | - Ryan McNulty
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA
| | - Fernando Morales
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA
| | - Jonathan Gorky
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Henry Foley
- New York Institute of Technology, New York, NY, USA
| | - Prasad Dhurjati
- Department of Chemical and Biomolecular Engineering, University of Delaware, Newark, Delaware, USA.
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50
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Bagheri SH, Asghari A, Farhadi M, Shamshiri AR, Kabir A, Kamrava SK, Jalessi M, Mohebbi A, Alizadeh R, Honarmand AA, Ghalehbaghi B, Salimi A, Dehghani Firouzabadi F. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran 2020. [PMID: 32974228 DOI: 10.1101/2020.03.23.20041889] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background: The occurrence of anosmia/hyposmia during novel Coronavirus disease 2019 (COVID-19) may indicate a relationship between coincidence of olfactory dysfunction and coronavirus disease 2019 (COVID-19). This study aimed to assess the frequency of self-reported anosmia/hyposmia during COVID-19 epidemic in Iran. Methods: This population-based cross sectional study was performed through an online questionnaire from March 12 to 17, 2020. Cases from all provinces of Iran voluntarily participated in this study. Patients completed a 33-item patient-reported online questionnaire, including smell and taste dysfunction and their comorbidities, along with their basic characteristics and past medical histories. The inclusion criteria were self-reported anosmia/hyposmia during the past 4 weeks, from the start of COVID-19 epidemic in Iran. Results: A total of 10 069 participants aged 32.5±8.6 (7-78) years took part in this study, of them 71.13% women and 81.68% nonsmokers completed the online questionnaire. The correlation between the number of olfactory disorders and reported COVID-19 patients in all provinces up to March 17, 2020 was highly significant (Spearman correlation coefficient = 0.87, P< 0.001). A sudden onset of olfactory dysfunction was reported in 76.24% of the participations and persistent anosmia in 60.90% from the start of COVID19 epidemic. In addition, 80.38% of participants reported concomitant olfactory and gustatory dysfunctions. Conclusion: An outbreak of olfactory dysfunction occurred in Iran during the COVID-19 epidemic. The exact mechanisms by which anosmia/hyposmia occurred in patients with COVID-19 call for further investigations.
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Affiliation(s)
- Seyed Hamidreza Bagheri
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alimohamad Asghari
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kamran Kamrava
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Rafieh Alizadeh
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Babak Ghalehbaghi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Salimi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- ENT and Head and Neck Research Center and Department, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
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