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Solé D, Kuschnir FC, Pastorino AC, Constantino CF, Galvão C, Chong E Silva DC, Baptistella E, Goudouris ES, Sakano E, Ejzenbaum F, Matsumoto FY, Mizoguchi FM, Aarestrup FM, Wandalsen GF, Chong Neto HJ, Brito de Oliveira JV, Faibes Lubianca Neto J, Rizzo MCV, Silva Chavarria MLF, Urrutia-Pereira M, Filho NAR, de Paula Motta Rubini N, Mion O, Piltcher OB, Ramos RT, Francesco RD, Roithmann R, Anselmo-Lima WT, Romano FR, de Mello Júnior JF. V Brazilian Consensus on Rhinitis - 2024. Braz J Otorhinolaryngol 2024; 91:101500. [PMID: 39388827 PMCID: PMC11497470 DOI: 10.1016/j.bjorl.2024.101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 10/12/2024] Open
Abstract
Since we published the "IV Brazilian Consensus on Rhinitis", in2017, several advances have been achieved and have enabled a further understanding of the different aspects of "Rhinitis". This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the "V Brazilian Consensus on Rhinitis" represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.
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Affiliation(s)
- Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Antônio Carlos Pastorino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clóvis F Constantino
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de Santo Amaro, São Paulo, SP, Brazil
| | - Clóvis Galvão
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Débora Carla Chong E Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Eduardo Baptistella
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Ekaterini Simões Goudouris
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eulália Sakano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fábio Ejzenbaum
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Fausto Yoshio Matsumoto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Flavio Massao Mizoguchi
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Fernando Monteiro Aarestrup
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto José Chong Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | | | - José Faibes Lubianca Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Marilyn Urrutia-Pereira
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Nelson Augusto Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná́, Curitiba, PR, Brazil
| | - Norma de Paula Motta Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - Otávio Bejzman Piltcher
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazi
| | - Regina Terse Ramos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Renata Di Francesco
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil, Canos, RS, Brazil
| | - Wilma Terezinha Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Fabrizio Ricci Romano
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil
| | - João Ferreira de Mello Júnior
- Universidade de São Paulo, São Paulo, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, São Paulo, SP, Brazil.
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Fornazieri MA, Garcia ECD, Montero RH, Borges R, Bezerra TFP, Pinna FR, Doty RL, Voegels RL. Prevalence and Magnitude of Olfactory Dysfunction in Allergic Rhinitis. Am J Rhinol Allergy 2024; 38:306-315. [PMID: 38759958 DOI: 10.1177/19458924241253642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Although allergic rhinitis (AR) can negatively impact the ability to smell, the degree to which this occurs is not clear and prevalence estimates vary among studies. This study had 4 main objectives: (1) To estimate the prevalence and the degree of olfactory dysfunction in AR patients; (2) To compare olfactory perception between AR patients with different persistence and severity of symptoms and determine if olfactory testing may aid in differentiating among Allergic Rhinitis and its Impact on Asthma (ARIA) groups; (3) To determine whether allergic reactions to different allergens differentially impact olfactory function, and (4) Verify possible changes in the olfactory epithelium (OE) caused by AR. METHODS One hundred thirty-three patients with AR and one hundred controls were tested. The main outcome was the score in University of Pennsylvania Smell Identification Test (UPSIT®). The OE was examined using immunofluorescence markers for neuronal activity, apoptosis, oxidative stress, signal transduction, eosinophils, and epithelial thickness. RESULTS Prevalence of olfactory dysfunction in the AR patients was higher (AR: 42.9% vs controls: 9%, P < .001). No difference was found either between intermittent and persistent disease cases (P = .58) or between cases with mild and those with moderate/severe symptomatology (P = .33). Lower olfactory capacity was not associated with the reaction to more (P = .48) or diverse types of allergens (Ps > .05). Although not significant, patients with AR had a greater amount of eosinophilia and a lower amount of cAMP (cyclic adenosine monophosphate) in the OE. CONCLUSION The study highlights a higher prevalence of olfactory dysfunction in AR patients compared to controls, but olfactory testing may not effectively differentiate AR severity or allergen sensitivities. Although trends suggest potential pathophysiological changes in the OE of AR patients, further research is needed to validate these findings.
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Affiliation(s)
- Marco A Fornazieri
- Department of Surgery, Londrina State University, Londrina, Brazil
- Department of Medicine, Pontifical Catholic University of Paraná, Londrina, Brazil
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
- Department of Otolaryngology, Smell and Test Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ellen C D Garcia
- Department of Surgery, Londrina State University, Londrina, Brazil
| | | | - Ricardo Borges
- Department of Surgery, Londrina State University, Londrina, Brazil
| | - Thiago F P Bezerra
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
| | - Fábio R Pinna
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
| | - Richard L Doty
- Department of Otolaryngology, Smell and Test Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Richard L Voegels
- Department of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
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Garcia ECD, Rosa LR, Santos ACRD, Ishimatsu GKA, Lopes NMD, Fornazieri MA. Investigating the efficacy of melatonin, topical sodium citrate, and multivitamin with zinc as a potential treatment for postinfectious loss of smell. Braz J Otorhinolaryngol 2024; 90:101496. [PMID: 39243697 PMCID: PMC11409182 DOI: 10.1016/j.bjorl.2024.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/01/2024] [Accepted: 08/03/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES Upper respiratory tract infections, including COVID-19, are associated with olfactory dysfunction and there is a need for novel therapeutic approaches. The aim of study was evaluating the effectiveness of adding melatonin, multivitamin and sodium citrate to olfactory training for the treatment of olfactory loss caused by COVID-19. METHODS We evaluated olfactory function using University of Pennsylvania Smell Identification Test (UPSIT ®) scores and self-reported patient outcomes in post-infectious smell loss cases. We investigated the effectiveness involved olfactory training combined with sodium citrate, melatonin, and multivitamin supplements with zinc over a three-month period compared to an olfactory training alone. RESULTS A total of 66 patients were included, with 33 in each group. There was no significant difference in the proportion of participants who showed improvement in UPSIT scores between the groups (OR = 1.43, 95% CI 0.43-4.8, p = 0.56). Both groups showed improvement in average test scores, but there were no significant differences in self-reported olfactory ability or discomfort with olfactory loss. Qualitative symptoms, such as parosmia and phantosmia, were reported by a similar proportion in both groups before and after the treatment (p = 0.11, p = 1, respectively). CONCLUSIONS Olfactory training alone and olfactory training with associated with melatonin, multivitamins and topical sodium citrate did not show significant differences in improving olfactory function in post-COVID-19 patients. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | - Letícia Ribeiro Rosa
- Universidade Estadual de Londrina (UEL), Departamento de Clínica Cirúrgica, Londrina, PR, Brasil
| | | | | | | | - Marco Aurélio Fornazieri
- Universidade Estadual de Londrina (UEL), Departamento de Clínica Cirúrgica, Londrina, PR, Brasil; Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Curitiba, PR, Brazil; Universidade de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; University of Pennsylvania, Perelman School of Medicine, Smell and Taste Center, Department of Otorhinolaryngology, Head and Neck Surgery, Philadelphia, PA, United States.
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Anselmo-Lima WT, Romano FR, Tamashiro E, Roithmann R, Dinarte VRP, Piltcher OB, Miyake MM, Fornazieri MA, Nakanishi M, Bezerra TFP, Dolci RLL, Mello JF, Lessa MM, Voegels RL, Kosugi EM, Sakano E, Valera FCP. Brazilian guideline for the use of immunobiologicals in chronic rhinosinusitis with nasal polyps ‒ 2024 update. Braz J Otorhinolaryngol 2024; 90:101394. [PMID: 38367543 PMCID: PMC10879704 DOI: 10.1016/j.bjorl.2024.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Biologics targeting type 2 inflammation have revolutionized the way we treat patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Particularly in severe and difficult-to-control cases, these drugs have provided a new reality for these patients, allowing for the effective and safe treatment of extensive diseases that were not completely managed with the typical strategy of surgery and topical medications. OBJECTIVES The experience achieved with the approval of these medications by ANVISA for use in CRSwNP and the knowledge obtained regarding outcomes, adverse effects, and the ideal patient profile prompted the update of the previously published guideline, with a detailed review of the most recent scientific literature, the personal experiences of experts, and the adaptation to the reality of the Brazilian healthcare system, both public and private. RESULTS We proposed a new eligibility criterion for biologics in patients with CRSwNP based on four pillars of indication: the impact of the disease on the patient's life, whether in the presence of specific symptoms or in overall quality of life; the extent of sinonasal disease; the presence of type 2 comorbidities, considering other associated diseases that may also benefit from anti-T2 biologics, and the presence of biomarkers to define type 2 inflammation, especially those associated with worse disease prognoses. CONCLUSIONS This innovative and pioneering method has two major advantages. First, it ensures a comprehensive evaluation of patients; second, it is flexible, as advancements in our understanding of the disease and changes in cost-effectiveness can be addressed by simply adjusting the required score for indication, without the need to modify the entire evaluation scheme.
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
| | - Fabrizio R Romano
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | | | | | - Otavio B Piltcher
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (FAMED-UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Marcel M Miyake
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil; Santa Casa de Misericórdia, Hospital de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco A Fornazieri
- Universidade Estatual de Londrina, Londrina, PR, Brazil; Pontifícia Universidade Católica do Paraná (PUCPR), Câmpus Londrina, Londrina, PR, Brazil
| | - Marcio Nakanishi
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação, Brasilia, DF, Brazil
| | | | | | - João F Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus M Lessa
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Richard L Voegels
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo M Kosugi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eulalia Sakano
- Universidade Estadual Paulista, Faculdade de Ciências Médicas, Departamento de Oftalmologia/Otorrinolaringologia, Campinas, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (FMRP-USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Maspero JF, Anselmo-Lima W, Bedoya D, Jimenez Chobillón MA, Ospina J, Roithmann R, Sadek Gonzalez A, Silva Rueda R. Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group. World Allergy Organ J 2024; 17:100886. [PMID: 38463018 PMCID: PMC10924205 DOI: 10.1016/j.waojou.2024.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.
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Affiliation(s)
| | - Wilma Anselmo-Lima
- Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - David Bedoya
- Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
| | | | - Javier Ospina
- Division of Otolaryngology - Sinus and Skull Base Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Renato Roithmann
- Universidade Luterana do Brasil, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Andrés Sadek Gonzalez
- Hospital Angeles del Pedregal, Camino a Santa Teresa 1055, Delegacion Alvaro Obregon, CP10700 Mexico City, Mexico
| | - Ricardo Silva Rueda
- Department of Otorhinolaryngology, Hospital Militar Central, Bogotá, Colombia
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Plantier DB, Pinna FDR, Olm MAK, Athanázio R, Pilan RRDM, Voegels RL. Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia. Int Arch Otorhinolaryngol 2023; 27:e423-e427. [PMID: 37564476 PMCID: PMC10411207 DOI: 10.1055/s-0042-1746193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 08/12/2023] Open
Abstract
Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis. Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis. Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively. Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery. Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.
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Affiliation(s)
- Diogo Barreto Plantier
- Department of Otorhinolaryngology and Ophthalmology, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fábio de Rezende Pinna
- Department of Otorhinolaryngology and Ophthalmology, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mary Anne Kowal Olm
- Department of Pathology, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Athanázio
- Pulmonary Division, Instituto do Coração, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Richard Louis Voegels
- Department of Otorhinolaryngology and Ophthalmology, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Barbosa da Silva JL, Anzolin LK, Nicacio SP, Doty RL, Pinna FDR, Voegels RL, Fornazieri MA. High prevalence of olfactory dysfunction detected in treatment-naive patients with head and neck cancer. Acta Otolaryngol 2023; 143:201-204. [PMID: 36861186 DOI: 10.1080/00016489.2023.2181984] [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: 03/03/2023]
Abstract
BACKGROUND Previous studies demonstrated the difficulty of patients with Head and Neck Cancer (HNC) in sensing food taste, a function in which olfaction has a significant role. However, neither study employed psychophysical tests or control groups to establish the veracity of such complaints. AIMS/OBJECTIVES In this study, we quantitatively tested the olfactory function of HNC individuals and compared their function to that of healthy controls. METHODS Thirty-one HNC naïve treatment patients and thirty-one controls, matched for sex, age, schooling, and smoking, were tested with the University of Pennsylvania Smell Identification Test (UPSIT). RESULTS The olfactory function was significantly worse among the patients diagnosed with head and neck cancer [UPSIT cancer = 22.9(CI 95%: 20.5-25.4) vs. UPSIT controls = 29.1(CI 95%: 26.9-31.3); p < .001]. Most patients with HNC had olfactory disorders (n = 29, 93.5%). The risk of olfactory loss was higher in the cancer group [OR: 10.5(CI 95%: 2.1-51.9; p = .001)]. CONCLUSION AND SIGNIFICANCE Olfactory disorders can be detected in more than 90% of patients with head and neck cancer when evaluated using a well-validated olfactory test. Smell disorders may be a potential marker for early diagnosis of HNC.
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Affiliation(s)
- José Lucas Barbosa da Silva
- Department of Clinical Surgery, State University of Londrina, Londrina, Brazil.,Department of Otorhinolaryngology, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Richard L Doty
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | | | | | - Marco Aurélio Fornazieri
- Department of Clinical Surgery, State University of Londrina, Londrina, Brazil.,Department of Otorhinolaryngology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Medicine, Pontifical Catholic University of Parana, Londrina, Brazil
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8
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Scussiatto HO, da Silva JLB, Figueiredo AF, Ramos RAMR, de Rezende Pinna F, Voegels RL, Pinto JM, Fornazieri MA. Association of air pollution with olfactory identification performance of São Paulo residents: a cross-sectional study. Int Arch Occup Environ Health 2023; 96:621-628. [PMID: 36719485 DOI: 10.1007/s00420-023-01956-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Exposure to particulate matter of 10 μm or less in diameter (PM10) has been implicated in pulmonary and cardiovascular diseases. However, the effect of PM10 on olfaction has not been well established. We estimated individual acute and chronic PM10 exposure levels in a large Brazilian cohort and related them to the ability to identify odors. METHODS Adults from São Paulo (n = 1358) were recruited from areas with different levels of air pollution. To verify individual exposure to air pollution, the averages of 30, 60, 90, 180 and 364 days of PM10 were interpolated to subjects' zip codes using the kriging method. Olfactory identification performance was tested using the University of Pennsylvania Smell Identification Test (UPSIT®). Multiple linear regressions were used to calculate the effect of air pollution on olfactory identification performance, controlling for demographic and other variables that affect the sense of smell. RESULTS Acute exposures to PM10 were related to worse UPSIT® scores, including 30- (β = - 0.94, 95% Confidence Interval [CI] - 0.98, - 0.89), 60- (β = - 1.09, 95% CI = - 1.13, - 1.04) and 90-day intervals (β = - 1.06, 95% CI - 1.10, - 1.02) (reference for β: 1 µm/m3 increase in PM10 exposure per point decrease in UPSIT® score). Chronic exposures were also associated with worse olfaction for both 180- (β = - 1.06, 95% CI - 1.10, - 1.03) and 364-day (β = - 0.87, 95% CI - 0.90, - 0.84) intervals. As in prior work, men, older, low-income, and low-schooling people demonstrated worse olfactory performance. CONCLUSION Acute and chronic exposure to PM10 is strongly associated with olfactory identification performance in Brazilian adults. Understanding the mechanisms which underlie these relationships could help to improve chemosensory function with a large public health impact.
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Affiliation(s)
- Henrique Ochoa Scussiatto
- Department of Surgery, State University of Londrina, Celso Garcia Cid Road, Londrina, Parana, 86057970, Brazil. .,Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, South Ellis Avenue, Chicago, IL, 60637, USA.
| | - Jose Lucas Barbosa da Silva
- Department of Surgery, State University of Londrina, Celso Garcia Cid Road, Londrina, Parana, 86057970, Brazil.,Department of Surgery, University of São Paulo, Doutor Arnaldo Avenue, São Paulo, 01246903, Brazil
| | - Alan Felipe Figueiredo
- Department of Surgery, State University of Londrina, Celso Garcia Cid Road, Londrina, Parana, 86057970, Brazil
| | | | - Fabio de Rezende Pinna
- Department of Surgery, University of São Paulo, Doutor Arnaldo Avenue, São Paulo, 01246903, Brazil
| | - Richard Louis Voegels
- Department of Surgery, University of São Paulo, Doutor Arnaldo Avenue, São Paulo, 01246903, Brazil
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, South Ellis Avenue, Chicago, IL, 60637, USA
| | - Marco Aurelio Fornazieri
- Department of Surgery, State University of Londrina, Celso Garcia Cid Road, Londrina, Parana, 86057970, Brazil.,Department of Surgery, University of São Paulo, Doutor Arnaldo Avenue, São Paulo, 01246903, Brazil.,Department of Surgery, Pontifical Catholic University of Parana, Jockey Club Avenue, Londrina, Parana, 86067000, Brazil
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9
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Fantin L, Pinzano C, Rumeau C, Hossu G, Ceyte H. Effects of Gender and Age on Self-reported Odor Imagery Ability. CHEMOSENS PERCEPT 2022. [DOI: 10.1007/s12078-022-09302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Leung JS, Cordano VP, Fuentes-López E, Lagos AE, García-Huidobro FG, Aliaga R, Díaz LA, García-Salum T, Salinas E, Toro A, Callejas CA, Riquelme A, Palmer JN, Medina RA, González G C. Phantosmia May Predict Long-Term Measurable Olfactory Dysfunction After COVID-19. Laryngoscope 2022; 132:2445-2452. [PMID: 36149773 PMCID: PMC9538510 DOI: 10.1002/lary.30391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Objectives Persistent olfactory dysfunction (OD) after 6 months caused by SARS‐CoV‐2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of long‐term OD and identify predisposing factors. Methods A prospective cohort study was conducted on 100 adults with COVID‐19. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and a symptom survey at the onset of disease and 30 days later. Patients with persistent quantitative OD at the second assessment were reevaluated after 1 year. Demographic variables, symptoms, and the degree of smell loss were analyzed. Results Participants included 100 patients. The mean age was 42.2 ± 15.6 years, 55 (55%) were female, and 56 (56%) were outpatients. Baseline smell loss was identified in 75/100 (75%) patients, decreasing to 39/95 (40%) after 1 month, and persisting in 29 patients after 1 year. Phantosmia at baseline was the only risk factor identified for persistent OD after 1 year (relative risk 2.51; 95% confidence interval 1.53–4.12; p < 0.001). Regardless of the outcome in smell function, a significant decline in olfaction was associated with the presence of phantosmia at 1 month (β = −12.39; 95% CI −19.82 to −4.95; p < 0.01). Conclusions SARS‐CoV‐2 (2019–2020 variants) produced a highly frequent OD that persisted in 29% of the patients after 1 year. The presence of phantosmia at baseline and 1 month was associated with a worse evolution, but phantosmia may interfere with the performance in an identification smell test. A longer follow‐up is required in these patients. Level of Evidence 2 Laryngoscope, 2022
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Affiliation(s)
- Jai-Sen Leung
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valentina Paz Cordano
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Elisa Lagos
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rodrigo Aliaga
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tamara García-Salum
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erick Salinas
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adriana Toro
- Pediatric Service, Clínica UC San Carlos, Red Salud UC-Christus, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Andrés Callejas
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Gastroenterología, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - James N Palmer
- Rhinology Division, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Rafael A Medina
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Claudia González G
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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11
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Yap AC, Mahendran R, Kua EH, Zhou W, Wang DY. Olfactory dysfunction is associated with mild cognitive impairment in community-dwelling older adults. Front Aging Neurosci 2022; 14:930686. [PMID: 36004001 PMCID: PMC9393534 DOI: 10.3389/fnagi.2022.930686] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Olfactory impairment is aging related and is associated with cognitive decline in older adults. However, it remains unclear if an olfactory impairment is associated with mild cognitive impairment (MCI) and the degree of impairment in the MCI subtypes. Materials and methods In a cohort of community-living older adults aged 60 years and above, 670 participants were recruited from the Community Health and Intergenerational (CHI) Study. Olfactory function was assessed using a locally developed nine-item smell test in association with neurocognitive assessments. Analysis of covariance (ANCOVA) was used to examine the association of smell identification score and clinical cognitive status while considering demographic, clinical, and neuropsychological factors with Bonferroni correction for group comparisons. Results Age-related smell detection between normal aging (NA) and MCI participants had no significant difference. The overall mean smell identification score in older adults was negatively correlated with age. The mean smell identification score of MCI participants was also not significantly different as compared with NA, but an amnestic MCI multiple domain (aMCI_MD) subgroup had significantly lower (impaired) mean smell identification scores compared with the NA and MCI single domain (amnestic and non-amnestic) group. Conclusion This study demonstrated that olfactory identification impairment is a comorbidity in older adults with amnestic MCI (aMCI) and is a potential marker associated with an early stage of a neurocognitive disorder. The smell test could act as a screening tool to help in the early detection of smell impairment for heterogeneous syndromes of MCI among community-dwelling older adults. Clinicians and researchers could benefit from utilizing the locally developed smell test to screen their patients or research participants before the initiation of an appropriate health intervention or in a clinical trial.
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Affiliation(s)
- Ai Che Yap
- Department of Food Science and Technology, National University of Singapore, Singapore, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee Heok Kua
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
- *Correspondence: Ee Heok Kua,
| | - Weibiao Zhou
- Department of Food Science and Technology, National University of Singapore, Singapore, Singapore
- Weibiao Zhou,
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- De Yun Wang,
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12
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Pires ÍDAT, Steffens ST, Mocelin AG, Shibukawa DE, Leahy L, Saito FL, Amadeu NT, Lopes NMD, Garcia ECD, Albanese ML, De Mari LF, Ferreira IM, Veiga CA, Jebahi Y, Coifman H, Fornazieri MA, Hamerschmidt R. Intensive Olfactory Training in Post-COVID-19 Patients: A Multicenter Randomized Clinical Trial. Am J Rhinol Allergy 2022; 36:780-787. [PMID: 35866202 DOI: 10.1177/19458924221113124] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Olfactory dysfunction (OD)-including anosmia and hyposmia-is a common symptom of COVID-19. Previous studies have identified olfactory training (OT) as an important treatment for postinfectious OD; however, little is known about its benefits and optimizations after SARS-CoV-2 infection. OBJECTIVE This study aimed to assess whether olfactory training performance can be optimized using more fragrances over a shorter period of time in patients with persistent OD after COVID-19. In addition, we determined the presence of other variables related to OD and treatment response in this population. METHODS This multicenter randomized clinical trial recruited 80 patients with persistent OD and prior COVID-19 infection for less than 3 months. The patients were divided into 2 groups receiving either 4 or 8 essences over 4 weeks. Subjective assessments and the University of Pennsylvania Smell Identification Test (UPSIT) were performed before and after the treatment. RESULTS Significant olfactory improvement was measured subjectively and using the UPSIT in both groups; however, no significant differences between the groups were observed. Additionally, the presence of olfactory fluctuations was associated with higher UPSIT scores. CONCLUSION These data suggest that training intensification by increasing the number of essences for 4 weeks does not show superiority over the classical method. Moreover, fluctuant olfaction seems to be related to a higher score on the UPSIT.
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Affiliation(s)
| | - Sara T Steffens
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | | | | | - Letícia Leahy
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Fernanda L Saito
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Nicole T Amadeu
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | | | | | | | | | | | - César A Veiga
- Olfactory Intelligence Nucleus of the Boticario Group, Curitiba, Brazil
| | - Yasser Jebahi
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Herton Coifman
- Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Marco A Fornazieri
- Division of Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
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13
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Nakanishi M, Fornazieri MA, Lança Gomes P, Dias LADM, Freire GSM, Vinha LGDA, Barbosa de Sa LC, Voegels RL, Galvão C, Lima WTA. The digital scent device as a new concept for olfactory assessment. Int Forum Allergy Rhinol 2022; 12:1263-1272. [PMID: 35224885 DOI: 10.1002/alr.22992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are major challenges in olfactory measurements in clinical practice; therefore, a handheld digital scent device (DSD; Noar MultiScent 20) was developed as a tablet with an integrated storage system for odors. The DSD is a self-administered, handheld device that controls the duration of odor release to the nasal cavity through a touchscreen digital interface with automatic database generation. In this study we aimed to determine the feasibility of this DSD as an olfactory assessment test. METHODS We recruited 180 participants (age [mean ± standard deviation], 34.58 ± 9.71 years; 114 women and 66 men) to participate in smell tests using both the DSD and the 40-item Smell Identification Test (SIT-40), which contained the same type and order of odors and the same multiple-choice answers. The scores were compared and evaluated for correlation between the tests, and test-retest reliability was calculated. RESULTS The DSD test scores were higher than the SIT-40 scores (median [interquartile range], 32 [5.0] vs 31 [7.0]; p = 0.005). The completion time was less for the DSD test than for the SIT-40 (12.5 [5.0] vs 16 [6.0] minutes; p < 0.001). The tests were strongly correlated (Spearman rho = 0.74; p < 0.001) and exhibited a high level of agreement (Bland-Altman regression coefficient = 0.672; p = 0.003). The DSD test-retest reliability coefficient was 0.820. CONCLUSION The DSD is feasible as an olfactory assessment test. The digitalization of olfactory assessment combined with data science may enable new research perspectives in the field of olfaction.
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Affiliation(s)
- Marcio Nakanishi
- Department of Otorhinolaryngology, University Hospital of Brasília UnB-EBSERH, Brasilia, Federal District, Brazil.,Department of Ophthalmology and Otorhinolaryngology, Ribeirão Preto Medical School-USP, Ribeirão Preto, São Paulo, Brazil.,Division of Otorhinolaryngology, D'Or Institute of Education and Research, Hospital Santa Luzia, Brasilia, Brazil
| | - Marco Aurélio Fornazieri
- Department of Otorhinolaryngology State University of Londrina, Pontifical Catholic University of Paraná, Londrina, PR, Brazil
| | - Pedro Lança Gomes
- Division of Otorhinolaryngology, D'Or Institute of Education and Research, Hospital Santa Luzia, Brasilia, Brazil
| | | | | | | | | | - Richard Louis Voegels
- Department of Ophthalmology and Otorhinolaryngology, University of São Paulo, São Paulo, Brazil
| | | | - Wilma Terezinha Anselmo Lima
- Department of Ophthalmology and Otorhinolaryngology, Ribeirão Preto Medical School-USP, Ribeirão Preto, São Paulo, Brazil
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14
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Fornazieri MA, Ebara LK, Araújo RGD, Lima JVF, Favareto FB, Pinna FR, Voegels RL, Doty RL. Adaptation of the Pediatric Smell Wheel TM to evaluate olfactory function in Brazilian children. Braz J Otorhinolaryngol 2021; 88 Suppl 5:S47-S51. [PMID: 34756795 PMCID: PMC9800946 DOI: 10.1016/j.bjorl.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/29/2021] [Accepted: 08/11/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Olfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell WheelTM (PSW) to evaluate olfactory function in Brazilian children. METHODS We modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases. First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test's ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. RESULTS Eleven odors were identified for inclusion in the test. The test-retest reliability was modest (r = 0.54, p < 0.001), although likely attenuated based on the inclusion of only data from children with normal function. The test clearly differentiated the olfactory function of children with adenoid hypertrophy from that of healthy children and demonstrated the return of function after adenoidectomy. An overall score <7 was found useful in defining hyposmia, although additional age-related cut-points were also defined. CONCLUSION A Brazilian version of the PSW was developed and validated and found to be efficacious in detecting smell dysfunction in children ranging in age from 5 to 12 years. LEVEL OF EVIDENCE 1b (Diagnosis).
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Affiliation(s)
- Marco A. Fornazieri
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Cliníca, Londrina, PR, Brazil,Pontifícia Universidade Católica do Paraná (PUC PR), Departamento de Medicina, Londrina, PR, Brazil,Universidade de São Paulo (USP), Departamento de Otorrinolaringolgia, São Paulo, SP, Brazil,University of Pennsylvania, Perelman School of Medicine, Smell and Test Center, Department of Otorhinolaryngology – Head and Neck Surgery, Pennsylvania, USA,Corresponding author.
| | - Lucas K. Ebara
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Cliníca, Londrina, PR, Brazil
| | | | | | - Felipe B. Favareto
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Cliníca, Londrina, PR, Brazil
| | - Fábio R. Pinna
- Universidade de São Paulo (USP), Departamento de Otorrinolaringolgia, São Paulo, SP, Brazil
| | - Richard L. Voegels
- Universidade de São Paulo (USP), Departamento de Otorrinolaringolgia, São Paulo, SP, Brazil
| | - Richard L. Doty
- University of Pennsylvania, Perelman School of Medicine, Smell and Test Center, Department of Otorhinolaryngology – Head and Neck Surgery, Pennsylvania, USA
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15
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Walker IM, Fullard ME, Morley JF, Duda JE. Olfaction as an early marker of Parkinson's disease and Alzheimer's disease. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:317-329. [PMID: 34266602 DOI: 10.1016/b978-0-12-819973-2.00030-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Olfactory impairment is a common and early sign of Parkinson's disease (PD) and Alzheimer's disease (AD), the two most prevalent neurodegenerative conditions in the elderly. This phenomenon corresponds to pathologic processes emerging in the olfactory system prior to the onset of typical clinical manifestations. Clinically available tests can establish hyposmia through odor identification assessment, discrimination, and odor detection threshold. There are significant efforts to develop preventative or disease-modifying therapies that slow down or halt the progression of PD and AD. Due to the convenience and low cost of its assessment, olfactory impairment could be used in these studies as a screening instrument. In the clinical setting, loss of smell may also help to differentiate PD and AD from alternative causes of Parkinsonism and cognitive impairment, respectively. Here, we discuss the pathophysiology of olfactory dysfunction in PD and AD and how it can be assessed in the clinical setting to aid in the early and differential diagnosis of these disorders.
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Affiliation(s)
- Ian M Walker
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle E Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - James F Morley
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John E Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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16
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Garcia ECD, Luz LDA, Anzolin LK, Barbosa da Silva JL, Doty RL, Pinna FDR, Voegels RL, Fornazieri MA. Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction? Braz J Otorhinolaryngol 2021; 88:787-793. [PMID: 34144902 PMCID: PMC9483995 DOI: 10.1016/j.bjorl.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/15/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Abstract
Olfactory biopsies from the superior part of the nasal septum did not significantly affect smell capacity. These biopsies obtain high rates of olfactory neurons. The described procedure also provides olfactory epithelium proper for morphological analysis.
Introduction Olfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established. Objective This study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum. Methods During nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure. Results Olfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT®]) between means before biopsy: 32.3 vs. postoperative: 32.5, p = 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p = 0.46). None out of the 56 different odorant identification significantly diminished (p > 0.05). Conclusion The technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact.
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Affiliation(s)
| | - Lucas de Almeida Luz
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Clínica, Londrina, PR, Brazil
| | - Lucas Kanieski Anzolin
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Clínica, Londrina, PR, Brazil
| | | | - Richard L Doty
- University of Pennsylvania, Perelman Medicine School, Smell and Taste Center, Philadelphia, United States
| | | | - Richard Louis Voegels
- Universidade de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Marco Aurélio Fornazieri
- Universidade Estadual de Londrina (UEL), Departamento de Cirurgia Clínica, Londrina, PR, Brazil; Universidade de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Londrina, PR, Brazil.
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17
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Hsieh CH, Chen PG, Zhou B, Lin LJ, Lai JT, Shen PH. Investigation of Normative Value of Commercialized Taiwan Smell Identification Test. ALLERGY & RHINOLOGY 2021; 12:2152656721991525. [PMID: 33643679 PMCID: PMC7894691 DOI: 10.1177/2152656721991525] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The Taiwan Smell Identification Test (TWSIT) was developed and successfully administered in Taiwanese population since 2015. However, for sanitation reason, the original liquid-jar form of this test is not appropriate. The commercialized TWSIT was then re-designed as “scratch-and-sniff” version: the TIBSIT (Top International Biotech, Taipei, Taiwan). This project aims to investigate the normative value of TIBSIT in different age groups and genders. Methods Volunteers aged 20 to 80 with no subjective smell loss were recruited in a rhinology clinic. The participants were given full instructions on using the TIBSIT. Results Two hundred and nine healthy subjects (female: male =107: 102) were enrolled into this study. The median TIBSIT score in female and male subjects is 47 and 46, respectively. Subjects were further divided into three age groups: (A) 20∼34 years (n = 77), (B) 35∼54 years (n = 77), and (C) 55∼80 years (n = 55). The TIBSIT scores at the tenth percentile value at each age group of male patients are 43, 42 and 37; while the scores at the tenth percentile value at each age group of female patients are 42, 42 and 41. TIBSIT score was significantly and inversely correlated with age (Spearman rho = − 0.20, p = 0.004.). Conclusion We established the normative values of the new TIBSIT in different age groups in Taiwan. Future nation-wide screening is needed for more sophisticated norms establishment.
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Affiliation(s)
- Ching-Hung Hsieh
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Li-Jung Lin
- Graduate Institute of Sports, Leisure & Hospitality Management, National Taiwan Normal University, Taipei
| | - Jen-Tsung Lai
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung
| | - Ping-Hung Shen
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung.,Department of Nursing, Hung-Kuang University, Taichung
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18
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Kaiserova M, Grambalova Z, Kurcova S, Otruba P, Prikrylova Vranova H, Mensikova K, Kanovsky P. Premotor Parkinson's disease: Overview of clinical symptoms and current diagnostic methods. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:103-112. [PMID: 33542542 DOI: 10.5507/bp.2021.002] [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: 10/27/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is characterized by typical motor symptoms. However, recent studies show several non-motor features that may precede the development of the motor symptoms of PD. The best known premotor symptoms include hyposmia, REM sleep behavior disorder (RBD), constipation, and depression; other symptoms are excessive daytime somnolence, orthostatic hypotension and symptomatic hypotension, erectile or urinary dysfunction, musculoskeletal symptoms, pain, and global cognitive deficit. In this review, we summarize currently available diagnostic methods for these symptoms. We also briefly summarize neuroimaging, polyneuropathy, peripheral markers, and cerebrospinal fluid biomarkers that may be used in the early diagnosis of PD.
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Affiliation(s)
- Michaela Kaiserova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Zuzana Grambalova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Sandra Kurcova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | | | - Katerina Mensikova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Petr Kanovsky
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
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Aniteli MB, Marson FAL, Cunha FR, Sakano E. Correlation and agreement of olfactory perception assessed by the Connecticut Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test †. Braz J Otorhinolaryngol 2020; 88:858-866. [PMID: 33408061 DOI: 10.1016/j.bjorl.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin' Sticks are the only tests validated in Brazil. OBJECTIVES To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test - University of Pennsylvania Smell Identification Test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. METHODS Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman's correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. RESULTS Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman's correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. CONCLUSIONS The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.
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Affiliation(s)
- Marcello Bailarini Aniteli
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil
| | - Fernando Augusto Lima Marson
- Universidade São Francisco, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Genética Humana e Médica, Bragança Paulista, SP, Brazil.
| | - Fernanda Rodrigues Cunha
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil
| | - Eulália Sakano
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil.
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Validation of the Connecticut olfactory test (CCCRC) adapted to Brazil. Braz J Otorhinolaryngol 2020; 88:725-732. [PMID: 33272838 PMCID: PMC9483934 DOI: 10.1016/j.bjorl.2020.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Olfactory changes are quite common in the population, causing a significant impact on the quality of life. Documentation of the olfactory function is essential for the diagnosis, treatment and follow-up of patients with inflammatory diseases of the upper airways, neurodegenerative diseases or viral infections. Among the different existing smell tests, the CCCRC is an inexpensive test, easy to apply, but it has not yet been evaluated on a large scale in the Brazilian population. Objective To validate the CCCRC smell test, after adaptation for the Brazilian population, evaluating the performance of healthy volunteers and the stability of the test in retests. Methods In this study, we carried out a cultural adaptation of the CCCRC test to Brazil. To validate and determine the normality scores, we applied the test to 334 healthy volunteers, aged >18 years of age. The retest was also carried out in up to four weeks on 34 additional volunteers to assess validity of the results. Results When evaluating the participants’ performance, normosmia and mild hyposmia values were obtained in more than 95% of them. Women (58.4%) showed better accuracy than men (41.6%): p < 0.02, and individuals over 60 years of age showed worse performance (median: 6; 75th percentile: 6.5; 25th percentile). The test and retest of the 34 volunteers demonstrated that there was agreement (ICC, intraclass correlation coefficient) considered good in the left nostril (ICC = 0.65) and excellent in the right nostril (ICC = 0.77) in the combined score. Conclusion The CCCRC test adapted to Brazil showed normal values, similar to the originally-described test and validations in other countries, with a high reproducibility rate. Considering the highly favorable cost-benefit ratio, the adapted CCCRC is a very useful tool for measuring olfactory function in the Brazilian population.
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Fornazieri MA, Garcia ECD, Lopes NMD, Miyazawa INI, Silva GDS, Monteiro RDS, Pinna FDR, Voegels RL, Doty RL. Adherence and Efficacy of Olfactory Training as a Treatment for Persistent Olfactory Loss. Am J Rhinol Allergy 2019; 34:238-248. [PMID: 31766853 DOI: 10.1177/1945892419887895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Among emerging therapies, olfactory training (OT) has been proposed as a potential treatment for persistent olfactory loss. This treatment has been suggested to improve olfactory function via sensorineural modulation from repeated odor exposure. However, due to the long treatment period that is required, many patients discontinue the treatment or do not follow the treatment regimen appropriately, potentially biasing estimates of treatment success. Moreover, spontaneous improvement is known to occur without any interventions. Objectives We evaluated both the adherence rates and the efficacy of OT in patients with persistent postinfectious, posttraumatic, or idiopathic olfactory loss. Methods Prospective observational study. Twenty-five patients with persistent olfactory loss underwent OT. Protocol adherence and olfactory function (scores on the University of Pennsylvania Smell Identification Test or UPSIT) were assessed 3 and 6 months after the initiation of treatment. A minimum improvement of 5 UPSIT points was considered clinically significant and adherence throughout the study. Results The adherence rate of the patients after 3 months was 88% and after 6 months was 56%. The corresponding percentages of clinical improvement were 23.5% and 25%. There was no relation of age, sex, time of olfactory loss, race, the degree of olfactory loss, etiology, education, and type of training to the adherence rate or treatment efficacy. Conclusions In this patient population, adherence to training remained high in the first 3 months of OT but declined moderately thereafter. The observed prevalence and degree of improvement were similar to that reported a number of studies, including some studies whose patients did not receive OT.
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Affiliation(s)
- Marco Aurélio Fornazieri
- Department of Clinical Surgery, Londrina State University, Londrina, Brazil.,Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil.,Department of Otolaryngology, University of São Paulo, São Paulo, Brazil.,Smell and Taste Center, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | - Richard L Doty
- Smell and Taste Center, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Safety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis. Eur Arch Otorhinolaryngol 2019; 277:483-492. [DOI: 10.1007/s00405-019-05728-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
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Fornazieri MA, Prina DMC, Favoreto JPM, Rodrigues e Silva K, Ueda DM, de Rezende Pinna F, Voegels RL, Cameron L, Doty RL. Olfaction During Pregnancy and Postpartum Period. CHEMOSENS PERCEPT 2019. [DOI: 10.1007/s12078-019-09259-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Effects of septorhinoplasty on smell perception. Eur Arch Otorhinolaryngol 2019; 276:1247-1250. [PMID: 30806808 DOI: 10.1007/s00405-019-05356-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess whether significant changes in smell perception occur after septorhinoplasty, and evaluate whether septum deviation, allergic rhinitis, and surgical technique affect postoperative smell perception. METHODS Thirty-four patients (> 18 years old) awaiting septorhinoplasty were included, while those with previous severe hyposmia or anosmia were excluded. The participants self-assessed their smell perception using a 100-mm visual analogue scale (VAS), where 0 mm indicated the inability to smell and 100 mm indicated normal smell perception. The University of Pennsylvania Smell Identification Test (UPSIT) was applied before the procedure, and 4 and 12 weeks after surgery. RESULTS The UPSIT score showed no significant changes at 4 (p = 0.59; 95% CI - 0.35 to + 2) or 12 weeks (p = 0.16; 95% CI - 1.13 to + 0.66). A comparison of the VAS scores before and 4 weeks after surgery (p = 0.62; 95% CI - 0.63 to + 0.39) yielded similar results. However, the average VAS scores improved 12 weeks after surgery (p = 0.007; 95% CI + 0.22 to + 1.30). Olfactory function, measured using the UPSIT, was not influenced by open or closed surgical techniques (p ≥ 0.10), the presence or absence of rhinitis (p ≥ 0.15), or obstructive septum deviation (p ≥ 0.38). Twelve weeks after surgery, self-evaluated smell perception was better in patients who underwent a closed procedure rather than an open procedure (p = 0.006; 95% CI: -1.39 to -0.37). CONCLUSION A validated test demonstrates that septorhinoplasty does not compromise smell perception 4 and 12 weeks after surgery. However, it might improve smell perception by the self-report observation.
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Fornazieri MA, Doty RL, Bezerra TFP, de Rezende Pinna F, Costa FO, Voegels RL, Silveira-Moriyama L. Relationship of socioeconomic status to olfactory function. Physiol Behav 2018; 198:84-89. [PMID: 30336228 DOI: 10.1016/j.physbeh.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/16/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
Socioeconomic status can significantly impact health. To what degree education and other socioeconomic factors influence the chemical sense of olfaction is not clear. Most studies that have assessed such influences come from countries lacking large disparities in education and income and generally view such measures as nuisance variables to be controlled for statistically. In this study, we evaluated the influences of education and income on odor identification in a diverse sample of subjects from Brazil, a society where large disparities in both income and education are present. The 40-item University of Pennsylvania Smell Identification Test (UPSIT) was administered to 1572 healthy Brazilian citizens with no self-reported olfactory or gustatory deficits and for whom detailed socioeconomic and educational status data were obtained. Univariate and multivariate models were employed to examine the influence of socioeconomic status on the test scores. After controlling for age, sex, ethnicity, and smoking behavior, income and educational level were positively and independently related to the olfactory test scores (respective ps < 0.001 & 0.01). Both linear and quadratic functions described the relationship between the UPSIT scores and the levels of education and socioeconomic status. Individuals of lower socioeconomic status performed significantly worse than those of higher socioeconomic status on 20 of the 40 odorant items. This study demonstrates socioeconomic status is significantly associated with influence the ability to identify odors. The degree to which this reflects differential exposures to xenobiotic agents, cultural differences, familiarity with odors or their names, cognitive development, or other factors requires further investigation.
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Affiliation(s)
- Marco Aurélio Fornazieri
- Department of Surgery, Londrina State University and Pontifical Catholic University of Paraná, Brazil.
| | - Richard L Doty
- Smell and Test Center, Perelman School of Medicine at the University of Pennsylvania, Brazil
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Fornazieri MA, Araújo RG, Lima JVF, Favareto FB, Pinna FDR, Voegels RL, Doty RL. The effects of adenoidectomy on the smell perception of children. Int Forum Allergy Rhinol 2018; 9:87-92. [DOI: 10.1002/alr.22209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Marco Aurélio Fornazieri
- Londrina State University; Londrina Paraná Brazil
- Pontifical Catholic University of Paraná; Londrina Brazil
- University of São Paulo; São Paulo SP Brazil
| | | | | | | | | | | | - Richard L. Doty
- Smell and Taste Center, Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
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Voznessenskaya VV, Klyuchnikova MA, Rodionova EI, Laktionova TK, Kvasha IG, Klinov AB, Voznesenskaya AE. A Standardized Test for Evaluation of Olfactory Function for the Russian Population. BIOL BULL+ 2018. [DOI: 10.1134/s1062359018050175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Morley JF, Cohen A, Silveira-Moriyama L, Lees AJ, Williams DR, Katzenschlager R, Hawkes C, Shtraks JP, Weintraub D, Doty RL, Duda JE. Optimizing olfactory testing for the diagnosis of Parkinson's disease: item analysis of the university of Pennsylvania smell identification test. NPJ PARKINSONS DISEASE 2018; 4:2. [PMID: 29354684 PMCID: PMC5768805 DOI: 10.1038/s41531-017-0039-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 11/09/2022]
Abstract
The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is an effective instrument to detect olfactory dusfunction in Parkinson's disease (PD). It is not clear, however, whether tests of this length are necessary to detect such dysfunction. Several studies have suggested that detection of certain odors is selectively compromised in PD, and that a test comprised of these odors could be shorter and more specific for this purpose. Therefore, we attempted to identify a subset of UPSIT odors that distinguish PD from controls with similar or improved test characteristics compared to the full test. The discriminatory power of each odor was examined using UPSIT data from a discovery cohort of 314 PD patients and 314 matched controls and ranked using multiple methods (including odds ratios, regression coefficients and discriminant analysis). To validate optimally discriminant subsets, we calculated test characteristics using data from two independent cohorts (totaling 306 PD and 343 controls). In the discovery cohort, multiple novel 12-item subsets (and the previously described Brief Smell Identification Test-B) performed similarly or improved upon the UPSIT and were better than 12 random items. However, in validation studies from independent cohorts, multiple subsets retained test characteristics similar to the full UPSIT, but did not outperform 12 random items. Differential discriminatory power of individual items is not conserved across independent cohorts arguing against selective hyposmia in PD. However, multiple 12-item subsets performed as well as the full UPSIT. These subsets could form the basis for shorter olfactory tests in the clinical evaluation of Parkinsonism.
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Affiliation(s)
- James F Morley
- 1Parkinson's Disease Research Education, Clinical and Education Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA.,2Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Abigail Cohen
- 3CCEB, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | | | - Andrew J Lees
- 6UCL Institute of Neurology, Monash University, Melbourne, VIC Australia
| | - David R Williams
- 7Department of Medicine, Monash University, Melbourne, VIC Australia
| | - Regina Katzenschlager
- 8Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Medical University of Vienna, Vienna, Austria
| | | | - Julie P Shtraks
- 1Parkinson's Disease Research Education, Clinical and Education Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA
| | - Daniel Weintraub
- 1Parkinson's Disease Research Education, Clinical and Education Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA.,2Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,4Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Richard L Doty
- 5Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - John E Duda
- 1Parkinson's Disease Research Education, Clinical and Education Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA.,2Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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SMELL-S and SMELL-R: Olfactory tests not influenced by odor-specific insensitivity or prior olfactory experience. Proc Natl Acad Sci U S A 2017; 114:11275-11284. [PMID: 29073044 DOI: 10.1073/pnas.1711415114] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Smell dysfunction is a common and underdiagnosed medical condition that can have serious consequences. It is also an early biomarker of neurodegenerative diseases, including Alzheimer's disease, where olfactory deficits precede detectable memory loss. Clinical tests that evaluate the sense of smell face two major challenges. First, human sensitivity to individual odorants varies significantly, so test results may be unreliable in people with low sensitivity to a test odorant but an otherwise normal sense of smell. Second, prior familiarity with odor stimuli can bias smell test performance. We have developed nonsemantic tests for olfactory sensitivity (SMELL-S) and olfactory resolution (SMELL-R) that use mixtures of odorants that have unfamiliar smells. The tests can be self-administered by healthy individuals with minimal training and show high test-retest reliability. Because SMELL-S uses odor mixtures rather than a single molecule, odor-specific insensitivity is averaged out, and the test accurately distinguished people with normal and dysfunctional smell. SMELL-R is a discrimination test in which the difference between two stimulus mixtures can be altered stepwise. This is an advance over current discrimination tests, which ask subjects to discriminate monomolecular odorants whose difference in odor cannot be quantified. SMELL-R showed significantly less bias in scores between North American and Taiwanese subjects than conventional semantically based smell tests that need to be adapted to different languages and cultures. Based on these proof-of-principle results in healthy individuals, we predict that SMELL-S and SMELL-R will be broadly effective in diagnosing smell dysfunction.
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Olfactory Dysfunction as an Early Biomarker in Parkinson's Disease. Neurosci Bull 2017; 33:515-525. [PMID: 28831680 DOI: 10.1007/s12264-017-0170-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
Abstract
Olfactory dysfunction is common in Parkinson's disease (PD) and often predates the diagnosis by years, reflecting early deposition of Lewy pathology, the histologic hallmark of PD, in the olfactory bulb. Clinical tests are available that allow for the rapid characterization of olfactory dysfunction, including tests of odor identification, discrimination, detection, and recognition thresholds, memory, and tests assessing the build-up of odor intensity across increasing suprathreshold stimulus concentrations. The high prevalence of olfactory impairment, along with the ease and low cost of assessment, has fostered great interest in olfaction as a potential biomarker for PD. Hyposmia may help differentiate PD from other causes of parkinsonism, and may also aid in the identification of "pre-motor" PD due to the early pathologic involvement of olfactory pathways. Olfactory function is also correlated with other non-motor features of PD and may serve as a predictor of cognitive decline. In this article, we summarize the existing literature on olfaction in PD, focusing on the potential for olfaction as a biomarker for early or differential diagnosis and prognosis.
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Abstract
Olfaction is often viewed as difficult, yet the empirical evidence suggests a different picture. A closer look shows people around the world differ in their ability to detect, discriminate, and name odors. This gives rise to the question of what influences our ability to smell. Instead of focusing on olfactory deficiencies, this review presents a positive perspective by focusing on factors that make someone a better smeller. We consider three driving forces in improving olfactory ability: one’s biological makeup, one’s experience, and the environment. For each factor, we consider aspects proposed to improve odor perception and critically examine the evidence; as well as introducing lesser discussed areas. In terms of biology, there are cases of neurodiversity, such as olfactory synesthesia, that serve to enhance olfactory ability. Our lifetime experience, be it typical development or unique training experience, can also modify the trajectory of olfaction. Finally, our odor environment, in terms of ambient odor or culinary traditions, can influence odor perception too. Rather than highlighting the weaknesses of olfaction, we emphasize routes to harnessing our olfactory potential.
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Affiliation(s)
- Asifa Majid
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands; Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Laura Speed
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands
| | - Ilja Croijmans
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands; International Max Planck Research School for Language Sciences, Nijmegen, The Netherlands
| | - Artin Arshamian
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Santos CGD, Bergmann A, Coça KL, Garcia AA, Valente TCDO. Função olfatória e qualidade de vida após a reabilitação do olfato em laringectomizados totais. Codas 2016; 28:669-677. [DOI: 10.1590/2317-1782/20162015255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/01/2016] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Avaliar os efeitos da reabilitação do olfato na função olfatória e na qualidade de vida de laringectomizados totais. Métodos Estudo clínico pré e pós-intervenção em laringectomizados totais submetidos à reabilitação do olfato pela técnica Nasal Airflow- Inducing Maneuver, por meio do Teste de Identificação do Olfato da Universidade da Pensilvânia, dos Questionários sobre a Acuidade Olfatória, do Questionário de Acompanhamento e do Questionário de Qualidade de Vida da Universidade de Washington. Resultados Foram incluídos 45 laringectomizados totais. Antes da reabilitação do olfato, 48,9% dos participantes tiveram o olfato classificado em anosmia, 46,8% apresentaram algum tipo de microsmia e 4,4% tiveram o olfato considerado normal. Depois da reabilitação, 4,4% dos participantes foram classificados como anosmia e 31,1% foram classificados dentro da normalidade. No Teste de Identificação do Olfato, o escore médio após a reabilitação apresentou melhora estatisticamente significante. Nos questionários sobre a acuidade olfatória após a reabilitação do olfato, os resultados demonstram melhora na frequência da percepção com relação ao olfato, paladar e à capacidade de sentir cheiros dos perfumes, alimentos, gás vazando e fumaça, após o aprendizado da manobra. Os escores do Questionário de Qualidade de Vida, embora já indicassem uma boa qualidade de vida antes da intervenção, apresentaram valores estatisticamente significantes após a reabilitação do olfato. Conclusão A reabilitação do olfato melhora a função olfatória e tem impacto positivo nas atividades de vida diária e na qualidade de vida dos laringectomizados totais.
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Affiliation(s)
- Christiane Gouvêa dos Santos
- Universidade Federal do Estado do Rio de Janeiro, Brasil; Instituto Nacional de Câncer José Alencar Gomes da Silva, Brasil
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brasil
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Liu G, Zong G, Doty RL, Sun Q. Prevalence and risk factors of taste and smell impairment in a nationwide representative sample of the US population: a cross-sectional study. BMJ Open 2016; 6:e013246. [PMID: 28157672 PMCID: PMC5129069 DOI: 10.1136/bmjopen-2016-013246] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/15/2016] [Accepted: 10/11/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of, and explore potential risk factors for, taste and smell dysfunction in the general population of the USA. DESIGN A cross-sectional study. SETTING A cross-sectional analysis of data collected in the National Health and Nutrition Examination Survey (NHANES 2013-2014). PARTICIPANTS A total of 3519 men and women aged 40 years and older who participated in NHANES 2013-2014. MAIN OUTCOME MEASURES Using the NHANES Pocket Smell Test, smell impairment was defined as failing to correctly identify 6 or more of the 8 odours. Taste impairment was defined as failing to correctly identify quinine or sodium chloride. RESULTS The estimated prevalence was 13.5% for smell impairment, 17.3% for taste impairment and 2.2% for taste and smell impairment. For smell, but not taste, prevalence estimates increased with age and were higher in men and ethnic minorities. In backward stepwise logistic regression, low educational attainment, low family income and a history of asthma or cancer were independently associated with a higher prevalence of smell impairment, whereas light-to-moderate alcohol consumption (1-3 drinks/day) was associated with a lower prevalence of this condition. After multivariate adjustment, being non-Hispanic Black Americans, consuming ≥4 drinks of alcohol per day and having a history of cardiovascular disease (CVD) were independently associated with a higher prevalence of taste impairment. CONCLUSIONS Based on a nationally representative multistage probability survey among the US population aged 40 years and older, smell and taste dysfunction affected ∼20.5 million (13.5%) and 26.3 million (17.3%) individuals, respectively. Age, gender, ethnicity, educational attainment, family income, light-to-moderate alcohol consumption and history of asthma or cancer were significant risk factors for smell dysfunction, whereas only ethnicity, heavy alcohol consumption and CVD history were associated with a higher prevalence of taste dysfunction.
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Affiliation(s)
- Gang Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Geng Zong
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Richard L Doty
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Jiang RS, Liang KL. Establishment of olfactory diagnosis for the traditional Chinese version of the University of Pennsylvania Smell Identification Test. Int Forum Allergy Rhinol 2016; 6:1308-1314. [DOI: 10.1002/alr.21818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/18/2016] [Accepted: 05/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Rong-San Jiang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taipei Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Department of Nursing; Hung Kuang University; Taichung Taiwan
| | - Kai-Li Liang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taipei Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
- Faculty of Medicine; National Yang-Ming Medical University; Taipei Taiwan
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Abstract
Insights into risk factors for olfactory decline are needed, because knowledge about its origin is limited. This impairment has important implications for human health. Several epidemiologic studies of olfaction provide insight into the prevalence of olfactory disorders. Here, we review the major population studies carried out on this topic to date. Our purpose is to characterize knowledge about olfactory disorders from human studies. We also describe the existing methods for measuring the sense of smell in population studies, present recent insights into the epidemiology of smell disorders, and discuss the risk factors identified to date. Synthesis of these data shows that olfactory dysfunction increases as people age and is worse in men. Further study of olfaction is warranted for gaining better information on the etiologies affecting its impairment, research that will have a large public health impact.
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Affiliation(s)
- Jingpu Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin Province, 130041, China
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 South Maryland Avenue, MC1035, Chicago, IL 60637
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Recovery of Olfactory Function in Postviral Olfactory Dysfunction Patients after Acupuncture Treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:4986034. [PMID: 27034689 PMCID: PMC4789421 DOI: 10.1155/2016/4986034] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/31/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
Abstract
Introduction. The aims of this study were to assess the impact of traditional Chinese acupuncture (TCA) in postviral olfactory dysfunction (PVOD) patients who were refractory to standardized treatment and to compare the results with the impact observed in an observation group. Methods. Fifty patients who presented to the outpatient clinic with PVOD and were refractory to standardized treatment were included: 25 were treated with TCA and 25 patients were simply observed. A subjective olfactory test was performed using the University of Pennsylvania Smell Identification Test (UPSIT). The effects of TCA were compared with the results obtained in the observation group. Results. Improved olfactory function was observed in eleven patients treated with TCA compared with four patients in the observation group. This study revealed significantly improved olfactory function outcomes in patients who underwent acupuncture compared with the observation group. No significant differences in olfaction recovery were found according to age, gender, or duration of disease between the two groups; however, hyposmic patients recovered at a higher rate than anosmic patients. Conclusion. TCA may aid the treatment of PVOD patients who are refractory to drugs or other therapies.
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37
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Santos CGD, Bergmann A, Coça KL, Garcia AA, Valente TCDO. Acuidade olfatória e qualidade de vida após a laringectomia total. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517611415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: identificar a prevalência e os fatores associados às alterações do olfato e descrever a qualidade de vida após a laringectomia total. Métodos: estudo transversal para avaliar a acuidade olfatória e a qualidade de vida de laringectomizados totais no Instituto Nacional de Câncer por meio da aplicação do Teste de Identificação do Olfato da Universidade da Pensilvânia, do Questionário de Qualidade de Vida da Universidade de Washington e do Questionário sobre a Acuidade Olfatória Pré-Reabilitação do Olfato. Resultados: foram avaliados 48 laringectomizados totais, sendo 39 do sexo masculino e 9 do sexo feminino, com idade média de 62 anos e tempo médio de 5,6 anos desde a laringectomia total. No Teste de Identificação do Olfato a pontuação média foi de 17,9. De acordo com a classificação do olfato no teste, a maioria dos participantes apresentou algum grau de alteração, sendo que apenas 2 indivíduos tiveram o olfato considerado dentro da normalidade. No Questionário de Qualidade de vida da Universidade de Washington, o escore composto foi 80,47. Os domínios que apresentaram as médias de pontos mais baixas foram paladar, saliva e fala. No questionário sobre a acuidade olfatória pré-reabilitação do olfato, a maioria dos participantes consideraram seu olfato de ruim a razoável. 21 indivíduos relataram apresentar algum grau de dificuldade em suas atividades de vida diária em decorrência de alterações do olfato. Conclusão: os laringectomizados totais apresentaram alta prevalência de alterações do olfato, com comprometimentos relacionados às suas atividades de vida diária.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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38
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Millar Vernetti P, Rossi M, Cerquetti D, Perez Lloret S, Merello M. Comparison of Olfactory Identification Patterns among Parkinson’s Disease Patients from Different Countries. Chem Senses 2015; 41:77-83. [DOI: 10.1093/chemse/bjv062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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