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Passali CG, Santantonio M, Passali D. The current possibilities of diagnosing and therapies for olfactory disorders. Expert Opin Pharmacother 2024; 25:973-983. [PMID: 38935483 DOI: 10.1080/14656566.2024.2368243] [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: 05/05/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Olfactory disorders significantly affect individuals, diminishing their capacity to detect dangers, appreciate flavors, and engage socially. Despite their considerable impact on quality of life, these disorders often receive less attention compared to other sensory impairments. This review emphasizes the importance of olfactory function and explores both traditional and innovative diagnostic and therapeutic approaches. AREAS COVERED This review comprehensively covers the pathophysiology, diagnostic challenges, and treatment options for olfactory disorders. It delves into the nuances of different disorders, such as anosmia and parosmia, and discusses the array of diagnostic tools from traditional sniff tests to advanced imaging techniques. The review also evaluates therapeutic strategies, from pharmacological treatments to emerging therapies like electrical stimulation and regenerative medicine, highlighting recent advances in the field. EXPERT OPINION Current insights suggest a growing recognition of the significance of olfactory disorders, driven by recent pandemics and advances in diagnostic and therapeutic technologies. Future perspectives indicate a promising direction toward more personalized medicine approaches and enhanced regenerative therapies. Continuous research and improved clinical awareness are critical for evolving the management strategies of olfactory impairments, potentially leading to better patient outcomes and quality of life enhancements.
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Affiliation(s)
- Cesare Giulio Passali
- Division of Otorhinolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariaconsiglia Santantonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Desiderio Passali
- IFOS Former President, ORL Head and Neck Surgery, University of Siena, Siena, Italy
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Simonini L, Frijia F, Ait Ali L, Foffa I, Vecoli C, De Gori C, De Cori S, Baroni M, Aquaro GD, Maremmani C, Lombardo F. A Comprehensive Review of COVID-19-Related Olfactory Deficiency: Unraveling Associations with Neurocognitive Disorders and Magnetic Resonance Imaging Findings. Diagnostics (Basel) 2024; 14:359. [PMID: 38396398 PMCID: PMC10888385 DOI: 10.3390/diagnostics14040359] [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: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Olfactory dysfunction (OD) is one of the most common symptoms in COVID-19 patients and can impact patients' lives significantly. The aim of this review was to investigate the multifaceted impact of COVID-19 on the olfactory system and to provide an overview of magnetic resonance (MRI) findings and neurocognitive disorders in patients with COVID-19-related OD. Extensive searches were conducted across PubMed, Scopus, and Google Scholar until 5 December 2023. The included articles were 12 observational studies and 1 case report that assess structural changes in olfactory structures, highlighted through MRI, and 10 studies correlating the loss of smell with neurocognitive disorders or mood disorders in COVID-19 patients. MRI findings consistently indicate volumetric abnormalities, altered signal intensity of olfactory bulbs (OBs), and anomalies in the olfactory cortex among COVID-19 patients with persistent OD. The correlation between OD and neurocognitive deficits reveals associations with cognitive impairment, memory deficits, and persistent depressive symptoms. Treatment approaches, including olfactory training and pharmacological interventions, are discussed, emphasizing the need for sustained therapeutic interventions. This review points out several limitations in the current literature while exploring the intricate effects of COVID-19 on OD and its connection to cognitive deficits and mood disorders. The lack of objective olfactory measurements in some studies and potential validity issues in self-reports emphasize the need for cautious interpretation. Our research highlights the critical need for extensive studies with larger samples, proper controls, and objective measurements to deepen our understanding of COVID-19's long-term effects on neurological and olfactory dysfunctions.
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Affiliation(s)
- Ludovica Simonini
- Institute of Clinical Physiology, National Research Council (CNR), 54100 Massa, Italy; (I.F.); (C.V.)
| | - Francesca Frijia
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy;
| | - Lamia Ait Ali
- Institute of Clinical Physiology, National Research Council (CNR), 54100 Massa, Italy; (I.F.); (C.V.)
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 54100 Massa, Italy
| | - Ilenia Foffa
- Institute of Clinical Physiology, National Research Council (CNR), 54100 Massa, Italy; (I.F.); (C.V.)
| | - Cecilia Vecoli
- Institute of Clinical Physiology, National Research Council (CNR), 54100 Massa, Italy; (I.F.); (C.V.)
| | - Carmelo De Gori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy; (C.D.G.); (S.D.C.); (F.L.)
| | - Sara De Cori
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy; (C.D.G.); (S.D.C.); (F.L.)
| | - Monica Baroni
- Fondazione “G. Monasterio” CNR-Regione Toscana, 54100 Massa, Italy;
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy;
| | - Carlo Maremmani
- Unit of Neurology, Ospedale Apuane, Azienda USL Toscana Nord Ovest, 54100 Massa, Italy;
| | - Francesco Lombardo
- Department of Radiology, Fondazione Monasterio/CNR, 56124 Pisa, Italy; (C.D.G.); (S.D.C.); (F.L.)
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Kumpitsch C, Fischmeister FPS, Lackner S, Holasek S, Madl T, Habisch H, Wolf A, Schöpf V, Moissl-Eichinger C. Reduced olfactory performance is associated with changed microbial diversity, oralization, and accumulation of dead biomaterial in the nasal olfactory area. Microbiol Spectr 2024; 12:e0154923. [PMID: 38193689 PMCID: PMC10846256 DOI: 10.1128/spectrum.01549-23] [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: 04/17/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
The partial or complete loss of the sense of smell, which affects about 20% of the population, impairs the quality of life in many ways. Dysosmia and anosmia are mainly caused by aging, trauma, infections, or even neurodegenerative disease. Recently, the olfactory area-a site containing the olfactory receptor cells responsible for odor perception-was shown to harbor a complex microbiome that reflects the state of olfactory function. This initially observed correlation between microbiome composition and olfactory performance needed to be confirmed using a larger study cohort and additional analyses. A total of 120 participants (middle-aged, no neurodegenerative disease) were enrolled in the study to further analyze the microbial role in human olfactory function. Olfactory performance was assessed using the Sniffin' Stick battery, and participants were grouped accordingly (normosmia: n = 93, dysosmia: n = 27). The olfactory microbiome was analyzed by 16S rRNA gene amplicon sequencing and supplemented by metatranscriptomics in a subset (Nose 2.0). Propidium monoazide (PMA) treatment was performed to distinguish between intact and non-intact microbiome components. The gastrointestinal microbiome of these participants was also characterized by amplicon sequencing and metabolomics and then correlated with food intake. Our results confirm that normosmics and dysosmics indeed possess a distinguishable olfactory microbiome. Alpha diversity (i.e., richness) was significantly increased in dysosmics, reflected by an increase in the number of specific taxa (e.g., Rickettsia, Spiroplasma, and Brachybacterium). Lower olfactory performance was associated with microbial signatures from the oral cavity and periodontitis (Fusobacterium, Porphyromonas, and Selenomonas). However, PMA treatment revealed a higher accumulation of dead microbial material in dysosmic subjects. The gastrointestinal microbiome partially overlapped with the nasal microbiome but did not show substantial variation with respect to olfactory performance, although the diet of dysosmic individuals was shifted toward a higher meat intake. Dysosmia is associated with a higher burden of dead microbial material in the olfactory area, indicating an impaired clearance mechanism. As the microbial community of dysosmics (hyposmics and anosmics) appears to be influenced by the oral microbiome, further studies should investigate the microbial oral-nasal interplay in individuals with partial or complete olfactory loss.IMPORTANCEThe loss of the sense of smell is an incisive event that is becoming increasingly common in today's world due to infections such as COVID-19. Although this loss usually recovers a few weeks after infection, in some cases, it becomes permanent-why is yet to be answered. Since this condition often represents a psychological burden in the long term, there is a need for therapeutic approaches. However, treatment options are limited or even not existing. Understanding the role of the microbiome in the impairment of olfaction may enable the prediction of olfactory disorders and/or could serve as a possible target for therapeutic interventions.
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Affiliation(s)
- Christina Kumpitsch
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Florian Ph. S. Fischmeister
- Department of Psychology, University of Graz, Graz, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- BioTechMed, Graz, Austria
| | - Sonja Lackner
- Otto Loewi Research Center, Division of Immunology, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Otto Loewi Research Center, Division of Immunology, Medical University of Graz, Graz, Austria
| | - Tobias Madl
- BioTechMed, Graz, Austria
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Ageing, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, Graz, Austria
| | - Hansjörg Habisch
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Ageing, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, Graz, Austria
| | - Axel Wolf
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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Lubojacký J, Čábalová L, Mladoňová M, Hránková V, Krejčí T, Mičaník J, Miklošová M, Ličev L, Komínek P, Matoušek P. Transnasal Endoscopic Pituitary Surgery-The Role of a CT Scan in Individual Tailoring of Posterior Septum Size Resection. Tomography 2023; 9:2222-2232. [PMID: 38133076 PMCID: PMC10747678 DOI: 10.3390/tomography9060172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This study was designed to evaluate the possibility of predicting the minimum size of septal resection for safe tumor extraction in transnasal paraseptal pituitary adenoma resection from preoperative computed tomography scans. METHODS A retrospective CT scan analysis was performed on 20 patients who underwent endoscopic pituitary surgery at the University Hospital in Ostrava. Virtual insertion of the straight instrument into the sphenoid cavity was simulated using a CT scan. The minimum septal resection size was predicted and compared to various diameters in the nasal cavity. The results were then compared with cadaveric dissections, in which septal resections were performed at 1 cm and 2 cm distances from the anterior sphenoid wall. The association between cadaver dissections and CT scan results was studied. RESULTS A total of 20 patients who underwent endoscopic transnasal surgery for pituitary adenoma between the years 2020 and 2021 were enrolled in the study. The mean virtual posterior septal size resection needed to reach the medial edge of the ICA with the straight instrument, without infracturing the nasal septum, was 13.2 mm. In cadavers with a 1 cm posterior septal resection, the medial edge of the ICA was reached with the straight instrument. In 2 cm resections, it was possible to reach beyond the lateral edge of the ICA. CONCLUSION There is no significant correlation between the minimum septal size resection and measured diameters in the nasal cavity. According to our study, a 1 cm resection is sufficient for a non-extended pituitary tumor extraction. More extensive septal resections allow for better maneuverability and overview in the surgical field.
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Affiliation(s)
- Jakub Lubojacký
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Lenka Čábalová
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Michaela Mladoňová
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Viktória Hránková
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
- Department of Anatomy, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Tomáš Krejčí
- Department of Neurosurgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Jakub Mičaník
- Department of Radiodiagnostics, Ostrava University Hospital, 70800 Ostrava, Czech Republic;
| | - Maria Miklošová
- Department of Anatomy, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Lačezar Ličev
- Faculty of Electrical Engineering and Computer Science, VŠB Technical University Ostrava, 70800 Ostrava, Czech Republic;
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
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Ramirez-Gil LS, Ley-Tomas JJ, Hernaiz-Leonardo JC, Alobid I, Mullol J, Ceballos-Cantu JC. Effects of Endoscopic Sinus Surgery on Olfactory Function. Curr Allergy Asthma Rep 2023; 23:715-731. [PMID: 38038879 DOI: 10.1007/s11882-023-01115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients. Endoscopic sinonasal surgical procedures may impact olfaction. Optimizing olfactory function requires proper surgical techniques, gentle handling of tissue, and perioperative care. Surgeons must discuss objectives and manage patient expectations. Routine olfactory assessment is crucial in surgical work-up and follow-up. Preserving anatomical structures while addressing the obstruction of the olfactory cleft helps to prevent decreased olfactory threshold. However, smell identification and discrimination do not always correlate with sinonasal anatomy.
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Affiliation(s)
- L Stefano Ramirez-Gil
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico
| | - J J Ley-Tomas
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, CDMX, Mexico
| | - J C Hernaiz-Leonardo
- Department of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - J C Ceballos-Cantu
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico.
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Han SA, Kim JK, Cho DY, Patel ZM, Rhee CS. The Olfactory System: Basic Anatomy and Physiology for General Otorhinolaryngologists. Clin Exp Otorhinolaryngol 2023; 16:308-316. [PMID: 37669740 PMCID: PMC10710919 DOI: 10.21053/ceo.2023.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
Olfaction is one of the five basic human senses, and it is known to be one of the most primitive senses. The sense of olfaction may have been critical for human survival in prehistoric society, and although many believe its importance has diminished over time, it continues to have an impact on human interaction, bonding, and propagation of the species. Even if we are unaware of it, the sense of smell greatly affects our lives and is closely related to overall quality of life and health. Nonetheless, olfaction has been neglected from a scientific perspective compared to other senses. However, olfaction has recently received substantial attention since the loss of smell and taste has been noted as a key symptom of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Studies investigating olfaction loss in association with coronavirus disease 2019 (COVID-19) have revealed that olfactory dysfunction can be both conductive and sensorineural, possibly causing structural changes in the brain. Olfactory training is an effective treatment for olfactory dysfunction, suggesting the reorganization of neural associations. A reduced ability to smell may also alert suspicion for neurodegenerative or psychiatric disorders. Here, we summarize the basic knowledge that we, as otorhinolaryngologists, should have about the sense of smell and the peripheral and central olfactory pathways for managing and helping patients with olfactory dysfunction.
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Affiliation(s)
- Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Do-Yeon Cho
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Otolaryngology, Department of Surgery, Veterans Affairs, Birmingham, AL, USA
| | - Zara M. Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Sensory Organ Research Institute and Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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Vohra V, Assi S, Kamath V, Soler ZM, Rowan NR. Potential Role for Diet in Mediating the Association of Olfactory Dysfunction and Cognitive Decline: A Nationally Representative Study. Nutrients 2023; 15:3890. [PMID: 37764674 PMCID: PMC10538071 DOI: 10.3390/nu15183890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
In the context of a growing body of evidence associating olfactory dysfunction (OD) with cognitive decline, this cross-sectional study used data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) sample in order to explore the role of dietary intake in this association. Leveraging a nationally representative sample of U.S. adults aged 60 years and older, this study analyzed dietary patterns using exploratory factor analysis. OD was categorized based on the NHANES Pocket Smell Test, and cognitive function was measured with a battery of tests. Survey-weighted multivariable regressions and causal mediation analysis were used to examine the relationship between dietary patterns, OD, and cognitive function. Results indicated that a poor adherence to a diet rich in monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs) was independently associated with both cognitive and olfactory dysfunctions, after adjusting for sociodemographic and health factors. Moreover, the relationship between OD and cognitive decline was found to be partly mediated by adherence to such a diet. This study proposes a potential link between diet, olfactory function, and cognitive decline, highlighting the role of nutritional interventions in mitigating cognitive decline, particularly in individuals with olfactory impairment.
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Affiliation(s)
- Varun Vohra
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Zachary M. Soler
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Nicholas R. Rowan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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8
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Liu ZY, Vaira LA, Boscolo-Rizzo P, Walker A, Hopkins C. Post-viral olfactory loss and parosmia. BMJ MEDICINE 2023; 2:e000382. [PMID: 37841969 PMCID: PMC10568123 DOI: 10.1136/bmjmed-2022-000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/26/2023] [Indexed: 10/17/2023]
Abstract
The emergence of SARS-CoV-2 has brought olfactory dysfunction to the forefront of public awareness, because up to half of infected individuals could develop olfactory dysfunction. Loss of smell-which can be partial or total-in itself is debilitating, but the distortion of sense of smell (parosmia) that can occur as a consequence of a viral upper respiratory tract infection (either alongside a reduction in sense of smell or as a solo symptom) can be very distressing for patients. Incidence of olfactory loss after SARS-CoV-2 infection has been estimated by meta-analysis to be around 50%, with more than one in three who will subsequently report parosmia. While early loss of sense of smell is thought to be due to infection of the supporting cells of the olfactory epithelium, the underlying mechanisms of persistant loss and parosmia remain less clear. Depletion of olfactory sensory neurones, chronic inflammatory infiltrates, and downregulation of receptor expression are thought to contribute. There are few effective therapeutic options, so support and olfactory training are essential. Further research is required before strong recommendations can be made to support treatment with steroids, supplements, or interventions applied topically or injected into the olfactory epithelium in terms of improving recovery of quantitative olfactory function. It is not yet known whether these treatments will also achieve comparable improvements in parosmia. This article aims to contextualise parosmia in the setting of post-viral olfactory dysfunction, explore some of the putative molecular mechanisms, and review some of the treatment options available.
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Affiliation(s)
- Zhen Yu Liu
- Department of ENT Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luigi Angelo Vaira
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Sardegna, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical, and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Abigail Walker
- Department of ENT, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Lerner DK, Garvey KL, Arrighi-Allisan A, Kominsky E, Filimonov A, Al-Awady A, Filip P, Liu K, Ninan S, Spock T, Tweel B, van Gerwen M, Schaberg M, Colley P, Del Signore A, Govindaraj S, Iloreta AM. Omega-3 Fatty Acid Supplementation for the Treatment of Persistent COVID-Related Olfactory Dysfunction. Am J Rhinol Allergy 2023:19458924231174799. [PMID: 37261995 DOI: 10.1177/19458924231174799] [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: 06/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of omega-3 fatty acid (O3FA) supplementation in the treatment of COVID-related olfactory dysfunction (OD). METHODS Patients with laboratory-confirmed or clinically-suspected COVID-19 infection and new-onset OD from August 2020 to November 2021 were prospectively recruited. Patients with quantitative OD, defined as a brief smell identification test (BSIT) score of 9 or less, were eligible for study inclusion. The experimental group received 2 g of O3FA supplementation, while the control group received an identical placebo to be taken daily for 6 weeks. The primary outcome was a change in BSIT score between the initial and 6-week follow-up tests. RESULTS One hundred and seventeen patients were included in the analysis, including 57 patients in the O3FA group and 60 in the placebo group. O3FA group patients demonstrated a mean BSIT improvement of 1.12 ± 1.99 compared to 0.68 ± 1.86 in the placebo group (p = 0.221). Seventy-seven patients, 42 within the O3FA group and 35 in the placebo group, completed a follow-up BSIT survey at an average of 717.8 days from study onset. At long-term follow-up, there was an average BSIT score improvement of 1.72 within the O3FA group compared to 1.76 within the placebo group (p = 0.948). CONCLUSION Among patients with persistent COVID-related OD, our study showed no clear evidence of relative short-term or long-term olfactory recovery among patients receiving high doses of O3FA supplementation.
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Affiliation(s)
- David K Lerner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine L Garvey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annie Arrighi-Allisan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Kominsky
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrey Filimonov
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Filip
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Liu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sen Ninan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd Spock
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Tweel
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maaike van Gerwen
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madeleine Schaberg
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick Colley
- Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY, USA
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hummel T, Power Guerra N, Gunder N, Hähner A, Menzel S. Olfactory Function and Olfactory Disorders. Laryngorhinootologie 2023; 102:S67-S92. [PMID: 37130532 PMCID: PMC10184680 DOI: 10.1055/a-1957-3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The sense of smell is important. This became especially clear to patients with infection-related olfactory loss during the SARS-CoV-2 pandemic. We react, for example, to the body odors of other humans. The sense of smell warns us of danger, and it allows us to perceive flavors when eating and drinking. In essence, this means quality of life. Therefore, anosmia must be taken seriously. Although olfactory receptor neurons are characterized by regenerative capacity, anosmia is relatively common with about 5 % of anosmic people in the general population. Olfactory disorders are classified according to their causes (e. g., infections of the upper respiratory tract, traumatic brain injury, chronic rhinosinusitis, age) with the resulting different therapeutic options and prognoses. Thorough history taking is therefore important. A wide variety of tools are available for diagnosis, ranging from short screening tests and detailed multidimensional test procedures to electrophysiological and imaging methods. Thus, quantitative olfactory disorders are easily assessable and traceable. For qualitative olfactory disorders such as parosmia, however, no objectifying diagnostic procedures are currently available. Therapeutic options for olfactory disorders are limited. Nevertheless, there are effective options consisting of olfactory training as well as various additive drug therapies. The consultation and the competent discussion with the patients are of major importance.
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Affiliation(s)
- T Hummel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - N Power Guerra
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Medizinische Universität Rostock, Rostock
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden
| | - A Hähner
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
| | - S Menzel
- Interdisziplinäres Zentrum Riechen und Schmecken, HNO Klinik, TU Dresden
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11
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Khoury S, Soubeyre V, Cabaret S, Grégoire S, Mézière E, Masson E, Grosmaitre X, Bretillon L, Berdeaux O, Acar N, Le Bon AM. Impact of dietary n-3 polyunsaturated fatty acid intake during the perinatal and post-weaning periods on the phospholipid and ganglioside composition of olfactory tissues. Prostaglandins Leukot Essent Fatty Acids 2023; 191:102556. [PMID: 36870298 DOI: 10.1016/j.plefa.2023.102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/02/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023]
Abstract
The olfactory mucosa (OM) and olfactory bulb (OB) are neuronal tissues that contribute to the early processing of olfactory information. They contain significant amounts of n-3 and n-6 polyunsaturated fatty acids (PUFAs), which are crucial for neuronal tissue development. In this study, we evaluated the impact of feeding mice diets that are either deficient in α-linolenic acid (ALA) or supplemented with n-3 long-chain PUFAs from gestation to adolescence on the phospholipid and ganglioside composition of these tissues. Both diets modified the levels of some phospholipid classes, notably the phosphatidylserine and phosphatidylethanolamine levels. In addition, the low-ALA diet enriched n-6 PUFAs in the main phospholipid classes of both tissues, while the diet supplemented with n-3 PUFAs enhanced the n-3 PUFA-containing phospholipid species level, mainly in OM. The diets also modulated the levels and profiles of several ganglioside classes in OM and OB. These modifications may have repercussions on the olfactory sensitivity.
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Affiliation(s)
- Spiro Khoury
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France; INRAE, PROBE Research Infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Vanessa Soubeyre
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Stéphanie Cabaret
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France; INRAE, PROBE Research Infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Stéphane Grégoire
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Esther Mézière
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France; INRAE, PROBE Research Infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Elodie Masson
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Xavier Grosmaitre
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Lionel Bretillon
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Olivier Berdeaux
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France; INRAE, PROBE Research Infrastructure, ChemoSens facility, F-21000 Dijon, France
| | - Niyazi Acar
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Anne Marie Le Bon
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France.
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Meller AE, Fokeev VA, Shakhova MA, Shakhov AV. [COVID-19-associated anosmia]. Vestn Otorinolaringol 2023; 88:63-68. [PMID: 37450393 DOI: 10.17116/otorino20228803163] [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: 07/18/2023]
Abstract
The article is a systematic review of the literature data summarizes to date on the issue of COVID-19-associated anosmia. We mainly used full-text and abstract electronic databases (PubMed, Scopus and Web of Science). The paper discusses hypothetical mechanisms of development, clinical features, as well as methods of diagnosis and treatment of COVID-19-associated anosmia.
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Affiliation(s)
- A E Meller
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - V A Fokeev
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - M A Shakhova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - A V Shakhov
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
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13
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Quality of Life Considerations in Endoscopic Endonasal Management of Anterior Cranial Base Tumors. Cancers (Basel) 2022; 15:cancers15010195. [PMID: 36612191 PMCID: PMC9818735 DOI: 10.3390/cancers15010195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Considering quality of life (QOL) is critical when discussing treatment options for patients undergoing endoscopic endonasal skull base surgery (EESBS) for cancers at the base of the skull. Several questionnaires have been developed and validated in the last 20 years to explore QOL in this patient population, including the Anterior Skull Base Questionnaire, Skull Base Inventory, EESBS Questionnaire, and the Sino-Nasal Outcome Test for Neurosurgery. The Sino-Nasal Outcomes Test-22 and Anterior Skull Base Nasal Inventory-12 are other tools that have been used to measure sinonasal QOL in anterior cranial base surgery. In addition to pathology-related perturbations in QOL endoscopic surgical options (transsellar approaches, anterior cranial base surgery, and various reconstructive techniques) all have unique morbidities and QOL implications that should be considered. Finally, we look ahead to new and emerging techniques and tools aimed to help preserve and improve QOL for patients with anterior cranial base malignancies.
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14
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Yan CH, Jang SS, Lin HC, Ma Y, Khanwalkar AR, Thai A, Patel ZM. Use of platelet-rich plasma for COVID-19-related olfactory loss: a randomized controlled trial. Int Forum Allergy Rhinol 2022; 13:989-997. [PMID: 36507615 PMCID: PMC9877663 DOI: 10.1002/alr.23116] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The current study evaluated the use of platelet-rich plasma (PRP), an autologous blood product with supraphysiologic concentrations of growth factors, in the treatment of prolonged coronavirus disease 2019 (COVID-19)-related smell loss. METHODS This multi-institutional, randomized controlled trial recruited patients with COVID-19 who had objectively measured smell loss (University of Pennsylvania Smell Identification Test [UPSIT] ≤ 33) between 6 and 12 months. Patients were randomized to three intranasal injections of either PRP or sterile saline into their olfactory clefts. The primary outcome measure was change in Sniffin' Sticks score (threshold, discrimination, and identification [TDI]) from baseline. The secondary end point measures included responder rate (achievement of a clinically significant improvement, ≥5.5 points TDI), change in individual TDI olfaction scores, and change in subjective olfaction via a visual analog scale. RESULTS A total of 35 patients were recruited and 26 completed the study. PRP treatment resulted in a 3.67-point (95% CI: 0.05-7.29, p = 0.047) greater improvement in olfaction compared with the placebo group at 3 months and a higher response rate (57.1% vs 8.3%, odds ratio 12.5 [95% exact bootstrap confidence interval, 2.2-116.7]). There was a greater improvement in smell discrimination following PRP treatment compared with placebo but no difference in smell identification or threshold. There was no difference in subjective scores between PRP and placebo. No adverse effects were reported. CONCLUSION Olfactory function following COVID-19 can improve spontaneously after 6 months and can improve to a greater extent with PRP injection. These data build on the promise of PRP to be a safe potential treatment option for patients with COVID-19-related smell loss, and larger-powered studies will help further assess its efficacy.
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Affiliation(s)
- Carol H. Yan
- Department of OtolaryngologyHead and Neck SurgeryUniversity of CaliforniaSan Diego School of MedicineLa JollaCaliforniaUSA
| | - Sophie S. Jang
- Department of OtolaryngologyHead and Neck SurgeryUniversity of CaliforniaSan Diego School of MedicineLa JollaCaliforniaUSA
| | - Hung‐Fu C. Lin
- Department of OtolaryngologyHead and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Yifei Ma
- Department of OtolaryngologyHead and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Ashoke R. Khanwalkar
- Department of OtolaryngologyHead and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Anthony Thai
- Department of OtolaryngologyHead and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Zara M. Patel
- Department of OtolaryngologyHead and Neck SurgeryStanford University School of MedicineStanfordCaliforniaUSA
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15
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Parikh KP, Motiwala M, Beer-Furlan A, Michael LM, Rangarajan SV, Choby GW, Kshettry VR, Saleh S, Mukherjee D, Kirsch C, McKean E, Sorenson JM. Skull Base Registries: A Roadmap. J Neurol Surg B Skull Base 2022; 83:561-578. [PMID: 36393883 PMCID: PMC9653294 DOI: 10.1055/a-1934-9191] [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: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/17/2023] Open
Abstract
Hospitals, payors, and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper, we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.
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Affiliation(s)
- Kara P. Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Moffitt Cancer Center, Tampa, Florida, United States
| | - L. Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, United States
| | - Garret W. Choby
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, United States
| | - Varun R. Kshettry
- Brain Tumor and Neuro-Oncology Center Cleveland Clinic, Cleveland, Ohio, United States
| | - Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, United States
| | - Claudia Kirsch
- Yale University School of Medicine Department of Radiology and Biomedical Imaging, New Haven, Connecticut, United States
- Department of Clinical Dentistry, University of Sheffield, Sheffield, South Yorkshire, England
- Mount Sinai Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erin McKean
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Jeffrey M. Sorenson
- Department of Neurosurgery, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
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16
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Novel Therapies in Olfactory Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022; 10:427-432. [PMID: 36312744 PMCID: PMC9589531 DOI: 10.1007/s40136-022-00436-z] [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] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Purpose of Review To summarize and critically review the recent literature on novel treatments for olfactory disorders (OD). Recent Findings Emerging therapies in the management of OD include multiple vitamins and supplements, biologics, neuromodulators, and intranasal agents. There is also an active investigation into treatments that harness the neuroregenerative properties of the olfactory epithelium, such as platelet-rich plasma and stem cell transplantation. Summary Successful management of OD is multimodal and tailored to the underlying etiology. As the findings of further investigations accrue, the management of OD will undoubtedly continue to be advanced and refined, and likely harness the intrinsic neuroregenerative properties of the olfactory system.
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17
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Konstantinidis I. Managing Post-traumatic Olfactory Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00431-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose of Review
This study aims to summarize and critically review recent literature on management of post-traumatic olfactory dysfunction (PTOD) with emphasis on the diagnostic procedure and treatment options.
Recent Findings
Magnetic resonance imaging and olfactory testing are the basis of the diagnostic procedure. Time of diagnosis is critical as the most improvement occurs within the first year after trauma. Olfactory training and oral steroids seem to be a relatively evidence-based therapeutic option but with non-optimal results. Surgery has a limited place in the management of PTOD. Promising future options could be the development of olfactory implants and transplantation of olfactory epithelium or stem cells.
Summary
PTOD management is challenging as it has several pathogenetic mechanisms and relatively poor prognosis. Patients with olfactory impairment and head trauma have diminished quality of life, and increased risk for harmful events and development of depression. Thus, clinicians should not only focus to therapeutic options but equally to appropriate counseling to their patients in order to decrease risks of personal injury and improve their daily life.
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18
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Hintschich CA, Dietz M, Haehner A, Hummel T. Topical Administration of Mometasone Is Not Helpful in Post-COVID-19 Olfactory Dysfunction. Life (Basel) 2022; 12:life12101483. [PMID: 36294918 PMCID: PMC9605508 DOI: 10.3390/life12101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Persistent olfactory dysfunction is a major concern post-COVID-19, affecting up to 5% of all patients. Different therapeutic options, including mometasone nasal spray, have been recommended, only some of which have been validated for post-COVID-19 olfactory dysfunction. In this study we psychophysically assessed the effect of intranasally applied mometasone furoate on the recovery of olfaction. The spray was applied with a long applicator so that the olfactory cleft could be reached effectively. After olfactory dysfunction had been confirmed psychophysically using Sniffin’ Sticks, patients were randomly assigned to two different treatment arms: the study group (n = 40) underwent olfactory training and intranasal administration of mometasone furoate twice daily, whereas the control group (n = 46) performed olfactory training only. After a study duration of three months, psychophysical testing of olfaction was repeated using Sniffin’ Sticks. We found no benefit of an additional topical administration of mometasone furoate compared to olfactory training alone. These results psychophysically confirm two previous studies which were based on patients’ subjective self-ratings. Our findings are in contrast to current recommendations for the management of olfactory dysfunction post-COVID-19, which might have to be adapted accordingly.
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Affiliation(s)
- Constantin A. Hintschich
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
- Department of Otorhinolaryngology, Regensburg University Hospital, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-9401
| | - Melanie Dietz
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
| | - Antje Haehner
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, 01307 Dresden, Germany
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19
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Omega-3 fatty acids in the treatment of spinal cord injury: untapped potential for therapeutic intervention? Mol Biol Rep 2022; 49:10797-10809. [DOI: 10.1007/s11033-022-07762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
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20
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Fjaeldstad AW, Smith B. The Effects of Olfactory Loss and Parosmia on Food and Cooking Habits, Sensory Awareness, and Quality of Life-A Possible Avenue for Regaining Enjoyment of Food. Foods 2022; 11:foods11121686. [PMID: 35741884 PMCID: PMC9222253 DOI: 10.3390/foods11121686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 12/23/2022] Open
Abstract
Olfactory dysfunction often has severe consequences on patients’ quality of life. The most common complaint in these patients is their reduced enjoyment of food in both patients with olfactory loss and parosmia. How the different types of olfactory dysfunction differ in relation to food and cooking habits, sensory awareness, and food-related quality of life has not yet received much attention. By applying questionnaires on cooking, food, olfactory function, weight changes, sensory awareness, and food-related quality of life, we investigated how various aspects of eating differ between participants with olfactory loss (n = 271), parosmia (n = 251), and normosmic controls (n = 166). Cooking habits in olfactory dysfunction revealed pronounced differences as compared with normosmic controls. Cooking with olfactory dysfunction was associated with, e.g., a lack of comfort and inspiration for cooking and an inability to make new foods successfully. Significant differences in cooking were also found between olfactory loss and parosmia. Food items were less familiar in participants with olfactory loss and parosmia, while the ratings of liking food items differed between olfactory loss and parosmia, indicating the importance of adapting ingredients in meals separately for olfactory loss and parosmia. Parosmia was associated with a higher incidence of weight loss, but we found no difference in food-related quality of life between participants with olfactory loss and parosmia. While olfactory loss and parosmia have wide-ranging consequences on patients’ cooking and food habits, adapting meals to include ‘safer food items’ and integrating multisensory stimulation may be a possible avenue for improving the enjoyment of food.
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Affiliation(s)
- Alexander Wieck Fjaeldstad
- Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Hospitalsparken 15, 7400 Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford OX3 9BX, UK
- Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London WC1E 7HU, UK;
- Correspondence:
| | - Barry Smith
- Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London WC1E 7HU, UK;
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21
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22
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Riech- und Schmeckstörungen. DGNEUROLOGIE 2022. [PMCID: PMC9007254 DOI: 10.1007/s42451-022-00434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ziel der vorliegenden Übersicht ist es, einen Überblick über die Ätiologie und Diagnostik von Riech- und Schmeckstörungen zu geben. Da etwa 5 % der Allgemeinbevölkerung betroffen sind, ist es ein häufiges Krankheitsbild. Riechen und Schmecken erhielten v. a. zuletzt Aufmerksamkeit während des Aufkommens der SARS-CoV-2-Pandemie, wobei eine plötzlich aufgetretene Riech- und/oder Schmeckstörung zu den typischen Symptomen zählt. Daneben sind Riechstörungen in der Frühdiagnostik neurodegenerativer Erkrankungen von Bedeutung. Häufig zeigen Patienten mit Riechstörungen Zeichen einer Depression. Die Auswirkungen von Riech‑/Schmeckstörungen sind also umfangreich, die Therapiemöglichkeiten aktuell begrenzt. Nach einem Einblick in die Ätiologie werden Diagnostik und Therapiemöglichkeiten auf dem aktuellen Stand der Literatur erörtert. Auch zukunftsweisende Behandlungsvorstellungen, wie z. B. autologe Schleimhauttransplantationen oder olfaktorische Implantate, werden angesprochen.
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23
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van der Meulen M, Verstegen MJT, Lobatto DJ, Kleijwegt MC, Pereira AM, Biermasz NR, van Furth WR, Zamanipoor Najafabadi AH. Impact of patient-reported nasal symptoms on quality of life after endoscopic pituitary surgery: a prospective cohort study. Pituitary 2022; 25:308-320. [PMID: 35001298 DOI: 10.1007/s11102-021-01199-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Endoscopic transsphenoidal surgery causes nasal morbidity and negatively affects health-related quality of life (HRQoL). Knowledge on actionable symptoms that could improve postoperative HRQoL is therefore important. This study assessed the impact of nasal symptoms on postoperative HRQoL. METHODS This perioperative cohort study included 103 adult patients undergoing endoscopic pituitary adenoma resection (August 2016-December 2018), with measurements preoperatively, and 5 days, 6 weeks and 6 months after surgery. Nasal symptoms were measured with the Anterior Skull base nasal inventory-12, and HRQoL with the Short Form-36 (SF-36) physical (PCS) and mental component scores (MCS). Linear regression analysis was used to assess (1) determinants of postoperative nasal morbidity, (2) associations between number of symptoms or (3) individual symptoms and HRQoL, and (4) the percentage of variance of HRQoL explained by nasal symptoms. RESULTS The number of nasal symptoms transiently increased after surgery. No significant treatment- or disease-related determinants of nasal morbidity were identified. The number of nasal symptoms was significantly associated with a lower PCS (β = - 1.0; 95%CI - 1.5, - 0.4), but not with MCS at 6 weeks. Similar results were observed at 6 months. Headaches (42.2%), problems with smell (42.0%), and taste (36.0%) were the most prevalent symptoms, while sense of smell and taste, and nasal discharge showed the strongest associations with HRQoL. CONCLUSIONS Postoperative nasal symptoms, in particular problems with smell and taste, significantly affect pituitary patients' physical HRQoL. Monitoring of these symptoms may aid in determining which patients may benefit from intensified follow-up and treatment, aiming to optimize HRQoL.
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Affiliation(s)
- Merel van der Meulen
- Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Marco J T Verstegen
- Department of Neurosurgery, Haaglanden Medical Center and Haga Teaching Hospital, University Neurosurgical Center Holland, Leiden University Medical Center, Leiden and The Hague, The Netherlands
| | - Daniel J Lobatto
- Department of Neurosurgery, Haaglanden Medical Center and Haga Teaching Hospital, University Neurosurgical Center Holland, Leiden University Medical Center, Leiden and The Hague, The Netherlands
| | - Maarten C Kleijwegt
- Department of Ear Nose and Throat-Head and Neck Cancer, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Haaglanden Medical Center and Haga Teaching Hospital, University Neurosurgical Center Holland, Leiden University Medical Center, Leiden and The Hague, The Netherlands
| | - Amir H Zamanipoor Najafabadi
- Division of Endocrinology, Department of Medicine, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center and Haga Teaching Hospital, University Neurosurgical Center Holland, Leiden University Medical Center, Leiden and The Hague, The Netherlands
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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Avanipully JN, Thekkekkara D, M S, Parihar VK, Manjula SN. The Role of Olfactory System in the Etiogenesis of Parkinson’s Diseases: An Overview. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221085802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Parkinson’s disease (PD) mainly affects the dopaminergic neuronal networks of the substantia nigra, which leads to both motor and nonmotor symptoms of the disease. Based on the reports from the previous studies, 95% of the cases are presented along with olfactory dysfunction. The relevant publications from 2002 to 2021 were searched and shortlisted using PubMed and Google Scholar. In this review, we have discussed the correlation between olfactory dysfunction and PD. Olfactory damage presents earlier than the motor symptoms. Because there are no current methodologies for the early detection of PD, olfactory dysfunction can be used as a potential marker for the early detection of PD and hence paving the way for better therapeutic approaches.
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Affiliation(s)
| | - Dithu Thekkekkara
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, Mysuru-570015, Karnataka, India
| | - Sahyadri M
- Department of Pharmacology, JSS College of Pharmacy, JSSAHER, Mysuru-570015, Karnataka, India
| | - Vipan K. Parihar
- Department of Pharmacology and Toxicology, NIPER-Hajipur, Bihar-844102, India
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Jozaghi Y, Phan J, Hanna EY, Kupferman ME, Su SY. Functional Outcomes and Quality of Life in Patients with Sinonasal, Nasopharyngeal, and Anterior Skull Base Tumors. Curr Oncol Rep 2022; 24:775-781. [PMID: 35290597 DOI: 10.1007/s11912-022-01214-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This article will review functional and QOL outcomes among patients treated predominantly for sinonasal and nasopharyngeal malignancies. RECENT FINDINGS Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the reduction in quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. Recent progress in QOL and Patient-Reported Outcome (PRO) instruments for this population will be covered. Sinonasal and nasopharyngeal tumors affect patients' quality of life, appearance, and critical functions. Tumors arise in proximity of vital structures including the orbit, cranial nerves, carotid artery, brain, cervical spine, and pituitary gland. Surgical morbidity, along with acute and late effects of systemic therapy and radiotherapy on normal tissues in this functionally critical region, may result in wide-ranging symptoms. Patients with skull base tumors report a high symptom burden at presentation, prior to treatment, relative to other malignancies in the head and neck region.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA.
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Ghods K, Alaee A. Olfactory and Taste Disorders in Patients Suffering from Covid-19, a Review of Literature. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2022; 23:1-6. [PMID: 35291682 PMCID: PMC8918638 DOI: 10.30476/dentjods.2021.87800.1284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/22/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023]
Abstract
Corona virus epidemic has caused a widespread disaster around the world. In studies, there are pieces of evidence of olfactory and taste dysfunction in patients with Covid-19. These symptoms occur independently or can be associated with other symptoms such as dry cough. The mechanism of the above-mentioned disorders and their clinical features in patients are not yet known. The rate of incidence of olfactory dysfunction in patients has been varied from 29.64% to 75.23% and the rate of incidence of taste dysfunction among the people can be different from 20.46% to 68.95%. Therefore, clinicians including ENT specialists and dentists should pay attention to the symptoms of anosmia and ageusia in these patients to prevent delayed diagnosis and inappropriate treatments. In this review article, data have been collected by searching the available articles in the domestic and foreign journals using databases such as PubMed, PubMed Central, Medline, EBSCO, Google Scholar, and Embase with key words of Anosmia, Ageusia, Dysgeusia, Covid-19, and Coronavirus from 2019 to 2020. Among the relevant references, 38 authoritative articles were chosen. The data showed that it seems olfactory and taste function disorders are the obvious symptoms of Covid-19, which can occur independently or with other symptoms, but the pathogenesis is not well specified yet. Therefore, further studies are required to achieve a reliable result in this area.
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Affiliation(s)
- Kimia Ghods
- Student of Dentistry, Membership of Dental Material Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Arezoo Alaee
- Dept. of Oral Medicine, Membership of Dental Material Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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28
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Hernandez AK, Woosch D, Haehner A, Hummel T. Omega-3 supplementation in postviral olfactory dysfunction: a pilot study. Rhinology 2022; 60:139-144. [PMID: 35112672 DOI: 10.4193/rhin21.378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to examine whether omega-3 supplementation would support olfactory recovery among postviral olfactory dysfunction patients. METHODOLOGY Patients with postviral olfactory dysfunction were included in this non-blinded, prospective pilot study. Structured medical history was taken from the patients, including the following: age, sex, history of COVID-19 infection, and duration of symptoms. Patients were randomly assigned to receive olfactory training only (control group) versus olfactory training with omega-3 supplementation (treatment group). All patients exposed themselves twice a day to four odours (phenyl ethyl alcohol [rose], eucalyptol [eucalyptus], citronellal [lemon], and eugenol [cloves]). Olfactory function was measured before and after training using "Sniffin' Sticks", comprised of tests for odour threshold, discrimination, and identification. The average interval between olfactory tests was 3 months. RESULTS Fifty-eight patients were included in the study, 25 men and 33 women. Generally, an improvement in olfactory scores was observed. Compared to the control group, the improvement in odour thresholds was more pronounced in the omega-3 group. Age, sex, and duration of symptoms had no effect on olfactory scores among both control and treatment groups. CONCLUSION Overall, the present results indicate that omega-3 supplementation may be an option for adjunct therapy with olfactory training in patients with postviral olfactory dysfunction.
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Affiliation(s)
- A K Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - D Woosch
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Abstract
Purpose of Review Olfactory dysfunction is a prevalent condition affecting 5–15% of the general population, with significant impact on quality of life. This review summarizes the most recent and relevant literature in the treatment of olfactory dysfunction. Recent Findings Current evidence supports the short-term use of topical corticosteroids and systemic therapy. These treatments may occur in conjunction with olfactory training, which is well supported by the literature. While there are several additional treatments currently under investigation, meaningful conclusions are not yet able to be made regarding their efficacy. Summary The treatment of olfactory dysfunction is targeted at the suspected etiology when possible. After normal aging, chronic rhinosinusitis, post-infectious sequelae including as a result SARS-CoV-2 infection (COVID-19), and head trauma are the most common causes. Current evidence supports the short-term use of topical corticosteroids and systemic therapy. Several additional treatments are under investigation but recommendations for their use cannot currently be made. Graphical abstract ![]()
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head & Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, University of Washington, Seattle, WA, 98195-6515, USA.
| | - Eric H Holbrook
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Abstract
Ziel der vorliegenden Übersicht ist es, einen Überblick über die Ätiologie und Diagnostik von Riech- und Schmeckstörungen zu geben. Da etwa 5 % der Allgemeinbevölkerung betroffen sind, ist es ein häufiges Krankheitsbild. Riechen und Schmecken erhielten v. a. zuletzt Aufmerksamkeit während des Aufkommens der SARS-CoV-2-Pandemie, wobei eine plötzlich aufgetretene Riech- und/oder Schmeckstörung zu den typischen Symptomen zählt. Daneben sind Riechstörungen in der Frühdiagnostik neurodegenerativer Erkrankungen von Bedeutung. Häufig zeigen Patienten mit Riechstörungen Zeichen einer Depression. Die Auswirkungen von Riech‑/Schmeckstörungen sind also umfangreich, die Therapiemöglichkeiten aktuell begrenzt. Nach einem Einblick in die Ätiologie werden Diagnostik und Therapiemöglichkeiten auf dem aktuellen Stand der Literatur erörtert. Auch zukunftsweisende Behandlungsvorstellungen, wie z. B. autologe Schleimhauttransplantationen oder olfaktorische Implantate, werden angesprochen.
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Affiliation(s)
- M M Speth
- Klinik für Hals‑, Nasen‑, Ohrenkrankheiten, Hals- und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Schweiz.
| | - U S Speth
- Klinik für Mund‑, Kiefer-, und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - T Hummel
- Universitäts-HNO Klinik, TU Dresden, Dresden, Deutschland
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Khani E, Khiali S, Beheshtirouy S, Entezari-Maleki T. Potential pharmacologic treatments for COVID-19 smell and taste loss: A comprehensive review. Eur J Pharmacol 2021; 912:174582. [PMID: 34678243 PMCID: PMC8524700 DOI: 10.1016/j.ejphar.2021.174582] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022]
Abstract
The acute loss of taste and smell following COVID-19 are hallmark symptoms that affect 20-85% of patients. However, the pathophysiology and potential treatments of COVID-19 smell and taste loss are not fully understood. We searched the literature to review the potential pathologic pathways and treatment options for COVID-19 smell and taste loss. The interaction of novel coronavirus with ACE-2 receptors expressed on sustentacular cells and taste buds results in direct damage to the olfactory and gustatory systems. Also, the invasion of the virus to the olfactory neurons and consequent local inflammation are other proposed mechanisms. Therefore, COVID-19 patients with smell or taste loss may benefit from neuroprotective, anti-inflammatory, or depolarizing agents. Based on the current evidence, phosphodiesterase inhibitors, insulin, and corticosteroids can be promising for the management of COVID-19 smell and taste loss. This review provided crucial information for treating COVID-19-related smell and/or taste loss, urging to perform large clinical trials to find optimum treatment options.
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Affiliation(s)
- Elnaz Khani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samineh Beheshtirouy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran,Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author. Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, P.O. Box: 51664-14766 12, Iran
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Sedighiyan M, Abdollahi H, Karimi E, Badeli M, Erfanian R, Raeesi S, Hashemi R, Vahabi Z, Asanjarani B, Mansouri F, Abdolahi M. Omega-3 polyunsaturated fatty acids supplementation improve clinical symptoms in patients with Covid-19: A randomised clinical trial. Int J Clin Pract 2021; 75:e14854. [PMID: 34516692 DOI: 10.1111/ijcp.14854] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We hypothesised that omega-3 fatty acids would be an appropriate adjunct therapy for alleviating the inflammatory response and clinical manifestation in hospitalised patients with Covid-19 disease. METHODS This was a single-blind randomised controlled trial in Amir-Alam hospital in Tehran. Thirty adult men and women diagnosed with Covid-19 were allocated to either control group (receiving Hydroxychloroquine) or intervention group (receiving Hydroxychloroquine plus 2 grams of Docosahexaenoic acid [DHA] + Eicosapentaenoic acid [EPA]) for 2 weeks. Primary outcome of the intervention including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) as well as clinical symptoms including body pain, fatigue, appetite and olfactory and secondary outcomes including liver enzymes were determined at the baseline and after omega-3 supplementation. Clinical signs were measured using self-reported questionnaires. There were commercial kits for determination of CRP and liver enzymes concentrations in the serum of patients. For determination of ESR automated haematology analyser was applied. The study of "Comparison of the effectiveness of omega-3 and Hydroxychloroquine on Inflammatory factors, liver enzymes and clinical symptoms in diabetic Covid-19 patients" was registered in Iranian Registry of Clinical Trials (IRCT) with ID number: IRCT20200511047399N1. RESULTS In comparison to control group, patients receiving omega-3 indicated favourable changes in all clinical symptoms except for olfactory (P < .001 for body pain and fatigue, P = .03 for appetite and P = .21 for olfactory). Reducing effects of omega-3 supplementation compared with control group were also observed in the levels of ESR and CRP after treatment (P < .001 for CRP and P = .02 for ESR). However, no between group differences in the liver enzymes serum concentrations were observed after supplementation (P > .05). CONCLUSION Current observations are very promising and indicate that supplementation with moderate dosages of omega-3 fatty acids may be beneficial in the management of inflammation-mediated clinical symptoms in Covid-19 patients.
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Affiliation(s)
- Mohsen Sedighiyan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Abdollahi
- Department of Anesthesiology, Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Karimi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Badeli
- Department of Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Raeesi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Hashemi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Memory and Behavioral Neurology Division, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Asanjarani
- Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Mansouri
- Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Abdolahi
- Amir Alam Hospital Complexes, Tehran University of Medical Sciences, Tehran, Iran
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Olfactory and Taste Dysfunction in Coronavirus Disease 2019 Pandemic. Indian J Otolaryngol Head Neck Surg 2021; 74:3159-3166. [PMID: 34631493 PMCID: PMC8487225 DOI: 10.1007/s12070-021-02871-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
This study is done to raise awareness of olfactory and taste dysfunction association in coronavirus disease, urging early detection and isolation of coronavirus positive patients thus breaking the chain of transmission of disease. This is a retrospective observational study done in outpatient department of tertiary care hospital in Mumbai, west India from 1st May 2020 to 1st August 2020 on patients who were confirmed positive for COVID-19 by real-time reverse transcription polymerase chain reaction (rRT-PCR) and having olfactory dysfunction and/or taste disorders. In study population, anosmia and ageusia occurred in 88% and 83.33% respectively. In control population, anosmia and ageusia occurred in 93% and 85.71% respectively. The mean duration of anosmia was around 2 weeks and 3 weeks for study and control group respectively. In study population 94.6% recovered from anosmia, whereas in control population 64.3% recovered from anosmia. Anosmia gradually improved to hyposmia. In the study population 94.3% hyposmia patients showed recovery, while in control population 85.2% showed recovery. Ageusia collaborated with the duration of anosmia. Recovery from taste dysfunction was 88.6% and 63.9% in study and control population respectively. Olfactory and taste dysfunction are very important clinical features of coronavirus positive patients with anosmia being the most prominent symptom. All patients presenting with smell and or taste dysfunction should be screened for coronavirus disease, helping in early detection in asymptomatic patients.
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Okada Y, Yoshimura K, Toya S, Tsuchimochi M. Pathogenesis of taste impairment and salivary dysfunction in COVID-19 patients. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:111-122. [PMID: 34257762 PMCID: PMC8266517 DOI: 10.1016/j.jdsr.2021.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/27/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly transmissible pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of the disease include a broad range of symptoms from mild to serious to death, with mild pneumonia to acute respiratory distress syndrome and complications in extrapulmonary organs. Taste impairment and salivary dysfunction are common early symptoms in COVID-19 patients. The mouth is a significant entry route for SARS-COV-2, similar to the nose and eyes. The cells of the oral epithelium, taste buds, and minor and major salivary glands express cell entry factors for SARS-COV-2, such as ACE2, TMPRSS2, and Furin. We describe the occurrence of taste impairment and salivary dysfunction in COVID-19 patients and show immunohistochemical findings regarding the cell entry factors in the oral tissue. We review and describe the pathogeneses of taste impairment and salivary dysfunction. Treatment for the oral disease is also described. Recently, it was reported that some people experience persistent and prolonged taste impairment and salivary dysfunction, described as post-COVID-19 syndrome or long COVID-19, after the acute illness of the infection has healed. To resolve these problems, it is important to understand the pathogenesis of oral complications. Recently, important advances have been reported in the understanding of gustatory impairment and salivary dysfunction. Although some progress has been made, considerable effort is still required for in-depth elucidation of the pathogenesis.
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Affiliation(s)
- Yasuo Okada
- Department of Pathology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Ken Yoshimura
- Department of Anatomy, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Shuji Toya
- Oral and Maxillofacial Surgery, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Makoto Tsuchimochi
- The Nippon Dental University (Emeritus Professor), 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan
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Neta FI, Fernandes ACL, Vale AJM, Pinheiro FI, Cobucci RN, Azevedo EPD, Guzen FP. Pathophysiology and possible treatments for olfactory-gustatory disorders in patients affected by COVID-19. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100035. [PMID: 34870148 PMCID: PMC8178068 DOI: 10.1016/j.crphar.2021.100035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 infects host cells mainly through the interaction between the virus's Spike protein and the viral receptors namely Angiotensin-Converting Enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Both are highly expressed in the gastrointestinal tract, in the nasal and bronchial epithelium, as well as in the type II alveolar epithelial cells. The aim of this review is to report the evidences from the scientific literature on the pathophysiology and the available treatments for olfactory-gustatory disorders in patients with COVID-19. The mechanisms involved in these disorders are still unclear and studies on specific therapies are scarce. However, it has been hypothesized that a decrease in the sensitivity of the sensory neurons as well as the co-expression of ACE2 and TMPRSS2 in the alveolar epithelial cells are the main causes of olfactory-gustatory disorders. The possible mechanisms described in the literature for changes in taste perception in patients with COVID-19 include olfactory disorders and a competitive activity of COVID-19 on ACE2 receptors in the taste buds. In addition, SARS-CoV-2 can bind to sialic acid receptors in the taste buds. In general, evidences show that there is no specific treatment for olfactory-taste disorders induced by SARS-CoV-2, even though some treatments have been used and have shown some promising results, such as olfactory training, intranasal application of sodium citrate and vitamin A, as well as systemic use of omega-3 and zinc. Corticosteroids have also been used as a pharmacological approach to treat patients with olfactory dysfunction with some contradictory results. The knowledge of the mechanisms by which SARS-CoV-2 influences the sensory systems and how effective therapies can treat the loss of smell and taste will have important implications on the understanding and clinical management of olfactory-taste disorders.
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Affiliation(s)
- Francisca Idalina Neta
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
| | - Amélia Carolina Lopes Fernandes
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
- Nurse Department, Nurse School, State University of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Adson José Martins Vale
- Tocogynecology Department, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Francisco Irochima Pinheiro
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
- Medical School, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Ricardo Ney Cobucci
- Tocogynecology Department, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
- Medical School, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Eduardo Pereira de Azevedo
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Fausto Pierdoná Guzen
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
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Desai M, Oppenheimer J. The Importance of Considering Olfactory Dysfunction During the COVID-19 Pandemic and in Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:7-12. [PMID: 33130145 PMCID: PMC7598761 DOI: 10.1016/j.jaip.2020.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/24/2020] [Indexed: 12/16/2022]
Abstract
The emergence of a worldwide pandemic due to coronavirus disease 2019 (COVID-19) and frequent reports of smell loss in COVID-19-infected patients have brought new attention to this very important sense. Data are emerging that smell impairment is a prominent symptom in COVID-19 and that this coronavirus behaves differently in causing olfactory dysfunction compared with other respiratory viruses. Anosmia and hyposmia, the complete and partial loss of smell, respectively, can result from many causes, most commonly from viral infections, sinonasal disease, and head trauma. Olfactory dysfunction negatively impacts quality of life, because sense of smell is important for flavor perception and the enjoyment of food. Olfaction is also important for the detection of warning smells, such as smoke, natural gas leaks, and spoiled food. Allergists and immunologists frequently encounter anosmia and hyposmia in patients with severe chronic rhinosinusitis with nasal polyps, and will likely see more infection-induced olfactory dysfunction in the era of COVID-19. Therefore, now more than ever, it is crucial that we understand this impairment, how to evaluate and how to measure it. In this review, we offer a clinically relevant primer for the allergist and immunologist on olfactory dysfunction subtypes, exploring the pathophysiology, appropriate clinical assessment, objective smell testing, and management of this condition. We will also focus on the emerging literature on COVID-19 olfactory dysfunction, its unique features, and its important implications for this pandemic.
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Affiliation(s)
- Mauli Desai
- Icahn School of Medicine at Mount Sinai, New York, NY.
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Zarbafian M, Dayan S, Fabi SG. Teachings from COVID-19 and aging-An oxidative process. J Cosmet Dermatol 2020; 19:3171-3176. [PMID: 32997887 PMCID: PMC7536979 DOI: 10.1111/jocd.13751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
As of June 2020, the COVID‐19 pandemic has totaled over 9 000 000 cases and 470 000 deaths globally (ref. 1). Emerging data from COVID‐19 patients have suggested a clear role for oxidative stress in the pathogenesis of SARS‐CoV‐2, the pathogenic agent of COVID‐19. Several comorbidities, including hypertension, diabetes, obesity, and aging, have been associated with an increase in baseline oxidative stress, likely explaining why such individuals at risk for poor outcomes with SARS‐CoV‐2 infection. Similarly, the concept of oxidative stress remains one of the best supported theories to explain the mechanism behind aging. Oxidative stress through both endogenous and exogenous sources has known deleterious effects in both aging and SARS‐CoV‐2 infection. Herein, we will review the role of oxidative stress as a key player in both aging and COVID‐19 and highlight why some individuals may have better or poorer outcomes because of this. Additionally, we will discuss potential therapeutic pathways for effectively anti‐aging as we take away from our learnings on COVID‐19.
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Affiliation(s)
- Misha Zarbafian
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Steven Dayan
- Clinical Assistant Professor, University of Illinois, Chicago, IL, USA
| | - Sabrina G Fabi
- Volunteer Assistant Clinical Professor, University of California, San Diego, CA, USA.,Goldman Butterwick Groff Fabi Wu & Boen Cosmetic Laser Dermatology, San Diego, CA, USA
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Vaira LA, Hopkins C, Petrocelli M, Lechien JR, Chiesa-Estomba CM, Salzano G, Cucurullo M, Salzano FA, Saussez S, Boscolo-Rizzo P, Biglioli F, De Riu G. Smell and taste recovery in coronavirus disease 2019 patients: a 60-day objective and prospective study. J Laryngol Otol 2020; 134:703-709. [PMID: 32782030 PMCID: PMC7471571 DOI: 10.1017/s0022215120001826] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The long-term recovery rate of chemosensitive functions in coronavirus disease 2019 patients has not yet been determined. METHOD A multicentre prospective study on 138 coronavirus disease 2019 patients was conducted. Olfactory and gustatory functions were prospectively evaluated for 60 days. RESULTS Within the first 4 days of coronavirus disease 2019, 84.8 per cent of patients had chemosensitive dysfunction that gradually improved over the observation period. The most significant increase in chemosensitive scores occurred in the first 10 days for taste and between 10 and 20 days for smell. At the end of the observation period (60 days after symptom onset), 7.2 per cent of the patients still had severe dysfunctions. The risk of developing a long-lasting disorder becomes significant at 10 days for taste (odds ratio = 40.2, 95 per cent confidence interval = 2.204-733.2, p = 0.013) and 20 days for smell (odds ratio = 58.5, 95 per cent confidence interval = 3.278-1043.5, p = 0.005). CONCLUSION Chemosensitive disturbances persisted in 7.2 per cent of patients 60 days after clinical onset. Specific therapies should be initiated in patients with severe olfactory and gustatory disturbances 20 days after disease onset.
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Affiliation(s)
- L A Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
| | - C Hopkins
- ENT Department, King's College, London, UK
| | - M Petrocelli
- Maxillofacial Surgery Operative Unit, Bellaria-Maggiore Hospital, Un'azienda Sanitaria Locale (‘AUSL’) Bologna, Italy
| | - J R Lechien
- COVID-19 Task Force of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (‘YO-IFOS’)
- Department of Human and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (‘UMons’), Belgium
| | - C M Chiesa-Estomba
- COVID-19 Task Force of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (‘YO-IFOS’)
- Department of Otorhinolaryngology, Osakidetza, Donostia University Hospital, Biodonostia Health Research Institute, San Sebastian, Spain
| | - G Salzano
- Maxillofacial Surgery Unit, University Hospital of Naples ‘Federico II’, Italy
| | - M Cucurullo
- Maxillofacial Surgery Department, San Paolo Hospital, Azienda Socio Sanitaria Territoriale (‘ASST’) Santi Paolo e Carlo, University of Milan, Italy
| | - F A Salzano
- Otolaryngology Operative Unit, Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Italy
| | - S Saussez
- COVID-19 Task Force of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (‘YO-IFOS’)
| | - P Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padua, Treviso, Italy
| | - F Biglioli
- Maxillofacial Surgery Department, San Paolo Hospital, Azienda Socio Sanitaria Territoriale (‘ASST’) Santi Paolo e Carlo, University of Milan, Italy
| | - G De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Italy
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Dolci RLL, de Carvalho ACM, Rickli JCK, de Souza JL, Encinas WE, Dolci JEL, Dos Santos ARL, Lazarini PR. Relationship Between the Bilateral Removal of the Middle Nasal Turbinate and the Olfactory Function in Endoscopic Skull Base Surgery. World Neurosurg 2020; 142:e337-e343. [PMID: 32653515 DOI: 10.1016/j.wneu.2020.06.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the impact of endonasal endoscopic access to the skull base on the olfaction sense, involving the harvest of a nasoseptal flap, with the removal of the middle nasal turbinate. METHODS A study was performed on a prospective cohort of 50 patients who underwent transnasal endoscopic surgery of the anterior skull base, with the harvest of a nasoseptal and reverse flap. The patients were divided into 2 groups: partial unilateral removal of the middle nasal turbinate and bilateral removal. Connecticut Chemosensory Clinical Research Center tests were administered before surgery and in months 1, 3, and 6 after surgery. RESULTS There was no difference in the olfactory sense, when comparing the partial removal of the middle nasal turbinate and the bilateral removal, as well as when comparing the side without the middle nasal turbinate and the side with this structure preserved. There was a worsening in olfaction (P < 0.001) in months 1 and 3 after surgery, returning to baseline in month 6 (P > 0.05). CONCLUSIONS Bilateral removal of the middle nasal turbinate, compared with unilateral resection, showed no impact on the olfactory function 6 months after surgery. In both groups, there was a transitory decrease in the first month, but this normalized by the sixth postoperative month.
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Affiliation(s)
- Ricardo L L Dolci
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil; Skull Base Surgery Center, Santa Casa de São Paulo, São Paulo, Brazil.
| | - Ana Carolina Mayor de Carvalho
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil
| | - Jeniffer Cristina Kozechen Rickli
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil
| | - Jamile Lopes de Souza
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil
| | - Williams Escalante Encinas
- Discipline of Neurosurgery, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil
| | - José Eduardo Lutaif Dolci
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil
| | - Américo Rubens Leite Dos Santos
- Discipline of Neurosurgery, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil; Skull Base Surgery Center, Santa Casa de São Paulo, São Paulo, Brazil
| | - Paulo Roberto Lazarini
- Department of Otolaryngology, Department of Surgery at Santa Casa de Misericórdia of São Paulo and College of Medical Sciences at Santa Casa of SP, São Paulo, Brazil; Skull Base Surgery Center, Santa Casa de São Paulo, São Paulo, Brazil
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40
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Affiliation(s)
- Katherine Lisa Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- UCL Ear Institute, University College London, London, United Kingdom
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Karapetyan LS, Svistushkin VM. [Olfactory dysfunction and COVID-19 - current state of the problem]. Vestn Otorinolaringol 2020; 85:100-104. [PMID: 33474926 DOI: 10.17116/otorino202085061100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
According to data from China, Italy, South Korea, Iran, USA, France, from 17 to 87% of patients with confirmed COVID-19 have a violation of smell and taste. Acute sudden anosmia may precede symptoms such as cough and shortness of breath. Also, hypo/anosmia may be the only symptom of mild COVID-19. European, American and domestic associations of otorhinolaryngologists warn that, these patients may be hidden carriers that contribute to the spread of COVID-19 infection, because they have no indications for testing for the virus and self-isolation. Including anosmia in the criteria for self-isolation can help prevent the spread of COVID-19 infection. In addition, it would signal the medical staff to use full personal protection when dealing with these patients and help reduce the number of infected doctors. It is known that olfactory disorders can be conductive, perceptual or mixed. Olfactory disturbances in COVID-19 are most likely of a perceptual nature. Although, at the moment, there is insufficient data to determine the exact mechanisms of the onset of anosmia in patients diagnosed with COVID-19, however, there are studies that confirm these or those theories. The article provides an overview of the data available in the literature on this topic.
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Affiliation(s)
- L S Karapetyan
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Svistushkin
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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