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Zou XY, Liu XH, Lu CL, Jin XY, He BX, Liao YL, Liu T, Dai YD, Qi SH, Sheng ZJ, Yan ZF, Yang GY, Stub T, Liu JP. Traditional Chinese medicine for post-viral olfactory dysfunction: A systematic review. Integr Med Res 2024; 13:101045. [PMID: 38831890 PMCID: PMC11144739 DOI: 10.1016/j.imr.2024.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
Background Post-viral olfactory dysfunction (PVOD) is the common symptoms of long COVID, lacking of effective treatments. Traditional Chinese medicine (TCM) is claimed to be effective in treating olfactory dysfunction, but the evidence has not yet been critically appraised. We conducted a systematic review to evaluate the effectiveness and safety of TCM for PVOD. Methods We searched eight databases to identified clinical controlled studies about TCM for PVOD. The Cochrane risk of bias tools and GRADE were used to evaluate the quality of evidence. Risk ratio (RR), mean differences (MD), and 95 % confidence interval (CI), were used for effect estimation and RevMan 5.4.1 was used for data analysis. Results Six randomized controlled trials (RCTs) (545 participants), two non-randomized controlled trials (non-RCTs) (112 participants), and one retrospective cohort study (30 participants) were included. The overall quality of included studies was low. Acupuncture (n = 8) and acupoint injection (n = 3) were the mainly used TCM therapies. Five RCTs showed a better effect in TCM group. Four trials used acupuncture, and three trials used acupoint injection. The results of two non-RCTs and one cohort study were not statistically significant. Two trials reported mild to moderate adverse events (pain and brief syncope caused by acupuncture or acupoint injection). Conclusions Limited evidence focus on acupuncture and acupoint injection for PVOD and suggests that acupuncture and acupoint injection may be effective in improving PVOD. More well-designed trials should focus on acupuncture to confirm the benefit. Protocol registration The protocol of this review was registered at PROSPERO: CRD42022366776.
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Affiliation(s)
- Xiang-yun Zou
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-han Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chun-li Lu
- Guangdong Pharmaceutical University, 280 Huandong Road, University Town, Guangzhou, Guangdong, China
| | - Xin-yan Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bai-xiang He
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-lei Liao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Guanganmen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ting Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-dan Dai
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-hao Qi
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhu-jun Sheng
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhan-feng Yan
- Department of Otolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guo-Yan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Trine Stub
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jian-ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway
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Duan HG, Ji F, Yan MX. Treatment of Postinfectious Olfactory Dysfunction Using Corticosteroids. EAR, NOSE & THROAT JOURNAL 2024; 103:NP108-NP112. [PMID: 34464164 DOI: 10.1177/01455613211040368] [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: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the efficacy of different doses and forms of corticosteroids in the treatment of postinfectious olfactory dysfunction and to specify the factors related to the curative effects. METHODS The medical records of patients diagnosed with postinfectious olfactory dysfunction from January 2018 to May 2019 were reviewed. All patients received different doses of oral corticosteroids for 12 days or inhaled corticosteroids for 1 month. RESULTS A review of the records of 43 patients showed that the mean follow-up time was 6.66 months, and the overall effective rate of treatment was 48.8%. Postinfectious olfactory dysfunction exhibited distinct seasonality, with the highest incidence in March. The curative effect was significantly related to the olfactory discrimination threshold at the first consultation (P = .022), but not significantly associated with age (P = .325), sex (P = .924), duration of disease (P = .526), follow-up time (P = .489), or treatment program (P = .330). CONCLUSIONS Different doses and forms of corticosteroids showed no significant difference in the therapeutic effect on postinfectious olfactory dysfunction. The olfactory discrimination threshold at the first consultation was the most important factor influencing the prognosis.
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Affiliation(s)
- Hong-Gang Duan
- Department of Otolaryngology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Ji
- Department of Neurology, First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Mao-Xiao Yan
- Department of Otolaryngology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Jegatheeswaran L, Gokani SA, Luke L, Klyvyte G, Espehana A, Garden EM, Tarantino A, Al Omari B, Philpott CM. Assessment of COVID-19-related olfactory dysfunction and its association with psychological, neuropsychiatric, and cognitive symptoms. Front Neurosci 2023; 17:1165329. [PMID: 37599993 PMCID: PMC10436231 DOI: 10.3389/fnins.2023.1165329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose of review To provide a detailed overview of the assessment of COVID-19-related olfactory dysfunction and its association with psychological, neuropsychiatric, and cognitive symptoms. Recent findings COVID-19-related olfactory dysfunction can have a detrimental impact to the quality of life of patients. Prior to the COVID-19 pandemic, olfactory and taste disorders were a common but under-rated, under-researched and under-treated sensory loss. The pandemic has exacerbated the current unmet need for accessing good healthcare for patients living with olfactory disorders and other symptoms secondary to COVID-19. This review thus explores the associations that COVID-19 has with psychological, neuropsychiatric, and cognitive symptoms, and provide a framework and rationale for the assessment of patients presenting with COVID-19 olfactory dysfunction. Summary Acute COVID-19 infection and long COVID is not solely a disease of the respiratory and vascular systems. These two conditions have strong associations with psychological, neuropsychiatric, and cognitive symptoms. A systematic approach with history taking and examination particularly with nasal endoscopy can determine the impact that this has on the patient. Specific olfactory disorder questionnaires can demonstrate the impact on quality of life, while psychophysical testing can objectively assess and monitor olfaction over time. The role of cross-sectional imaging is not yet described for COVID-19-related olfactory dysfunction. Management options are limited to conservative adjunctive measures, with some medical therapies described.
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Affiliation(s)
- Lavandan Jegatheeswaran
- Department of Ear, Nose and Throat Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
| | - Shyam Ajay Gokani
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Louis Luke
- Department of Ear, Nose and Throat Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Gabija Klyvyte
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Andreas Espehana
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Elizabeth Mairenn Garden
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Alessia Tarantino
- Department of Ear, Nose and Throat Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
| | - Basil Al Omari
- Department of Ear, Nose and Throat Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
| | - Carl Martin Philpott
- Department of Ear, Nose and Throat Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, United Kingdom
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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De Luca R, Bonanno M, Rifici C, Quartarone A, Calabrò RS. Post-traumatic olfactory dysfunction: a scoping review of assessment and rehabilitation approaches. Front Neurol 2023; 14:1193406. [PMID: 37521284 PMCID: PMC10374209 DOI: 10.3389/fneur.2023.1193406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Post-traumatic Olfactory Dysfunction (PTOD) consists of a complete or partial loss of olfactory function that may occur after a traumatic brain injury (TBI). PTOD may be linked to some neuropsychiatric features, such as social, cognitive and executive dysfunction, as well as behavioral symptoms, especially when TBI involves the orbito-frontal cortex. The diagnosis of PTOD is based on medical history and clinical data and it is supported by psychometric tests (i.e., subjective tools) as well as electrophysiological and neuroimaging measures (i.e., objective methods). The assessment methods allow monitoring the changes in olfactory function over time and help to establish the right therapeutic and rehabilitative approach. In this context, the use of the olfactory training (OT), which is a non-pharmacological and non-invasive treatment option, could promote olfactory function through top-down (central) and bottom-up (peripheral) processes. To better manage patients with TBI, PTOD should be detected early and properly treated using the various therapeutic rehabilitative possibilities, both conventional and advanced, also taking into consideration the emerging neuromodulation approach.
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The Effect of Traditional Chinese Medicine on Postviral Olfactory Dysfunction: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:7448034. [PMID: 36714533 PMCID: PMC9876686 DOI: 10.1155/2023/7448034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/06/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
Objective The aim of this study is to evaluate the efficacy and safety of traditional Chinese medicine (TCM) for postviral olfactory dysfunction (PVOD). Methods PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical (CBM) Database, and Wanfang Database were electronically searched from their inception to July 25, 2022. Two authors independently performed study selection, data extraction, and quality assessment to ensure systematic quality evaluation. Randomized controlled trials (RCTs) comparing TCM with olfactory training and/or drug therapy (OTDT) were included. The outcomes were the effective rate, QOD-P, TDI score, UPSIT score, and adverse effects. Cochrane RoB was the guideline used to evaluate the methodological quality of the included trials. RevMan 5.3 software was used for statistical analysis. Results A total of 6 RCTs involving 467 patients with PVOD were selected. Compared with OTDT, TCM plus OTDT decreased QOD-P (MD = -1.73, 95% CI (-2.40, -1.06), P < 0.0001) but did not increase the effective rate (T&T) (RR = 1.28, 95% CI (0.86, 1.90), P=0.22, I 2 = 61%). Compared with no treatment, TCM seemed to increase the treatment success rate (UPSIT) (RR = 3.17, 95% CI (1.78, 5.65), P < 0.0001, I 2 = 0%), but there was no statistically significant difference in improving the UPSIT score (MD = 3.44, 95% CI (-1.36, 8.24), P=0.16). Compared with drug therapy, TCM plus drug therapy appeared to increase the effective rate (ΔVAS) (RR = 2.36, 95% CI (1.41, 3.94), I 2 = 0%), but there was no statistically significant difference in improving the TDI score (MD = 2.10, 95% CI (-1.99, 6.19), P=0.31). No significant differences in adverse reactions were reported between TCM and OTDT. Conclusion TCM may be an effective treatment for PVOD. With a lack of high-quality RCTs, further large-scale and high-quality RCTs are still warranted.
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Tang C, He X, Fu W, Du Y, Huang Y, Liu L, Lan W, Luo R, Liu Y. Efficacy and safety of acupuncture in the treatment of the sequela of olfactory disorders after infection with COVID-19: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2022; 101:e30844. [PMID: 36181022 PMCID: PMC9524526 DOI: 10.1097/md.0000000000030844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND From the end of 2019 to now, coronavirus disease 2019 (COVID-19) has put enormous strain on the world's health systems. As a characteristic sign of COVID-19 patient, olfactory dysfunction (OD) poses considerable problems for patients. In China, acupuncture has been widely used to treat OD caused by COVID-19, but there is still a lack of evidence-based medical evaluation. This study was designed to evaluate the effectiveness and safety of acupuncture for the treatment of COVID-19 OD. METHODS According to the retrieval strategies, randomized controlled trials on the acupuncture for COVID-19 OD were obtained from Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database and the Wanfang Database, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using Review Manager (RevMan 5.3) and STATA 14.2 software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide up-to-date summary proof for evaluating the effectiveness and safety of acupuncture for COVID-19 OD.
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Affiliation(s)
- Chao Tang
- The fifth Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Xiaoqin He
- Clinical Medical College of Acupuncture and Rehabilitation, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Wenkang Fu
- The fifth Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Yaxin Du
- The first Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Yuxin Huang
- The fifth Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Lu Liu
- The first Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Wanning Lan
- The first Clinical Medical College of Guangzhou University of traditional Chinese Medicine, Guangzhou, China
| | - Runjun Luo
- Dongguan Hospital of Guangzhou University of Traditional Chinese Medicine, Dongguan, China
| | - Yue Liu
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
- *Correspondence: Yue Liu, Guangdong Second Traditional Chinese Medicine Hospital, 510000 (e-mail: )
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7
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Javed N, Ijaz Z, Khair AH, Dar AA, Lopez ED, Abbas R, Sheikh AB. COVID-19 loss of taste and smell: potential psychological repercussions. Pan Afr Med J 2022; 43:38. [PMID: 36505013 PMCID: PMC9716963 DOI: 10.11604/pamj.2022.43.38.31329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/03/2022] [Indexed: 12/15/2022] Open
Abstract
The novel coronavirus (COVID-19) has become a cause for global concern. Apart from a multitude of symptoms, the virus is known for its ability to cause loss of taste and smell that can be irreversible in a few cases. In fact, even after recovery, post-covid syndrome can still lead to devastating outcomes, specifically with reference to loss of smell and taste. A number of mechanisms that have been postulated include receptor-mediated uptake, increased inflammation, transneuronal migration, and direct damage to the olfactory pathway. Considering how important these two senses are, many psychological, social, and emotional repercussions can be expected. These repercussions include lowering of self-esteem and developmental of mental health issues. Long-term altered taste sensation can also lead to the development of unhealthy eating habits that can result in increasing risk for diabetes and hypertension. A few solutions have been investigated for treating these chemosensory dysfunctions, such as olfactory training, corticosteroids, theophylline and acupuncture. Although the results have been promising but a new modality, virtual reality, requires more in-depth exploration because it targets not only the dysfunction but also the mental health issues being experienced. It is important that affected individuals be provided with strong emotional and family support. Additionally, physicians can help the patients through support groups, cognitive behavioural therapy, olfactory, and virtual reality training.
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Affiliation(s)
- Nismat Javed
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Zainab Ijaz
- Department of Psychiatry, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ali Hamza Khair
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Aimen Asim Dar
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Erick Daniel Lopez
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, New Mexico, USA
| | - Ramsha Abbas
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Abu Baker Sheikh
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, New Mexico, USA,Corresponding author: Abu Baker Sheikh, University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, New Mexico, USA.
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2022; 9:CD013876. [PMID: 36062970 PMCID: PMC9443431 DOI: 10.1002/14651858.cd013876.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Olfactory dysfunction is a common consequence of COVID-19 infection and persistent symptoms can have a profound impact on quality of life. At present there is little guidance on how best to treat this condition. A variety of interventions have been suggested to promote recovery, including medication and olfactory training. However, it is uncertain whether any intervention is of benefit. This is an update of the 2021 review with one additional study added. OBJECTIVES: 1) To evaluate the benefits and harms of any intervention versus no treatment for people with persisting olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance that had persisted for at least four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included two studies with 30 participants. The studies evaluated the following interventions: systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant and palmitoylethanolamide plus luteolin. Systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant compared to no intervention We included a single RCT with 18 participants who had anosmia for at least 30 days following COVID-19 infection. Participants received a 15-day course of oral corticosteroids combined with nasal irrigation (consisting of an intranasal corticosteroid/mucolytic/decongestant solution) or no intervention. Psychophysical testing was used to assess olfactory function at 40 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. Palmitoylethanolamide plus luteolin compared to no intervention We included a single RCT with 12 participants who had anosmia or hyposmia for at least 90 days following COVID-19 infection. Participants received a 30-day course of palmitoylethanolamide and luteolin or no intervention. Psychophysical testing was used to assess olfactory function at 30 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2022; 9:CD013877. [PMID: 36063364 PMCID: PMC9443936 DOI: 10.1002/14651858.cd013877.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Loss of olfactory function is well recognised as a symptom of COVID-19 infection, and the pandemic has resulted in a large number of individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority the symptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recovery and prevent persisting olfactory disturbance. This is an update of the 2021 review with four studies added. OBJECTIVES 1) To evaluate the benefits and harms of any intervention versus no treatment for people with acute olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance, which had been present for less than four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia, change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included five studies with 691 participants. The studies evaluated the following interventions: intranasal corticosteroid sprays, intranasal corticosteroid drops, intranasal hypertonic saline and zinc sulphate. Intranasal corticosteroid spray compared to no intervention/placebo We included three studies with 288 participants who had olfactory dysfunction for less than four weeks following COVID-19. Presence of normal olfactory function The evidence is very uncertain about the effect of intranasal corticosteroid spray on both self-rated recovery of olfactory function and recovery of olfactory function using psychophysical tests at up to four weeks follow-up (self-rated: risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; psychophysical testing: RR 2.3, 95% CI 1.16 to 4.63; 1 study; 77 participants; very low-certainty evidence). Change in sense of smell The evidence is also very uncertain about the effect of intranasal corticosteroid spray on self-rated change in the sense of smell (at less than 4 weeks: mean difference (MD) 0.5 points lower, 95% CI 1.38 lower to 0.38 higher; 1 study; 77 participants; at > 4 weeks to 3 months: MD 2.4 points higher, 95% CI 1.32 higher to 3.48 higher; 1 study; 100 participants; very low-certainty evidence, rated on a scale of 1 to 10, higher scores mean better olfactory function). Intranasal corticosteroids may make little or no difference to the change in sense of smell when assessed with psychophysical testing (MD 0.2 points, 95% CI 2.06 points lower to 2.06 points higher; 1 study; 77 participants; low-certainty evidence, 0- to 24-point scale, higher scores mean better olfactory function). Serious adverse effects The authors of one study reported no adverse effects, but their intention to collect these data was not pre-specified so we are uncertain if these were systematically sought and identified. The remaining two studies did not report on adverse effects. Intranasal corticosteroid drops compared to no intervention/placebo We included one study with 248 participants who had olfactory dysfunction for ≤ 15 days following COVID-19. Presence of normal olfactory function Intranasal corticosteroid drops may make little or no difference to self-rated recovery at > 4 weeks to 3 months (RR 1.00, 95% CI 0.89 to 1.11; 1 study; 248 participants; low-certainty evidence). No other outcomes were assessed by this study. Data on the use of hypertonic saline nasal irrigation and the use of zinc sulphate to prevent persistent olfactory dysfunction are included in the full text of the review. AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Morita A, Murakami A, Uchihara T, Ohashi N, Ryu K, Watanabe Y, Ochi S, Okudaira K, Hirasaki Y, Namiki T. Case Report: Acupuncture is an effective treatment for olfactory dysfunction in the post COVID-19 condition. Front Neurol 2022; 13:916944. [PMID: 36081871 PMCID: PMC9445155 DOI: 10.3389/fneur.2022.916944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
Olfactory dysfunction in the post COVID-19 condition reported worldwide are refractory for some patients. For this reason, appropriate treatment is desired. In this article, we describe two cases of olfactory dysfunction in the post COVID-19 condition that was improved by traditional acupuncture treatment. By using the Yingxiang point (LI20), which is said to improve the sense of smell since ancient times, acupuncture treatment was performed 1-2 times a week in two patients about 6 and 7 months after the diagnosis of COVID-19. Acupuncture needles with a body length of 30 mm and a body diameter of 0.16 mm were inserted about 10 mm deep into the skin. We stimulated LI20 of the right and left sides until the patients felt the de qi sensation (acupuncture resonance), and left needles in the points for about 15 min. Immediately after the acupuncture treatment, the symptoms of olfactory dysfunction were alleviated, and the improvement in olfactory dysfunction lasted for 2-4 days. As the number of acupuncture treatments increased, the time until the flareup of olfactory dysfunction was prolonged, and the symptoms tended to decrease. In our experience, the acupuncture treatment was effective in a short period for treating residual olfactory dysfunction of the post COVID-19 condition, suggesting that acupuncture may serve as an adjunct to modern medical treatment, and it may also be a new option for patients who are resistant to Western medical treatment or unable to continue treatment because of side effects. In conclusion, acupuncture may be a new option for patients who are resistant to modern medical treatment or who are unable to continue treatment because of side effects.
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Affiliation(s)
- Akira Morita
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Aya Murakami
- Center for Pharmaceutical Education, Faculty of Pharmacy, Yokohama University of Pharmacy, Yokohama, Japan
| | - Takushu Uchihara
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Noriyuki Ohashi
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Ryu
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Watanabe
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadayuki Ochi
- Center for Pharmaceutical Education, Faculty of Pharmacy, Yokohama University of Pharmacy, Yokohama, Japan
| | - Kazuho Okudaira
- Center for Pharmaceutical Education, Faculty of Pharmacy, Yokohama University of Pharmacy, Yokohama, Japan
| | - Yoshiro Hirasaki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takao Namiki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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11
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Nag AK, Saltagi AK, Saltagi MZ, Wu AW, Higgins TS, Knisely A, Ting JY, Illing EA. Management of Post-Infectious Anosmia and Hyposmia: A Systematic Review. Ann Otol Rhinol Laryngol 2022:34894221118186. [PMID: 35959948 DOI: 10.1177/00034894221118186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anosmia and hyposmia significantly affect patients' quality of life and have many etiologies, including trauma, inflammatory conditions including chronic rhinosinusitis, neoplasm, and viral infections, such as rhinovirus and SARS-CoV-2. OBJECTIVE Our purpose was to establish whether a consensus exists regarding optimal management of olfactory dysfunction and to provide insight into the treatment of anosmia in the current climate of increased prevalence secondary to COVID-19. Thus, we aimed to systematically review the literature on the management of non-Chronic-rhinosinusitis- related anosmia/hyposmia. METHODS PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating management of anosmia and hyposmia written in the English language, with original data, a minimum of 3 months of follow-up except for COVID-related studies, at least 2 patients, and well-defined and measurable outcomes. RESULTS A total of 3013 unique titles were returned upon the initial search. Of these, 297 abstracts were examined, yielding 19 full texts meeting inclusion criteria (8 with level 1 evidence, 3 with level 2, 1 with level 3, and 7 with level 4). The studies included a total of 1522 subjects, with follow up ranging from 3 to 72 months, with an exception for COVID related studies. Endpoints were based on clinically significant improvements of olfactory functions as measured through validated smell tests. Treatments with the most robust data were intranasal corticosteroids and olfactory training. CONCLUSION The literature on the treatment of anosmia and hyposmia includes randomized trials showing the efficacy of a few modalities. While further research is needed to expand therapeutic options for this debilitating condition, the current literature supports the use of olfactory training and topical corticosteroids.
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Affiliation(s)
- Amit K Nag
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abdul K Saltagi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohamad Z Saltagi
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Arthur W Wu
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY, USA.,Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, WA, USA
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
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12
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Bhat AK, Krishna Kumar V, Johnson JD. "An integrative approach with Ayurveda and Traditional Chinese Acupuncture in post covid parosmia - A case study". J Ayurveda Integr Med 2022; 14:100560. [PMID: 35851219 PMCID: PMC9287594 DOI: 10.1016/j.jaim.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/10/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
This case is about a post viral olfactory dysfunction due to SARS-CoV-2 infection, since six months treated effectively by a unique integrative approach with Ayurveda and Traditional Chinese Acupuncture (TCA). It started as a sudden onset of anosmia in the month of August 2020 with fever history two weeks prior. After three months Parosmia commenced which gradually worsened. A month later she experienced dysgeusia and nausea leading to tremendous stress and sleep disturbances. Ayurveda treatment included Shadbindu taila marsha nasya for seven days followed by Shadbindu taila pratimarsha nasya (intra nasal oil instillation) for a period of four months. Naradiya laxmivilasa rasa orally for one month. GV.20, LI.20, Ex.1, H.7, LI.11, GB.8, GB.21 and GV.25 Points were selected for TCA. The Indian Smell identification test score on day one of treatment was zero, day seven was four, at the end of one month was eight and after four months it was ten. Parosmia was assessed by VAS which was ten on day one and zero on day seven. We could achieve complete normalcy in olfactory function within four months of this treatment. This integrative approach was found to be safe and effective in treating Post covid parosmia.
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Affiliation(s)
- Akshatha K. Bhat
- Department of Shalakya Tantra, Yenepoya Ayurveda Medical College and Hospital, Naringana, Mangalore, Karnataka, 575018, India,Corresponding author
| | - Venugopalan Krishna Kumar
- Research Officer (Ayurveda), National Ayurveda Research Institute for Panchakarma, CCRAS, Cheruthuruthy, Thrissur, 679531, India
| | - Jim Daniel Johnson
- President, Indian Association of Acupuncturists. T.D. Johnson Memorial, Acupuncture Clinic, Mourishka Tower Bendoor, Kadri, Mangalore, Karnataka, 575002, India
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13
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Helman SN, Adler J, Jafari A, Bennett S, Vuncannon JR, Cozart AC, Wise SK, Kuruvilla ME, Levy JM. Treatment strategies for postviral olfactory dysfunction: A systematic review. Allergy Asthma Proc 2022; 43:96-105. [PMID: 35317886 DOI: 10.2500/aap.2022.43.210107] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has been associated with a dramatic increase in postviral olfactory dysfunction (PVOD) among patients who are infected. A contemporary evidence-based review of current treatment options for PVOD is both timely and relevant to improve patient care. Objective: This review seeks to impact patient care by qualitatively reviewing available evidence in support of medical and procedural treatment options for PVOD. Systematic evaluation of data quality and of the level of evidence was completed to generate current treatment recommendations. Methods: A systematic review was conducted to identify primary studies that evaluated treatment outcomes for PVOD. A number of medical literature data bases were queried from January 1998 to May 2020, with completion of subsequent reference searches of retrieved articles to identify all relevant studies. Validated tools for the assessment of bias among both interventional and observational studies were used to complete quality assessment. The summary level of evidence and associated outcomes were used to generate treatment recommendations. Results: Twenty-two publications were identified for qualitative review. Outcomes of alpha-lipoic acid, intranasal and systemic corticosteroids, minocycline, zinc sulfate, vitamin A, sodium citrate, caroverine, intranasal insulin, theophylline, and Gingko biloba are reported. In addition, outcomes of traditional Chinese acupuncture and olfactory training are reviewed. Conclusion: Several medical and procedural treatments may expedite the return of olfactory function after PVOD. Current evidence supports olfactory training as a first-line intervention. Additional study is required to define specific treatment recommendations and expected outcomes for PVOD in the setting of COVID-19.
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Affiliation(s)
- Samuel N. Helman
- From the Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | - Jonah Adler
- School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aria Jafari
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Sasha Bennett
- School of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jackson R. Vuncannon
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ashley C. Cozart
- College of Medicine, University of Central Florida College of Medicine, Orlando, Florida; and
| | - Sarah K. Wise
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Merin E. Kuruvilla
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Georgia
| | - Joshua M. Levy
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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14
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Taziki Balajelini MH, Vakili MA, Rajabi A, Mohammadi M, Tabarraei A, Hosseini SM. Recovery of olfactory and gustatory dysfunctions in coronavirus disease 2019 patients: a prospective cohort study. J Laryngol Otol 2022; 136:1-8. [PMID: 35220983 PMCID: PMC8886089 DOI: 10.1017/s0022215121003935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to determine the association of some demographic and clinical factors with recovery from olfactory and gustatory dysfunction in coronavirus disease 2019 patients in Iran. METHODS This prospective cohort study was performed on 242 coronavirus disease 2019 patients with olfactory and gustatory dysfunction. The time from onset to recovery for olfactory and gustatory dysfunction was estimated by the Kaplan-Meier estimator. RESULTS After six months, 239 patients (98.8 per cent) had completely recovered from olfactory dysfunction. Olfactory and gustatory dysfunction symptoms resolved in 80.99 per cent and 83.56 per cent of the patients, respectively, within the first 30 days of symptom onset. Mean recovery time for olfactory dysfunction (35.07 ± 4.25 days) was significantly longer in those infected during the first epidemic wave compared with those infected during the second wave (21.65 ± 2.05 days) (p = 0.004). A similar pattern in recovery time was observed for cases of gustatory dysfunction (p = 0.005). CONCLUSION The recovery rate for coronavirus disease 2019 related olfactory and gustatory dysfunction is high within the first month of symptom onset.
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Affiliation(s)
- M H Taziki Balajelini
- Department of Otorhinolaryngology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - M A Vakili
- Department of Family and Community Medicine, School of Medicine, Golestan, University of Medical Sciences, Gorgan, Iran
| | - A Rajabi
- Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - M Mohammadi
- Golestan Research Centre of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - A Tabarraei
- Department of Microbiology, School of Medicine, Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - S M Hosseini
- Department of Physiology, School of Medicine, Neuroscience Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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15
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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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16
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Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013877. [PMID: 34291812 PMCID: PMC8406518 DOI: 10.1002/14651858.cd013877.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loss of olfactory function is well recognised as a cardinal symptom of COVID-19 infection, and the ongoing pandemic has resulted in a large number of affected individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority the symptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recovery and prevent persisting olfactory disturbance. OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to prevent persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Individuals who had symptoms for less than four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Our primary outcomes were the presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia, change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study of 100 participants, which compared an intranasal steroid spray to no intervention. Participants in both groups were also advised to undertake olfactory training for the duration of the trial. Data were identified for only two of the prespecified outcomes for this review, and no data were available for the primary outcome of serious adverse effects. Intranasal corticosteroids compared to no intervention (all using olfactory training) Presence of normal olfactory function after three weeks of treatment was self-assessed by the participants, using a visual analogue scale (range 0 to 10, higher scores = better). A score of 10 represented "completely normal smell sensation". The evidence is very uncertain about the effect of intranasal corticosteroids on self-rated recovery of sense of smell (estimated absolute effect 619 per 1000 compared to 520 per 1000, risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; very low-certainty evidence). Change in sense of smell was not reported, but the self-rated score for sense of smell was reported at the endpoint of the study with the same visual analogue scale (after three weeks of treatment). The median scores at endpoint were 10 (interquartile range (IQR) 9 to 10) for the group receiving intranasal corticosteroids, and 10 (IQR 5 to 10) for the group receiving no intervention (1 study; 100 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence regarding the efficacy of different interventions at preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a small number of additional ongoing studies in this area. As this is a living systematic review, the evidence will be updated regularly to incorporate new data from these, and other relevant studies, as they become available. For this (first) version of the living review, we identified a single study of intranasal corticosteroids to include in this review, which provided data for only two of our prespecified outcomes. The evidence was of very low certainty, therefore we were unable to determine whether intranasal corticosteroids may have a beneficial or harmful effect.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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17
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013876. [PMID: 34291813 PMCID: PMC8406942 DOI: 10.1002/14651858.cd013876.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Olfactory dysfunction is an early and sensitive marker of COVID-19 infection. Although self-limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post-COVID-19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post-viral anosmia (such as medication or olfactory training). OBJECTIVES To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included one study with 18 participants, which compared the use of a 15-day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low-certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low-certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post-COVID-19 olfactory dysfunction is very uncertain.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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18
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Hunter JE, Phillips ME, Walker FDL, Busby D. Post-viral olfactory dysfunction treated with acupuncture. Acupunct Med 2021; 39:738-739. [PMID: 34284636 DOI: 10.1177/09645284211026315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Hajare PS, Harugop AS, Goswami L, Padmavathy O, Aggarwal U, Reddy YL. Prevalence of Olfactory and Gustatory Dysfunction in Coronavirus Disease (COVID-19): A Cross Sectional Study in Our Tertiary Care Hospital. Indian J Otolaryngol Head Neck Surg 2021; 74:3012-3015. [PMID: 34249666 PMCID: PMC8258488 DOI: 10.1007/s12070-021-02702-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/20/2021] [Indexed: 12/14/2022] Open
Abstract
COVID-19 pandemic is affecting millions of people all across the globe. Along with other clinical features, anosmia and dysgeusia are important symptoms being seen. This study evaluates the prevalence of olfactory and gustatory dysfunction in patients with SARS CoV-2 infection in a tertiary care centre and the severity and duration of altered taste and smell sensation in COVID positive patients. A total number of 167 patients that had tested positive for COVID 19 KLES Dr. Prabhakar Kore hospital in the study period of 3 months were assessed for presence and severity of olfactory and gustatory sensations. The prevalence of alteration of sense in COVID 19 patients in our tertiary care centre was found to be 62.87% and alteration of taste was 58.68%. This study shows that smell and taste loss has a high prevalence in patients of COVID 19 and health care workers should keep high degree of suspicion for COVID 19 when patients present with these symptoms. The early identification may help to reduce the risk of spread.
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Affiliation(s)
- Priti S. Hajare
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
| | - Anil S. Harugop
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
| | - Lakshmi Goswami
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
| | - O. Padmavathy
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
| | - Umang Aggarwal
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
| | - Yannamreddy Lavanya Reddy
- Department of ENT, Head and Neck Surgery, J.N. Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka India
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20
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Drews T, Hummel T, Rochlitzer B, Hauswald B, Hähner A. Acupuncture is associated with a positive effect on odour discrimination in patients with postinfectious smell loss-a controlled prospective study. Eur Arch Otorhinolaryngol 2021; 279:1329-1334. [PMID: 34032906 PMCID: PMC8897321 DOI: 10.1007/s00405-021-06872-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023]
Abstract
Introduction Smell disorders are common in the general population and occur e.g., after infections, trauma or idiopathically Treatment strategies for smell loss range from surgery, medication to olfactory training, depending on the pathology, but they are limited This study examined the effect of acupuncture on olfactory function. Methods Sixty patients with smell loss following infections of the upper respiratory tract were included in this investigation Half of the study group were randomly assigned to verum acupuncture and the other half to sham acupuncture Olfaction was measured by means of the “Sniffin’ Sticks” test battery (odour threshold, discrimination and identification). Results Compared to sham acupuncture, verum was associated with an improvement of smell function as measured by the TDI score (p = 0.039) The improvement was largely determined by improvement in odour discrimination, and was significantly better in patients with a shorter duration of the disorder. Conclusion The present results suggest that acupuncture is an effective supplementary treatment option for patients with olfactory loss.
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Affiliation(s)
- Tanja Drews
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Technical University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany. .,Department of Otorhinolaryngology, Bundeswehrkrankenhaus Berlin, Scharnhorststr 13, 10115, Berlin, Germany.
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Technical University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Bettina Rochlitzer
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Technical University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany.,Klinik Für Augenheilkunde, Städtisches Klinikum Görlitz, Girbigsdorfer Str 1-3, Görlitz, Germany
| | - Bettina Hauswald
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Technical University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Antje Hähner
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Technical University of Dresden Medical School, Fetscherstrasse 74, 01307, Dresden, Germany
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21
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Dörig P, Gunder N, Witt M, Welge-Lüssen A, Hummel T. [Future therapeutic strategies for olfactory disorders: electrical stimulation, stem cell therapy, and transplantation of olfactory epithelium-an overview]. HNO 2021; 69:623-632. [PMID: 33988723 PMCID: PMC8120256 DOI: 10.1007/s00106-021-01060-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/08/2022]
Abstract
Passagere oder permanente Riechstörungen können verschiedene Ursachen haben. Ganz aktuell berichtet eine Vielzahl von Patienten im Rahmen von COVID-19-Infektionen über ein fehlendes oder vermindertes Riechvermögen. In der Vergangenheit wurden vielfältige Therapieoptionen untersucht, diese variieren vom Riechtraining über Akupunktur und medikamentöse Therapien bis hin zur transkraniellen Magnetstimulation oder, z. B. bei ausgeprägten qualitativen Riechstörungen, der chirurgischen Resektion der Riechschleimhaut. Die Entwicklung einer bioelektrischen Nase, z. B. in Verbindung mit direkter elektrischer Stimulation des Bulbus olfactorius, oder die Transplantation von Riechschleimhaut oder von Stammzellen stellen Behandlungsmöglichkeiten der Zukunft dar. Die Grundlagen für diese Entwicklungen sowie der Stand des Wissens werden in der vorliegenden Arbeit erläutert.
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Affiliation(s)
- P Dörig
- Universitäts-HNO Klinik Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - N Gunder
- Universitäts-HNO Klinik Dresden, Dresden, Deutschland
| | - M Witt
- Institut für Anatomie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A Welge-Lüssen
- Universitäts-HNO Klinik Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - T Hummel
- Universitäts-HNO Klinik Dresden, Dresden, Deutschland
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22
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Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Hippokratia 2021. [DOI: 10.1002/14651858.cd013877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Katie E Webster
- Cochrane ENT; Nuffield Department of Surgical Sciences, University of Oxford; Oxford UK
| | | | - Carl Philpott
- Department of Medicine; Norwich Medical School, University of East Anglia; Norwich UK
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23
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Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021. [DOI: 10.1002/14651858.cd013876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Katie E Webster
- Cochrane ENT; Nuffield Department of Surgical Sciences, University of Oxford; Oxford UK
| | | | - Carl Philpott
- Department of Medicine; Norwich Medical School, University of East Anglia; Norwich UK
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24
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Addison AB, Wong B, Ahmed T, Macchi A, Konstantinidis I, Huart C, Frasnelli J, Fjaeldstad AW, Ramakrishnan VR, Rombaux P, Whitcroft KL, Holbrook EH, Poletti SC, Hsieh JW, Landis BN, Boardman J, Welge-Lüssen A, Maru D, Hummel T, Philpott CM. Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction. J Allergy Clin Immunol 2021; 147:1704-1719. [PMID: 33453291 DOI: 10.1016/j.jaci.2020.12.641] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Respiratory tract viruses are the second most common cause of olfactory dysfunction. As we learn more about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the recognition that olfactory dysfunction is a key symptom of this disease process, there is a greater need than ever for evidence-based management of postinfectious olfactory dysfunction (PIOD). OBJECTIVE Our aim was to provide an evidence-based practical guide to the management of PIOD (including post-coronavirus 2019 cases) for both primary care practitioners and hospital specialists. METHODS A systematic review of the treatment options available for the management of PIOD was performed. The written systematic review was then circulated among the members of the Clinical Olfactory Working Group for their perusal before roundtable expert discussion of the treatment options. The group also undertook a survey to determine their current clinical practice with regard to treatment of PIOD. RESULTS The search resulted in 467 citations, of which 107 articles were fully reviewed and analyzed for eligibility; 40 citations fulfilled the inclusion criteria, 11 of which were randomized controlled trials. In total, 15 of the articles specifically looked at PIOD whereas the other 25 included other etiologies for olfactory dysfunction. CONCLUSIONS The Clinical Olfactory Working Group members made an overwhelming recommendation for olfactory training; none recommended monocycline antibiotics. The diagnostic role of oral steroids was discussed; some group members were in favor of vitamin A drops. Further research is needed to confirm the place of other therapeutic options.
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Affiliation(s)
- Alfred B Addison
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Billy Wong
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Tanzime Ahmed
- East Sussex North Essex Foundation Trust, Ipswich, United Kingdom
| | - Alberto Macchi
- ENT University of Insubria, Italian Academy of Rhinology, Varese, Italy
| | - Iordanis Konstantinidis
- Smell and Taste Clinic, 2nd ORL University Department, Aristotle University, Thessaloniki, Greece
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Research Center, Sacré-Coeur Hospital Montréal, Montréal, Québec, Canada
| | - Alexander W Fjaeldstad
- Flavour Clinic, ENT Department, Regional Hospital West Jutland, Holstebro, Denmark; Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, Colo; Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Philippe Rombaux
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Katherine L Whitcroft
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, London, United Kingdom; South Yorkshire Deanery, Yorkshire and Humber School of Surgery, Yorkshire, United Kingdom
| | - Eric H Holbrook
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Sophia C Poletti
- Department of Otorhinolaryngology - Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julien W Hsieh
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospitals of Geneva, Geneva, Switzerland
| | - Basile N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Devina Maru
- Royal College of General Practitioners, London, United Kingdom
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Carl M Philpott
- Fifth Sense, Barrow-in-Furness, United Kingdom; Norfolk Smell and Taste Clinic, James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
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25
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Brookes NRG, Fairley JW, Brookes GB. Acute Olfactory Dysfunction-A Primary Presentation of COVID-19 Infection. EAR, NOSE & THROAT JOURNAL 2020; 99:94-98. [PMID: 32757995 PMCID: PMC7412078 DOI: 10.1177/0145561320940119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
COVID-19 is a zoonotic illness caused by a new strain of coronavirus and has recently been declared a pandemic by the World Health Organization, with an estimated fatality rate of 1% to 2%. Early identification and isolation of patients in the preliminary infective stage has been a mainstay of most governmental strategies in order to limit transmission. Four otherwise healthy patients presented to a specialist open access Ear, Nose & Throat Clinic in central London with acute total or subtotal loss of their sense of smell in a single one-week period, coinciding with rapid escalation of COVID-19 infection in the indigenous population. The diagnosis was confirmed by the validated University of Pennsylvania Smell Identification Test (UPSIT) in 3. Endoscopic examination and magnetic resonance imaging (2 cases) excluded a range of alternative potential pathological conditions. Covid-19 antibody testing carried out 6 to 8 weeks after the onset of nasal symptoms showed positive immunoglobulin G antibodies in 3 of the 4 patients. Acute severe anosmia is therefore almost certainly an unusual presenting local nasal feature of a COVID-19 viral infection. All 4 patients achieved significant partial olfactory recovery by one week after treatment with subjective ratings of 40% to 85% of normal (mean 60%) and complete olfaction recovery after 2 to 3 weeks in all 4 patients. The significance, possible pathogenesis, and public health implications are highlighted and discussed.
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26
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Jalessi M, Barati M, Rohani M, Amini E, Ourang A, Azad Z, Hosseinzadeh F, Cavallieri F, Ghadirpour R, Valzania F, Iaccarino C, Ahmadzadeh A, Farhadi M. Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19. Neurol Sci 2020; 41:2331-2338. [PMID: 32656713 PMCID: PMC7354355 DOI: 10.1007/s10072-020-04590-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Olfactory dysfunction has shown to accompany COVID-19. There are varying data regarding the exact frequency in the various study population. The outcome of the olfactory impairment is also not clearly defined. OBJECTIVE To find the frequency of olfactory impairment and its outcome in hospitalized patients with positive swab test for COVID-19. METHODS This is a prospective descriptive study of 100 hospitalized COVID-19 patients, randomly sampled, from February to March 2020. Demographics, comorbidities, and laboratory findings were analyzed according to the olfactory loss or sinonasal symptoms. The olfactory impairment and sinonasal symptoms were evaluated by 9 Likert scale questions asked from the patients. RESULTS Ninety-two patients completed the follow-up (means 20.1 (± 7.42) days). Twenty-two (23.91%) patients complained of olfactory loss and in 6 (6.52%) patients olfactory loss was the first symptom of the disease. The olfactory loss was reported to be completely resolved in all but one patient. Thirty-nine (42.39%) patients had notable sinonasal symptoms while rhinorrhea was the first symptom in 3 (3.26%). Fifteen patients (16.3%) had a taste impairment. Patients with sinonasal symptoms had a lower age (p = 0.01). There was no significant relation between olfactory loss and sinonasal symptoms (p = 0.07). CONCLUSIONS Sudden olfactory dysfunction and sinonasal symptoms have a considerable prevalence in patients with COVID-19. No significant association was noted between the sinonasal symptoms and the olfactory loss, which may suggest that other mechanisms beyond upper respiratory tract involvement are responsible for the olfactory loss.
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Affiliation(s)
- Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mitra Barati
- Department of Infectious Diseases, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Skull Base Research Center, The Five Senses Institute, Department of Neurology, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elahe Amini
- Skull Base Research Center, The Five Senses Institute, Department of Neurology, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- ENT and Head & Neck Research center and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Anis Ourang
- Department of Infectious Diseases, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Azad
- Skull Base Research Center, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Hosseinzadeh
- Skull Base Research Center, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Reza Ghadirpour
- Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Iaccarino
- Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Arman Ahmadzadeh
- Rheumatology Unit, Loghman Hakim Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research center and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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27
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Hura N, Xie DX, Choby GW, Schlosser RJ, Orlov CP, Seal SM, Rowan NR. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2020; 10:1065-1086. [PMID: 32567798 PMCID: PMC7361320 DOI: 10.1002/alr.22624] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022]
Abstract
Background Post‐viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence‐based recommendations for their use. Methods A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence‐based review with recommendations. Results From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin’ Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non‐steroidal oral medications, and acupuncture. Conclusion Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short‐term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high‐quality studies limits the ability to make meaningful evidence‐based recommendations for the use of these therapies for the treatment of PVOD.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deborah X Xie
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Cinthia P Orlov
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stella M Seal
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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28
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Kahn CI, Huestis MJ, Cohen MB, Levi JR. Evaluation of Acupuncture's Efficacy Within Otolaryngology. Ann Otol Rhinol Laryngol 2020; 129:727-736. [PMID: 32090591 DOI: 10.1177/0003489420908289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology. METHODS A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review. RESULTS Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies. CONCLUSION Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions.
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Affiliation(s)
- Chase I Kahn
- Boston University School of Medicine, Boston, MA, USA
| | | | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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29
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Altundag A, Temirbekov D, Haci C, Yildirim D, Cayonu M. Olfactory Cleft Width and Volume: Possible Risk Factors for Postinfectious Olfactory Dysfunction. Laryngoscope 2020; 131:5-9. [PMID: 32027030 DOI: 10.1002/lary.28524] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/01/2020] [Accepted: 01/05/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Upper respiratory tract infections are a common cause of temporary and permanent olfactory dysfunction in the general population. Postviral or postinfectious olfactory loss (PIOL) develops only in rare cases. The aim of this study was to investigate the anatomical features of olfactory cleft (OC) in patients with PIOL to shed light on possible predisposing factors for PIOL. STUDY DESIGN Retrospective study. METHODS We retrospectively evaluated paranasal sinus computed tomography (CT) scan results of patients diagnosed with PIOL. A control group consisted of normosmic individuals who underwent paranasal sinus CT scans before septoplasty surgery. We compared the olfactory fossa depth, OC width, and volume on the CT scans of the PIOL and control groups. RESULTS In total, 71 individuals fulfilled the study criteria (PIOL group, n = 32; control group, n = 39). There was no statistically significant difference in the olfactory fossa depth in the two groups. The OC width and volume in the PIOL group was found to be significantly increased than that in the control group (P < .001 for both). CONCLUSIONS Patients with PIOL had increased OC width and volume than the healthy controls. An extra-wide olfactory cleft may be a predisposing factor in the pathogenesis of PIOL. LEVEL OF EVIDENCE 4 Laryngoscope, 131:5-9, 2021.
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Affiliation(s)
- Aytug Altundag
- Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey.,Department of Otorhinolaryngology, Biruni University Medicine Faculty, Istanbul, Turkey
| | - Dastan Temirbekov
- Department of Otorhinolaryngology, Istanbul Aydın University, Medical Park Florya Hospital, Istanbul, Turkey
| | - Cemal Haci
- Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Duzgun Yildirim
- Department of Medical Imaging, Acibadem University, Vocational School of Health Sciences, Istanbul, Turkey
| | - Melih Cayonu
- Department of Otorhinolaryngology and Head & Neck Surgery, Ankara City Hospital, Bilkent, Turkey
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30
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Liebell D. Waking Up and Literally Smelling the Coffee: Inducing Olfactory Function with 3-Phase Auricular Therapy. Med Acupunct 2019; 31:45-48. [PMID: 30805079 DOI: 10.1089/acu.2018.1326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Loss of the sense of smell, from both known and unknown causes, can be refractory to medical intervention. Cases unrelated to head trauma or infection might be ignored or assumed to be untreatable. Case: A 20-year-old male had lifelong anosmia. This patient received a single session of 3-phase auricular therapy (3PAT), including electrical stimulation and insertion of 3-mm, semipermanent ear acupuncture needles, covered by surgical tape and adhesive. Results: Approximately 1 month following insertion of the acupuncture needles, the patient acquired a sense of smell, which had always been absent. He acquired and maintained his sustained sense of smell naturally in response to the 3PAT. Conclusions: For cases of loss of sense of smell, particularly those of unknown etiology, 3PAT and its required evaluation techniques should be considered.
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31
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Jiang RS, Twu CW, Liang KL. The Effect of Olfactory Training on the Odor Threshold in Patients with Traumatic Anosmia. Am J Rhinol Allergy 2017; 31:317-322. [DOI: 10.2500/ajra.2017.31.4466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Olfactory training is a novel intervention that has been used to treat olfactory dysfunction. This study attempted to investigate the effect of olfactory training in patients with traumatic anosmia. Methods Patients with a clear history of anosmia after experiencing a head injury and whose phenyl ethyl alcohol (PEA) odor detection thresholds were — 1 after steroid and zinc treatment were included. The patients were randomly divided into two groups, with patients in one group given a bottle of PEA and those in another group given a bottle of mineral oil for 3-month olfactory training. All the patients were followed up with a PEA threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC). Magnetic resonance imaging was performed to measure the volume of the olfactory bulbs. Any patient whose PEA threshold result was below —1.01 or whose UPSIT-TC score increased four or more points was considered to have shown improvement in their olfactory function. Results Forty-two patients received PEA olfactory training, whereas 39 received olfactory training with mineral oil. The improvement of PEA thresholds function was observed in 10 patients within the PEA group and in 2 patients in the mineral oil group. The frequency of improvement of threshold within the PEA group was significantly higher than that of the mineral oil group. Neither olfactory bulb volume nor UPSIT-TC score was significantly different between the two groups. Conclusion Our results showed that olfactory training with PEA can improve PEA odor threshold levels in patients with traumatic anosmia.
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Affiliation(s)
- Rong-San Jiang
- -Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Otolaryngology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Chih-Wen Twu
- -Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Otolaryngology, School of Medicine, Yang-Ming Medical Medical University, Taipei, Taiwan
| | - Kai-Li Liang
- -Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Otolaryngology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Otolaryngology, School of Medicine, Yang-Ming Medical Medical University, Taipei, Taiwan
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32
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Cavazzana A, Larsson M, Münch M, Hähner A, Hummel T. Postinfectious olfactory loss: A retrospective study on 791 patients. Laryngoscope 2017; 128:10-15. [DOI: 10.1002/lary.26606] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/17/2017] [Accepted: 03/09/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Annachiara Cavazzana
- Smell and Taste Clinic; Technical University of Dresden; Dresden Germany
- Gösta Ekman Laboratory; Department of Psychology, Stockholm University; Stockholm Sweden
| | - Maria Larsson
- Gösta Ekman Laboratory; Department of Psychology, Stockholm University; Stockholm Sweden
| | - Marcus Münch
- Smell and Taste Clinic; Technical University of Dresden; Dresden Germany
| | - Antje Hähner
- Smell and Taste Clinic; Technical University of Dresden; Dresden Germany
| | - Thomas Hummel
- Smell and Taste Clinic; Technical University of Dresden; Dresden Germany
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