1
|
Agarwal K, Luk JW, Stangl BL, Schwandt ML, Momenan R, Goldman D, Diazgranados N, Kareken DA, Leggio L, Ramchandani VA, Joseph PV. Parosmia Is Positively Associated With Problematic Drinking, as Is Phantosmia With Depressive Symptoms. J Addict Med 2024:01271255-990000000-00315. [PMID: 38776446 DOI: 10.1097/adm.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Alcohol use disorder (AUD) is a global health problem with significant negative consequences, including preventable deaths. Although olfactory dysfunction is associated with chronic alcohol drinking, the relationship among specific types of olfactory deficits, depressive symptoms, and problematic drinking remains to be explored. Here, we examined the prevalence of olfactory distortion (parosmia) and hallucination (phantosmia) and assessed their associations with problematic drinking and depressive symptoms. METHODS In April-June 2022, 250 participants across the spectrum of AUD were recruited for assessment in the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol study. Surveys covered self-reported olfactory function, depressive symptoms, and problematic drinking, with key measures assessed, including the Alcohol Use Disorders Identification Test and the Patient Health Questionnaire. Predictors in the analysis included parosmia and phantosmia, with covariates comprising age, sex, socioeconomic status, race, ethnicity, COVID-19 infection status, and smoking status. RESULTS Among 250 individuals, 5.2% experienced parosmia and 4.4% reported phantosmia. Parosmia was associated with higher Alcohol Use Disorders Identification Test scores (β = 7.14; 95% confidence interval = 3.31, 10.96; P < 0.001), whereas phantosmia was linked to higher Patient Health Questionnaire scores (β = 3.32; 95% confidence interval = 0.22, 6.42; P = 0.03). These associations persisted in both the full sample and the subset of participants without COVID-19. CONCLUSIONS Our study highlights strong existing links among olfactory deficits, problem drinking, and depressive symptoms, underscoring the need to assess smell impairments in clinical settings. Future research should explore these connections further to develop new treatments for individuals with AUD and depression.
Collapse
Affiliation(s)
- Khushbu Agarwal
- From the Section of Sensory Science and Metabolism, National Institute on Alcohol Abuse and Alcoholism, and National Institute of Nursing Research, National Institutes of Health, Bethesda, MD (KA, PVJ); Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (JWL, MLS, DG, ND); Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (BLS, VAR); Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD (DG); Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD (RM); Department of Neurology, Indiana University School of Medicine, Indianapolis, IN (DAK); and Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Biological Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health (LL)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Espetvedt A, Wiig S, Myrnes-Hansen KV, Brønnick KK. The assessment of qualitative olfactory dysfunction in COVID-19 patients: a systematic review of tools and their content validity. Front Psychol 2023; 14:1190994. [PMID: 37408960 PMCID: PMC10319418 DOI: 10.3389/fpsyg.2023.1190994] [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: 03/21/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023] Open
Abstract
Background There is a lack of overview of the tools used to assess qualitative olfactory dysfunction, including parosmia and phantosmia, following COVID-19 illness. This could have an impact on the diagnosis and treatment offered to patients. Additionally, the formulations of symptoms are inconsistent and often unclear, and consensus around the wording of questions and responses is needed. Aim of study The aim of this systematic review is to provide an overview of tools used to assess qualitative olfactory dysfunction after COVID-19, in addition to addressing the content validity (i.e., item and response formulations) of these tools. Methods MEDLINE, Web of Science, and EMBASE were searched 5th of August 2022 and updated on the 25th of April 2023 to identify studies that assess qualitative olfactory dysfunction in COVID-19 patients. Primary outcomes were the tool used (i.e., questionnaire or objective test) and item and response formulations. Secondary outcomes included psychometric properties, study design, and demographic variables. Results The assessment of qualitative olfactory dysfunction is characterized by heterogeneity, inconsistency, and lack of validated tools to determine the presence and degree of symptoms. Several tools with overlapping and distinct features were identified in this review, of which some were thorough and detailed, while others were merely assessing the presence of symptoms as a binary measure. Item and response formulations are also inconsistent and often used interchangeably, which may lead to confusion, incorrect diagnoses, and inappropriate methods for solving the problem. Conclusions There is an unmet need for a reliable and validated tool for assessing qualitative olfactory dysfunction, preferably one that also captures quantitative olfactory issues (i.e., loss of smell), to ensure time-effective and specific assessment of the ability to smell. A consensus around the formulation of items and response options is also important to increase the understanding of the problem, both for clinicians, researchers, and the patient, and ultimately to provide the appropriate diagnosis and treatment. Registration and protocol The URL is https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=351621. A preregistered protocol was submitted and accepted (12.09.22) in the International prospective register of systematic reviews (PROSPERO) with the registration number CRD42022351621.
Collapse
Affiliation(s)
- Annelin Espetvedt
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kai Victor Myrnes-Hansen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The Norwegian School of Hotel Management, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The Cognitive and Behavioral Neuroscience Lab, University of Stavanger, Stavanger, Norway
| |
Collapse
|
3
|
Andrea XP, Joceline LM, Jose OF, Jose PO. Human Nasal Epithelium Damage as the Probable Mechanism Involved in the Development of Post-COVID-19 Parosmia. Indian J Otolaryngol Head Neck Surg 2023; 75:458-464. [PMID: 36817017 PMCID: PMC9927037 DOI: 10.1007/s12070-023-03559-x] [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: 12/21/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose Since the beginning of the COVID-19 pandemic, understanding the physiopathological mechanisms of its manifestations has been crucial to understand the disease and its implications. As the disease evolved, post-infection complications have arisen such as olfactory dysfunctions including parosmia in which odourants are perceived in a distorted or an unpleasant way. Methods In this article, we attempt to clarify these mechanisms and the role of human nasal epithelium in the development of post-COVID-19 parosmia. Results The mechanisms by which SARS-CoV-2 generates olfactory dysfunction have not been elucidated, and multiple theories have been proposed pointing to the sustentacular cells of the olfactory epithelium as the main probable target of the virus. Conclusion Establishing the main physiopathological mechanism of post-COVID-19 parosmia will set a path for further investigations and determine treatment and preventive options for patients who have been reported to be extensively affected in multiple aspects of their lives such as eating habits and mental health.
Collapse
Affiliation(s)
- Xolalpa-Peniche Andrea
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Lucas-Mata Joceline
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Osante-Forastieri Jose
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| | - Pérez-Ochoa Jose
- grid.441070.60000 0001 2111 4953Facultad Mexicana de Medicina, Universidad La Salle, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, México
| |
Collapse
|
4
|
Finlay JB, Brann DH, Abi-Hachem R, Jang DW, Oliva AD, Ko T, Gupta R, Wellford SA, Moseman EA, Jang SS, Yan CH, Matusnami H, Tsukahara T, Datta SR, Goldstein BJ. Persistent post-COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium. Sci Transl Med 2022; 14:eadd0484. [PMID: 36542694 PMCID: PMC10317309 DOI: 10.1126/scitranslmed.add0484] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
SARS-CoV-2 causes profound changes in the sense of smell, including total smell loss. Although these alterations are often transient, many patients with COVID-19 exhibit olfactory dysfunction that lasts months to years. Although animal and human autopsy studies have suggested mechanisms driving acute anosmia, it remains unclear how SARS-CoV-2 causes persistent smell loss in a subset of patients. To address this question, we analyzed olfactory epithelial samples collected from 24 biopsies, including from nine patients with objectively quantified long-term smell loss after COVID-19. This biopsy-based approach revealed a diffuse infiltrate of T cells expressing interferon-γ and a shift in myeloid cell population composition, including enrichment of CD207+ dendritic cells and depletion of anti-inflammatory M2 macrophages. Despite the absence of detectable SARS-CoV-2 RNA or protein, gene expression in the barrier supporting cells of the olfactory epithelium, termed sustentacular cells, appeared to reflect a response to ongoing inflammatory signaling, which was accompanied by a reduction in the number of olfactory sensory neurons relative to olfactory epithelial sustentacular cells. These findings indicate that T cell-mediated inflammation persists in the olfactory epithelium long after SARS-CoV-2 has been eliminated from the tissue, suggesting a mechanism for long-term post-COVID-19 smell loss.
Collapse
Affiliation(s)
- John B. Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC 27710
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - David H. Brann
- Harvard Medical School Department of Neurobiology, Boston, MA 02115
| | - Ralph Abi-Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - David W. Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - Allison D. Oliva
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | - Tiffany Ko
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
| | - Rupali Gupta
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
| | | | - E. Ashley Moseman
- Department of Immunology, Duke University School of Medicine, Durham, NC 27710
| | - Sophie S. Jang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA 92037
| | - Carol H. Yan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA 92037
| | - Hiroaki Matusnami
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27710
- Duke Institute for Brain Sciences, Duke University School of Medicine, Durham, NC 27710
| | | | | | - Bradley J. Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710
- Department of Neurobiology, Duke University School of Medicine, Durham, NC 27710
| |
Collapse
|
5
|
Bérubé S, Demers C, Bussière N, Cloutier F, Pek V, Chen A, Bolduc-Bégin J, Frasnelli J. Olfactory Training Impacts Olfactory Dysfunction Induced by COVID-19: A Pilot Study. ORL J Otorhinolaryngol Relat Spec 2022; 85:57-66. [PMID: 36529118 PMCID: PMC9843729 DOI: 10.1159/000528188] [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: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Olfactory dysfunction is one of the main symptoms of COVID-19 and may last beyond resolution of the infection. The most promising intervention for post-viral olfactory dysfunction is olfactory training (OT), which involves exposing the olfactory system to a range of odors daily. This approach is thought of promoting the regeneration of olfactory receptor cells, but its effectiveness in patients with post-COVID-19 olfactory dysfunction has yet to be confirmed. METHODS This double-blind randomized pilot study compared the effectiveness of OT versus placebo in the treatment of post-COVID-19 olfactory dysfunction. Twenty-five participants were recruited in each group. OT protocol consisted of sniffing 4 scents (rose, orange, clove, and eucalyptus) for 5 min twice daily for 12 weeks. Olfactory function was assessed before and after the training using (1) a validated odor identification test (UPSIT-40) and (2) a 10-point visual analog scale; we further assessed the presence of (3) parosmia. RESULTS While we did not observe any effect of OT on olfactory test scores, we observed a significant improvement of subjective olfactory function in the intervention group, while no such effect was observed in the placebo group. Finally, the frequency of parosmia was significantly lower in the intervention group. CONCLUSIONS This study highlights an increase in subjective but not objective olfactory function when performing OT for 12 weeks. Further, parosmia seems to be positively affected by OT. These results may serve as a starting point for larger scale studies to assess the efficacy of OT for treatment of post-COVID-19 olfactory dysfunction.
Collapse
Affiliation(s)
- Simon Bérubé
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada,*Simon Bérubé,
| | - Claudia Demers
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada,Department of Psychiatry and Neurosciences, Université Laval, Québec, Québec, Canada
| | - Nicholas Bussière
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Frank Cloutier
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Valérie Pek
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Angela Chen
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Josiane Bolduc-Bégin
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada,Division of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada,Research Centre, Sacré-Coeur Hospital Montréal, CIUSSS-NIM, Montréal, Québec, Canada,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,**Johannes Frasnelli,
| |
Collapse
|
6
|
Garcia JAP, Miller E, Norwood TG, Dorin NA, Grayson J, Woodworth B, Cho D. Gabapentin improves parosmia after COVID-19 infection. Int Forum Allergy Rhinol 2022; 13:1034-1036. [PMID: 36484400 PMCID: PMC9877759 DOI: 10.1002/alr.23117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Jaime A. Pena Garcia
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Emily Miller
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Timothy G. Norwood
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Natalie A. Dorin
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jessica Grayson
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Bradford Woodworth
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Gregory Fleming James Cystic Fibrosis Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Do‐Yeon Cho
- Department of Otolaryngology Head & Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Gregory Fleming James Cystic Fibrosis Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA,Division of OtolaryngologyDepartment of SurgeryVeterans AffairsBirminghamAlabamaUSA
| |
Collapse
|
7
|
Koyama S, Mori E, Ueha R. Insight into the mechanisms of olfactory dysfunction by COVID-19. Auris Nasus Larynx 2022:S0385-8146(22)00230-9. [PMID: 36529610 PMCID: PMC9731926 DOI: 10.1016/j.anl.2022.12.002] [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: 09/25/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
One of the unique symptoms of COVID-19 is chemosensory dysfunction. Almost three years since the beginning of the pandemic of COVID-19, there have been many studies on the symptoms, progress, and possible causes, and also studies on methods that may facilitate recovery of the senses. Studies have shown that some people recover their senses even within a couple of weeks whereas there are other patients that fail to recover chemosensory functions fully for several months and some never fully recover. Here we summarize the symptoms and the progress, and then review the papers on the causation as well as the treatments that may help facilitate the recovery of the symptoms. Depending on the differences in the levels of severity and the locations where the main pathological venues are, what is most effective in facilitating recovery can vary largely across patients and thus may require individualized strategies for each patient. The goal of this paper is to provide some thoughts on these choices depending on the differences in the causes and severity.
Collapse
Affiliation(s)
- Sachiko Koyama
- Indiana University, School of Medicine, Department of Medicine, United States,Correspondence author at: Indiana University, Richard L. Roudebush VA Medical Center, 1481 W Tenth St., Indianapolis, IN, 46202, United States
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Japan
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Japan,Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Japan
| |
Collapse
|
8
|
Schulze H, Charles James J, Trampe N, Richter D, Pakeerathan T, Siems N, Ayzenberg I, Gold R, Faissner S. Cross-sectional analysis of clinical aspects in patients with long-COVID and post-COVID syndrome. Front Neurol 2022; 13:979152. [PMID: 36313487 PMCID: PMC9614029 DOI: 10.3389/fneur.2022.979152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Regarding pathogenesis, clinical manifestations, at-risk individuals, and diagnostic methods for stratifying patients for therapeutic approaches, our understanding of post-COVID syndrome is limited. Here, we set out to assess sociodemographic and clinical aspects in patients with the long-COVID and post-COVID syndrome. Methods We performed a cross-sectional analysis of patients presenting at our specialized university hospital outpatient clinic. We assessed patients' clinical presentation, fatigue, symptoms of depression and anxiety, and impairment of smell. Results A total of 101 patients were included (73.3% female), of whom 78.2% had a mild course of COVID-19. At presentation, 93.1% suffered from fatigue, 82.2% from impaired concentration, and 79.2% from impaired memory, 53.5% had impaired sleep. The most common secondary diagnosis found in our cohort was thyroid disease. Fatigue analysis showed that 81.3% of female and 58.8% of male patients had severe combined fatigue. Female gender was an independent risk factor for severe fatigue (severe cognitive fatigue OR = 8.045, p = 0.010; severe motor fatigue OR = 7.698, p = 0.013). Males suffered from more depressive symptoms, which correlated positively with the duration of symptom onset. 70.3% of patients with anamnestic smell impairment had hyposmia, and 18.9% were anosmic. Interpretation Most long-COVID patients suffered from severe fatigue, with the female sex as an independent risk factor. Fatigue was not associated with symptoms of depression or anxiety. Patients with long-COVID symptoms should receive an interdisciplinary diagnostic and therapeutic approach depending on the clinical presentation.
Collapse
|
9
|
Two-Year Follow-Up on Chemosensory Dysfunction and Adaptive Immune Response after Infection with SARS-CoV-2 in a Cohort of 44 Healthcare Workers. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101556. [PMID: 36294991 PMCID: PMC9605261 DOI: 10.3390/life12101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
Persistent chemosensory dysfunction (PCD) is a common symptom of long-COVID. Chemosensory dysfunction (CD) as well as SARS-CoV-2-specific antibody levels and CD8+ T-cell immunity were investigated in a cohort of 44 healthcare workers up to a median of 721 days after a positive PCR test. CD was assessed using questionnaires and psychophysical screening tests. After 721 days, 11 of 44 (25%) participants reported PCD, with five describing an impaired quality of life. One participant reported hyperosmia (increased sense of smell). The risk of PCD at 721 days was higher for participants reporting qualitative changes (parosmia (altered smell), dysgeusia (altered taste), or phantosmia (hallucination of smell)) during initial infection than in those with isolated quantitative losses during the first COVID-19 infection (62.5% vs. 7.1%). The main recovery rate occurred within the first 100 days and did not continue until follow-up at 2 years. No correlation was found between antibody levels and CD, but we observed a trend of a higher percentage of T-cell responders in participants with CD. In conclusion, a significant proportion of patients suffer from PCD and impaired quality of life 2 years after initial infection. Qualitative changes in smell or taste during COVID-19 pose a higher risk for PCD.
Collapse
|
10
|
Lechien JR, Vaira LA, Saussez S. Effectiveness of olfactory training in COVID-19 patients with olfactory dysfunction: a prospective study. Eur Arch Otorhinolaryngol 2022; 280:1255-1263. [PMID: 36153785 PMCID: PMC9510568 DOI: 10.1007/s00405-022-07665-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/16/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate effectiveness of olfactory training (OT) in COVID-19 patients with persistent olfactory dysfunction (OD). METHODS From March 2020 to March 2022, COVID-19 patients with OD were prospectively followed in three European medical centers for a period of 18 months. A standardized OT protocol were recommended to patients. Patient-reported outcome questionnaires and psychophysical evaluations were used to evaluate olfaction at baseline, 6, 12, and 18 months after the start of OT. The evolution of olfactory outcome was compared according to the adherence to the OT protocol. RESULTS Fifty-seven patients completed the evaluations. Thirty-two patients fully adhered to the OT, while 25 did not adhere. The psychophysical scores significantly improved from baseline to 6-month post-infection in both groups. In the OT group, the psychophysical scores continued to significantly improve from 6 to 12 months after the start of OT (p = 0.032). The mean duration of OT was 15.4 weeks. The mean delay of patient recovery perception was comparable between groups (27.4 weeks). The occurrence of cacosmia (35.1%) and parosmia (43.9%) throughout the follow-up period was comparable between groups. There proportion of phantosmia was higher in training (34.4%) compared with no-OT (16.0%; p = 0.007) group. The baseline Sniffin'Sticks tests was positively associated with the 6-month Sniffin'Sticks tests (rs = 0.685; p < 0.001) and negatively associated with the time of recovery (rs = - 0.369; p = 0.034). CONCLUSIONS The adherence to an OT protocol was associated with better mid-term improvement of psychophysical scores. Future large-cohort randomized-controlled studies are needed to confirm the effectiveness of OT in COVID-19 patients.
Collapse
Affiliation(s)
- Jerome R. Lechien
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan, Poitiers, France ,grid.8364.90000 0001 2184 581XDepartment of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium ,grid.12832.3a0000 0001 2323 0229Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France ,grid.490660.dDepartment of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium
| | - Luigi A. Vaira
- grid.11450.310000 0001 2097 9138Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy ,grid.11450.310000 0001 2097 9138Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Sven Saussez
- grid.8364.90000 0001 2184 581XDepartment of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium ,grid.490660.dDepartment of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium
| |
Collapse
|
11
|
Leung JS, Cordano VP, Fuentes-López E, Lagos AE, García-Huidobro FG, Aliaga R, Díaz LA, García-Salum T, Salinas E, Toro A, Callejas CA, Riquelme A, Palmer JN, Medina RA, González G C. Phantosmia May Predict Long-Term Measurable Olfactory Dysfunction After COVID-19. Laryngoscope 2022; 132:2445-2452. [PMID: 36149773 PMCID: PMC9538510 DOI: 10.1002/lary.30391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Objectives Persistent olfactory dysfunction (OD) after 6 months caused by SARS‐CoV‐2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of long‐term OD and identify predisposing factors. Methods A prospective cohort study was conducted on 100 adults with COVID‐19. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and a symptom survey at the onset of disease and 30 days later. Patients with persistent quantitative OD at the second assessment were reevaluated after 1 year. Demographic variables, symptoms, and the degree of smell loss were analyzed. Results Participants included 100 patients. The mean age was 42.2 ± 15.6 years, 55 (55%) were female, and 56 (56%) were outpatients. Baseline smell loss was identified in 75/100 (75%) patients, decreasing to 39/95 (40%) after 1 month, and persisting in 29 patients after 1 year. Phantosmia at baseline was the only risk factor identified for persistent OD after 1 year (relative risk 2.51; 95% confidence interval 1.53–4.12; p < 0.001). Regardless of the outcome in smell function, a significant decline in olfaction was associated with the presence of phantosmia at 1 month (β = −12.39; 95% CI −19.82 to −4.95; p < 0.01). Conclusions SARS‐CoV‐2 (2019–2020 variants) produced a highly frequent OD that persisted in 29% of the patients after 1 year. The presence of phantosmia at baseline and 1 month was associated with a worse evolution, but phantosmia may interfere with the performance in an identification smell test. A longer follow‐up is required in these patients. Level of Evidence 2 Laryngoscope, 2022
Collapse
Affiliation(s)
- Jai-Sen Leung
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valentina Paz Cordano
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Elisa Lagos
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Rodrigo Aliaga
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tamara García-Salum
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erick Salinas
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adriana Toro
- Pediatric Service, Clínica UC San Carlos, Red Salud UC-Christus, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Andrés Callejas
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Carrera de Fonoaudiología, Departamento de Ciencias de la Salud, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Gastroenterología, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - James N Palmer
- Rhinology Division, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Rafael A Medina
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Claudia González G
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Interdisciplinary Rehabilitation Register (AIRR) - COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
12
|
Graham EL, Koralnik IJ, Liotta EM. Therapeutic Approaches to the Neurologic Manifestations of COVID-19. Neurotherapeutics 2022; 19:1435-1466. [PMID: 35861926 PMCID: PMC9302225 DOI: 10.1007/s13311-022-01267-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
As of May 2022, there have been more than 527 million infections with severe acute respiratory disease coronavirus type 2 (SARS-CoV-2) and over 6.2 million deaths from Coronavirus Disease 2019 (COVID-19) worldwide. COVID-19 is a multisystem illness with important neurologic consequences that impact long-term morbidity and mortality. In the acutely ill, the neurologic manifestations of COVID-19 can include distressing but relatively benign symptoms such as headache, myalgias, and anosmia; however, entities such as encephalopathy, stroke, seizures, encephalitis, and Guillain-Barre Syndrome can cause neurologic injury and resulting disability that persists long after the acute pulmonary illness. Furthermore, as many as one-third of patients may experience persistent neurologic symptoms as part of a Post-Acute Sequelae of SARS-CoV-2 infection (Neuro-PASC) syndrome. This Neuro-PASC syndrome can affect patients who required hospitalization for COVID-19 or patients who did not require hospitalization and who may have had minor or no pulmonary symptoms. Given the large number of individuals affected and the ability of neurologic complications to impair quality of life and productivity, the neurologic manifestations of COVID-19 are likely to have major and long-lasting personal, public health, and economic consequences. While knowledge of disease mechanisms and therapies acquired prior to the pandemic can inform us on how to manage patients with the neurologic manifestations of COVID-19, there is a critical need for improved understanding of specific COVID-19 disease mechanisms and development of therapies that target the neurologic morbidities of COVID-19. This current perspective reviews evidence for proposed disease mechanisms as they inform the neurologic management of COVID-19 in adult patients while also identifying areas in need of further research.
Collapse
Affiliation(s)
- Edith L Graham
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Igor J Koralnik
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Eric M Liotta
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA.
| |
Collapse
|
13
|
Gupta S, Lee JJ, Perrin A, Khan A, Smith HJ, Farrell N, Kallogjeri D, Piccirillo JF. Efficacy and Safety of Saline Nasal Irrigation Plus Theophylline for Treatment of COVID-19-Related Olfactory Dysfunction: The SCENT2 Phase 2 Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:830-837. [PMID: 35797024 DOI: 10.1001/jamaoto.2022.1573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Recent studies suggest that theophylline added to saline nasal irrigation (SNI) can be an effective treatment for postviral olfactory dysfunction (OD), a growing public health concern during the COVID-19 pandemic. Objective To evaluate the efficacy and safety of theophylline added to SNI compared with placebo for COVID-19-related OD. Design, Setting, and Participants This triple-blinded, placebo-controlled, phase 2 randomized clinical trial was conducted virtually between March 15 and August 31, 2021. Adults residing in Missouri or Illinois were recruited during this time period if they had OD persisting for 3 to 12 months following suspected COVID-19 infection. Data analysis was conducted from October to December 2021. Interventions Saline sinus rinse kits and bottles of identical-appearing capsules with either 400 mg of theophylline (treatment) or 500 mg of lactose powder (control) were mailed to consenting study participants. Participants were instructed to dissolve the capsule contents into the saline rinse and use the solution to irrigate their nasal cavities in the morning and at night for 6 weeks. Main Outcomes and Measures The primary outcome was the difference in the rate of responders between the treatment and the control arms, defined as a response of at least slightly better improvement in the Clinical Global Impression-Improvement scale posttreatment. Secondary outcome measures included changes in the University of Pennsylvania Smell Identification Test (UPSIT), the Questionnaire for Olfactory Disorders, the 36-Item Short Form Health Survey on general health, and COVID-19-related questions. Results A total of 51 participants were enrolled in the study; the mean (SD) age was 46.0 (13.1) years, and 36 (71%) participants were women. Participants were randomized to SNI with theophylline (n = 26) or to SNI with placebo (n = 25). Forty-five participants completed the study. At the end of treatment, 13 (59%) participants in the theophylline arm reported at least slight improvement in the Clinical Global Impression-Improvement scale (responders) compared with 10 (43%) in the placebo arm (absolute difference, 15.6%; 95% CI, -13.2% to 44.5%). The median difference for the UPSIT change between baseline and 6 weeks was 3.0 (95% CI, -1.0 to 7.0) for participants in the theophylline arm and 0.0 (95% CI, -2.0 to 6.0) for participants in the placebo arm. Mixed-model analysis revealed that the change in UPSIT scores through study assessments was not statistically significantly different between the 2 study arms. Eleven (50%) participants in the theophylline arm and 6 (26%) in the placebo arm had a change of 4 or more points in UPSIT scores from baseline to 6 weeks. The difference in the rate of responders as measured by the UPSIT was 24% (95% CI, -4% to 52%) in favor of theophylline. Conclusions and Relevance This randomized clinical trial suggests that the clinical benefit of theophylline nasal irrigations on olfaction in participants with COVID-19-related OD is inconclusive, though suggested by subjective assessments. Larger studies are warranted to investigate the efficacy of this treatment more fully. Trial Registration ClinicalTrials.gov Identifier: NCT04789499.
Collapse
Affiliation(s)
- Shruti Gupta
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Medical College of Georgia, Augusta University, Augusta
| | - Jake J Lee
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amber Perrin
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amish Khan
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Nyssa Farrell
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
14
|
Choi R, Gupta R, Finlay JB, Goldstein BJ. Olfactory dysfunction and COVID-19. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:141-146. [PMID: 35505955 PMCID: PMC9050605 DOI: 10.1016/j.otot.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here, we provide an overview of olfactory dysfunction associated with COVID-19. We provide background regarding the organization and function of the peripheral olfactory system. A review of the relevant literature on anosmia and parosmia due to infection with SARS-CoV-2, the virus causing COVID-19, is provided. Specific attention is focused on possible mechanisms by which the virus may interact with and damage the cell populations of peripheral olfactory system. Evidence from human studies as well as animal models is considered. Finally, we discuss current recommendations for evaluation and management of patients with persistent post-COVID olfactory dysfunction, as well as possible future research directions.
Collapse
Affiliation(s)
- Rhea Choi
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, United States
| | - Rupali Gupta
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, United States
| | - John B Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC, United States
| | - Bradley J Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC 27710, United States
- Department of Neurobiology, Duke University School of Medicine, Durham, NC, United States
| |
Collapse
|
15
|
Finlay JB, Brann DH, Abi-Hachem R, Jang DW, Oliva AD, Ko T, Gupta R, Wellford SA, Moseman EA, Jang SS, Yan CH, Matusnami H, Tsukahara T, Datta SR, Goldstein BJ. Persistent post-COVID-19 smell loss is associated with inflammatory infiltration and altered olfactory epithelial gene expression. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2022.04.17.488474. [PMID: 35478953 PMCID: PMC9044903 DOI: 10.1101/2022.04.17.488474] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most human subjects infected by SARS-CoV-2 report an acute alteration in their sense of smell, and more than 25% of COVID patients report lasting olfactory dysfunction. While animal studies and human autopsy tissues have suggested mechanisms underlying acute loss of smell, the pathophysiology that underlies persistent smell loss remains unclear. Here we combine objective measurements of smell loss in patients suffering from post-acute sequelae of SARS-CoV-2 infection (PASC) with single cell sequencing and histology of the olfactory epithelium (OE). This approach reveals that the OE of patients with persistent smell loss harbors a diffuse infiltrate of T cells expressing interferon-gamma; gene expression in sustentacular cells appears to reflect a response to inflammatory signaling, which is accompanied by a reduction in the number of olfactory sensory neurons relative to support cells. These data identify a persistent epithelial inflammatory process associated with PASC, and suggests mechanisms through which this T cell-mediated inflammation alters the sense of smell.
Collapse
|