The COVANOS trial - insight into post-COVID olfactory dysfunction and the role of smell training

BACKGROUND

Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted.

METHODOLOGY

We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants.

RESULTS

218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia.

CONCLUSIONS

Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.

Vitamin D and COVID-19 Infection

INTRODUCTION

The COVID-19 pandemic has prompted the medical world to look at factors that may influence outcomes. There have been connections made between vitamin D and COVID-19, as vitamin D has previously been shown to play a role in the maintenance of immune homeostasis.

MATERIALS AND METHODS

We performed a prospective cohort study on 103 patients at Wigan Wrightington and Leigh NHS Foundation Trust looking at serum vitamin D levels of patients with positive COVID-19 swabs. Results were collated and correlations were made to compare vitamin D levels with age; severity of illness; hospital outcomes; and frailty. Comparisons were also made between frailty and outcome.

RESULTS

The results showed that there was a significant statistical difference between vitamin D levels and severity of infection: those who were treated in the intensive care units (ICU) (severe symptoms) had lower vitamin D levels than those treated on the ward (p=0.0446). There was also a correlation between vitamin D levels and frailty: those who were more frail had higher vitamin D levels than fitter patients (P=0.005). Vitamin D and frailty had no effect on hospital outcomes of COVID-19 infection.

CONCLUSION

Ultimately, we concluded that low vitamin D can increase susceptibility of contracting COVID-19, increase severity of infection but does not affect mortality.

539 Post-Covid-19 Smell Clinic - Management of Patients With ‘Long Covid’

Introduction

Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”.

Method

The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected.

Results

Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151.

Conclusions

Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score

Implementing a COVID-19 specialist smell clinic: experience at the Wrightington, Wigan and Leigh Teaching Hospitals (WWL), NHS Foundation Trust, United Kingdom

INTRODUCTION

It is clear that a proportion of patients continue to suffer long-lasting symptoms following acute infection with coronavirus disease 2019 (COVID-19). Persistent olfactory dysfunction is one of the commonest complaints reported in the condition colloquially known as long COVID (now known as post-acute sequelae of SARS-CoV-2 infection (PASC)). The prevalence, risk factors and clinical course of long COVID olfactory dysfunction are not yet well understood. At present, the main stay of treatment is olfactory training. Quantitative olfactory testing and impacts on patient quality of life have not been widely studied. This study describes our experiences at Wrightington, Wigan and Leigh Teaching Hospitals, UK (WWL) of establishing a COVID-19 smell clinic, along with preliminary data on patient demographics, baseline smell test scores and quality of life questionnaire scores before olfactory training.

METHODS

We piloted a COVID-19 smell clinic. We recorded patient demographics and clinical characteristics then performed clinical assessment of each patient. Quantitative measurements of olfactory dysfunction were recorded using the University of Pennsylvania Smell Identification Test (UPSIT). We measured the impact of olfactory dysfunction on patient quality of life using the validated English Olfactory Disorders Questionnaire (eODQ).

RESULTS

20 patients participated in the clinic. 4 patients were excluded from analysis due to missing data. Median age was 35 years. 81% (n=13) of the participants were female. 50% (n=8) of patients suffered with a combination of anosmia/ageusia and parosmia, whilst 43% (n=7) of patients suffered with anosmia/ageusia without parosmia. Almost all the patients registered UPSIT scores in keeping with impaired olfaction. Patient scores ranged from 22 to 35, with the median score at 30. All patients reported that their olfactory dysfunction had an impact on their quality of life. The median eODQ score reported was 90, with scores ranging from 42 to 169 out of a maximum of 180.

CONCLUSION

We have demonstrated that it is simple and feasible to set up a COVID-19 smell clinic. The materials are inexpensive, but supervised completion of the UPSIT and eODQ is time-consuming. Patients demonstrate reduced olfaction on quantitative testing and experience significant impacts on their quality of life as a result. More research is needed to demonstrate if olfactory training results in measurable improvements in smell test scores and quality of life.

Teaching and training in Otorhinolaryngology (ORL) during the pandemic and beyond, in the United Kingdom

No abstract provided.

Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom

Sudden sensory neural hearing Loss (SSNHL) needs to be identified and managed correctly in a secondary or tertiary centre. Whilst 45% of presentations are said to be idiopathic in nature, several viruses have been linked to its aetiology. It was noted, anecdotally, that more patients were presenting with SSNHL during the COVID-19 pandemic to our ENT service at Wrightington Wigan and Leigh teaching hospitals, UK (WWL). We identified 4 COVID-19 positive patients who presented to our ENT service with SSNHL. Despite normal findings on external ear examination, three of the patients showed bilateral hearing loss, whilst one had a predominantly unilateral loss. Given our findings we would like to present these four cases, as well as providing hypotheses on possible aetiology of this association. This may aid in research, diagnosis and treatment of future COVID positive patients with SSNHL.

Specimen: Lymphangioma of Liver

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Congenital Laryngeal Stridor. Case for Diagnosis

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