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Whitcroft KL, Alobid I, Altundag A, Andrews P, Carrie S, Fahmy M, Fjaeldstad AW, Gane S, Hopkins C, Hsieh JW, Huart C, Hummel T, Konstantinidis I, Landis BN, Mori E, Mullol J, Philpott C, Poulios A, Vodička J, Ward VM. International clinical assessment of smell: An international, cross-sectional survey of current practice in the assessment of olfaction. Clin Otolaryngol 2024; 49:220-234. [PMID: 38153760 DOI: 10.1111/coa.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS ENT surgeons who assess olfaction. RESULTS Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.
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Affiliation(s)
- Katherine L Whitcroft
- UCL Ear Institute, University College London, London, UK
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona University, Barcelona, Spain
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aytug Altundag
- Department of Otolaryngology, Head and Neck Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Sean Carrie
- Department of Otolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miriam Fahmy
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Alexander W Fjaeldstad
- Department of Otorhinolaryngology, Flavour Clinic, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Simon Gane
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- Royal National and ENT Hospital (RNENT), London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Julien Wen Hsieh
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Caroline Huart
- ENT Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
| | - Iordanis Konstantinidis
- 2nd Academic Department, Smell and Taste Clinic, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Baslie N Landis
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Joaquim Mullol
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Rhinology Unit and Smell Clinic, ENT Department Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carl Philpott
- Norwich Medical School, Norwich, UK
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, James Paget and Norfolk and Norwich University Hospitals, Norfolk, UK
- Fifth Sense, London, UK
| | - Aristotelis Poulios
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Jan Vodička
- Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital Pardubice, Pardubice, Czech Republic
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Victoria M Ward
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Whitcroft KL, Kelly C, Andrews P. Patient Experience and Preferences for the Assessment of Olfaction: The Patient International Clinical Assessment of Smell Survey. ORL J Otorhinolaryngol Relat Spec 2024; 86:16-31. [PMID: 38266502 PMCID: PMC10880803 DOI: 10.1159/000535794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/10/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Olfactory dysfunction (OD) is common and carries significant personal and societal burden of disease. Accurate assessment of olfaction is required for good clinical care and affords patients insight into their condition. However, the accuracy of assessment varies with technique used, and there is presently little standardisation of clinical practice. We therefore aimed to determine experience of and preferences for olfactory assessment in healthcare-seeking adults. METHODS An anonymous patient co-produced survey was developed in collaboration with a UK-based OD charity. Distribution was via their social media patient forum. "Healthcare seeking" adults (i.e., who had undergone olfactory assessment by a healthcare professional [any care level/speciality] or may do so in the future) were included. RESULTS 576 people (88.5% female, mean 46 years) responded. Hyposmia, parosmia, and retronasal OD were most frequently reported. 55.2% had been assessed by a healthcare professional - GP most commonly, followed by ENT. Importantly, only 15.6% and 16.9% of respondents had undergone systematic assessment with smell tests or symptom questionnaires, respectively. Most respondents had not undergone imaging. Mean satisfaction was higher in those seen by ENT. Interestingly, respondents prioritise orthonasal odour identification over other forms of smell test. Unfortunately, many felt that healthcare professionals (across specialities) were dismissive towards OD and lacked appropriate knowledge of both its pathophysiology and effects. We propose simple steps that can be taken to improve olfactory assessment, including education and establishment of robust referral networks. CONCLUSION We hope these results and supporting practical recommendations will inform future service planning, funding allocation and research, as well as better aligning patient and clinician priorities.
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Affiliation(s)
- Katherine L. Whitcroft
- UCL Ear Institute, University College London, London, UK
- Department of Otolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Germany
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- ENT Department, The Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Peter Andrews
- UCL Ear Institute, University College London, London, UK
- Department of Rhinology and Facial Plastics, Royal National Throat Nose and Ear Hospital, London, UK
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Li S, Boscolo-Rizzo P, Uderzo F, Tirelli G, Whitcroft KL, Hummel T. Orthonasal and retronasal odor identification in patients with parosmia. Eur Arch Otorhinolaryngol 2023; 280:4933-4938. [PMID: 37338584 PMCID: PMC10562280 DOI: 10.1007/s00405-023-08072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To compare retronasal and orthonasal perception in parosmic COVID-19 patients, in order to determine whether COVID-19 has a differential effect on these functions. METHODS Using the Sniffin Sticks test battery orthonasal function was examined for odor threshold, discrimination and identification. Retronasal function was assessed using 20 tasteless aromatized powders. Gustatory function was measured using the Taste Strips test. RESULTS This study included 177 patients (127 women, 50 men; mean age 45 years), of whom 127 (72%) were hyposmic and 50 (28%) normosmic. Compared to patients without parosmia, parosmic patients performed worse in odor identification for both orthonasal (F = 4.94, p = 0.03) and retronasal tests (F = 11.95, p < 0.01). However, an interaction effect between route of odor identification (orthonasal or retronasal) and parosmia status was found (F = 4.67, p = 0.03): patients with parosmia had relatively lower retronasal scores than patients without parosmia. CONCLUSION Our results suggest that COVID-19 may affect the olfactory mucosa differently along the anterior-posterior axis, thereby possibly contributing to the pathophysiology of parosmia. Patients with parosmia also exhibit a higher degree of impairment when odors are presented through the retronasal route during eating and drinking.
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Affiliation(s)
- Shubin Li
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technical University of Dresden, Fetscherstrasse. 74, 01307 Dresden, Germany
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Francesco Uderzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Katherine L. Whitcroft
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technical University of Dresden, Fetscherstrasse. 74, 01307 Dresden, Germany
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technical University of Dresden, Fetscherstrasse. 74, 01307 Dresden, Germany
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Whitcroft KL, Altundag A, Balungwe P, Boscolo-Rizzo P, Douglas R, Enecilla MLB, Fjaeldstad AW, Fornazieri MA, Frasnelli J, Gane S, Gudziol H, Gupta N, Haehner A, Hernandez AK, Holbrook EH, Hopkins C, Hsieh JW, Huart C, Husain S, Kamel R, Kim JK, Kobayashi M, Konstantinidis I, Landis BN, Lechner M, Macchi A, Mazal PP, Miri I, Miwa T, Mori E, Mullol J, Mueller CA, Ottaviano G, Patel ZM, Philpott C, Pinto JM, Ramakrishnan VR, Roth Y, Schlosser RJ, Stjärne P, Van Gerven L, Vodicka J, Welge-Luessen A, Wormald PJ, Hummel T. Position paper on olfactory dysfunction: 2023. Rhinology 2023; 61:1-108. [PMID: 37454287 DOI: 10.4193/rhin22.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.
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Affiliation(s)
- K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
- and The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
| | - A Altundag
- Department of Otorhinolaryngology, Istanbul Surgery Hospital, Istanbul, Turkey
| | - P Balungwe
- Faculté de Médecine, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
- and Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of the Congo
| | - P Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - R Douglas
- Department of Otorhinolaryngology, University of Auckland, New Zealand
| | - M L B Enecilla
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Luke's Medical Center, Global City, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otorhinolaryngology, Medical Center Taguig, Taguig, Philippines
| | - A W Fjaeldstad
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- and Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
- and Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
| | - M A Fornazieri
- Department of Clinical Surgery, Universidade Estadual de Londrina and Pontifícia Universidade Católica do Paraná, Londrina, Brazil
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- and Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - S Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Studies, University of London, London, UK
- and Royal National Throat Nose and Ear Hospital, UCLH, London
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - A K Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- and Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
- and Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines
| | - E H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - C Hopkins
- Guys and St Thomas NHS Trust, London, United Kingdom
| | - J W Hsieh
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - C Huart
- Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- and Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - S Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - J K Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University, College of Medicine, Seoul, Republic of Korea
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK
- and UCL Cancer Institute, University College London, London, UK
- and ENT Department, Homerton Healthcare NHS Foundation Trust, London, UK
| | - A Macchi
- ENT Clinic, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - P P Mazal
- Servicio de Otorrinolaringología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Miri
- Service Médecine Physique Réadaptation fonctionnelle, Institut Mohamed Kassab d'Orthopédie, Mannouba, Tunisia
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - E Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Tokyo, Japan
| | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, Universitat de Barcelona
- IDIBAPS
- CIBERES. Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - Z M Patel
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- and The Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Indiana University of School Medicine, Indianapolis, IN, USA
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - L Van Gerven
- Department of Otorhinolaryngology, UZ Leuven, Belgium
- and Department of Neurosciences, Experimental Otorhinolaryngology, KU Leuven, Belgium
- and Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Belgium
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
| | - P J Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Hernandez AK, Landis BN, Altundag A, Fjaeldstad AW, Gane S, Holbrook EH, Huart C, Konstantinidis I, Lechner M, Macchi A, Portillo Mazal P, Miwa T, Philpott CM, Pinto JM, Poletti SC, Vodicka J, Welge-Luessen A, Whitcroft KL, Hummel T. Olfactory Nomenclature: An Orchestrated Effort to Clarify Terms and Definitions of Dysosmia, Anosmia, Hyposmia, Normosmia, Hyperosmia, Olfactory Intolerance, Parosmia, and Phantosmia/Olfactory Hallucination. ORL J Otorhinolaryngol Relat Spec 2023; 85:312-320. [PMID: 37062268 PMCID: PMC10711772 DOI: 10.1159/000530211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/10/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Definitions are essential for effective communication and discourse, particularly in science. They allow the shared understanding of a thought or idea, generalization of knowledge, and comparison across scientific investigation. The current terms describing olfactory dysfunction are vague and overlapping. SUMMARY As a group of clinical olfactory researchers, we propose the standardization of the terms "dysosmia," "anosmia," "hyposmia," "normosmia," "hyperosmia," "olfactory intolerance," "parosmia," and "phantosmia" (or "olfactory hallucination") in olfaction-related communication, with specific definitions in this text. KEY MESSAGES The words included in this paper were determined as those which are most frequently used in the context of olfactory function and dysfunction, in both clinical and research settings. Despite widespread use in publications, however, there still exists some disagreement in the literature regarding the definitions of terms related to olfaction. Multiple overlapping and imprecise terms that are currently in use are confusing and hinder clarity and universal understanding of these concepts. There is a pressing need to have a unified agreement on the definitions of these olfactory terms by researchers working in the field of chemosensory sciences. With the increased interest in olfaction, precise use of these terms will improve the ability to integrate and advance knowledge in this field.
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Affiliation(s)
- Anna Kristina Hernandez
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Otolaryngology – Head and Neck Surgery, Philippine General Hospital, University of the Philippines – Manila, Manila, Philippines
- Department of Otolaryngology – Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines
| | - Basile N. Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospital of Geneva, Geneva, Switzerland
| | - Aytug Altundag
- Department of Otolaryngology, Head and Neck Surgery, Biruni University Medical School, Istanbul, Turkey
| | - Alexander Wieck Fjaeldstad
- Department of Otorhinolaryngology, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
- Center for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Simon Gane
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Eric H. Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Iordanis Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matt Lechner
- Division of Surgery and Interventional Science, University College London, London, UK
- UCL Cancer Institute, University College London, London, UK
- ENT Department, Homerton Healthcare NHS Foundation Trust, London, UK
| | - Alberto Macchi
- ENT Clinic, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Patricia Portillo Mazal
- Servicio de Otorrinolaringología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Takaki Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Japan
| | - Carl M. Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
- The Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - Jayant M. Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Sophia C. Poletti
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Antje Welge-Luessen
- Department of Otorhinolaryngology, University Hospital Basel, Basel, Switzerland
| | - Katherine L. Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, University of London, London, UK
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Whitcroft KL, Mancini L, Yousry T, Hummel T, Andrews PJ. Functional septorhinoplasty alters brain structure and function: Neuroanatomical correlates of olfactory dysfunction. Front Allergy 2023; 4:1079945. [PMID: 37089704 PMCID: PMC10117949 DOI: 10.3389/falgy.2023.1079945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/09/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionWe previously demonstrated functionally significant structural plasticity within the central olfactory networks, in association with improved olfaction after surgical treatment of chronic rhinosinusitis (CRS). In order to confirm and expand on these findings, the primary aim of this study was to determine whether these same regions undergo functionally significant structural plasticity following functional septorhinoplasty (fSRP), in patients with non-CRS olfactory dysfunction (OD) of mixed cause. fSRP has previously been shown to improve olfactory function, and the secondary aim of this study was to provide initial insights into the mechanism by which fSRP affects olfaction.MethodsWe performed a pilot prospective, multimodal neuroimaging study in 20 participants undergoing fSRP, including patients with non-CRS OD of mixed cause, as well as normosmic surgical controls. Participants underwent psychophysical olfactory testing, assessment of nasal airway, structural and functional neuroimaging. This was performed pre- and postoperatively in patients, and preoperatively in controls.ResultsThere was a statistically and clinically significant improvement in mean psychophysical olfactory scores after surgery. This was associated with structural and functional plasticity within areas of the central olfactory network (anterior cingulate, orbitofrontal cortex, insula, temporal pole). Improved psychophysical scores were significantly correlated with change in bilateral measures of nasal airflow, not measures of airflow symmetry, suggesting that improved overall airflow was more important than correction of septal deviation.ConclusionThis work highlights the importance of these neuroanatomical regions as potential structural correlates of olfactory function and dysfunction. Our results also provide initial insight into the mechanistic effects of fSRP on olfaction. Further work could investigate the utility of these regions as personalised biomarkers of OD, as well as the role of fSRP in treating OD.
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Affiliation(s)
- Katherine L. Whitcroft
- UCL Ear Institute, University College London, London, United Kingdom
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, United Kingdom
- Department of Rhinology and Facial Plastics, Royal National Throat Nose and Ear Hospital, London, United Kingdom
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
- Correspondence: Katherine L. Whitcroft
| | - Laura Mancini
- Lysholm Department of Neuroradiology, the National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, the National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Peter J. Andrews
- UCL Ear Institute, University College London, London, United Kingdom
- Department of Rhinology and Facial Plastics, Royal National Throat Nose and Ear Hospital, London, United Kingdom
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7
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Whitcroft KL, Noltus J, Andrews P, Hummel T. Sinonasal surgery alters brain structure and function: Neuroanatomical correlates of olfactory dysfunction. J Neurosci Res 2021; 99:2156-2171. [PMID: 34110641 DOI: 10.1002/jnr.24897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022]
Abstract
Olfactory dysfunction (OD) is more common than hearing loss, partial blindness, or blindness and can have a significant impact on the quality of life. Moreover, unexplained OD is an early biomarker in neurodegenerative diseases and increases 5-year mortality risk. Structural alterations in olfactory eloquent brain regions may represent the neuroanatomical correlates of OD. Previous studies have demonstrated reduced gray matter (GM) volume in areas of presumed olfactory relevance in patients with OD. However, being cross-sectional in nature, these studies do not provide evidence of causality, for which longitudinal work is required. At present, however, longitudinal studies addressing olfactory structural plasticity are limited, both in number and methodological approach: to our knowledge, such work has not included parallel functional imaging to confirm the relevance of structural change. We therefore performed a longitudinal multimodal neuroimaging study investigating structural and functional plasticity in 24 patients undergoing surgical treatment for chronic rhinosinusitis, compared with 17 healthy controls. We demonstrated functionally significant structural plasticity within the orbitofrontal, anterior cingulate and insular cortices, and temporal poles in patients 3 months after surgery. Of interest, GM volume decreased in these regions, in association with increased psychophysical scores and BOLD signal. To our knowledge, this is the first study to demonstrate both structural and functional plasticity of the central olfactory networks, thereby confirming these areas as neuroanatomical correlates of olfactory function/dysfunction.
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Affiliation(s)
- Katherine L Whitcroft
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.,UCL Ear Institute, University College London, London, UK.,Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, UK.,Royal National Throat Nose and Ear Hospital, London, UK
| | - Jan Noltus
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Peter Andrews
- UCL Ear Institute, University College London, London, UK.,Royal National Throat Nose and Ear Hospital, London, UK
| | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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8
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Huart C, Philpott CM, Altundag A, Fjaeldstad AW, Frasnelli J, Gane S, Hsieh JW, Holbrook EH, Konstantinidis I, Landis BN, Macchi A, Mueller CA, Negoias S, Pinto JM, Poletti SC, Ramakrishnan VR, Rombaux P, Vodicka J, Welge-Lüessen A, Whitcroft KL, Hummel T. Systemic corticosteroids in coronavirus disease 2019 (COVID-19)-related smell dysfunction: an international view. Int Forum Allergy Rhinol 2021; 11:1041-1046. [PMID: 33728824 PMCID: PMC8251281 DOI: 10.1002/alr.22788] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
The frequent association between coronavirus disease 2019 (COVID‐19) and olfactory dysfunction is creating an unprecedented demand for a treatment of the olfactory loss. Systemic corticosteroids have been considered as a therapeutic option. However, based on current literature, we call for caution using these treatments in early COVID‐19–related olfactory dysfunction because: (1) evidence supporting their usefulness is weak; (2) the rate of spontaneous recovery of COVID‐19–related olfactory dysfunction is high; and (3) corticosteroids have well‐known potential adverse effects. We encourage randomized placebo‐controlled trials investigating the efficacy of systemic steroids in this indication and strongly emphasize to initially consider smell training, which is supported by a robust evidence base and has no known side effects.
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Affiliation(s)
- Caroline Huart
- Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Neuroscience, Univeristé catholique de Louvain, Brussels, Belgium
| | - Carl M Philpott
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, Gorleston, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aytug Altundag
- Department of Otorhinolaryngology, Biruni University, Istanbul, Turkey
| | - Alexander W Fjaeldstad
- Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Holstebro, Denmark.,Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Simon Gane
- Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Ear Institute, University College London, London, UK
| | - Julien W Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, Rhinology-Olfactory Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Eric H Holbrook
- Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts
| | - Iordanis Konstantinidis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Basile N Landis
- Department of Otorhinolaryngology-Head and Neck Surgery, Rhinology-Olfactory Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Alberto Macchi
- ENT clinic Asst-Settelaghi-University of Insubriae, Varese, Italy
| | - Christian A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Simona Negoias
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, CH-4051, Basel, Switzerland
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois
| | - Sophia C Poletti
- Department of Otorhinolaryngology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philippe Rombaux
- Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institute of Neuroscience, Univeristé catholique de Louvain, Brussels, Belgium
| | - Jan Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital of Pardubice, Pardubice, Czech Republic
| | - Antje Welge-Lüessen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, CH-4051, Basel, Switzerland
| | - Katherine L Whitcroft
- UCL Ear Institute, University College London, London, UK.,The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, London, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Parma V, Ohla K, Veldhuizen MG, Niv MY, Kelly CE, Bakke AJ, Cooper KW, Bouysset C, Pirastu N, Dibattista M, Kaur R, Liuzza MT, Pepino MY, Schöpf V, Pereda-Loth V, Olsson SB, Gerkin RC, Rohlfs Domínguez P, Albayay J, Farruggia MC, Bhutani S, Fjaeldstad AW, Kumar R, Menini A, Bensafi M, Sandell M, Konstantinidis I, Di Pizio A, Genovese F, Öztürk L, Thomas-Danguin T, Frasnelli J, Boesveldt S, Saatci Ö, Saraiva LR, Lin C, Golebiowski J, Hwang LD, Ozdener MH, Guàrdia MD, Laudamiel C, Ritchie M, Havlícek J, Pierron D, Roura E, Navarro M, Nolden AA, Lim J, Whitcroft KL, Colquitt LR, Ferdenzi C, Brindha EV, Altundag A, Macchi A, Nunez-Parra A, Patel ZM, Fiorucci S, Philpott CM, Smith BC, Lundström JN, Mucignat C, Parker JK, van den Brink M, Schmuker M, Fischmeister FPS, Heinbockel T, Shields VDC, Faraji F, Santamaría E, Fredborg WEA, Morini G, Olofsson JK, Jalessi M, Karni N, D'Errico A, Alizadeh R, Pellegrino R, Meyer P, Huart C, Chen B, Soler GM, Alwashahi MK, Welge-Lüssen A, Freiherr J, de Groot JHB, Klein H, Okamoto M, Singh PB, Hsieh JW, Reed DR, Hummel T, Munger SD, Hayes JE. Corrigendum to: More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis. Chem Senses 2021; 46:6457126. [PMID: 34879393 PMCID: PMC8689756 DOI: 10.1093/chemse/bjab050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Valentina Parma
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Kathrin Ohla
- Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Wilhelm-Johnen-Straße, Jülich, Germany
| | - Maria G Veldhuizen
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Masha Y Niv
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Alyssa J Bakke
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
| | - Keiland W Cooper
- Center for the Neurobiology of Learning and Memory, University of California and Qureshey Research Laboratory, Irvine, CA, USA
| | - Cédric Bouysset
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK
| | - Michele Dibattista
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, Università degli Studi di Bari A. Moro, P.zza G. Cesare, Bari, Italy
| | - Rishemjit Kaur
- CSIR-Central Scientific Instruments Organisation, Chandigarh, India
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Marta Y Pepino
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel, Vienna, Austria
| | - Veronica Pereda-Loth
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthese, UMR 5288 CNRS, Universitéde Toulouse, Toulouse, France
| | - Shannon B Olsson
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, GKVK Campus, Bengaluru, India
| | - Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Paloma Rohlfs Domínguez
- Department of Psychology and Anthropology, University of Extremadura, Avenida de la Universidad, s/n, Cáceres, Spain
| | - Javier Albayay
- Department of General Psychology, University of Padova, Via Venezia, Padova, Italy
| | - Michael C Farruggia
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego State University, San Diego, CA, USA
| | - Alexander W Fjaeldstad
- Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Central Denmark Region, Laegaardvej, Holstebro, Denmark
| | - Ritesh Kumar
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Anna Menini
- Neuroscience Area, International School for Advanced Studies, SISSA, Via Bonomea, Trieste, Italy
| | - Moustafa Bensafi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Mari Sandell
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.,Functional Foods Forum, University of Turku, Turku, Finland
| | | | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, Lise-Meitner-Str., Freising, Germany
| | | | - Lina Öztürk
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Thierry Thomas-Danguin
- CSGA-Centre for Taste and Feeding Behavior, INRAE, CNRS, AgroSup Dijon, Université Bourgogne Franche-Comté, 17 rue Sully, Dijon, France
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, boul. des Forges, Trois-Rivières, QC, Canada
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, the Netherlands
| | - Özlem Saatci
- Department of Otorhinolaryngology, Medical Science University, Emek, Sancaktepe-İstanbul, Turkey
| | - Luis R Saraiva
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Sidra Medicine, Out Patient Clinic, Doha, Qatar
| | - Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Jérôme Golebiowski
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Liang-Dar Hwang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | | | - Maria Dolors Guàrdia
- IRTA-Food Technology Programme, IRTA, Finca Camps i Armet, Monells, Girona, Spain
| | | | - Marina Ritchie
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Jan Havlícek
- Department of Zoology, Charles University, Viničná, Nové Město, Czechia
| | - Denis Pierron
- Équipe de Médecine Evolutive, UMR5288 CNRS/Université Toulouse III, faculté de chirurgie dentaire, 3 Chemin des Maraîchers, Toulouse, France
| | - Eugeni Roura
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Marta Navarro
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Alissa A Nolden
- Department of Food Science, University of Massachusetts, Holdsworth Way, Amherst, MA, USA
| | - Juyun Lim
- Department of Food Science and Technology, Oregon State University, Corvallis, OR, USA
| | | | | | - Camille Ferdenzi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Evelyn V Brindha
- Department of Electrical and Electronics Engineering, Karunya Institute of Technology and Sciences, Karunya Nagar, Coimbatore, Tamilnadu, India
| | - Aytug Altundag
- Otorhinolaryngology Department, Biruni University, Protokol Yolu, Topkapı, Zeytinburnu, Istanbul, Turkey
| | - Alberto Macchi
- Italian Academy of Rhinology Asst Settelaghi-University of Insubriae, via Guicciardini, Varese, Italy
| | - Alexia Nunez-Parra
- Department of Biology, Universidad de Chile, Las Palmeras, Santiago, Chile
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sébastien Fiorucci
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Carl M Philpott
- The Norfolk Smell and Taste Clinic, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Barry C Smith
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Johan N Lundström
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg, Stockholm, Sweden
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, via Marzolo, Padova, Italy
| | - Jane K Parker
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, UK
| | - Mirjam van den Brink
- Laboratory of Behavioural Gastronomy, Maastricht University Campus Venlo, Nassaustraat, BV Venlo, the Netherlands
| | - Michael Schmuker
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | | | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, N.W., Washington, DC, USA
| | - Vonnie D C Shields
- Biological Sciences Department, Fisher College of Science and Mathematics, Towson University, Towson, MD USA
| | - Farhoud Faraji
- Division of Otolaryngology, Head & Neck Surgery, University of California San Diego Health, MC La Jolla, CA, USA
| | - Enrique Santamaría
- Clinical Neuroproteomics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Proteored-ISCIII, Pamplona, Spain
| | - William E A Fredborg
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Gabriella Morini
- University of Gastronomic Sciences, Piazza Vittorio Emanuele II 9, Bra, Pollenzo, CN, Italy
| | - Jonas K Olofsson
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Rasoul Akram Hospital, Sattarkhan Ave., Tehran, Iran
| | - Noam Karni
- Internal Medicine Department, Hadassah Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Anna D'Errico
- Department of Molecular and Cellular Neurobiology, Goethe Universität Frankfurt, Goethe Universität Frankfurt, Max von Laue Strasse, Frankfurt am Main, Germany
| | - Rafieh Alizadeh
- ENT and Head and Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, Iran
| | - Robert Pellegrino
- Food Science Department, University of Tennessee, Knoxville, TN, USA
| | - Pablo Meyer
- Health Care and Life Sciences, IBM T. J. Watson Research Center, Yorktown Heights, NY, USA
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Ben Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Liwan District, Guangzhou City, China
| | - Graciela M Soler
- Department of Otorhinolaringology, Buenos Aires University and GEOG (Grupo de Estudio de Olfato y Gusto), Calle Paraguay, Piso 3. CABA (Ciudad Autónoma de Buenos Aires), Argentina
| | - Mohammed K Alwashahi
- Surgery Department, ENT Division, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Jessica Freiherr
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage, Erlangen, Germany
| | - Jasper H B de Groot
- Department of Psychology, Utrecht University, Heidelberglaan 1, CS Utrecht, The Netherlands
| | - Hadar Klein
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Masako Okamoto
- Department of Applied Biological Chemistry, The University of Tokyo, Yayoi, Bunkyo-ku, Tokyo, Japan
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Blindern, Oslo, Norway
| | - Julien W Hsieh
- Rhinology-Olfactology Unit, ENT Department, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | | | | | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Helmholtzstr., Dresden, Germany
| | - Steven D Munger
- Center for Smell and Taste, University of Florida, , Rm LG-101D, Gainesville, FL, USA.,Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - John E Hayes
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
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11
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Gerkin RC, Ohla K, Veldhuizen MG, Joseph PV, Kelly CE, Bakke AJ, Steele KE, Farruggia MC, Pellegrino R, Pepino MY, Bouysset C, Soler GM, Pereda-Loth V, Dibattista M, Cooper KW, Croijmans I, Di Pizio A, Ozdener MH, Fjaeldstad AW, Lin C, Sandell MA, Singh PB, Brindha VE, Olsson SB, Saraiva LR, Ahuja G, Alwashahi MK, Bhutani S, D’Errico A, Fornazieri MA, Golebiowski J, Dar Hwang L, Öztürk L, Roura E, Spinelli S, Whitcroft KL, Faraji F, Fischmeister FPS, Heinbockel T, Hsieh JW, Huart C, Konstantinidis I, Menini A, Morini G, Olofsson JK, Philpott CM, Pierron D, Shields VDC, Voznessenskaya VV, Albayay J, Altundag A, Bensafi M, Bock MA, Calcinoni O, Fredborg W, Laudamiel C, Lim J, Lundström JN, Macchi A, Meyer P, Moein ST, Santamaría E, Sengupta D, Rohlfs Dominguez P, Yanik H, Hummel T, Hayes JE, Reed DR, Niv MY, Munger SD, Parma V. Recent Smell Loss Is the Best Predictor of COVID-19 Among Individuals With Recent Respiratory Symptoms. Chem Senses 2021; 46:bjaa081. [PMID: 33367502 PMCID: PMC7799216 DOI: 10.1093/chemse/bjaa081] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In a preregistered, cross-sectional study, we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n = 4148) or negative (C19-; n = 546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean ± SD, C19+: -82.5 ± 27.2 points; C19-: -59.8 ± 37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC = 0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4 < OR < 10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.
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Affiliation(s)
- Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Kathrin Ohla
- Institute of Neuroscience and Medicine (INM3), Forschungszentrum Jülich, Jülich, Germany
| | | | - Paule V Joseph
- National Institute of Nursing Research, Bethesda, MD, USA
- National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
- National Institutes of Health, Bethesda, MD, USA
| | | | - Alyssa J Bakke
- Department of Food Science, The Pennsylvania State University, University Park, PA, USA
| | - Kimberley E Steele
- National Institutes of Health, Bethesda, MD, USA
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | - Robert Pellegrino
- Department of Food Science, University of Tennessee, Knoxville, TN, USA
| | - Marta Y Pepino
- Department of Food Science and Human Nutrition, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Cédric Bouysset
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d’Azur, Nice, France
| | - Graciela M Soler
- Grupo de Estudio de Olfato y Gusto (GEOG), Buenos Aires, Argentina
- Department of Otorhinolaryngology, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Michele Dibattista
- Department of Basic Medical Science, Neuroscience and Sense Organs, Università degli Studi di Bari A. Moro, Bari, Italy
| | - Keiland W Cooper
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Ilja Croijmans
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, Freising, Germany
| | | | - Alexander W Fjaeldstad
- Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Holstebro, Denmark
| | - Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Mari A Sandell
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Preet B Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - V Evelyn Brindha
- Department of Electrical and Electronics Engineering, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - Shannon B Olsson
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bengaluru, Karnataka, India
| | | | - Gaurav Ahuja
- Computational Biology, Indraprastha Institute of Information Technology, New Delhi, India
| | | | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Anna D’Errico
- Cellular and Molecular Neurobiology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Jérôme Golebiowski
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d’Azur, Nice, France
| | - Liang Dar Hwang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Lina Öztürk
- Department of Anatomy, Mersin University, Yenişehir/Mersin, Turkey
| | - Eugeni Roura
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St. Lucia, QLD, Australia
| | - Sara Spinelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Florence, Italy
| | | | - Farhoud Faraji
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, La Jolla, CA, USA
| | | | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, Washington, DC, USA
| | - Julien W Hsieh
- Department of Otorhinolaryngology, Rhinology-Olfactology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Huart
- ENT Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Anna Menini
- Neuroscience Area, SISSA, International School for Advanced Studies, Trieste, Italy
| | | | - Jonas K Olofsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Carl M Philpott
- Norwich Medical School, The Norfolk Smell & Taste Clinic, University of East Anglia, Norwich, UK
| | - Denis Pierron
- Medecine Evolutive UMR5288, University of Toulouse, Toulouse, France
| | - Vonnie D C Shields
- Biological Sciences Department, Fisher College of Science and Mathematics, Towson University, Towson, MD, USA
| | | | - Javier Albayay
- Department of General Psychology, University of Padova, Padova, Italy
| | - Aytug Altundag
- Otorhinolaryngology Department, Biruni University, Zeytinburnu/İstanbul, Turkey
| | | | - María Adelaida Bock
- Departamento de Salud Pública ORL, Hospital General Barrio Obrero, Asunción, Paraguay
| | | | - William Fredborg
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Juyun Lim
- Department of Food Science and Technology, Oregon State University, Corvallis, OR, USA
| | - Johan N Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Macchi
- ENT Department, University of Insubria Varese, ASST-Sette Laghi, Varese, Italy
- Italian Academy of Rhinology, Varese, Italy
| | - Pablo Meyer
- Health Care and Life Sciences, IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Shima T Moein
- School of Biological Sciences, Institute for Research in Fundamental Sciences, Tehran, Iran
| | | | - Debarka Sengupta
- Computational Biology, Indraprastha Institute of Information Technology, New Delhi, India
| | | | - Hüseyin Yanik
- Department of Electrical and Electronics Engineering, Mersin University, Yenişehir/Mersin, Turkey
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - John E Hayes
- Department of Food Science, The Pennsylvania State University, University Park, PA, USA
| | | | - Masha Y Niv
- The Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Steven D Munger
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
- Center for Smell and Taste, University of Florida, Gainesville, FL, USA
| | - Valentina Parma
- Department of Psychology, Temple University, Philadelphia, PA, USA
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12
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Huart C, Philpott C, Konstantinidis I, Altundag A, Whitcroft KL, Trecca EMC, Cassano M, Rombaux P, Hummel T. Comparison of COVID-19 and common cold chemosensory dysfunction. Rhinology 2020; 58:623-625. [PMID: 32812014 DOI: 10.4193/rhin20.251] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anosmia constitutes a prominent symptom of COVID-19. However, anosmia is also a common symptom of acute colds of various origins. In contrast to an acute cold, it appears from several questionnaire-based studies that in the context of COVID-19 infection, anosmia is the main rhinological symptom and is usually not associated with other rhinological symptoms such as rhinorrhoea or nasal obstruction. Until now, no study has directly compared smell and taste function between COVID-19 patients and patients with other causes of upper respiratory tract infection (URTI) using valid and reliable psychophysical tests. In this study, we aimed to objectively assess and compare olfactory and gustatory functions in 10 COVID-19 patients (PCR diagnosed, assessed on average 2 weeks after infection), 10 acute cold (AC) patients (assessed before the COVID-19 outbreak) and 10 healthy controls, matched for age and sex. Smell performance was assessed using the extended "Sniffin' Sticks" test battery (4), while taste function was assessed using "taste strips" (5). Receiver Operating Characteristic (ROC) curves were built to probe olfactory and gustatory scores in terms of their discrimination between COVID-19 and AC patients. Our results suggest that mechanisms of COVID-19 related olfactory dysfunction are different from those seen in an AC and may reflect, at least to some extent, a specific involvement at the level of central nervous system in some COVID-19 patients. In the future, studies to assess the prevalence of persistent anosmia and neuroanatomical changes on MRI correlated to chemosensory function, will be useful to understand these mechanisms.
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Affiliation(s)
- C Huart
- Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - C Philpott
- The Norfolk Smell and Taste Clinic, James Paget University Hospital, Gorleston, UK
| | - I Konstantinidis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - A Altundag
- Department of Otorhinolaryngology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - K L Whitcroft
- UCL Ear Institute, University College London, London, UK
| | - E M C Trecca
- Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy
| | - M Cassano
- Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Ph Rombaux
- Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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13
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Parma V, Ohla K, Veldhuizen MG, Niv MY, Kelly CE, Bakke AJ, Cooper KW, Bouysset C, Pirastu N, Dibattista M, Kaur R, Liuzza MT, Pepino MY, Schöpf V, Pereda-Loth V, Olsson SB, Gerkin RC, Rohlfs Domínguez P, Albayay J, Farruggia MC, Bhutani S, Fjaeldstad AW, Kumar R, Menini A, Bensafi M, Sandell M, Konstantinidis I, Di Pizio A, Genovese F, Öztürk L, Thomas-Danguin T, Frasnelli J, Boesveldt S, Saatci Ö, Saraiva LR, Lin C, Golebiowski J, Hwang LD, Ozdener MH, Guàrdia MD, Laudamiel C, Ritchie M, Havlícek J, Pierron D, Roura E, Navarro M, Nolden AA, Lim J, Whitcroft KL, Colquitt LR, Ferdenzi C, Brindha EV, Altundag A, Macchi A, Nunez-Parra A, Patel ZM, Fiorucci S, Philpott CM, Smith BC, Lundström JN, Mucignat C, Parker JK, van den Brink M, Schmuker M, Fischmeister FPS, Heinbockel T, Shields VDC, Faraji F, Santamaría E, Fredborg WEA, Morini G, Olofsson JK, Jalessi M, Karni N, D'Errico A, Alizadeh R, Pellegrino R, Meyer P, Huart C, Chen B, Soler GM, Alwashahi MK, Welge-Lüssen A, Freiherr J, de Groot JHB, Klein H, Okamoto M, Singh PB, Hsieh JW, Reed DR, Hummel T, Munger SD, Hayes JE. More Than Smell-COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis. Chem Senses 2020; 45:609-622. [PMID: 32564071 PMCID: PMC7337664 DOI: 10.1093/chemse/bjaa041] [Citation(s) in RCA: 300] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (-79.7 ± 28.7, mean ± SD), taste (-69.0 ± 32.6), and chemesthetic (-37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.
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Affiliation(s)
- Valentina Parma
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Kathrin Ohla
- Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Wilhelm-Johnen-Straße, Jülich, Germany
| | - Maria G Veldhuizen
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Masha Y Niv
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Alyssa J Bakke
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
| | - Keiland W Cooper
- Center for the Neurobiology of Learning and Memory, University of California and Qureshey Research Laboratory, Irvine, CA, USA
| | - Cédric Bouysset
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK
| | - Michele Dibattista
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, Università degli Studi di Bari A. Moro, P.zza G. Cesare, Bari, Italy
| | - Rishemjit Kaur
- CSIR-Central Scientific Instruments Organisation, Chandigarh, India
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, Italy
| | - Marta Y Pepino
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel, Vienna, Austria
| | - Veronica Pereda-Loth
- Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthese, UMR 5288 CNRS, Universitéde Toulouse, Toulouse, France
| | - Shannon B Olsson
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, GKVK Campus, Bengaluru, India
| | - Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Paloma Rohlfs Domínguez
- Department of Psychology and Anthropology, University of Extremadura, Avenida de la Universidad, s/n, Cáceres, Spain
| | - Javier Albayay
- Department of General Psychology, University of Padova, Via Venezia, Padova, Italy
| | - Michael C Farruggia
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Surabhi Bhutani
- School of Exercise and Nutritional Sciences, 5500 Campanile Drive, San Diego State University, San Diego, CA, USA
| | - Alexander W Fjaeldstad
- Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Central Denmark Region, Laegaardvej, Holstebro, Denmark
| | - Ritesh Kumar
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | - Anna Menini
- Neuroscience Area, International School for Advanced Studies, SISSA, Via Bonomea, Trieste, Italy
| | - Moustafa Bensafi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Mari Sandell
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.,Functional Foods Forum, University of Turku, Turku, Finland
| | | | - Antonella Di Pizio
- Leibniz-Institute for Food Systems Biology at the Technical University of Munich, Lise-Meitner-Str., Freising, Germany
| | | | - Lina Öztürk
- Department of Anatomy, Faculty of Medicine, Mersin University, Çiftlikköy Campus, Yenişehir, Mersin, Turkey
| | - Thierry Thomas-Danguin
- CSGA-Centre for Taste and Feeding Behavior, INRAE, CNRS, AgroSup Dijon, Université Bourgogne Franche-Comté, 17 rue Sully, Dijon, France
| | - Johannes Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, boul. des Forges, Trois-Rivières, QC, Canada
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Stippeneng, WE Wageningen, the Netherlands
| | - Özlem Saatci
- Department of Otorhinolaryngology, Medical Science University, Emek, Sancaktepe-İstanbul, Turkey
| | - Luis R Saraiva
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Sidra Medicine, Out Patient Clinic, Doha, Qatar
| | - Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Jérôme Golebiowski
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Liang-Dar Hwang
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | | | - Maria Dolors Guàrdia
- IRTA-Food Technology Programme, IRTA, Finca Camps i Armet, Monells, Girona, Spain
| | | | - Marina Ritchie
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Jan Havlícek
- Department of Zoology, Charles University, Viničná, Nové Město, Czechia
| | - Denis Pierron
- Équipe de Médecine Evolutive, UMR5288 CNRS/Université Toulouse III, faculté de chirurgie dentaire, 3 Chemin des Maraîchers, Toulouse, France
| | - Eugeni Roura
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Marta Navarro
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, St Lucia, QLD, Australia
| | - Alissa A Nolden
- Department of Food Science, University of Massachusetts, Holdsworth Way, Amherst, MA, USA
| | - Juyun Lim
- Department of Food Science and Technology, Oregon State University, Corvallis, OR, USA
| | | | | | - Camille Ferdenzi
- Neuropop Team, Lyon Neuroscience Research Center, CNRS UMR5292-INSERM U1028-University Claude Bernard Lyon 1, 95 bd Pinel, Bron, France
| | - Evelyn V Brindha
- Department of Electrical and Electronics Engineering, Karunya Institute of Technology and Sciences, Karunya Nagar, Coimbatore, Tamilnadu, India
| | - Aytug Altundag
- Otorhinolaryngology Department, Biruni University, Protokol Yolu, Topkapı, Zeytinburnu, Istanbul, Turkey
| | - Alberto Macchi
- Italian Academy of Rhinology Asst Settelaghi-University of Insubriae, via Guicciardini, Varese, Italy
| | - Alexia Nunez-Parra
- Department of Biology, Universidad de Chile, Las Palmeras, Santiago, Chile
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sébastien Fiorucci
- Institut de Chimie de Nice, UMR CNRS 7272, Université Côte d'Azur, Avenue Valrose, Nice, France
| | - Carl M Philpott
- The Norfolk Smell and Taste Clinic, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Barry C Smith
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, UK
| | - Johan N Lundström
- Monell Chemical Senses Center, Philadelphia, PA, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg, Stockholm, Sweden
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, via Marzolo, Padova, Italy
| | - Jane K Parker
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, UK
| | - Mirjam van den Brink
- Laboratory of Behavioural Gastronomy, Maastricht University Campus Venlo, Nassaustraat, BV Venlo, the Netherlands
| | - Michael Schmuker
- Biocomputation Group, Department of Computer Science, University of Hertfordshire, Hatfield, UK
| | | | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, N.W., Washington, DC, USA
| | - Vonnie D C Shields
- Biological Sciences Department, Fisher College of Science and Mathematics, Towson University, Towson, MD USA
| | - Farhoud Faraji
- Division of Otolaryngology, Head & Neck Surgery, University of California San Diego Health, MC La Jolla, CA, USA
| | - Enrique Santamaría
- Clinical Neuroproteomics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Proteored-ISCIII, Pamplona, Spain
| | - William E A Fredborg
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Gabriella Morini
- University of Gastronomic Sciences, Piazza Vittorio Emanuele II 9, Bra, Pollenzo, CN, Italy
| | - Jonas K Olofsson
- Department of Psychology, Stockholm University, Frescativägen, Stockholm, Sweden
| | - Maryam Jalessi
- Skull Base Research Center, The Five Senses Institute, Iran University of Medical Sciences, Rasoul Akram Hospital, Sattarkhan Ave., Tehran, Iran
| | - Noam Karni
- Internal Medicine Department, Hadassah Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Anna D'Errico
- Department of Molecular and Cellular Neurobiology, Goethe Universität Frankfurt, Goethe Universität Frankfurt, Max von Laue Strasse, Frankfurt am Main, Germany
| | - Rafieh Alizadeh
- ENT and Head and Neck Research Center and Department, Hazrat Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, Iran
| | - Robert Pellegrino
- Food Science Department, University of Tennessee, Knoxville, TN, USA
| | - Pablo Meyer
- Health Care and Life Sciences, IBM T. J. Watson Research Center, Yorktown Heights, NY, USA
| | - Caroline Huart
- Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, Brussels, Belgium
| | - Ben Chen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Liwan District, Guangzhou City, China
| | - Graciela M Soler
- Department of Otorhinolaringology, Buenos Aires University and GEOG (Grupo de Estudio de Olfato y Gusto), Calle Paraguay, Piso 3. CABA (Ciudad Autónoma de Buenos Aires), Argentina
| | - Mohammed K Alwashahi
- Surgery Department, ENT Division, Sultan Qaboos University Hospital, Al Khoud, Muscat, Oman
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Jessica Freiherr
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage, Erlangen, Germany
| | - Jasper H B de Groot
- Department of Psychology, Utrecht University, Heidelberglaan 1, CS Utrecht, The Netherlands
| | - Hadar Klein
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Masako Okamoto
- Department of Applied Biological Chemistry, The University of Tokyo, Yayoi, Bunkyo-ku, Tokyo, Japan
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Blindern, Oslo, Norway
| | - Julien W Hsieh
- Rhinology-Olfactology Unit, ENT Department, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | | | | | - Thomas Hummel
- Department of Otorhinolaryngology, TU Dresden, Helmholtzstr., Dresden, Germany
| | - Steven D Munger
- Center for Smell and Taste, University of Florida, , Rm LG-101D, Gainesville, FL, USA.,Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, USA
| | - John E Hayes
- Department of Food Science, The Pennsylvania State University, Erickson Food Science Building, University Park, PA, USA
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14
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Li CH, Kaura A, Tan C, Whitcroft KL, Leung TS, Andrews P. Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5:796-806. [PMID: 32904889 PMCID: PMC7461538 DOI: 10.1002/lio2.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives There is a need to develop a medical device which can accurately measure normal and abnormal nasal breathing which the patient can better understand in addition to being able to diagnose the cause for their nasal obstruction. The aim is to evaluate the accuracy of the nasal acoustic device (NAD) in diagnosing the common causes for nasal obstruction and diagnosing normal and abnormal (nasal obstruction) nasal breathing. Methods This pilot study recruited 27 patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS), and a deviated nasal septum (DNS) which represents the common causes for NO and 26 controls (with normal nasal breathing). Nasal breathing sounds were recorded by the NAD akin to two small stethoscopes placed over the left and right nasal ala. The novel outcome metrics for the NAD include inspiratory nasal acoustic score (INA) score, expiratory nasal acoustic (ENA) score and the inspiratory nasal obstruction balance index (NOBI). The change in acoustic score following decongestant is key in this diagnostic process. Results Pre‐decongestant ENA score was used to detect the presence of nasal obstruction in patients compared to controls, with a sensitivity of 0.81 (95% CI: 0.66‐0.96) and a specificity of 0.77 (0.54‐1.00). Post‐decongestant percentage change in INA score was used to identify the presence of AR or CRS, with a sensitivity of 0.87 (0.69‐1.00) and specificity of 0.72 (0.55‐0.89) for AR; and a sensitivity of 0.92 (0.75‐1.00) and specificity of 0.69 (0.52‐0.86) for CRS. Post‐decongestant inspiratory NOBI was used to identify DNS, with a sensitivity of 0.77 (0.59‐0.95) and specificity of 0.94 (0.82‐1.00). Conclusion We have demonstrated that the NAD can help distinguish between normal and abnormal nasal breathing and help diagnose AR, CRS, and DNS. Such a device has not been invented and could revolutionize COVID‐19 recovery telemedicine. Level of Evidence Diagnostic accuracy study—Level III.
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Affiliation(s)
- Chia-Hung Li
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Anika Kaura
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Calvin Tan
- Department of Medical Physics and Biomedical Engineering University College London London UK.,UCL Medical School, Faculty of Medical Sciences University College London London UK
| | - Katherine L Whitcroft
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Peter Andrews
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
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15
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Gerkin RC, Ohla K, Veldhuizen MG, Joseph PV, Kelly CE, Bakke AJ, Steele KE, Farruggia MC, Pellegrino R, Pepino MY, Bouysset C, Soler GM, Pereda-Loth V, Dibattista M, Cooper KW, Croijmans I, Di Pizio A, Ozdener MH, Fjaeldstad AW, Lin C, Sandell MA, Singh PB, Brindha VE, Olsson SB, Saraiva LR, Ahuja G, Alwashahi MK, Bhutani S, D'Errico A, Fornazieri MA, Golebiowski J, Hwang LD, Öztürk L, Roura E, Spinelli S, Whitcroft KL, Faraji F, Fischmeister FPS, Heinbockel T, Hsieh JW, Huart C, Konstantinidis I, Menini A, Morini G, Olofsson JK, Philpott CM, Pierron D, Shields VDC, Voznessenskaya VV, Albayay J, Altundag A, Bensafi M, Bock MA, Calcinoni O, Fredborg W, Laudamiel C, Lim J, Lundström JN, Macchi A, Meyer P, Moein ST, Santamaría E, Sengupta D, Domínguez PP, Yanık H, Boesveldt S, de Groot JHB, Dinnella C, Freiherr J, Laktionova T, Mariño S, Monteleone E, Nunez-Parra A, Abdulrahman O, Ritchie M, Thomas-Danguin T, Walsh-Messinger J, Al Abri R, Alizadeh R, Bignon E, Cantone E, Cecchini MP, Chen J, Guàrdia MD, Hoover KC, Karni N, Navarro M, Nolden AA, Mazal PP, Rowan NR, Sarabi-Jamab A, Archer NS, Chen B, Di Valerio EA, Feeney EL, Frasnelli J, Hannum M, Hopkins C, Klein H, Mignot C, Mucignat C, Ning Y, Ozturk EE, Peng M, Saatci O, Sell EA, Yan CH, Alfaro R, Cecchetto C, Coureaud G, Herriman RD, Justice JM, Kaushik PK, Koyama S, Overdevest JB, Pirastu N, Ramirez VA, Roberts SC, Smith BC, Cao H, Wang H, Balungwe P, Baguma M, Hummel T, Hayes JE, Reed DR, Niv MY, Munger SD, Parma V. The best COVID-19 predictor is recent smell loss: a cross-sectional study. medRxiv 2020. [PMID: 32743605 DOI: 10.1101/2020.07.22.20157263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND COVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19. METHODS This preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery. RESULTS Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ~50% of participants and was best predicted by time since illness onset. CONCLUSIONS As smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (10<OR<4), especially when viral lab tests are impractical or unavailable.
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16
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Charbel Issa P, Reuter P, Kühlewein L, Birtel J, Gliem M, Tropitzsch A, Whitcroft KL, Bolz HJ, Ishihara K, MacLaren RE, Downes SM, Oishi A, Zrenner E, Kohl S, Hummel T. Olfactory Dysfunction in Patients With CNGB1-Associated Retinitis Pigmentosa. JAMA Ophthalmol 2019; 136:761-769. [PMID: 29800053 DOI: 10.1001/jamaophthalmol.2018.1621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Co-occurrence of retinitis pigmentosa (RP) and olfactory dysfunction may have a common genetic cause. Objective To report olfactory function and the retinal phenotype in patients with biallelic mutations in CNGB1, a gene coding for a signal transduction channel subunit expressed in rod photoreceptors and olfactory sensory neurons. Design, Setting, and Participants This case series was conducted from August 2015 through July 2017. The setting was a multicenter study involving 4 tertiary referral centers for inherited retinal dystrophies. Participants were 9 patients with CNGB1-associated RP. Main Outcomes and Measures Results of olfactory testing, ocular phenotyping, and molecular genetic testing using targeted next-generation sequencing. Results Nine patients were included in the study, 3 of whom were female. Their ages ranged between 34 and 79 years. All patients had an early onset of night blindness but were usually not diagnosed as having RP before the fourth decade because of slow retinal degeneration. Retinal features were characteristic of a rod-cone dystrophy. Olfactory testing revealed reduced or absent olfactory function, with all except one patient scoring in the lowest quartile in relation to age-related norms. Brain magnetic resonance imaging and electroencephalography measurements in response to olfactory stimulation were available for 1 patient and revealed no visible olfactory bulbs and reduced responses to odor, respectively. Molecular genetic testing identified 5 novel (c.1312C>T, c.2210G>A, c.2492+1G>A, c.2763C>G, and c.3044_3050delGGAAATC) and 5 previously reported mutations in CNGB1. Conclusions and Relevance Mutations in CNGB1 may cause an autosomal recessive RP-olfactory dysfunction syndrome characterized by a slow progression of retinal degeneration and variable anosmia or hyposmia.
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Affiliation(s)
- Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Peggy Reuter
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Laura Kühlewein
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Johannes Birtel
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Martin Gliem
- Oxford Eye Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Anke Tropitzsch
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Katherine L Whitcroft
- University College London (UCL) Ear Institute and Royal National Throat, Nose and Ear Hospital, London, United Kingdom.,Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, United Kingdom.,Smell and Taste Clinic, Department of Otorhinolaryngology-Head and Neck Surgery, Technische Universität Dresden, Dresden, Germany
| | - Hanno J Bolz
- Bioscientia Center for Human Genetics, Ingelheim, Germany.,Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Robert E MacLaren
- Oxford Eye Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Susan M Downes
- Oxford Eye Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eberhart Zrenner
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Susanne Kohl
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology-Head and Neck Surgery, Technische Universität Dresden, Dresden, Germany
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17
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Affiliation(s)
- Katherine L. Whitcroft
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany
- UCL Ear Institute, University College London, London, United Kingdom
- Centre for the Study of the Senses, School of Advanced Study, Institute of Philosophy, London, United Kingdom
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany
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18
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Bogdanov V, Walliczek‐Dworschak U, Whitcroft KL, Landis BN, Hummel T. Response to Glucocorticosteroids Predicts Olfactory Outcome After ESS in Chronic Rhinosinusitis. Laryngoscope 2019; 130:1616-1621. [DOI: 10.1002/lary.28233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Vasyl Bogdanov
- Smell & Taste Clinic, Department of OtorhinolaryngologyTechnische Universität Dresden Dresden
- Klinik für Hals‐Nasen‐Ohrenkrankheiten, Kopf‐ und HalschirurgieCarl‐Thiem‐Klinium Cottbus gGmbH Cottbus Germany
- Department of OtorhinolaryngologyCRI CTMU Crimean University Clinic of the Crimean State Medical University n.a. S.I. Georgievsky Simferopol Ukraine
| | - Ute Walliczek‐Dworschak
- Smell & Taste Clinic, Department of OtorhinolaryngologyTechnische Universität Dresden Dresden
- Klinik für Hals‐Nasen und OhrenheilkundeUniversitätsklinikum Gießen und Marburg Standort Marburg
| | - Katherine L. Whitcroft
- Smell & Taste Clinic, Department of OtorhinolaryngologyTechnische Universität Dresden Dresden
- University College London (UCL) Ear Institute London United Kingdom
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced StudyUniversity of London London United Kingdom
| | - Basile N. Landis
- Smell & Taste Clinic, Department of OtorhinolaryngologyTechnische Universität Dresden Dresden
- Unité de Rhinologie‐Olfactologie, Service d'Oto‐Rhino‐Laryngologie et de Chirurgie cervico‐facialeHôpitaux Universitaires de Genève Genève Switzerland
| | - Thomas Hummel
- Smell & Taste Clinic, Department of OtorhinolaryngologyTechnische Universität Dresden Dresden
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19
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Abstract
It has been suggested that systemic pentoxifylline may be beneficial in the treatment of olfactory dysfunction. The postulated mechanism of action involves nonselective competitive phosphodiesterase inhibition, leading to increased intracellular cyclic adenosine monophosphate and consequent increased olfactory neuron activity. This should in theory lead to improved olfactory function. We describe a pilot case series from our tertiary referral center of patients treated with oral pentoxifylline for olfactory dysfunction. Six patients with post-traumatic impairment who were treated with systemic pentoxifylline were included. Patients were treated with 200 mg of oral prolonged release pentoxifylline, 3 times a day for 21 days. Olfactory function was tested pre and post-treatment for odor threshold (T), discrimination (D), identification (I) and composite 'TDI' score using a psychophysical test battery, the "Sniffin' Sticks." Oral pentoxifylline was well tolerated and all patients completed the treatment period. There was a small improvement in odor threshold and identification scores, but these did not reach statistical or clinical significance. There were deteriorations in discrimination and composite TDI score, which did not reach significance. While our case series was small, systemic pentoxifylline did not appear to be beneficial in the treatment of hyposmia in this patient group.
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Affiliation(s)
- Katherine L Whitcroft
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany.,University College London Ear Institute, London, United Kingdom.,Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, London, United Kingdom
| | - Volker Gudziol
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany
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20
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Whitcroft KL, Fischer J, Han P, Raue C, Bensafi M, Gudziol V, Andrews P, Hummel T. Structural Plasticity of the Primary and Secondary Olfactory cortices: Increased Gray Matter Volume Following Surgical Treatment for Chronic Rhinosinusitis. Neuroscience 2018; 395:22-34. [PMID: 30326289 DOI: 10.1016/j.neuroscience.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 01/19/2023]
Abstract
Functional plasticity of the adult brain is well established. Recently, the structural counterpart to such plasticity has been suggested by neuroimaging studies showing experience-dependent differences in gray matter (GM) volumes. Within the primary and secondary olfactory cortices, reduced GM volumes have been demonstrated in patients with olfactory loss. However, these cross-sectional studies do not provide causal evidence for GM volume change, and thereby structural plasticity. Disorders of the peripheral olfactory system, such as chronic rhinosinusitis (CRS), provide an ideal model to study GM structural plasticity, given that patients may experience long periods of olfactory impairment, followed by near complete recovery with treatment. We therefore performed a prospective longitudinal study in patients undergoing surgical treatment for CRS. We used voxel-based morphometry (VBM) to investigate GM volume change in 12 patients (M:F = 7:5; 47.2 ± 14.9 years), 3 months post-op. There was a significant improvement in olfactory function according to birhinal psychophysical testing. We performed a voxel-wise region of interest analysis, with significance corrected for number of regions (p < 0.0036corr). We found significantly increased post-operative GM volumes within the primary (left piriform cortex, right amygdala) and secondary (right orbitofrontal cortex, caudate nucleus, hippocampal-parahippocampal complex and bilateral temporal poles) olfactory networks, and decreased GM volumes within the secondary network only (left caudate nucleus and temporal pole, bilateral hippocampal-parahippocampal complex). As a control measure, we assessed GM change within V1, S1 and A1, where there were no suprathreshold voxels. To our knowledge, this is the first study to demonstrate GM structural plasticity within the primary and secondary olfactory cortices, following restoration of olfaction.
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Affiliation(s)
- K L Whitcroft
- Interdisciplinary Smell and Taste Lab, TU Dresden, Dresden, Germany; UCL Ear Institute, University College London, UK; Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, UK; Royal National Throat Nose and Ear Hospital, Department of Rhinology and Facial Plastic Surgery, London, UK.
| | - J Fischer
- Interdisciplinary Smell and Taste Lab, TU Dresden, Dresden, Germany
| | - P Han
- Interdisciplinary Smell and Taste Lab, TU Dresden, Dresden, Germany
| | - C Raue
- Department of Neuroradiology, TU Dresden, Dresden, Germany
| | - M Bensafi
- Department of Psychology, University of Lyon I, Lyon, France
| | - V Gudziol
- Interdisciplinary Smell and Taste Lab, TU Dresden, Dresden, Germany
| | - P Andrews
- UCL Ear Institute, University College London, UK; Royal National Throat Nose and Ear Hospital, Department of Rhinology and Facial Plastic Surgery, London, UK
| | - T Hummel
- Interdisciplinary Smell and Taste Lab, TU Dresden, Dresden, Germany
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21
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Oleszkiewicz A, Rambacher L, Whitcroft KL, Hummel T. The confounding effect of background odors on olfactory sensitivity testing. J Neurosci Methods 2018; 306:88-91. [PMID: 29782885 DOI: 10.1016/j.jneumeth.2018.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Human olfactory sensitivity is known to vary significantly across subjects. Furthermore, environmental factors such as background noise and odor are known to affect target odor threshold scores but have not yet been fully delineated. We aimed to determine whether congruent and non-congruent background odor impaired target odor threshold scores. NEW METHOD We performed odor threshold testing in 103 normosmic adults, using phenylethylalcohol (PEA) or linalool as target odors, under three conditions: (a) congruent target and background odors (e.g., PEA in the test and PEA in the background), (b) non-congruent target and background odors (e.g. PEA in the test and Linalool in the background) and (c) no background odor. Background odor was applied to the investigator's glove and testing was performed in an otherwise odorless room. RESULTS We found that congruent background odors significantly impaired target odor threshold scores. Non-congruent background odors also impaired target odor threshold, but significantly more so with PEA as target and Linalool as background odor. The best threshold scores were obtained with no background odor. Comparison with Existing Method(s). At present, many testing environments may be contaminated with ambient background odors. We have shown that this may negatively affect odor threshold scores, particularly where background and target odors are congruent. CONCLUSIONS We suggest that investigators performing odor threshold testing do so in well ventilated, odor free environments.
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Affiliation(s)
- A Oleszkiewicz
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany; University of Wroclaw, Institute of Psychology, Wroclaw, Poland.
| | - L Rambacher
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany
| | - K L Whitcroft
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany; UCL Ear Institute, University College London, London, UK; Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, London, UK; Royal National Throat Nose and Ear Hospital, University College London Hospitals, London, UK
| | - T Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Germany
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22
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehne A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2018. [PMID: 29528615 DOI: 10.4193/rhino16.248] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major
health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following:
• Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy
with small diameter endoscopes.
• Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability.
• Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour
threshold, and/or one of odour identification or discrimination.
• Comprehensive chemosensory assessment should include gustatory screening.
• Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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23
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Whitcroft KL, Cuevas M, Andrews P, Hummel T. Monitoring olfactory function in chronic rhinosinusitis and the effect of disease duration on outcome. Int Forum Allergy Rhinol 2018; 8:769-776. [DOI: 10.1002/alr.22104] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine L. Whitcroft
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
- UCL Ear Institute; London UK
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Studies; University of London; London UK
- Department of Rhinology and Facial Plastic Surgery; Royal National Throat Nose and Ear Hospital; London UK
| | - Mandy Cuevas
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
| | - Peter Andrews
- UCL Ear Institute; London UK
- Department of Rhinology and Facial Plastic Surgery; Royal National Throat Nose and Ear Hospital; London UK
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
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24
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Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehner A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A. Position paper on olfactory dysfunction. Rhinology 2017. [PMID: 28623665 DOI: 10.4193/rhin16.248] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. CONCLUSIONS We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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Affiliation(s)
- T Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - K L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - P Andrews
- UCL Ear Institute, Faculty of Brain Sciences, University College London, London, UK
| | - A Altundag
- Department of Otorhinolaryngoglogy, Istanbul Surgery Hospital, Istanbul, Turkey
| | - C Cinghi
- Department of Otolaryngology; Eskisehir Osmangazi University, Istanbul, Turkey
| | - R M Costanzo
- Smell and Taste Disorders Center, Department of Otolaryngology Head and Neck Surgery, VCU School of Medicine, Richmond, VA, USA
| | - M Damm
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center, Cologne, Germany
| | - J Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, QC, Canada
| | - H Gudziol
- Department of Otorhinolaryngology, University of Jena, Jena, Germany
| | - N Gupta
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - E Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - S C Hong
- Department of Otorhinolaryngology, Konkuk University Medical Center, Hwayang-dong, Gwangjin-gu, Seoul, South Korea
| | - D Hornung
- Dept. of Biology, St. Lawrence University, Canton, NY, USA
| | | | - R Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
| | - M Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - I Konstantinidis
- Smell and Taste Clinic, Second Academic Otorhinolaryngology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B N Landis
- Department for ENT, Head and Neck Surgery, Bern University Hospital, Bern, Switzerland
| | - D A Leopold
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - A Macchi
- ENT Clinic, University of Insubria, ASST, sette laghi, Varese, Italy
| | - T Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa, Japan
| | - R Moesges
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - J Mullol
- Rhinology Unit and Smell Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - C A Mueller
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - G Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University, Padua, Italy
| | - G C Passali
- Head and Neck section, Department of Aging, Neurosciences, Head and Neck and Orthopedic; Catholic University of Sacred heart, A. Gemelli Hospital Foundation, Rome, Italy
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - V J Ramakrishnan
- Departments of Otolaryngology and Neurosurgery, University of Colorado, Aurora, CO, USA
| | - P Rombaux
- Universite Catholique de Louvain, Institute of Neurosciences, Unit of Otorhinolaryngology, Brussels, Belgium
| | - Y Roth
- The Institute for Nose and Sinus Therapy and Clinical Investigations, Department of Otolaryngology - Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler Faculty of Medicine, Holon, Israel
| | - R A Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical Univeristy of South Carolina, Charleston, SC, USA
| | - B Shu
- Department of Otolaryngology, Taipei Veterans General Hospital, National Yang Ming University School of Medicine Faculty of Medicine, Taipei, Taiwan
| | - G Soler
- Division of Otorhinolaryngology, Area of Smell and Taste, Hospital de Clinicas, University of Buenos Aires, Buenos Aires City, Argentina
| | - P Stjärne
- Section of Rhinology, Department of Otorhinolaryngology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - B A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Germany
| | - J Vodicka
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Pardubice, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - A Welge-Luessen
- University Hospital Basel - Otorhinolaryngology, Basel, Switzerland
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Hummel T, Whitcroft KL, Rueter G, Haehner A. Intranasal vitamin A is beneficial in post-infectious olfactory loss. Eur Arch Otorhinolaryngol 2017; 274:2819-2825. [PMID: 28434127 DOI: 10.1007/s00405-017-4576-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
Vitamin A plays a decisive role in the regeneration of olfactory receptor neurons. In this retrospective study we investigated the effectiveness of topical vitamin A in patients with post-infectious and posttraumatic smell disorders. Retrospective cohort. A total of 170 patients (age range 18-70 years, mean age 52 years) participated. Forty-six patients were treated with smell training only. The remaining 124 patients received smell training and topical vitamin A. Olfactory function was assessed using the Sniffin' Sticks test kit, a validated technique to measure odor thresholds, discrimination and identification. The duration of olfactory training was 12 weeks. In patients receiving vitamin A, this was applied topically (head back position) at a dose of 10,000 IU/day for 8 weeks. Follow-up testing was performed approximately 10 months after the first assessment. Thirty-seven per cent of all post-infectious patients treated with vitamin A exhibited clinical improvement, whereas only 23% improved in controls. Using a Chi-square test, this was a significant result (χ 2 = 7.06, df = 2, p = 0.03). In addition, when comparing change in score after treatment, olfactory training + vitamin A produced significantly greater improvement compared with training alone, in discrimination score for all patients (1.4 points, p = 0.008), and in threshold and discrimination in the post-infectious group (1.6 points, p = 0.01 and 1.4 points, p = 0.04, respectively). Intranasal vitamin A at a dose of 10,000 IU per day for 2 months may be useful in the treatment of post-infectious olfactory loss. Further work with prospective, placebo-controlled studies is required to confirm these findings.
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Affiliation(s)
- Thomas Hummel
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Katherine L Whitcroft
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,UCL Ear Institute, London, UK
| | - Gina Rueter
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Han P, Whitcroft KL, Fischer J, Gerber J, Cuevas M, Andrews P, Hummel T. Olfactory brain gray matter volume reduction in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:551-556. [DOI: 10.1002/alr.21922] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/03/2017] [Accepted: 01/10/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Pengfei Han
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
- Department of Neuropediatrics; University Hospital Carl Gustav Carus; Dresden Germany
| | - Katherine L. Whitcroft
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
- UCL Ear Institute; London UK
| | - Jessica Fischer
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
| | - Johannes Gerber
- Department of Neuroradiology; Technische Universität Dresden; Dresden Germany
| | - Mandy Cuevas
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
| | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology; Technische Universität Dresden; Dresden Germany
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Whitcroft KL, Andrews PJ, Randhawa PS. Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery. Clin Otolaryngol 2017; 42:1187-1192. [PMID: 28247540 DOI: 10.1111/coa.12859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). DESIGN Prospective cohort. SETTING Royal National Throat Nose and Ear Hospital. PARTICIPANTS Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). MAIN OUTCOME MEASURES PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. RESULTS In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). CONCLUSIONS Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire.
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Affiliation(s)
- K L Whitcroft
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK.,UCL Ear Institute, London, UK
| | - P J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK.,UCL Ear Institute, London, UK
| | - P S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
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Whitcroft KL, Merkonidis C, Cuevas M, Haehner A, Philpott C, Hummel T. Intranasal sodium citrate solution improves olfaction in post-viral hyposmia. Rhinology 2017; 54:368-374. [PMID: 27316224 DOI: 10.4193/rhino16.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Calcium plays an integral role in olfactory signal transduction, including feedback inhibition. Sodium citrate acts as a calcium sequestrant and when applied intranasally, reduces free calcium available for feedback inhibition, which should theoretically improve olfaction. We aimed to investigate the utility of intranasal sodium citrate in improving the olfactory function of hyposmic patients, by performing this prospective placebo controlled, single-blind trial. METHODOLOGY Monorhinal olfactory testing for odour identification and threshold was performed in hyposmic patients using Sniffin Sticks, before and after treatment. Treatment consisted of one-off sodium citrate solution application to the olfactory cleft. Sodium chloride solution was applied to the contralateral olfactory cleft, which therefore acted as placebo control. Patients were blinded to the side of sodium citrate application, and side of treatment was randomized between patients. RESULTS 57 patients participated, aged 22-79. Causes of hyposmia included: post-viral (7); posttraumatic (10); sinonasal disease (30) and idiopathic (10). Compared with placebo, there was significant improvement in the identification scores of participants with post-viral hyposmia, following sodium citrate treatment. No significant change in olfactory function occurred for either identification or threshold in any other aetiological subgroup. CONCLUSIONS Intranasal sodium citrate may be of benefit to patients with post-viral hyposmia.
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Affiliation(s)
- K L Whitcroft
- Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany
| | - C Merkonidis
- ENT Department, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, United Kingdom
| | - M Cuevas
- Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany
| | - A Haehner
- Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - T Hummel
- Smell and Taste Clinic, Department of ORL, TU Dresden, Dresden, Germany
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Whitcroft KL, Ezzat M, Cuevas M, Andrews P, Hummel T. The effect of intranasal sodium citrate on olfaction in post-infectious loss: results from a prospective, placebo-controlled trial in 49 patients. Clin Otolaryngol 2016; 42:557-563. [PMID: 27860366 DOI: 10.1111/coa.12789] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Free calcium plays an integral role in peripheral olfactory processing, including feedback inhibition. It has therefore been suggested that reduction of intranasal free calcium with buffer solutions such as sodium citrate may improve olfactory function in patients with smell impairment. Several previous studies have supported this hypothesis, particularly in post-infectious olfactory loss. We therefore aimed to determine whether treatment with intranasal sodium citrate improves olfactory function in patients with post-infectious impairment. DESIGN Prospective, single-blind, placebo-controlled trial. SETTING Interdisciplinary Smell and Taste Clinic, TU Dresden (tertiary referral centre). PARTICIPANTS Forty-nine adult participants with post-infectious olfactory impairment (M : F = 11 : 38, mean age 58.71 ± 11.03 years). MAIN OUTCOME MEASURES Olfactory function (odour threshold and identification) before and after treatment as determined using "Sniffin' Sticks". Patients were treated monorhinally with 1 mL sodium citrate solution. The contralateral nasal cavity was treated with 1 mL physiological sodium chloride solution, which acted as internal control. Clinical improvement was assumed where threshold or identification score increased by ≥2.5 or 3 points, respectively, or ≥5.5 points together. RESULTS We demonstrated a statistically significant improvement in composite threshold + identification scores following treatment with sodium citrate, compared with placebo. This was true for all patients (mean improvement 0.87 ± 2.68 points, P = 0.04), and on subgroup analysis in those with hyposmia (mean improvement 1.15 ± 2.37 points, P = 0.02). However, the effect size did not reach clinical significance. CONCLUSIONS Further basic and clinical work is required to fully delineate the effect of intranasal sodium citrate in the treatment of post-infectious olfactory loss.
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Affiliation(s)
- K L Whitcroft
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Dresden, Germany.,Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK.,UCL Ear Institute, London, UK
| | - M Ezzat
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Dresden, Germany
| | - M Cuevas
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Dresden, Germany
| | - P Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK.,UCL Ear Institute, London, UK
| | - T Hummel
- Department of Otorhinolaryngology, Interdisciplinary Center for Smell and Taste, TU Dresden, Dresden, Germany
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Whitcroft KL, Cuevas M, Haehner A, Hummel T. Patterns of olfactory impairment reflect underlying disease etiology. Laryngoscope 2016; 127:291-295. [PMID: 27556251 DOI: 10.1002/lary.26229] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 06/20/2016] [Accepted: 07/12/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We aimed to determine whether the pattern of olfactory impairment seen in psychophysical testing reflects underlying disease etiology. STUDY DESIGN Retrospective cohort. METHODS We performed a retrospective analysis of 1,226 patients from our tertiary referral center. Only hyposmic patients with the following conditions were included: postinfectious hyposmia, posttraumatic hyposmia, hyposmia secondary to sinonasal disease, and hyposmia secondary to Parkinson disease. Patients with anosmia were excluded. RESULTS Using a repeated measures analysis of variance (within subject factor "test": threshold [T], discrimination [D], identification [I]; between subject factor: "etiology") with posthoc Bonferroni corrected t tests, we found significant interaction between the factors "test" and "etiology" (F6,2444 = 8.46, P < 0.001), indicating that different causes of hyposmia produce different patterns of olfactory loss with respect to the individual subtests T, D, and I . Specifically, patients with Parkinson disease performed relatively well in odor threshold testing, but poorly in odor identification and discrimination compared with the other etiology groups. Conversely, patients with sinonasal disease performed well in odor identification and discrimination but poorly in odor threshold. Patients with postinfectious and posttraumatic hyposmia performed relatively well in both thresholds and discrimination but poorly in identification. However, patients with posttraumatic hyposmia had globally reduced scores compared with the other groups. CONCLUSION This is the first study to comprehensively show that patterns of olfactory impairment reflect underlying disease etiology. We suggest that multicomponent olfactory testing should be performed, especially if there is diagnostic uncertainty. However, to clearly separate different patterns of olfactory loss to the various causes at an individual level, more work is needed. LEVEL OF EVIDENCE 4. Laryngoscope, 2016 127:291-295, 2017.
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Affiliation(s)
- Katherine L Whitcroft
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Mandy Cuevas
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Antje Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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Whitcroft KL, Williamson P, Odutoye T, Mathew RG. Clinical staging in laryngeal cancer: accuracy of the 0- and 30-degree Hopkins rod-lens endoscope in measuring tumour extent: an experimental study with 23 volunteers: Our Experience. Clin Otolaryngol 2014; 39:194-7. [PMID: 24801810 DOI: 10.1111/coa.12255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- K L Whitcroft
- Department of Otolaryngology, Head and Neck Surgery, St George's Hospital NHS Trust, Tooting, London, UK
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Whitcroft KL, Massouh L, Amirfeyz R, Bannister GC. A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects. J Manipulative Physiol Ther 2011; 34:119-22. [PMID: 21334544 DOI: 10.1016/j.jmpt.2010.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 11/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis. METHODS Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace. RESULTS The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks. CONCLUSION Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.
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