Nocturnal exposure to a preferred ambient scent does not affect dream emotionality or post-sleep core affect valence in young adults

Emotions experienced within sleep mentation (dreaming) affect mental functioning in waking life. There have been attempts at enhancing dream emotions using olfactory stimulation. Odors readily acquire affective value, but to profoundly influence emotional processing, they should bear personal significance for the perceiver rather than be generally pleasant. The main objective of the present sleep laboratory study was to examine whether prolonged nocturnal exposure to self-selected, preferred ambient room odor while asleep influences emotional aspects of sleep mentation and valence of post-sleep core affect. We asked twenty healthy participants (12 males, mean age 25 ± 4 years) to pick a commercially available scented room diffuser cartridge that most readily evoked positively valenced mental associations. In weekly intervals, the participants attended three sessions. After the adaptation visit, they were administered the odor exposure and odorless control condition in a balanced order. Participants were awakened five minutes into the first rapid eye movement (REM) stage that took place after 2:30 a.m. and, if they had been dreaming, they were asked to rate their mental sleep experience for pleasantness, emotional charge, and magnitude of positive and negative emotions and also to evaluate their post-sleep core affect valence. With rs < 0.20, no practically or statistically significant differences existed between exposure and control in any outcome measures. We conclude that in young, healthy participants, the practical value of olfactory stimulation with self-selected preferred scents for enhancement of dream emotions and post-sleep core affect valence is very limited.

An observational study of olfactory functions in total laryngectomees

OBJECTIVE

To evaluate the olfactory acuity and quality of life in patients who have undergone total laryngectomy. The study also aims to identify any specific patient-related risk factors linked to worse olfactory outcomes.

METHODS

This is a prospective cross-sectional study conducted at the University Malaya Medical Centre. A total of 30 patients who have undergone total laryngectomy were assessed objectively using the Sniffin' Sticks test and compared against normal age-matched Malaysians. Subsequently, they also filled out the modified Questionnaire on Olfactory Disorders. Correlations of patient demographics, disease and treatment variables against olfactory outcomes were conducted.

RESULTS

All subjects suffered olfactory impairment, with 66.7% of them being anosmic after total laryngectomy. The Sniffin' Sticks test demonstrated a statistically significant difference between laryngectomees and the normal age-matched Malaysian population in all three subtests for odor threshold, discrimination and identification. 37% of patients developed olfactory adaptive methods, which resulted in higher olfactory scores and a better quality of life. There were no patient demographics, disease or treatment variables associated with a poorer olfactory outcome identified.

CONCLUSION

Olfactory impairment should not be overlooked among patients after total laryngectomy. Although as many as a third of patients developed some sort of olfactory adaptive behavior, early rehabilitation should be integrated into the multidisciplinary rehabilitation program after total laryngectomy.

Early corticosteroid treatment enhances recovery from SARS-CoV-2 induced loss of smell in hamster

Among the numerous long COVID symptoms, olfactory dysfunction persists in ∼10 % of patients suffering from SARS-CoV-2 induced anosmia. Among the few potential therapies, corticoid treatment has been used for its anti-inflammatory effect with mixed success in patients. In this study, we explored its impact using hamster as an animal model. SARS-CoV-2 infected hamsters lose their smell abilities and this loss is correlated with damage of the olfactory epithelium and persistent presence of innate immunity cells. We started a dexamethasone treatment 2 days post infection, when olfaction was already impacted, until 11 days post infection when it started to recover. We observed an improvement of olfactory capacities in the animals treated with corticoid compared to those treated with vehicle. This recovery was not related to differences in the remaining damage to the olfactory epithelium, which was similar in both groups. This improvement was however correlated with a reduced inflammation in the olfactory epithelium with a local increase of the mature olfactory neuron population. Surprisingly, at 11 days post infection, we observed an increased and disorganized presence of immature olfactory neurons, especially in persistent inflammatory zones of the epithelium. This unusual population of immature olfactory neurons coincided with a strong increase of olfactory epithelium proliferation in both groups. Our results indicate that persistent inflammation of the olfactory epithelium following SARS-CoV-2 infection may alter the extent and speed of regeneration of the olfactory neuron population, and that corticoid treatment is effective to limit inflammation and improve olfaction recovery following SARS-CoV-2 infection.

Olfactory tract/bulb metal concentration in Manganese-exposed mineworkers

BACKGROUND

Manganese (Mn) is an essential micronutrient as well as a well-established neurotoxicant. Occupational and environmental exposures may bypass homeostatic regulation and lead to increased systemic Mn levels. Translocation of ultrafine ambient airborne particles via nasal neuronal pathway to olfactory bulb and tract may be an important pathway by which Mn enters the central nervous system.

OBJECTIVE

To measure olfactory tract/bulb tissue metal concentrations in Mn-exposed and non-exposed mineworkers.

METHODS

Using inductively coupled plasma-mass spectrometry (ICP-MS), we measured and compared tissue metal concentrations in unilateral olfactory tracts/bulbs of 24 Mn-exposed and 17 non-exposed South African mineworkers. We used linear regression to investigate the association between cumulative Mn exposures and olfactory tract/bulb Mn concentration.

RESULTS

The difference in mean olfactory tract/bulb Mn concentrations between Mn-exposed and non-Mn exposed mineworkers was 0.16 µg/g (95% CI -0.11, 0.42); but decreased to 0.09 µg/g (95% CI 0.004, 0.18) after exclusion of one influential observation. Olfactory tract/bulb metal concentration and cumulative Mn exposure suggested there may be a positive association; for each mg Mn/m3-year there was a 0.05 µg/g (95% CI 0.01, 0.08) greater olfactory tract/bulb Mn concentration overall, but -0.003 (95% CI -0.02, 0.02) when excluding the three influential observations. Recency of Mn exposure was not associated with olfactory tract/bulb Mn concentration.

CONCLUSIONS

Our findings suggest that Mn-exposed mineworkers might have higher olfactory tract/bulb tissue Mn concentrations than non-Mn exposed mineworkers, and that concentrations might depend more on cumulative dose than recency of exposure.

Assessment of a virtual sensory laboratory for consumer sensory evaluations

As technology advances in the field of food sciences, the sensory experience of food consumption remains complex and influenced by various factors. Traditional consumer testing, often conducted in isolated booth environments, presents challenges in terms of construct validity and user engagement for perception formation. The growing accessibility and sophistication of virtual reality (VR) technology offer a promising avenue for research. This study focuses on the assessment of a virtual sensory laboratory, seamlessly integrating traditional sensory practices into the virtual realm to explore disparities in consumer responses, especially in sensory analysis. The virtual laboratory, designed for compatibility with VR gear, closely resembles a sensory booth. The virtual environment enables the researchers to change the visual clues of the products being tested as well as the surroundings (e.g., colors, furniture, or even the environment). Additionally, the level of immersion can be enhanced by playing any type of music, if needed. One crucial question is to assess the opinions of the participants, if they feel comfortable in the created environment. Specific participant numbers are omitted, and the study engages participants. The success of this initiative could signify a substantial advance in analysis and cost savings, adding a layer of significance to the study's potential impact on optimizing research practices. The study lays the groundwork for optimal VR practices and anticipates further exploration with immersive elements to deepen our understanding of how virtual reality influences consumer behaviour in food selection compared to traditional sensory methods.

GPRC5C regulates the composition of cilia in the olfactory system

BACKGROUND

Olfactory sensory neurons detect odourants via multiple long cilia that protrude from their dendritic endings. The G protein-coupled receptor GPRC5C was identified as part of the olfactory ciliary membrane proteome, but its function and localization is unknown.

RESULTS

High-resolution confocal and electron microscopy revealed that GPRC5C is located at the base of sensory cilia in olfactory neurons, but not in primary cilia of immature neurons or stem cells. Additionally, GPRC5C localization in sensory cilia parallels cilia formation and follows the formation of the basal body. In closer examination, GPRC5C was found in the ciliary transition zone. GPRC5C deficiency altered the structure of sensory cilia and increased ciliary layer thickness. However, primary cilia were unaffected. Olfactory sensory neurons from Gprc5c-deficient mice exhibited altered localization of olfactory signalling cascade proteins, and of ciliary phosphatidylinositol-4,5-bisphosphat. Sensory neurons also exhibited increased neuronal activity as well as altered mitochondrial morphology, and knockout mice had an improved ability to detect food pellets based on smell.

CONCLUSIONS

Our study shows that GPRC5C regulates olfactory cilia composition and length, thereby controlling odour perception.

Human-derived air-liquid interface cultures decipher Alzheimer's disease-SARS-CoV-2 crosstalk in the olfactory mucosa

BACKGROUND

The neurological effects of the coronavirus disease of 2019 (COVID-19) raise concerns about potential long-term consequences, such as an increased risk of Alzheimer's disease (AD). Neuroinflammation and other AD-associated pathologies are also suggested to increase the risk of serious SARS-CoV-2 infection. Anosmia is a common neurological symptom reported in COVID-19 and in early AD. The olfactory mucosa (OM) is important for the perception of smell and a proposed site of viral entry to the brain. However, little is known about SARS-CoV-2 infection at the OM of individuals with AD.

METHODS

To address this gap, we established a 3D in vitro model of the OM from primary cells derived from cognitively healthy and AD individuals. We cultured the cells at the air-liquid interface (ALI) to study SARS-CoV-2 infection under controlled experimental conditions. Primary OM cells in ALI expressed angiotensin-converting enzyme 2 (ACE-2), neuropilin-1 (NRP-1), and several other known SARS-CoV-2 receptor and were highly vulnerable to infection. Infection was determined by secreted viral RNA content and confirmed with SARS-CoV-2 nucleocapsid protein (NP) in the infected cells by immunocytochemistry. Differential responses of healthy and AD individuals-derived OM cells to SARS-CoV-2 were determined by RNA sequencing.

RESULTS

Results indicate that cells derived from cognitively healthy donors and individuals with AD do not differ in susceptibility to infection with the wild-type SARS-CoV-2 virus. However, transcriptomic signatures in cells from individuals with AD are highly distinct. Specifically, the cells from AD patients that were infected with the virus showed increased levels of oxidative stress, desensitized inflammation and immune responses, and alterations to genes associated with olfaction. These results imply that individuals with AD may be at a greater risk of experiencing severe outcomes from the infection, potentially driven by pre-existing neuroinflammation.

CONCLUSIONS

The study sheds light on the interplay between AD pathology and SARS-CoV-2 infection. Altered transcriptomic signatures in AD cells may contribute to unique symptoms and a more severe disease course, with a notable involvement of neuroinflammation. Furthermore, the research emphasizes the need for targeted interventions to enhance outcomes for AD patients with viral infection. The study is crucial to better comprehend the relationship between AD, COVID-19, and anosmia. It highlights the importance of ongoing research to develop more effective treatments for those at high risk of severe SARS-CoV-2 infection.

Olfactory dysfunction in patients with Parkinson's disease: A systematic review and meta-analysis

Background: Parkinson's disease (PD) is a progressive neuro-degenerative disease and olfactory dysfunction is considered as an important issue in these patients. The prevalence of olfactory dysfunction in patients with PD was reported variously in previous studies. Therefore, we designed this systematic review and meta-analysis to estimate the pooled prevalence of olfactory dysfunction in patients with PD. Methods: Two expert researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the papers, and conference abstracts. The titles and abstracts of the potential studies were evaluated after deleting the duplicates. We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, mean disease duration, female/male, number with olfactory dysfunction, and name of the test. We evaluated the risk of potential bias by the Newcastle-Ottawa Quality Assessment Scale (adapted for cross-sectional studies). All statistical analyses were done using Stata software. To determine heterogeneity between the findings of included studies, inconsistency (I2) was calculated. We applied random effect model when I2 was more than 50%. P-value less than 0.05 was considered significant. Results: The literature search revealed 1546 studies; after deleting duplicates, 894 remained. Finally, twelve studies remained for meta-analysis. Studies were published between years of 2009 to 2021, the sample size of studies ranged between 30 and 2097, and the mean age ranged between 61 and 70 years. The pooled prevalence of olfactory dysfunction in patients with PD was estimated as 64% [95% confidence interval (CI): 44-84, I2 = 99.7%, P < 0.001]. The pooled prevalence of olfactory dysfunction using Sniffin's test was 67% (95% CI: 51-83) and using other tests was 60% (95% CI: 28-92). Conclusion: The results of this systematic review and meta-analysis showed that the pooled prevalence of olfactory dysfunction in patients with PD was 64% which should be considered by physicians.

Correlations between gustatory, trigeminal, and olfactory functions and nasal airflow

PURPOSE

To determine the relationship of chemosensory screening and nasal airflow tests among the same set of participants, and to determine other factors that are related to the outcomes of these tests.

METHODS

Participants had no chemosensory complaints. Structured medical history was taken. Participants underwent 5 screening tests: q-sticks (orthonasal olfaction), q-powders (retronasal olfaction), trigeminal lateralization test, taste sprays, and peak nasal inspiratory flow (PNIF). Ratings of smell/taste ability and nasal airflow were obtained using visual analogue scales (VAS). Composite sinusitis symptoms and significance of olfaction questionnaire scores were also determined.

RESULTS

Four hundred participants were included in the study, 156 men, 244 women; aged 18-82 years (mean: 46). The q-powders and taste spray scores were weakly positively correlated with all the other chemosensory tests and PNIF. However, chemosensory test scores were not correlated with VAS, composite sinusitis symptoms, and significance of olfaction questionnaire scores. Various tests showed significant decrease starting at specific ages (in years, PNIF and trigeminal lateralization: 40, q-powders: 60, and q-sticks: 70).

CONCLUSION

Chemosensory screening tests and self-rated chemosensory function showed no correlation in participants without chemosensory complaints. In addition, gustatory function appeared to be correlated with olfactory and trigeminal function but also with nasal airflow, and nasal airflow was related not only to olfactory but also to trigeminal and taste function. Over all, the results suggest that chemosensory functions (orthonasal olfactory, trigeminal, retronasal olfactory, gustatory) and nasal airflow are correlated with each other, which we propose may be possibly mediated, at least in part, through central nervous system interactions.

Sensing and avoiding sick conspecifics requires Gαi2+ vomeronasal neurons

BACKGROUND

Rodents utilize chemical cues to recognize and avoid other conspecifics infected with pathogens. Infection with pathogens and acute inflammation alter the repertoire and signature of olfactory stimuli emitted by a sick individual. These cues are recognized by healthy conspecifics via the vomeronasal or accessory olfactory system, triggering an innate form of avoidance behavior. However, the molecular identity of the sensory neurons and the higher neural circuits involved in the detection of sick conspecifics remain poorly understood.

RESULTS

We employed mice that are in an acute state of inflammation induced by systemic administration of lipopolysaccharide (LPS). Through conditional knockout of the G-protein Gαi2 and deletion of other key sensory transduction molecules (Trpc2 and a cluster of 16 vomeronasal type 1 receptors), in combination with behavioral testing, subcellular Ca²⁺ imaging, and pS6 and c-Fos neuronal activity mapping in freely behaving mice, we show that the Gαi2⁺ vomeronasal subsystem is required for the detection and avoidance of LPS-treated mice. The active components underlying this avoidance are contained in urine whereas feces extract and two selected bile acids, although detected in a Gαi2-dependent manner, failed to evoke avoidance behavior. Our analyses of dendritic Ca²⁺ responses in vomeronasal sensory neurons provide insight into the discrimination capabilities of these neurons for urine fractions from LPS-treated mice, and how this discrimination depends on Gαi2. We observed Gαi2-dependent stimulation of multiple brain areas including medial amygdala, ventromedial hypothalamus, and periaqueductal grey. We also identified the lateral habenula, a brain region implicated in negative reward prediction in aversive learning, as a previously unknown target involved in these tasks.

CONCLUSIONS

Our physiological and behavioral analyses indicate that the sensing and avoidance of LPS-treated sick conspecifics depend on the Gαi2 vomeronasal subsystem. Our observations point to a central role of brain circuits downstream of the olfactory periphery and in the lateral habenula in the detection and avoidance of sick conspecifics, providing new insights into the neural substrates and circuit logic of the sensing of inflammation in mice.

Alpha variant: a brief report

OBJECTIVES

To investigate the prevalence and the evolution of olfactory disorders (OD) related to coronavirus disease 2019 (COVID-19) in patients infected during the first and the second European waves.

METHODS

From March 2020 to October 2020, COVID-19 patients with OD were recruited and followed over the 12-month post-infection. The following data were collected: demographic, treatments, vaccination status, and olfactory function. Olfaction was assessed with the Olfactory Disorder Questionnaire (ODQ), and threshold, discrimination, and identification (TDI) test. Outcomes were compared between patients of the first wave (group 1: wild/D614G virus) and the second wave (group 2: B.1.1.7. Alpha variant) at 1-, 3- and 12-month post-infection.

RESULTS

Sixty patients completed the evaluations accounting for 33 and 27 patients in group 1 and 2, respectively. The 1-month TDI score (23.7 ± 5.3) was significantly lower in group 2 compared to group 1 (29.8 ± 8.7; p = 0.017). Proportion of normosmic patients at 1-month post-infection was significantly higher in group 1 compared to group 2 (p = 0.009). TDI scores only significantly increased from 1- to 3-month post-infection in anosmic and hyposmic patients. Focusing on There was a negative association between the 1-month ODQ and the 1-month TDI (r_s = - 0.493; p = 0.012). ODQ was a significant predictor of TDI scores at 3- and 12-month post-infection. The 12-month prevalence of parosmia was 60.6% in group 1 and 42.4% in group 2, respectively. There was no significant influence of oral corticosteroid treatment, adherence to an olfactory training and vaccination status on the olfactory outcomes.

CONCLUSIONS

Patients of the second wave (Alpha B.1.1.7. variant) reported significant higher proportion of psychophysical test abnormalities at 1-month post-infection than patients infected during the first wave (D614G virus).

Role of redox stress

BACKGROUND

Glioblastoma multiforme, described as glioblastoma, is a malignancy originating from glial progenitors in the central nervous system and is the most malignant subtype of brain tumors which attracted researcher's attention due to their high recurrence and mortality despite optimal treatments. In the study, we aimed to research whether glioblastoma-originated exosomes play a role in olfactory nerve cell toxicity.

METHODS AND RESULTS

For this aim, exosomes obtained from U373 and T98G cells were applied to olfactory nerve cell culture at distinct doses. Then, glutathione (GSH), lactate dehydrogenase (LDH), total antioxidant capacity (TAC), 3-(4,5-Dimethylthiazol-2-yl)- 2,5-diphenyltetrazolium bromide (MTT), total oxidant status (TOS) and Immunofluorescence analyzes were performed. We found that both glioblastoma-derived exosomes decreased cell viability in olfactory neurons with increasing doses. According to the obtained data, the olfactory neuron vitality rate was 71% in T98G-exosome, but the decrease in U373-exosome was more obvious (48%). In particular, the 100 µg/ml dose exacerbated oxidative stress by increasing TOS. It also increased cellular apoptosis compared to the control group due to LDH leakage. However, the results of GSH and TAS showed that antioxidant levels were significantly reduced.

CONCLUSION

In the microenvironment of olfactory neurons, GBM-derived exosomes increased oxidative stress-induced toxicity by reducing TAC and GSH levels. Therefore, glioblastoma cells by induction of exosome-based stress support malignant growth.

The proust effect: Scents, food, and nostalgia

Autobiographical memories activated by the senses, particularly smell and taste, can be among the most potent and influential, an experience labelled the Proust Effect. Contemporary research has helped to explain the physiological, neurological, and psychological reasons underlying this phenomenon. Nostalgic memories triggered by taste and smell are especially self-relevant, arousing, and familiar. These memories have an even more positive emotional profile than nostalgic memories elicited by other means, with individuals reporting lower levels of negative or ambivalent emotions. Scent-evoked and food-evoked nostalgia also confer numerous psychological benefits, including enhanced self-esteem, feelings of social connectedness, and deeper meaning in life. Such memories might be harnessed in clinical or other settings.

A modified microscopic-endoscopic bilateral transseptal approach for pituitary adenoma

BACKGROUND

Endoscopic transnasal surgery for tumors in the sellar region has become popular across the globe. However, postoperative nasal outcomes related to endoscopic transnasal surgery have yet to be described in detail.

METHOD

Here, we introduce a modified microscopic-endoscopic bilateral transseptal approach for the surgical treatment of tumors in the sellar region. This technique yielded satisfactory postoperative nasal outcomes without any loss of the visual advantages associated with endoscopy.

CONCLUSION

The modified microscopic-endoscopic bilateral transseptal approach described herein is a minimally invasive endoscopic transnasal approach and results in satisfactory postoperative outcomes in terms of nasal structure and olfactory function.

Vasopressin receptor 1a, oxytocin receptor, and oxytocin knockout male and female mice display normal perceptual abilities towards non-social odorants

Genetic knockouts of the vasopressin receptor 1a (Avpr1a), oxytocin receptor (Oxtr), or oxytocin (Oxt) gene in mice have helped cement the causal relationship between these neuropeptide systems and various social behaviors (e.g., social investigation, recognition, and communication, as well as territoriality and aggression). In mice, these social behaviors depend upon the olfactory system. Thus, it is critical to assess the olfactory capabilities of these knockout models to accurately interpret the observed differences in social behavior. Prior studies utilizing these transgenic mice have sought to test for baseline deficits in olfactory processing; predominantly through use of odor habituation/dishabituation tasks, buried food tests, or investigation assays using non-social odorants. While informative, these assays rely on the animal's intrinsic motivation and locomotor behavior to measure olfactory capabilities and thus, often yield mixed results. Instead, psychophysical analyses using operant conditioning procedures and flow-dilution olfactometry are ideally suited to precisely quantify olfactory perception. In the present study, we used these methods to assess the main olfactory capabilities of adult male and female Avpr1a, Oxtr, and Oxt transgenic mice to volatile non-social odorants. Our results indicate that homozygous and heterozygous knockout mice of all three strains have the same sensitivity and discrimination ability as their wild-type littermates. These data strongly support the hypothesis that the observed social deficits of these global knockout mice are not due to baseline deficits of their main olfactory system.

Drug-induced olfactory and gustatory dysfunction: Analysis of FDA adverse events reporting system

OBJECTIVES

With the COVID-19 pandemic, there is growing interest and research in olfactory and gustatory dysfunction (OGD). Drug-induced dysfunction is an often overlooked etiology. While several medications include smell or taste disturbance as a side effect, there are no publications describing which medications are most frequently implicated. We aim to describe the patterns of these adverse drug reactions (ADRs) using the FDA Adverse Events Reporting System (FAERS).

METHODS

The FAERS database was queried from 2011 to 2021 for terms describing ADRs related to OGD. Terms included anosmia, hyposmia, olfactory test abnormal, olfactory nerve disorder, hallucination olfactory, parosmia, ageusia, hypogeusia, dysgeusia, and taste disorder. We identified the top reported medications associated with general smell dysfunction, general taste dysfunction, reduced smell, and altered smell.

RESULTS

From 2011 to 2021, 16,091 ADRs were reported with OGD, of which13,641 (84.8%) and 2,450 (15.2%) were associated with gustatory and olfactory reactions, respectively. Zinc products (370 reports) and fluticasone propionate (214) were most commonly associated with olfactory dysfunction, specifically reduced olfaction. Varenicline (24) and fluticasone propionate (23) were most commonly associated with altered smell. Lenalidomide (490) and sunitinib (468) were most commonly associated with gustatory dysfunction. Antineoplastic and immunomodulating medications accounted for 21.6% and 36.3% of olfactory and gustatory ADRs, respectively. Among this category, immunoglobulin drugs were the most commonly associated with OGD ADRs.

CONCLUSION

Gustatory dysfunction is more commonly reported ADR compared with olfactory dysfunction. Immunologic/rheumatologic medications are the leading culprit of reported OGD. With increasing numbers of patients presenting to otolaryngologists for OGD, it is important to consider drug-induced etiology.

LEVEL OF EVIDENCE

III.

Nature, smells, and human wellbeing

The link between nature and human wellbeing is well established. However, few studies go beyond considering the visual and auditory underpinnings of this relationship, even though engaging with nature is a multisensory experience. While research linking smell to wellbeing exists, it focuses predominantly on smells as a source of nuisance/offence. Smells clearly have a prominent influence, but a significant knowledge gap remains in the nexus of nature, smell, and wellbeing. Here, we examine how smells experienced in woodlands contribute to wellbeing across four seasons. We show that smells are associated with multiple wellbeing domains, both positively and negatively. They are linked to memories, and specific ecological characteristics and processes over space/time. By making the link between the spatiotemporal variability in biodiversity and wellbeing explicit, we unearth a new line of enquiry. Overall, the multisensory experience must be considered by researchers, practitioners, policy-makers and planners looking to improve wellbeing through nature.

Pathophysiology of SARS-CoV-2 Infection of Nasal Respiratory and Olfactory Epithelia and Its Clinical Impact

PURPOSE OF REVIEW

While the predominant cause for morbidity and mortality with SARS-CoV-2 infection is the lower respiratory tract manifestations of the disease, the effects of SARS-CoV-2 infection on the sinonasal tract have also come to the forefront especially with the increased recognition of olfactory symptom. This review presents a comprehensive summary of the mechanisms of action of the SARS-CoV-2 virus, sinonasal pathophysiology of COVID-19, and the correlation with the clinical and epidemiological impact on olfactory dysfunction.

RECENT FINDINGS

ACE2 and TMPRSS2 receptors are key players in the mechanism of infection of SARS-CoV-2. They are present within both the nasal respiratory as well as olfactory epithelia. There are however differences in susceptibility between different groups of individuals, as well as between the different SARS-CoV-2 variants. The sinonasal cavity is an important route for SARS-CoV-2 infection. While the mechanism of infection of SARS-CoV-2 in nasal respiratory and olfactory epithelia is similar, there exist small but significant differences in the susceptibility of these epithelia and consequently clinical manifestations of the disease. Understanding the differences and nuances in sinonasal pathophysiology in COVID-19 would allow the clinician to predict and counsel patients suffering from COVID-19. Future research into molecular pathways and cytokine responses at different stages of infection and different variants of SARS-CoV-2 would evaluate the individual clinical phenotype, prognosis, and possibly response to vaccines and therapeutics.

Netrins and Netrin Receptors are Essential for Normal Targeting of Sensory Axons in the Zebrafish Olfactory Bulb

Olfactory sensory neurons that express related odorant receptors specifically target large identifiable neuropils called protoglomeruli when they first reach the olfactory bulb in the zebrafish. This crude odorant receptor-related mapping is further refined as odorant receptor-specific glomeruli segregate from protoglomeruli later in development. Netrins are a prominent class of axon guidance molecules whose contribution to olfactory circuit formation is poorly studied. Morpholino knock down experiments have suggested that Netrin/Dcc signaling is involved in normal protoglomerular targeting. Here we extend these findings with more detailed characterization and modeling of netrin expression, and by examining protoglomerular targeting in mutant lines fornetrin1a (ntn1a), netrin1b (ntn1b), and their receptorsunc5b,dcc, andneo1a. We confirm thatntn1a,ntn1b, anddccare required for normal protoglomerular guidance of a subset of olfactory sensory neurons that are labeled with the Tg(or111-7:IRES:Gal4) transgene. We also observe errors in the targeting of these axons inunc5bmutants, but not inneo1a mutants. Our findings are consistent with ntn1a andntn1bacting primarily as attractants for olfactory sensory neurons targeting the central zone protoglomerulus.

Primary Culture of the Human Olfactory Neuroepithelium and Utilization for Henipavirus Infection In Vitro

The olfactory receptor neurons (ORNs) are a unique cell type involved in the initial perception of odors. These specialized epithelial cells are located in the neuroepithelium of the nasal cavities and directly connect the nasal cavity with the central nervous system (CNS) via axons, which traverse the cribriform plate to synapse within the olfactory bulb. ORNs are derived from precursor cells that lie adjacent to the basal lamina of the olfactory epithelium. These precursor cells divide several times and their progeny differentiate into mature sensory neurons throughout life. In addition to its major and critical role in sensory transduction, the olfactory neuroepithelium may be an important tissue for viral replication and represents a potential site for viral entry into the CNS. In general, to gain access to the CNS, neurotropic viruses such as henipaviruses can use peripheral neural pathways or the circulatory system. However, the olfactory system has been reported to provide a portal of entry to the CNS for henipaviruses. The ability to obtain biopsies from living human subjects and culture these cells in the laboratory provides the opportunity to examine viral replication and effects on a neuronal cell population. As the most exposed and unprotected segment of the nervous system, the olfactory neuroepithelium may have an important role in neuropathology and systemic dissemination of viruses with established CNS effects. This chapter presents methods for primary culture of human ORNs, which have been used successfully by multiple investigators. The protocol provides a consistent, heterogeneous olfactory epithelial cell population, which demonstrates functional responses to odorant mixtures and exhibits several key features of the olfactory receptor neuron phenotype, encompassing olfactory receptors and signaling pathways.

Validity and reliability of a french version of the olfactory disorders questionnaire

Objective

To validate a French version of the Olfactory Disorders Questionnaire (Fr-ODQ).

Methods

Patients with olfactory disorder (OD) and controls were enrolled from two medical centers. Individuals completed the Fr-ODQ and the French version of the sinonasal outcome tool-22 (SNOT-22). The extended Sniffin'Sticks procedure was used to test odor Threshold, Discrimination, and Identification (TDI). Cronbach’s alpha was used to measure the internal consistency of Fr-ODQ. The reliability and the external validity were evaluated through a test–retest approach and by correlating Fr-ODQ and SNOT-22 scores.

Results

Eighty-nine patients with OD and 65 healthy individuals completed the evaluations. The Cronbach’s alpha was 0.827, reporting adequate internal consistency. The test–retest reliability was high (r_s = 0.944, p = 0.001). The external validity was adequate regarding the significant correlation between Fr-ODQ and SNOT-22 (r_s = 0.498; p = 0.001). Patients with OD reported a significant higher score of Fr-ODQ than healthy individuals (p < 0.001), indicating a high internal validity. The baseline Fr-ODQ significantly improved after 3-month olfactory training, which corroborated the improvement of TDI scores.

Conclusion

The Fr-ODQ is the first patient-reported outcome questionnaire validated for French speaking patients. Fr-ODQ is reliable and valid for the evaluation of the olfactory dysfunction and the related impact on quality of life of French-speaking patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40463-022-00598-2.

Nonhuman Primate Paternal Care: Species and Individual Differences in Behavior and Mechanisms

Direct care of offspring by the father (sire) is relatively rare in primates. Besides humans, there are a number of species where the male is essential for the survival of offspring: marmosets, tamarins, titis and owl monkeys, some lemurs, and siamangs. All these species show reduced sexual dimorphism, territoriality, and biparental care. However, timing and levels of direct care may vary among these species. Here, relying on both lab and field data, we address the variability found in father's involvement with his infants, the behavioral, neuroendocrine and sensory systems that are a cause and consequence of paternal care, and social bonds between the breeding pair. We integrate studies of laboratory animals (where detailed observations and experimentation are possible) with field studies (which illuminate the ecological and evolutionary functions of paternal care) and discuss the future directions for examining the proximate and ultimate mechanisms of paternal care in nonhuman primates.

Identification of differentially expressed genes based on antennae RNA-seq analyses in Culex quinquefasciatus and Culex pipiens molestus

Background

Both Culex quinquefasciatus and Cx. pipiens molestus are sibling species within Cx. pipiens complex. Even though they are hard to distinguish morphologically, they have different physiological behaviors. However, the molecular mechanisms underlying these differences remain poorly understood.

Methods

Transcriptome sequencing was conducted on antennae of two sibling species. The identification of the differentially expressed genes (DEGs) was performed by the software DESeq2. Database for Annotation, Visualization and Integrated Discovery was used to perform GO pathway enrichment analysis. The protein–protein interaction (PPI) network was constructed with Cytoscape software. The hub genes were screened by the CytoHubba plugin and Degree algorithms. The identified genes were verified by quantitative real-time PCR.

Results

Most annotated transcripts (14,687/16,005) were expressed in both sibling species. Among 15 identified odorant-related DEGs, OBP10 was expressed 17.17 fold higher in Cx. pipiens molestus than Cx. quinquefasciatus. Eighteen resistance-related DEGs were identified, including 15 from CYP gene family and three from acetylcholinesterase, in which CYP4d1 was 86.59 fold more highly expressed in C. quinquefasciatus. Three reproductive DEGs were indentified with the expression from 5.01 to 6.55 fold. Among eight vision-related DEGs, retinoic acid receptor RXR-gamma in Cx. pipiens molestus group was more expressed with 214.08 fold. Among the 30 hub genes, there are 10 olfactory-related DEGs, 16 resistance-related DEGs, and four vision-related DEGs, with the highest score hub genes being OBP lush (6041148), CYP4C21 (6044704), and Rdh12 (6043932). The RT-qPCR results were consistent with the transcriptomic data with the correlation coefficient R = 0.78.

Conclusion

The study provided clues that antennae might play special roles in reproduction, drug resistance, and vision, not only the traditional olfactory function. OBP lush, CYP4C21, and Rdh12 may be key hints to the potential molecular mechanisms behind the two sibling species' biological differences.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05482-6.

Effectiveness of olfactory training in COVID-19 patients with olfactory dysfunction: a prospective study

OBJECTIVES

To investigate effectiveness of olfactory training (OT) in COVID-19 patients with persistent olfactory dysfunction (OD).

METHODS

From March 2020 to March 2022, COVID-19 patients with OD were prospectively followed in three European medical centers for a period of 18 months. A standardized OT protocol were recommended to patients. Patient-reported outcome questionnaires and psychophysical evaluations were used to evaluate olfaction at baseline, 6, 12, and 18 months after the start of OT. The evolution of olfactory outcome was compared according to the adherence to the OT protocol.

RESULTS

Fifty-seven patients completed the evaluations. Thirty-two patients fully adhered to the OT, while 25 did not adhere. The psychophysical scores significantly improved from baseline to 6-month post-infection in both groups. In the OT group, the psychophysical scores continued to significantly improve from 6 to 12 months after the start of OT (p = 0.032). The mean duration of OT was 15.4 weeks. The mean delay of patient recovery perception was comparable between groups (27.4 weeks). The occurrence of cacosmia (35.1%) and parosmia (43.9%) throughout the follow-up period was comparable between groups. There proportion of phantosmia was higher in training (34.4%) compared with no-OT (16.0%; p = 0.007) group. The baseline Sniffin'Sticks tests was positively associated with the 6-month Sniffin'Sticks tests (r_s = 0.685; p < 0.001) and negatively associated with the time of recovery (r_s = - 0.369; p = 0.034).

CONCLUSIONS

The adherence to an OT protocol was associated with better mid-term improvement of psychophysical scores. Future large-cohort randomized-controlled studies are needed to confirm the effectiveness of OT in COVID-19 patients.

Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study

Preliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.

A Case Series of Olfactory Dysfunction in Imported COVID-19 Patients: A 12-Month Follow-Up Study

OBJECTIVE

The scientific community knows little about the long-term influence of coronavirus disease 2019 (COVID-19) on olfactory dysfunction (OD). With the COVID-19 pandemic ongoing worldwide, the risk of imported cases remains high. In China, it is necessary to understand OD in imported cases.

METHODS

A prospective follow-up design was adopted. A total of 11 self-reported patients with COVID-19 and OD from Xi'an No. 8 Hospital were followed between August 19, 2021, and December 12, 2021. Demographics, clinical characteristics, laboratory and radiological findings, and treatment outcomes were analyzed at admission. We surveyed the patients via telephone for recurrence and sequelae at the 1-, 6-, and 12-month follow-up.

RESULTS

Eleven patients with OD were enrolled; of these, 54.5% (6/11) had hyposmia and 45.5% (5/11) had anosmia. 63.6% (7/11) reported OD before or on the day of admission as their initial symptom; of these, 42.9% (3/7) described OD as the only symptom. All patients in the study received combined treatment with traditional Chinese medicine and Western medicine, and 72.7% (8/11) had partially or fully recovered at discharge. In terms of OD recovery at the 12-month follow-up, 45.5% (5/11) reported at least one sequela, 81.8% (9/11) had recovered completely, 18.2% (2/11) had recovered partially, and there were no recurrent cases.

CONCLUSIONS

Our data revealed that OD frequently presented as the initial or even the only symptom among imported cases. Most OD improvements occurred in the first 2 weeks after onset, and patients with COVID-19 and OD had favorable treatment outcomes during long-term follow-up. A better understanding of the pathogenesis and appropriate treatment of OD is needed to guide clinicians in the care of these patients.

Clinical outcomes, Kadish-INSICA staging and therapeutic targeting of somatostatin receptor 2 in olfactory neuroblastoma

INTRODUCTION

Olfactory neuroblastoma (ONB) is a rare cancer of the sinonasal region. We provide a comprehensive analysis of this malignancy with molecular and clinical trial data on a subset of our cohort to report on the potential efficacy of somatostatin receptor 2 (SSTR2)-targeting imaging and therapy.

METHODS

We conducted a retrospective analysis of 404 primary, locally recurrent, and metastatic olfactory neuroblastoma (ONB) patients from 12 institutions in the United States of America, United Kingdom and Europe. Clinicopathological characteristics and treatment approach were evaluated. SSTR2 expression, SSTR2-targeted imaging and the efficacy of peptide receptor radionuclide therapy [PRRT](177Lu-DOTATATE) were reported in a subset of our cohort (LUTHREE trial; NCT03454763).

RESULTS

Dural infiltration at presentation was a significant predictor of overall survival (OS) and disease-free survival (DFS) in primary cases (n = 278). Kadish-Morita staging and Dulguerov T-stage both had limitations regarding their prognostic value. Multivariable survival analysis demonstrated improved outcomes with lower stage and receipt of adjuvant radiotherapy. Prophylactic neck irradiation significantly reduces the rate of nodal recurrence. 82.4% of the cohort were positive for SSTR2; treatment of three metastatic cases with SSTR2-targeted peptide-radionuclide receptor therapy (PRRT) in the LUTHREE trial was well-tolerated and resulted in stable disease (SD).

CONCLUSIONS

This study presents pertinent clinical data from the largest dataset, to date, on ONB. We identify key prognostic markers and integrate these into an updated staging system, highlight the importance of adjuvant radiotherapy across all disease stages, the utility of prophylactic neck irradiation and the potential efficacy of targeting SSTR2 to manage disease.

Loss of Neuropilin2a/b or Sema3fa alters olfactory sensory axon dynamics and protoglomerular targeting

BACKGROUND

Olfactory Sensory Neuron (OSN) axons project from the zebrafish olfactory epithelium to reproducible intermediate target locations in the olfactory bulb called protoglomeruli at early stages in development. Two classes of OSNs expressing either OMP or TRPC2 exclusively target distinct, complementary protoglomeruli. Using RNAseq, we identified axon guidance receptors nrp2a and nrp2b, and their ligand sema3fa, as potential guidance factors that are differentially expressed between these two classes of OSNs.

METHODS

To investigate their role in OSN axon guidance, we assessed the protoglomerular targeting fidelity of OSNs labeled by OMP:RFP and TRPC2:Venus transgenes in nrp2a, nrp2b, or sema3fa mutants. We used double mutant and genetic interaction experiments to interrogate the relationship between the three genes. We used live time-lapse imaging to compare the dynamic behaviors of OSN growth cones during protoglomerular targeting in heterozygous and mutant larvae.

RESULTS

The fidelity of protoglomerular targeting of TRPC2-class OSNs is degraded in nrp2a, nrp2b, or sema3fa mutants, as axons misproject into OMP-specific protoglomeruli and other ectopic locations in the bulb. These misprojections are further enhanced in nrp2a;nrp2b double mutants suggesting that nrp2s work at least partially in parallel in the same guidance process. Results from genetic interaction experiments are consistent with sema3fa acting in the same biological pathway as both nrp2a and nrp2b. Live time-lapse imaging was used to examine the dynamic behavior of TRPC2-class growth cones in nrp2a mutants compared to heterozygous siblings. Some TRPC2-class growth cones ectopically enter the dorsal-medial region of the bulb in both groups, but in fully mutant embryos, they are less likely to correct the error through retraction. The same result was observed when TRPC2-class growth cone behavior was compared between sema3fa heterozygous and sema3fa mutant larvae.

CONCLUSIONS

Our results suggest that nrp2a and nrp2b expressed in TRPC2-class OSNs help prevent their mixing with axon projections in OMP-specific protoglomeruli, and further, that sema3fa helps to exclude TRPC2-class axons by repulsion from the dorsal-medial bulb.

Systematic Review of Olfactory Outcomes After Nasoseptal Flap Harvest for Endoscopic Skull Base Surgery: Does Using Cold Steel or Olfactory Strip Preservation Matter?

BACKGROUND

Several studies have described techniques aimed at mitigating olfactory dysfunction after nasoseptal flap (NSF) harvest for endoscopic skull base surgery (ESBS). No consensus exists as to whether popular methods including using cold-steel (CS) versus electrocautery (EC) or septal olfactory strip (SOS) preservation offer an advantage. This systematic review was performed to examine the impact of these two technical variations of NSF harvest on postoperative olfactory outcomes.

METHODS

Following PRISMA guidelines, Pubmed, Scopus, and Web of Science were searched for articles reporting olfactory outcomes in ESBS cases employing a NSF. Original articles focusing on technique variations of the NSF and reporting at least 1 objective olfactory measure were included.

RESULTS

Nine studies comprising 610 patients were included. Various, olfactory testing outcomes were reported, and post-op follow-up ranged from 6 weeks to 12 months. Three studies, including a randomized-controlled trial, compared the use of CS and EC for the superior incision of the NSF. No significant difference was found in objective olfactory function (p>0.05) when comparing these techniques. Five studies comprising 504 patients reported results from SOS sparing. SOS sparing technique in NSF harvest demonstrated smell preservation in the post-op setting when compared to pre-op measures (p>0.05), however, no direct comparison to non-SOS sparing techniques was made.

CONCLUSION

Use of CS as opposed to EC for the superior NSF incision does not appear to confer an advantage in preserving post-op olfactory function (grade B evidence). SOS preservation may be associated with better olfactory outcomes in NSF harvest (grade C evidence). This article is protected by copyright. All rights reserved.

Uniqueness of inspiratory airflow patterns in a realistic rat nasal cavity

In this study, we present a detailed flow analysis using an anatomically accurate rat nasal cavity model, in which the anatomy and physiology of the nasal airway was thoroughly examined. Special efforts were given to the swirling flow structures in the nasal vestibule (anterior section of the nose, lined by squamous epithelium), fractional flow patterns in the olfactory (posterior superior section of the rat nose, lined by olfactory epithelium), and a designated method to precisely quantify flow apportionment in the olfactory region was developed. Results revealed distinct inspiratory flow patterns in the anterior vestibule region, where the accelerated airflow undergoes two sharp turns as traveling through the tortuous airway, making a route in a shape of 8. Besides this, exceptionally large flow apportionment was observed at the interface of the olfactory recess, which can be as much as 15 times greater than that in the human nose. The thorough understanding of the airflow dynamics in the rat nasal cavity is necessary to avoid potential misinterpretation of rat-derived inhalation toxicity results. Research findings are expected to play a fundamental role in developing unbiased rat to human interspecies data extrapolation schemes.

Evaluation of Olfactory Function by Iranian Smell Diagnostic Test in Patients with Parkinson's disease in North of Iran

Introduction

Parkinson's disease is a neurodegenerative and multisystem disorder affecting systems more than the motor system. The olfactory disorder is an early non-motor symptom of Parkinson's disease.

Materials and Methods

The present study was conducted on 110 patients aged 50-95 years with a diagnosis of Parkinson's disease referred to the Neurology Clinic of Babol University of Medical Sciences between 2018-2019. The control group consisted of 50-95-year-old non-neurological patients who were matched for age and gender with patients with Parkinson's disease. Data were collected by examination, demographic and clinical information questionnaire (duration of disease, the severity of disease, symptom index), as well as Iranian smell diagnostic test. A p-value less than 0.05 was considered statistically significant.

Results

The mean age scores of Parkinson's disease and control groups were obtained at 69±9 and 66±9 years, respectively. The mean duration of the disease was 5 years. Patients with Parkinson's disease scored lower on the Iranian smell test, and olfactory function was significantly reduced in the case group (P<0.001). Based on the results, olfactory function in patients with Parkinson's disease was not significantly correlated with gender, marital status, education, place of residence, and occupation(P<0.05). Only olfactory dysfunction was increased with age (P=0.01). In addition, olfactory dysfunction showed no significant relationship with severity of disease, duration of disease, and clinical index sign. Rapid Iranian smell test with a cut-off of 3.5% had a sensitivity of 87.3% and a specificity of 66.4%.

Conclusion

According to the obtained results, olfactory dysfunction is an important non-motor and a primary symptom in patients with Parkinson's disease and is not related to the duration and severity of motor symptoms and symptom index.

Neuroectodermal tumours of the sino-nasal tract: a clinicopathological study of 18 cases with a newly proposed revised classification and a brief review of literature

AIM

Sino-nasal tract tumours constitute 3% of the head and neck malignancies. Among these tumours, neuroectodermal tumours are rare with histo-morphological and immunohistochemical overlap making them a challenge for the pathologist. We included Ewing's/PNET, olfactory neuroblastoma (OFN), mucosal malignant melanomas (MMM), Melanotic neuroectodermal tumour of infancy (MNTI), small-cell neuroendocrine carcinoma (SNEC), and the newest entity Adamantinoma like Ewing's sarcoma (ALES) as part of the neuroectodermally derived tumours of the sino-nasal tract. The last three entities were added to the existing ones, which also has been emphasized in this paper.

METHODS AND RESULTS

A comprehensive analysis was done on all neuroectodermally derived tumours from 2016 to 2020. A total of 18 cases were collected, which included OFN (10 cases), SNEC (2 cases), MMM (2 cases), Ewing's/PNET (2 cases), MNTI (1 case), and ALES (1 case). The most common presentation in NE tumours was nasal obstruction (80-100%). Except for OFN, all other tumours were confined to the nasal and paranasal sinuses. 4/10 cases of OFN showed orbital extension. Cervical lymph-node metastasis was seen in 50% of cases of SNEC and MMM groups. An array of relevant immune-histochemical markers were performed. The marker expression was very subtle among the groups. On follow-up, recurrence was seen in the OFN and MMM groups in 30 and 50%, respectively. Metastasis was seen in SNEC group (100%) and OFN group (10%).

CONCLUSION

As sino-nasal neuroectodermal tumours pose a diagnostic challenge and have different therapies and are prognostically different, the pathologist must be aware of the subtle morphological, immunohistochemical clues which have been dealt with in-depth in this study.

A cross-sectional study of olfactory and taste disorders among COVID-19 patients in China

To determine the prevalence and clinical features of olfactory and taste disorders among coronavirus disease 2019 (COVID-19) patients in China. A cross-sectional study was performed in Wuhan from April 3, 2020 to April 15, 2020. A total of 187 patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) completed face-to-face interviews or telephone follow-ups. We found that the prevalence of olfactory and taste disorders was significantly lower in the Chinese cohort than in foreign COVID-19 cohorts. Females were more prone to olfactory and taste disorders. In some patients, olfactory and taste disorders precede other symptoms and can be used as early screening and warning signs.

Recovery rate and factors associated with smell and taste disruption in patients with coronavirus disease 2019

Purpose

To determine the occurrence of olfactory and gustatory disruptions in COVID-19 patients, their association with demographic and clinical features and prognosis.

Material and methods

This observational cohort study involved consecutively diagnosed COVID-19 patients tested between March the 3rd 2020 and March the 24th 2020, in a geographically defined cohort area. All COVID-19 patients were evaluated in a University Hospital. The primary outcome of interest is the prevalence of smell and taste alterations, factors associated and recovery rate. Univariate and multivariate analysis by logistic regression was performed to detect factors associated to these symptoms.

Results

151 patients were included and 99 (65.6%) reported olfactory or gustatory symptoms. Olfactory dysfunction was reported by 75 patients (49.7%). Isolated anosmia was found in 2 patients (1.3%). Gustatory dysfunction was reported by 91 patients (60.3%). Factors associated with higher prevalence of smell dysfunction included age, sex, and comorbidities. The time to smell disruption development was significantly shorter in mild to moderate patients than in severe patients (p = 0.043). In 85.3% of patients with smell disruption, the symptom had been resolved in the first 2 months. 14.7% of patients remained symptomatic after 3 months of follow-up.

Conclusions

Olfactory and gustatory dysfunction was common in COVID-19 patients. Smell disruption has high recovery rate and was associated with age, sex, and clinical severity. It may be beneficial to investigate the appearance of taste and/or smell disruptions in individual patients, with respect to diagnosis and prognosis.

OdoriFy: A conglomerate of artificial intelligence-driven prediction engines for olfactory decoding

The molecular mechanisms of olfaction, or the sense of smell, are relatively underexplored compared with other sensory systems, primarily because of its underlying molecular complexity and the limited availability of dedicated predictive computational tools. Odorant receptors (ORs) allow the detection and discrimination of a myriad of odorant molecules and therefore mediate the first step of the olfactory signaling cascade. To date, odorant (or agonist) information for the majority of these receptors is still unknown, limiting our understanding of their functional relevance in odor-induced behavioral responses. In this study, we introduce OdoriFy, a Web server featuring powerful deep neural network–based prediction engines. OdoriFy enables (1) identification of odorant molecules for wildtype or mutant human ORs (Odor Finder); (2) classification of user-provided chemicals as odorants/nonodorants (Odorant Predictor); (3) identification of responsive ORs for a query odorant (OR Finder); and (4) interaction validation using Odorant–OR Pair Analysis. In addition, OdoriFy provides the rationale behind every prediction it makes by leveraging explainable artificial intelligence. This module highlights the basis of the prediction of odorants/nonodorants at atomic resolution and for the ORs at amino acid levels. A key distinguishing feature of OdoriFy is that it is built on a comprehensive repertoire of manually curated information of human ORs with their known agonists and nonagonists, making it a highly interactive and resource-enriched Web server. Moreover, comparative analysis of OdoriFy predictions with an alternative structure-based ligand interaction method revealed comparable results. OdoriFy is available freely as a web service at https://odorify.ahujalab.iiitd.edu.in/olfy/.

Presence of gustatory and olfactory dysfunction in the time of the COVID-19 pandemic

BACKGROUND

The unexpected outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused more than 49 million cases and an estimated 2,000,000 associated deaths worldwide. In Germany, there are currently more than 2,000,000 laboratory-confirmed coronavirus disease 2019 (COVID-19) cases including 51,800 deaths. However, regional differences also became apparent and with the second wave of infections, the detailed characterization of COVID-19 patients is crucial to early diagnosis and disruption of chains of infections.

METHODS

Handing out detailed questionnaires to all individuals tested for COVID-19, we evaluated the clinical characteristics of negative and positive tested individuals. Expression of symptoms, symptom duration and association between predictor variables (i.e. age, gender) and a binary outcome (olfactory and gustatory dysfunction) were assessed.

RESULTS

Overall, the most common symptoms among individuals who tested positive for SARS-CoV-2 were fatigue, headache, and cough. Olfactory and gustatory dysfunction were also reported by many SARS-CoV-2 negative individuals, more than 20% of SARS-CoV-2 negative tested individuals in our study reported olfactory and gustatory dysfunction. Independent of SARS-CoV-2 status, more females displayed symptoms of gustatory (29.8%, p = 0.0041) and olfactory dysfunction (22.9%, p = 0.0174) compared to men.

CONCLUSIONS

Bringing early SARS-CoV-2 tests to the populations at risk must be a main focus for the upcoming months. The reliability of olfactory and gustatory dysfunction in COVID-19 negative tested individuals requires deeper investigation in the future.

COVID-19 survivorship: How otolaryngologist-head and neck surgeons can restore quality of life after critical illness

Mortality from COVID-19 has obscured a subtler crisis – the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.

Is there a correlation between viral load and olfactory & taste dysfunction in COVID-19 patients?

Objectives

To evaluate the correlation between cycle threshold (Ct) value and occurrence of olfactory and taste dysfunction in COVID-19 patients.

Methods

This comparative study included COVID-19 patients diagnosed by reverse transcription- polymerase chain reaction (RT-PCR) based test at our hospital with mild to moderate disease. The demographic details and detailed clinical history of the patient, including history of loss of smell and taste was taken at the time of presentation. The patients were divided into 2 groups, group A: COVID-19 patients with OTD; group B: COVID-19 patients without OTD. 100 contiguous patients were recruited in each group. The COVID-19 test by RT-PCR was done and Ct value of the 3 genes: E (Envelope encoding) gene, N (Nucleocapsid encoding) gene, and RdRp (RNA-dependent RNA polymerase) gene, was used for data analysis. The Ct values of each of the three genes were compared between groups A and B.

Results

Group A and B did not differ significantly in terms of basic demographics. The differences in the Ct values of the 3 genes E gene, N gene and RdRp gene, of group A and B were found to be statistically significant (p = 0.005, p = 0.001 and p = 0.002, respectively).

Conclusion

The patients with OTD had a lower Ct value at diagnosis, and hence, a higher viral load than those without OTD. The evaluation of Ct value and viral load in COVID-19 patients may help in further reducing the transmission of the virus in the community.

Electrogastrography for diagnosis of early-stage Parkinson's disease

INTRODUCTION

Patients with Parkinson's disease (PD) often present with gastric symptoms. Electrogastrography (EGG) can noninvasively assess gastric electric activity and may be useful for early PD diagnosis. The present study aimed to compare the efficacy of EGG in early PD diagnosis with those of ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and odor stick identification test -Japanese version (OSIT-J).

METHODS

Thirty-seven untreated PD patients (mean age ± SD, 66 ± 8years; disease duration < 3 years) and 20 healthy control subjects (68 ± 6.9 years) were recruited. EGG and OSIT-J were performed in both groups, and MIBG scintigraphy in the PD group. EGG parameters were assessed in the preprandial and early and late postprandial segments using power spectrum analysis.

RESULTS

Irregular EGG waves were observed in PD patients. The preprandial instability coefficient of dominant frequency (ICDF), an index of EGG irregularity, in PD patients (9.5% [6.3%]) was higher than that in controls (3.9% [3.9%], p = 0.00005). The OSIT-J score was also lower in PD patients (4.6 [3.3]) than in controls (7.7 [3.3], p = 0.006). In receiver operating characteristics analyses, the areas under the curves of preprandial ICDF and OSIT-J were 0.83 and 0.72, respectively. The sensitivities of preprandial ICDF and MIBG (delayed-phase) scintigraphy were 73% and 70%, respectively.

CONCLUSIONS

Early and untreated PD patients showed irregular EGG waves and high ICDF. EGG showed better accuracy than the olfactory test for early PD diagnosis and similar sensitivity to MIBG scintigraphy.

Olfactory rehabilitation and olfactory bulb volume changes in patients after total laryngectomy: a prospective randomized study

Introduction

After total laryngectomy, decreased olfactory function and olfactory bulb volume shrinkage have been reported to occur due to olfactory deprivation caused by nasal airflow interruption. There is evidence that the olfactory system can be modulated by repeated exposure to odors in a procedure called olfactory training. However, it is not known whether any recovery of the lost olfactory bulb volume is possible by eliminating olfactory deprivation via olfactory rehabilitation long after laryngectomy.

Objective

This study examined the recovery of olfactory function and the change in olfactory bulb volume via long-term olfactory rehabilitation after total laryngectomy.

Methods

Possible causes of olfactory dysfunction in the study participants were evaluated by collecting detailed anamnesis. As olfactory tests, orthonasal butanol threshold and odor discrimination tests were performed. Three-dimensional olfactory bulb volumes were calculated using manual segmentation on T2-weighted coronal magnetic resonance images. In olfactory rehabilitation, four different odors were applied to all patients orthonasally, using a larynx bypass technique for 30 min per day for 6 months. Olfactory tests were performed before the rehabilitation and after 6 months of rehabilitation, and olfactory bulb volume measurements were performed using magnetic resonance images.

Results

Eleven patients diagnosed with advanced laryngeal cancer who underwent total laryngectomy and postoperative radiotherapy with a follow-up of 5–10 years were included in the study. All patients were male, and the mean age was 58.18 ± 4.17 years. In total laryngectomized patients, the olfactory bulb volumes measured on magnetic resonance images were 42.25 ± 12.8 mm³ before and 55.5 ± 11.22 mm³ after rehabilitation, and this increase was highly significant. Olfactory test scores were 2.3 ± 1.27 before and 4.39 ± 0.86 after rehabilitation, and this increase was also highly significant.

Conclusion

As a result of the olfactory rehabilitation applied by providing orthonasal air flow, the olfactory function lost after total laryngectomy was improved considerably, and the olfactory bulb volume was significantly increased. The increase in olfactory bulb volume in total laryngectomy patients via olfactory rehabilitation to eliminate olfactory deprivation due to nasal airflow interruption was demonstrated for the first time in this prospective longitudinal study.

Olfactory function in patients with obstructive sleep apnea and the effect of positive airway pressure treatment: a systematic review and meta-analysis

OBJECTIVES

To investigate olfactory function (OF) in patients with obstructive sleep apnea (OSA) and evaluate whether or not the use of positive airway pressure (PAP) treatment has an impact on olfactory performance.

METHODS

All studies published in English that gave satisfactory data regarding the assessment of OF in patients with OSA were included in this review. First, a baseline assessment of OF in patients with OSA who had not received any treatment was examined. Second, the effect of PAP therapy on OF was assessed to be able to make before and after comparisons. The primary outcome of this study was the threshold-discrimination identification (TDI) scores, obtained from the Sniffin' Sticks test.

RESULTS

The database search identified 552 articles. According to the exclusion criteria, 11 studies involving 557 patients diagnosed with OSA were included in this meta-analysis. The general rate of olfactory dysfunction was 73% (95% CI: 56.481-87.057) among the patients with OSA. The patients with OSA had lower TDI scores compared to the control group and the difference was statistically significant (p < 0.001). PAP treatment significantly improved the TDI scores in patients with OSA (p < 0.001). There was a significant negative correlation between the severity of apnea-hypopnea index and TDI scores (p = 0.001, z = -3.377, r = -0.438) and between age and TDI scores (p = 0.007, z = -2.695, r = -0.236).

CONCLUSION

This meta-analysis demonstrates that OSA impairs OF, while PAP treatment can reverse the olfactory performance of patients with OSA.

Predictors of Olfactory Decline in Aging: A Longitudinal Population-Based Study

BACKGROUND

Olfactory dysfunction is common in aging and associated with dementia and mortality. However, longitudinal studies tracking change in olfactory ability are scarce. We sought to identify predictors of interindividual differences in rate of olfactory identification change in aging.

METHOD

Participants were 1780 individuals, without dementia at baseline and with at least 2 olfactory assessments over 12 years of follow-up (mean age = 70.5 years; 61.9% female), from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Odor identification was assessed with the Sniffin' Sticks. We estimated the impact of demographic, health, and genetic factors on rate of olfactory change with linear mixed effect models.

RESULTS

Advancing age, manufacturing profession, history of cerebrovascular disease, higher cardiovascular disease burden, diabetes, slower walking speed, higher number of medications, and the APOE ε4 allele were associated with accelerated odor identification decline (ps < .014). Multi-adjusted analyses showed unique associations of age, diabetes, and ε4 to olfactory decline (ps < .017). In 1531 participants who remained free of dementia (DSM IV criteria) during follow-up, age, cardiovascular disease burden, and diabetes were associated with accelerated decline (ps < .011). Of these, age and diabetes remained statistically significant in the multi-adjusted model (ps < .001).

CONCLUSION

Demographic, vascular, and genetic factors are linked to rate of decline in odor identification in aging. Although some olfactory loss may be an inevitable part of aging, our results highlight the importance of vascular factors for the integrity of the olfactory system, even in the absence of dementia.

Psychic euosmia among obsessive-compulsive personality disorder patients: A case control study

BACKGROUND

Psychic euosmia (PE) has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure, order and calmness in obsessive-compulsive personality disorder (OCPD). In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity. Disgust and morality are significantly associated in people with obsessive-compulsive personality traits. We expected that OCPD patients would experience higher levels of PE.

AIM

To investigate the PE frequency in OCPD patients and healthy controls (HC) and to evaluate the relationship between PE and disgust.

METHODS

A single-center, case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders. The sample consisted of 129 subjects: 45 OCPD patients and 84 HC. In both groups we submitted the Disgust Scale Revised (DS-R) and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE. In order to verify differences between groups, t-test was employed for continuous variables and ² test for categorical variable; odds ratio was employed to analyze group differences in the PE survey. Correlation was explored with Pearson r correlations.

RESULTS

No differences were observed between groups in gender composition or education. A slight significant difference was found in mean age (t = 1.988; P = 0.049). The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC (OR: 5.3, 2.28-12.46). Patients with OCPD were more likely to report PE (n = 36; 80%) whereas a much lower proportion endorsed PE in the HC group (n = 36; 42.9%). Interestingly, no differences were observed between groups in mean score for the Disgust Scale. There was also no difference between the two groups in any of the Disgust Scale Revised subscales. Moreover, no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales.

CONCLUSION

Results suggested that PE might be part of the clinical spectrum of OCPD, and it does not reflect the counterpart of disgust. This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness. Further studies will need to be undertaken to better understand PE and its significance in OCPD.