Olfactory Dysfunction in Patients with Chronic Rhinosinusitis

Objectives. To measure the prevalence of and identify the clinical characteristics associated with olfactory decline in patients with chronic rhinosinusitis.Methods and Materials. There is analytical, prospective, and observational study in adult patients with a diagnosis of chronic rhinosinusitis. The olfactory test used was the Connecticut Chemosensory Clinical Research Center (CCCRC).Results. They are 33 patients total. Within the group of patients aged 18 to 39, 9% had normosmia, 73% hyposmia, and 18% anosmia (P<0.001). Between 40 and 64 years old, there was no patient with normosmia, 63% hyposmia, and 37% anosmia (P<0.001). Of patients older than 65 years old, 33% showed mild hyposmia, 34% severe hyposmia, and 33% anosmia (P<0.001). 52% were females, and 48% were males.Conclusion. Nasal polyposis, asthma, septal deviation, turbinate hypertrophy, tobacco, and allergic rhinitis are predicting factors of olfactory dysfunction. Antecedents of previous endoscopic surgeries, age, and gender would not be associated with olfactory loss.

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Testing olfactory dysfunction in acute and recovered COVID-19 patients: a single center study in Italy

Neurological Sciences ◽

10.1007/s10072-021-05200-7 ◽

2021 ◽

Author(s):

Jacopo Pasquini ◽

Carlo Maremmani ◽

Stefano Salvadori ◽

Vincenzo Silani ◽

Nicola Ticozzi

Keyword(s):

Acute Illness ◽

Olfactory Dysfunction ◽

Italian Population ◽

Olfactory Loss ◽

Olfactory Test ◽

Psychophysical Testing ◽

Positive Antibody ◽

Olfactory Testing ◽

High Level ◽

Acute Patients

Abstract Background Olfactory dysfunction in coronavirus disease 2019 (COVID-19) is common during acute illness and appears to last longer than other symptoms. The aim of this study was to objectively investigate olfactory dysfunction in two cohorts of patients at two different stages: during acute illness and after a median recovery of 4 months. Methods Twenty-five acutely ill patients and 26 recovered subjects were investigated. Acute patients had a molecular diagnosis of COVID-19; recovered subjects had a positive antibody assay and a negative molecular test. A 33-item psychophysical olfactory identification test tailored for the Italian population was performed. Results Median time from symptoms onset to olfactory test was 33 days in acute patients and 122 days in recovered subjects. The former scored a significantly higher number of errors at psychophysical testing (median [IQR]: 8 [13] vs 3 [2], p < 0.001) and were more frequently hyposmic (64% vs 19%, p = 0.002). Recovered subjects reported a variable time to subjective olfactory recovery, from days up to 4 months. Participants included in the study reported no significant nasal symptoms at olfactory testing. Among recovered subject who reported olfactory loss during acute COVID-19, four (27%) were still hyposmic. Demographic and clinical characteristics did not show significant associations with olfactory dysfunction. Conclusion Moderate-to-severe hospitalized patients showed a high level and frequency of olfactory dysfunction compared to recovered subjects. In the latter group, subjects who reported persisting olfactory dysfunction showed abnormal scores on psychophysical testing, indicating that, at least in some subjects, persistent hyposmia may represent a long-term sequela of COVID-19.

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Olfactory Cleft Opacification in COVID-19 Related Smell Loss: CT Findings and Correlation With Objective Testing

Ear Nose & Throat Journal ◽

10.1177/01455613211011285 ◽

2021 ◽

pp. 014556132110112

Author(s):

Erkan Yıldız ◽

Aydın Balcı ◽

Okan Selendili ◽

Selçuk Kuzu

Keyword(s):

Control Group ◽

Sudden Loss ◽

Olfactory Cleft ◽

Olfactory Loss ◽

Olfactory Test ◽

Ct Findings ◽

Clinical Research Center ◽

Significant Difference ◽

And Control ◽

The Relationship

Objectives: Besides the common symptoms of the coronavirus disease 2019 (COVID-19) including fever, shortness of breath, and cough, a “sudden loss of smell” has recently been added as a diagnostic symptom. The relationship between paranasal sinus computed tomography (PNS CT) and sudden loss of smell in COVID-19 was examined. Materials and Methods: Two groups were selected for the study, the COVID-19 and the control groups. The control group consisted of 40 patients who applied to our clinic with headache and therefore underwent PNS CT. The other group consisted of 40 patients with COVID-19 who were diagnosed with sudden loss of smell with the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. Clinical and demographic characteristics, tomography results, and olfactory test scores of patients with COVID-19 loss of smell and control group patients were recorded. The relationship between CT changes in the olfactory cleft and the degree of loss of smell was evaluated. The “Opacification in the olfactory cleft” was accepted as a positive CT finding. Results: Comparison of patients with COVID-19 who had a loss of smell and the control group indicated that a significant difference was observed in terms of CT findings ( P = .022). When we evaluated the paranasal CTs obtained from our patients with loss of smell, the CT of 13 patients showed pathological findings ( P < .05). As the COVID-19 progressed (pneumonia and respiratory failure), the degree of loss of smell increased ( P < .05). A statistically significant relationship was found between the CCCRC score and the presence of PNS CT findings ( P = .0012). Conclusion: The PNS CT findings are significant in patients with COVID-19 with a loss of smell and were significantly associated with the degree of loss of smell. In patients with olfactory loss due to COVID-19, PNS CT can help in diagnosis. However, for this imaging to be diagnostic, a larger patient series is needed.

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The Impact of Nasal Polyposis on Olfactory Dysfunction in Chronic Rhinosinusitis

Journal of Rhinology ◽

10.18787/jr.2017.24.1.31 ◽

2017 ◽

Vol 24 (1) ◽

pp. 31 ◽

Cited By ~ 1

Author(s):

Hee Chul Yoon ◽

Tae Min Kim ◽

Jae Woo Joo ◽

In Sik Song ◽

Seung-No Hong ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Olfactory Dysfunction ◽

The Impact

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Is there a close association of depression with either constipation or dysosmia in Parkinson’s disease?

Scientific Reports ◽

10.1038/s41598-020-72381-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ting-Ya Chang ◽

Yi-Huei Chen ◽

Ming-Hong Chang ◽

Ching-Heng Lin

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Close Association ◽

Cross Sectional Study ◽

Olfactory Dysfunction ◽

Cross Sectional ◽

Age And Gender ◽

Severe Constipation ◽

And Gender

Abstract A possible association between depression and either the severity of constipation or dysosmia in Parkinson’s disease (PD) patients was investigated in this cross-sectional study. One-hundred six patients who had the history of PD for less than 5 years were recruited. Depression was measured using the Beck Depression Inventory-II (BDI-II), and our patients were divided into depressive and non-depressive groups (DP: BDI-II ≥ 14; n = 22 and NDP: BDI-II < 14; n = 84). Olfactory dysfunction was assessed by the University of Pennsylvania Smell Identification Test (UPSIT). Constipation severity was defined by stool softener dosage and amount. Statistical analyses with one-tailed T- or chi-squared test, odds ratios (OR), and beta-coefficient were used to determine significant differences. Total scores based on the Unified Parkinson’s Disease Rating Scale (UPDRS) were significantly higher in the DP group. A significant relationship was observed between PD patients with depression and severe constipation; PD patients with depression were more likely to present with severe constipation (OR 5.81; 95% CI 1.24–27.29, p = 0.026, adjusted for age and gender); but the significance became marginal after adjusted for age, gender and UPDRS part 3 (OR 4.46, 95% CI 0.93–21.33; p = 0.061). However, no association between olfactory dysfunction and depression was detected. There were significant positive correlations between BDI-II scores and severe constipation (β ± SE 7.65 ± 2.02; p = < 0.001, adjusted for age and gender; β ± SE 7.06 ± 2.04; p = 0.001, adjusted for age, gender, and UPDRS-3). Besides, we detected a marginally significant correlation that PD patients with higher BDI-II scores tended to present more severe motor symptoms. Olfactory dysfunction seemed to be less relevant to BDI-II scores. Based on our findings, we speculate that depression may be more closely related to brainstem nuclei than to the limbic pathway.

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Recovery of Sense of Smell by Mepolizumab in a Patient with Chronic Rhinosinusitis and Nasal Polyposis – A Case Report

New Emirates Medical Journal ◽

10.2174/0250688202002022006 ◽

2020 ◽

Vol 01 ◽

Author(s):

Mohamed Abuzakouk ◽

Omar Ghorab ◽

Safieeldin Ghazala ◽

Anastasios Hantzakos

Keyword(s):

Chronic Rhinosinusitis ◽

Nasal Polyps ◽

Nasal Polyposis ◽

Symptom Relief ◽

Olfactory Dysfunction ◽

Topical Steroids ◽

Eosinophilic Asthma ◽

Sense Of Smell ◽

Nasal Sprays ◽

Oral Steroids

Introduction: To date, there is no permanent medical treatment for nasal polyposis and loss of sense of smell. Mepolizumab is an anti-IL-5 monoclonal antibody approved for the treatment of patients with eosinophilic asthma. It has been suggested that it is capable of improving olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyposis. Case: We present a 35-year-old Emirati male with progressively worsening rhinosinusitis, recurring nasal polyps and total loss of sense of smell. He was treated with oral steroids, normal saline nasal sprays and all available topical steroids without significant or permanent symptom relief. He was commenced on Mepolizumab, and upon receiving the 4th dose, he reported full recovery of his sense of smell. Conclusion: Mepolizumab appears to be very effective in treating loss of sense of smell. Further studies should be conducted to assess the efficacy and effectiveness of Mepolizumab in patients with chronic rhinosinusitis, nasal polyposis and anosmia.

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The Development of Glaucoma after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224456 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4456

Author(s):

Siu-Fung Chau ◽

Pei-Hsuan Wu ◽

Chi-Chin Sun ◽

Jing-Yang Huang ◽

Chan-Wei Nien ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Conditional Logistic Regression ◽

Sinus Surgery ◽

Cumulative Probability ◽

Control Group ◽

Study Group ◽

Diagnostic Code ◽

Research Database ◽

Age And Gender ◽

And Gender

This study investigates the development of glaucoma in subjects with surgery-indicated chronic rhinosinusitis (CRS) by the use of the National Health Insurance Research Database in Taiwan. Individuals that received the functional endoscopic sinus surgery (FESS) with a diagnostic code of CRS were regarded as surgery-indicated CRS and enrolled in the study group. Four non-CRS patients were age- and gender-matched to each patient in the study group. The exclusion criteria included legal blindness, ocular tumor, history of eyeball removal, and previous glaucoma. The outcome was regarded as the development of glaucoma, and conditional logistic regression was used for the statistical analysis, which involved multiple potential risk factors in the multivariate model. A total of 6506 patients with surgery-indicated CRS that received FESS and another 26,024 non-CRS individuals were enrolled after exclusion. The age and gender distributions were identical between the two groups due to matching. There were 108 and 294 glaucoma events in the study group and control group, respectively, during the follow-up period, and the study group had a significantly higher adjusted hazard ratio (1.291, 95% confidential interval: 1.031–1.615). The cumulative probability analysis also revealed a correlation between the occurrence of glaucoma and the CRS disease interval. In the subgroup analysis, the chance of developing open-angle glaucoma and normal-tension glaucoma was significantly higher in the study group than in the control group. In conclusion, the existence of surgery-indicated CRS is a significant risk factor for the development of glaucoma, which correlated with the disease interval.

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Predicting Olfactory Loss In Chronic Rhinosinusitis Using Machine Learning

Chemical Senses ◽

10.1093/chemse/bjab042 ◽

2021 ◽

Author(s):

Vijay R Ramakrishnan ◽

Jaron Arbet ◽

Jess C Mace ◽

Krithika Suresh ◽

Stephanie Shintani Smith ◽

...

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Logistic Regression ◽

Chronic Rhinosinusitis ◽

Prediction Models ◽

Predictive Analytics ◽

Olfactory Dysfunction ◽

Olfactory Loss ◽

Smell Loss

Abstract Objective Compare machine learning (ML) based predictive analytics methods to traditional logistic regression in classification of olfactory dysfunction in chronic rhinosinusitis (CRS-OD), and identify predictors within a large multi-institutional cohort of refractory CRS patients. Methods Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were assessed for baseline CRS-OD using a smell identification test (SIT) or brief SIT (bSIT). Four different ML methods were compared to traditional logistic regression for classification of CRS normosmics versus CRS-OD. Results Data were collected for 611 study participants who met inclusion criteria between April 2011 and July 2015. 34% of enrolled patients demonstrated olfactory loss on psychophysical testing. Differences between CRS normosmics and those with smell loss included objective disease measures (CT and endoscopy scores), age, sex, prior surgeries, socioeconomic status, steroid use, polyp presence, asthma, and aspirin sensitivity. Most ML methods performed favorably in terms of predictive ability. Top predictors include factors previously reported in the literature, as well as several socioeconomic factors. Conclusion Olfactory dysfunction is a variable phenomenon in CRS patients. ML methods perform well compared to traditional logistic regression in classification of normosmia versus smell loss in CRS, and are able to include numerous risk factors into prediction models. Several actionable features were identified as risk factors for CRS-OD. These results suggest that ML methods may be useful for current understanding and future study of hyposmia secondary to sinonasal disease, the most common cause of persistent olfactory loss in the general population.

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Radiological Markers of the Olfactory Cleft: Relations to Unilateral Orthonasal and Retronasal Olfactory Function

Diagnostics ◽

10.3390/diagnostics10110989 ◽

2020 ◽

Vol 10 (11) ◽

pp. 989

Author(s):

David T. Liu ◽

Ursula Schwarz-Nemec ◽

Bertold Renner ◽

Christian A. Mueller ◽

Gerold Besser

Keyword(s):

Correlation Analysis ◽

Chronic Rhinosinusitis ◽

Nasal Polyposis ◽

Olfactory Function ◽

Test Results ◽

Olfactory Cleft ◽

Olfactory Test ◽

Air Volume ◽

Function Correlation ◽

Retronasal Olfaction

The opacification of the olfactory cleft (OC) has been associated with birhinal orthonasal olfaction in patients with chronic rhinosinusitis (CRS). The aim of this study was to determine the associations between monorhinal and birhinal orthonasal, and retronasal olfaction with radiological markers of the OC in a cohort of patients with CRS. Results were analyzed in a CRS-cohort including 13 patients with nasal polyposis (CRSwNP) and 12 patients with non-eosinophilic CRS (non-eCRS). Monorhinal and birhinal orthonasal olfactory function, and OC-air volume were higher in non-eCRS compared CRSwNP. OC-opacification was also higher in CRSwNP compared to non-eCRS. In the entire CRS-cohort, those with higher OC-opacification showed significantly lower orthonasal and retronasal olfactory test results compared to those with lower OC-opacification across all three coronal planes. Similarly, higher unilateral OC-opacification was also associated with lower ipsilateral orthonasal olfactory function. Correlation analysis further revealed a positive correlation between monorhinal and birhinal orthonasal olfaction with ipsilateral and overall OC-air volume. Likewise, birhinal and monorhinal orthonasal, and retronasal olfactory test results correlated negatively with the overall and ipsilateral Lund-Mackay scores. Monorhinal and birhinal orthonasal, and retronasal olfactory function were lower in CRS patients with higher ipsilateral and overall OC-opacification compared to those with lower OC-opacification.

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Predicting Olfactory Loss In Chronic Rhinosinusitis Using Machine Learning

10.1101/2020.10.12.20210500 ◽

2020 ◽

Author(s):

Vijay R. Ramakrishnan ◽

Jaron Arbet ◽

Jess C. Mace ◽

Stephanie Shintani Smith ◽

Zachary M. Soler ◽

...

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Chronic Rhinosinusitis ◽

Prediction Models ◽

Predictive Analytics ◽

Predictive Ability ◽

Olfactory Dysfunction ◽

Olfactory Loss ◽

Smell Loss

ABSTRACTObjectiveCompare machine learning (ML) based predictive analytics methods to traditional logistic regression in classification of olfactory dysfunction in chronic rhinosinusitis (CRS-OD), and identify predictors within a large multi-institutional cohort of refractory CRS patients.MethodsAdult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were assessed for baseline CRS-OD using a smell identification test (SIT) or brief SIT (bSIT). Four different ML methods were compared to traditional logistic regression for classification of CRS normosmics versus CRS-OD.ResultsData were collected for 611 study participants who met inclusion criteria between April 2011 and July 2015. 34% of enrolled patients demonstrated olfactory loss on psychophysical testing. Differences between CRS normosmics and those with smell loss included objective disease measures (CT and endoscopy scores), age, sex, prior surgeries, socioeconomic status, steroid use, polyp presence, asthma, and aspirin sensitivity. Most ML methods outperformed traditional logistic regression in terms of predictive ability. Top predictors include factors previously reported in the literature, as well as several socioeconomic factors.ConclusionOlfactory dysfunction is a variable phenomenon in CRS patients. ML methods outperform traditional logistic regression in classification of normosmia versus smell loss in CRS, and are able to include numerous risk factors into prediction models. These results carry implications for basic science and clinical research in hyposmia secondary to sinonasal disease, the most common cause of persistent olfactory loss in the general population.

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