Severity of Anosmia as an Early Symptom of COVID-19 Infection May Predict Lasting Loss of Smell

Introduction: To evaluate the recovery rate of loss of smell (LOS) with objective olfactory testing in COVID-19 patients.Methods: Adults with confirmed COVID-19 and self-reported sudden LOS were prospectively recruited through a public call from the University of Mons (Belgium). Epidemiological and clinical data were collected using online patient-reported outcome questionnaires. Patients benefited from objective olfactory evaluation (Sniffin-Sticks-test) and were invited to attend for repeated evaluation until scores returned to normal levels.Results: From March 22 to May 22, 2020, 88 patients with sudden-onset LOS completed the evaluations. LOS developed after general symptoms in 44.6% of cases. Regarding objective evaluation, 22 patients (25.0%) recovered olfaction within 14 days following the onset of LOS. The smell function recovered between the 16th and the 70th day post-LOS in 48 patients (54.5%). At the time of final assessment at 2 months, 20.5% of patients (N = 18) had not achieved normal levels of olfactory function. Higher baseline severity of olfactory loss measured using Sniffin-Sticks was strongly predictive of persistent loss (p < 0.001).Conclusion: In the first 2 months, 79.5% of patients may expect to have complete recovery of their olfactory function. The severity of olfactory loss, as detected at the first Sniffin-Sticks-test, may predict the lack of mid-term recovery.

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Objective olfactory testing in patients presenting with sudden onset olfactory dysfunction as the first manifestation of confirmed COVID-19 infection

10.1101/2020.04.15.20066472 ◽

2020 ◽

Cited By ~ 5

Author(s):

Jerome R. Lechien ◽

Pierre Cabaraux ◽

Carlos M. Chiesa-Estomba ◽

Mohamad Khalife ◽

Jan Plzak ◽

...

Keyword(s):

Viral Load ◽

Patient Reported Outcome ◽

Sudden Onset ◽

Screening Tools ◽

Pcr Analysis ◽

Rt Pcr ◽

Olfactory Testing ◽

Patient Reported ◽

Group 2 ◽

Group 1

AbstractBackgroundThe aims of this study are to investigate the COVID-19 status of patients with initial sudden olfactory anosmia (ISOA) using nasopharyngeal swabs for RT-PCR analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation.MethodologyThis prospective study included 78 ISOA patients who fulfilled a patient-reported outcome questionnaire and underwent a nasopharyngeal swabs. Among these, 46 patients performed psychophysical olfactory evaluation using sniffing tests. Based on the duration of the ISOA, two groups of patients were compared: patients with anosmia duration ≤12 days (group 1) and those with duration >12 days (group 2).ResultsAmong group 1, 42 patients (87.5%) had a positive viral load regarding RT-PCR while 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. Among the 46 patients having performed a psychophysical olfactory evaluation, we observed anosmia in 52% (N=24), hyposmia in 24% (N=11) and normosmia in 24% (N=11) of patients. The viral load significantly decreased throughout the 14-days following the onset of the olfactory disorder.ConclusionsOur results support that a high proportion of ISOA patients are Covid+. Our study supports the need to add anosmia to the list of symptoms used in screening tools for possible COVID-19 infection.

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Office Procedures for Quantitative Assessment of Olfactory Function

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3043 ◽

2007 ◽

Vol 21 (4) ◽

pp. 460-473 ◽

Cited By ~ 93

Author(s):

Richard L. Doty

Keyword(s):

Sensory System ◽

Complete Recovery ◽

Olfactory Function ◽

Airway Patency ◽

Medical Interventions ◽

Olfactory Loss ◽

Electrophysiological Tests ◽

Olfactory Testing ◽

Nasal Disease ◽

Psychophysical Tests

Background Despite the importance of the sense of smell for establishing the flavor of foods and beverages, as well as protecting against environmental dangers, this primary sensory system is commonly ignored by the rhinologist. Methods In this article basic issues related to practical measurement of olfactory function in the clinic are described and examples of the application of the two most common paradigms for such measurement—odor identification and detection–are presented. A listing is made of the 27 olfactory tests currently used clinically, along with their strengths and weaknesses. A brief review of common nasosinus-related disorders for which quantitative olfactory testing has been performed is provided. Results Although many psychophysical tests are available for quantifying olfactory loss, it is apparent that a number are limited in terms of practicality, sensitivity, and reliability. In general, sensitivity and reliability are positively correlated with test length. Given the strengths of the more reliable forced-choice pyschophysical tests and the limitations of electrophysiological tests, the common distinction between “subjective” and “objective” tests is misleading and should not be used. Complete recovery of olfactory function, as measured quantitatively, rarely follows surgical or medical interventions in patients with rhinosinusitis. Conclusion Given the availability of practical clinical olfactory tests, the modern rhinologist can easily quantify cranial nerve (CN) I function. The application of such tests has led to a new understanding of the effects of nasal disease on olfactory function. Except in cases of total or near-total nasal obstruction, olfactory and airway patency measures usually are unrelated, in accord with the concept that rhinosinusitis primarily influences olfactory function by apoptotic pathological changes within the olfactory neuroepithelium.

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Quality of Life in Patients With Olfactory Loss Is Better Predicted by Flavor Identification Than by Orthonasal Olfactory Function

Chemical Senses ◽

10.1093/chemse/bjz027 ◽

2019 ◽

Vol 44 (6) ◽

pp. 371-377 ◽

Cited By ~ 11

Author(s):

Anna Oleszkiewicz ◽

Dahae Park ◽

Katarzyna Resler ◽

Julia Draf ◽

Anja Schulze ◽

...

Keyword(s):

Quality Of Life ◽

Predictive Value ◽

Wide Spectrum ◽

Olfactory Function ◽

Self Report ◽

Hierarchical Regression ◽

Upper Respiratory Tract ◽

Olfactory Loss ◽

Olfactory Testing

Abstract To date, most studies on the relationship between chemosensory performance and quality of life have focused on orthonasal measures of olfactory function. In the current investigation, we examined the predictive value of orthonasal and flavor identification indices of olfactory function on a wide spectrum of health and sociopsychological factors, including quality of life, life satisfaction, overall health, and depressive symptoms. Participants were 178 ENT patients (Mage = 58 ± 1), representing various causes of olfactory loss: idiopathic smell loss (n = 51; Mage = 63 ± 2), sinunasal disease (n = 27; Mage = 56 ± 3), head trauma (n = 33; Mage = 51 ± 2), and infections of the upper respiratory tract (n = 67; Mage = 59 ± 2). They completed self-report questionnaires and underwent olfactory testing using Sniffin’ Sticks (orthonasal olfactory testing) and “Taste Powder” (intraorally applied flavors for retronasal olfactory testing, additionally inducing taste sensation). Data were analyzed with hierarchical regression models wherein the first step included subjects’ sex, age, and orthonasal olfaction score. In the second step, we included the “Taste Powder” score. Tested models revealed that the first step was not significantly predicting variables of interest; however, there was an improvement of the model’s predictive value when the “Taste Powder” score was added. Results of this study suggest that flavor identification significantly improves predictions of health and sociopsychological functioning of ENT patients with various etiologies.

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Adherence and Efficacy of Olfactory Training as a Treatment for Persistent Olfactory Loss

American Journal of Rhinology and Allergy ◽

10.1177/1945892419887895 ◽

2019 ◽

Vol 34 (2) ◽

pp. 238-248 ◽

Cited By ~ 1

Author(s):

Marco Aurélio Fornazieri ◽

Ellen Cristine Duarte Garcia ◽

Natália Medeiros Dias Lopes ◽

Isabela Naomi Iha Miyazawa ◽

Gislene dos Santos Silva ◽

...

Keyword(s):

Treatment Success ◽

Olfactory Function ◽

University Of Pennsylvania ◽

Adherence Rate ◽

Olfactory Loss ◽

Emerging Therapies ◽

Spontaneous Improvement ◽

Clinically Significant ◽

The University ◽

Olfactory Training

Background Among emerging therapies, olfactory training (OT) has been proposed as a potential treatment for persistent olfactory loss. This treatment has been suggested to improve olfactory function via sensorineural modulation from repeated odor exposure. However, due to the long treatment period that is required, many patients discontinue the treatment or do not follow the treatment regimen appropriately, potentially biasing estimates of treatment success. Moreover, spontaneous improvement is known to occur without any interventions. Objectives We evaluated both the adherence rates and the efficacy of OT in patients with persistent postinfectious, posttraumatic, or idiopathic olfactory loss. Methods Prospective observational study. Twenty-five patients with persistent olfactory loss underwent OT. Protocol adherence and olfactory function (scores on the University of Pennsylvania Smell Identification Test or UPSIT) were assessed 3 and 6 months after the initiation of treatment. A minimum improvement of 5 UPSIT points was considered clinically significant and adherence throughout the study. Results The adherence rate of the patients after 3 months was 88% and after 6 months was 56%. The corresponding percentages of clinical improvement were 23.5% and 25%. There was no relation of age, sex, time of olfactory loss, race, the degree of olfactory loss, etiology, education, and type of training to the adherence rate or treatment efficacy. Conclusions In this patient population, adherence to training remained high in the first 3 months of OT but declined moderately thereafter. The observed prevalence and degree of improvement were similar to that reported a number of studies, including some studies whose patients did not receive OT.

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Psychophysical Olfactory Tests and Detection of COVID-19 in Patients With Sudden Onset Olfactory Dysfunction: A Prospective Study

Ear Nose & Throat Journal ◽

10.1177/0145561320929169 ◽

2020 ◽

Vol 99 (9) ◽

pp. 579-583 ◽

Cited By ~ 12

Author(s):

Jerome R. Lechien ◽

Pierre Cabaraux ◽

Carlos M. Chiesa-Estomba ◽

Mohamad Khalife ◽

Jan Plzak ◽

...

Keyword(s):

Viral Load ◽

Patient Reported Outcome ◽

Sudden Onset ◽

Olfactory Dysfunction ◽

Pcr Analysis ◽

Rt Pcr ◽

Patient Reported ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Objective: To investigate the coronavirus disease 2019 (COVID-19) status of patients with initial sudden olfactory anosmia (ISOA) through nasopharyngeal swabs for reverse transcription–polymerase chain reaction (RT-PCR) analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. Methods: A total of 78 ISOA patients were recruited from April 6, 2020, to April 10, 2020, through a public call of University of Mons (Mons, Belgium). Patients benefited from nasopharyngeal swabs and fulfilled the patient-reported outcome questionnaire. Among them, 46 patients performed psychophysical olfactory evaluation using olfactory identification testing. Based on the duration of the ISOA, 2 groups of patients were compared: patients with olfactory dysfunction duration ≤12 days (group 1) and those with duration >12 days (group 2). Results: In group 1, 42 patients (87.5%) had a positive viral load determined by RT-PCR and 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. The psychophysical olfactory evaluation reported that anosmia and hyposmia occurred in 24 (52%) and 11 (24%) patients, respectively. Eleven patients were normosmic. The viral load was significantly higher in patients of group 1 compared with those of group 2. Conclusions: Coronavirus disease 2019 was detected in a high proportion of ISOA patients, especially over the first 12 days of olfactory dysfunction. Anosmia is an important symptom to consider in the detection of COVID-19 infection.

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A Pilot Study of Olfactory Training in Older Hyposmic Adults

American Journal of Rhinology and Allergy ◽

10.1177/1945892419858793 ◽

2019 ◽

Vol 33 (6) ◽

pp. 650-656 ◽

Cited By ~ 3

Author(s):

Jensine M. Lamira ◽

Zachary M. Soler ◽

Rodney J. Schlosser

Keyword(s):

Well Being ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Neural Regeneration ◽

Subjective Well Being ◽

Olfactory Loss ◽

Patient Reported ◽

Baseline Factors ◽

The Impact ◽

Olfactory Training

Background Olfactory loss is a common problem that significantly impacts quality of life. Olfactory training (OT) has been used most commonly for viral and traumatic olfactory dysfunction (OD) in younger subjects with hopes of neural regeneration, improved olfactory function, and subjective well-being. The objective of this study was to investigate the impact of a novel form of OT using 12 odors in participants over 45 years of age with objective OD. Methods Twenty-nine participants underwent OT using 12 standardized odor pens for a duration of 6 months. Objective OT of Threshold, Discrimination, and Identification and patient-reported outcomes were assessed at baseline and after 6 months of OT. Results Of the 29 participants who entered the protocol, only 16 subjects completed all 6 months of OT. Significant improvements were seen in overall Threshold Discrimination Identification (TDI; mean 4.40 points, P = .007), Discrimination (mean 1.44 points, P = .019), and Identification (mean 2.02 points, P = .011). Forty-four percent of subjects who completed OT achieved a mean clinically important difference of at least 5.5 points on TDI. Conclusion There was no significant change in patient-reported outcome measures, and no baseline factors were associated with change in olfaction. In this study, OT with 12 odors improves objective olfaction in nearly half of the older adults with OD. Further investigation is necessary to determine the impact of improved olfaction on overall health outcomes.

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Abstract P1-11-11: Evaluating cosmetic outcome following breast conserving surgery in trials; panel verus objective evaluation and the role of patient reported outcome measures (PROMs)

10.1158/1538-7445.sabcs16-p1-11-11 ◽

2017 ◽

Author(s):

M Lagendijk ◽

EL Vos ◽

EML Corten ◽

C Verhoef ◽

LB Koppert

Keyword(s):

Outcome Measures ◽

Objective Evaluation ◽

Breast Conserving Surgery ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cosmetic Outcome ◽

Patient Reported

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Patient reported outcome measures in septorhinoplasty surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925059075 ◽

2015 ◽

Vol 97 (1) ◽

pp. 63-65 ◽

Cited By ~ 15

Author(s):

TC Biggs ◽

LR Fraser ◽

MJ Ward ◽

VS Sunkaraneni ◽

PG Harries ◽

...

Keyword(s):

Outcome Measures ◽

Primary Care Providers ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

University Hospital ◽

Care Providers ◽

Outcomes Evaluation ◽

Assess Patient Satisfaction ◽

Patient Reported ◽

The University

Introduction Surgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of ‘limited clinical benefit’ by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients’ perspective, are becoming increasingly important in documenting the effectiveness of such procedures. Methods The Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust. Results Overall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery. Conclusions This study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.

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Olfactory groove meningioma with a 10-year history of smell loss and olfactory recovery after surgery

BMJ Case Reports ◽

10.1136/bcr-2021-244145 ◽

2021 ◽

Vol 14 (8) ◽

pp. e244145

Author(s):

Andreas Steenholt Niklassen ◽

Rasmus Langelund Jørgensen ◽

Alexander Wieck Fjaeldstad

Keyword(s):

Psychiatric Symptoms ◽

Negative Impact ◽

Olfactory Nerve ◽

Olfactory Function ◽

Olfactory Groove ◽

Olfactory Loss ◽

Olfactory Testing ◽

History Of ◽

Olfactory Groove Meningioma ◽

Olfactory Impairment

A rare cause of olfactory impairment is olfactory groove meningiomas with insidious onset of non-specific symptoms like headache, olfactory dysfunction, psychiatric symptoms such as depression, personality changes, declining cognitive function, visual disturbances or seizures. A common complication of surgery is loss of olfactory function. Still, the preservation of olfactory function should be attempted as olfactory loss often has a severe negative impact on quality of life. This report describes a woman with an olfactory groove meningioma and a 10-year history of olfactory impairment. It includes preoperatively and postoperatively extended olfactory testing, a neurosurgical approach to preserve the olfactory function and postoperative olfactory rehabilitation. After rehabilitation, the patient regained a normal olfactory function, even though the right-sided olfactory nerve could not be preserved during surgery. The case demonstrates the importance of performing neuroimaging in selected patients with olfactory loss and a method for preserving and potentially improving postoperative olfactory function.

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