Long-lasting olfactory dysfunction in COVID-19 patients

Objectives Olfactory dysfunction (OD) is a common symptom of Coronavirus Disease 2019 (COVID-19). Although many patients have been reported to regain olfactory function within the first month, long-term observation reports vary. Therefore, we aimed to assess the course of chemosensory function in patients diagnosed with COVID-19 within 3–15 months after the infection. Methods One hundred and two patients (71 females and 31 males; mean age 38.8 years) diagnosed with laboratory-confirmed COVID-19 and subjective OD participated in this single-center study 111–457 days after onset of OD. Patients first performed chemosensory tests at home, followed by psychophysical testing (Sniffin’ Sticks (TDI), 27-item Candy Smell Test (CST), Taste Strips Test (TST)) in the clinic. Questionnaires regarding importance of olfaction (IOQ) and olfactory-specific quality of life (QOD) were applied at both timepoints. Results After a mean 216 days (SD 73; range 111–457) between OD onset and follow-up testing, the mean Sniffin’ Sticks (TDI) score was 27.1 points (SD 5.8; range 4.25–38.5): 4.0% were anosmic, 72.5% hyposmic, and 23.5% normosmic. At follow-up testing, 73.5% of patients reported improvement, 5.9% deterioration, and 20.6% no change in OD. Moreover, full recovery of self-perceived smell, flavor, and taste was not observed. According to questionnaires, the individual importance of smell did not change, but participants showed improvement in OD-related quality of life (p < 0.001) and had increased parosmia scores (p = 0.014) at follow-up. Conclusion Our results show that long-lasting OD after SARS-CoV-2 infection is a common symptom. The majority of patients had OD in the range of hyposmia, which was confirmed by comprehensive smell tests.

Qualitative smell/taste disorders as sequelae of acute COVID-19

Background Qualitative smell/taste disorders (such as phantosmia, parosmia, phantogeusia, and parageusia) have not yet been fully characterized in patients who had COVID-19, whereas quantitative disturbances (i.e., reduction/loss of smell/taste) have been widely investigated. Objective To simultaneously assess the presence of both quantitative and qualitative smell/taste dysfunctions in patients who suffered from COVID-19. Methods We enrolled 17 consecutive patients who suffered from COVID-19 over the last 6 months and 21 healthy controls, matched for sex and age. After a negative nasopharyngeal swab, the Sniffin’ Sticks Test and the Taste Strips were used to assess olfactory and taste function, respectively. At the same time, the presence of phantosmia, parosmia, phantogeusia, and parageusia was investigated with a standardized questionnaire. Results Qualitative disturbances of smell and/or taste were found in 6/17 (35.3%) patients. Phantosmia was reported in 2/17 (11.8%) patients and parosmia in 4/17 (23.5%). There were no significant differences in smell test scores between patients who reported phantosmia and/or parosmia and patients who did not. Phantogeusia was described in 3/17 (17.6%) patients, and parageusia was identified in 4/17 (23.5%) patients. All tested patients were normogeusic. Conclusion Around one-third of patients who recover from COVID-19 may have persistent qualitative dysfunction in smell/taste domains. Detection of phantogeusia in long-term COVID-19 patients represents a further novel finding. Further investigation is needed to better characterize the pathophysiology of phantosmia, parosmia, phantogeusia, and parageusia in patients who had COVID-19.

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

Introduction Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”. Method The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected. Results Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151. Conclusions Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score

A-74 COVID-19 and Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): Acute and Longitudinal Analysis of Anosmia and Ageusia with Delayed Sudden-Onset Neuropsychiatric Symptoms

Objective Patients with COVID-19 and PASC may exhibit chemosensory dysfunction associated with acute neuroinflammation from immune system overactivation (Uzunova, Pallanti, & Hollander, 2021). Neuropsychiatric disturbances in patients with no history of anxiety or depression have also been reported. These central nervous system manifestations of COVID-19 may be sequelae of trans-olfactory and infralimbic tract penetration (Speth et al., 2020). Methods Our case involved a 52-year-old, right-handed, American Indian female, who at three months post neuropsychological evaluation, was diagnosed with laboratory confirmed COVID-19 with onset of complete anosmia and ageusia. Two months later, a sudden-onset of panic and depression occurred with no precipitating event. All symptoms were documented daily until return of function. Results Pre-COVID-19 neuropsychological testing revealed findings consistent with ophthalmologic/vestibular migraine and ruled out dementia, and formal anxiety and depressive disorders. Post-COVID-19 neuropsychological analysis and follow-up revealed that anosmia and ageusia had largely resolved after 8-months, and that the delayed sudden-onset panic and depression also resolved within that same time period. Conclusions A paucity of data exists concerning COVID-19 and PASC anosmia and ageusia, and sudden-onset neuropsychiatric symptoms. Our case is unique since neuropsychological testing preceded the COVID-19 infection, which provided a baseline of functioning (e.g., Pocket Smell Test: 3/3 baseline and 0/3 acute COVID-19) and pre-morbid diagnostic specificity. The present case findings align with Cappali and Gatti (2021) whereby 91% of patients reported olfactory recovery, with 53% total recovery after 8-months. No other known reports simultaneously documented detailed recovery of anosmia, ageusia and delayed sudden-onset panic and depression, and COVID-19 antibody laboratory testing.

A novel capsule-based smell test fabricated via coaxial dripping

In this paper, we demonstrate that aromatic oil capsules, produced by dripping droplets, can offer a simple, yet effective, testing tool to aid in the diagnosis of various diseases, in which the loss of smell is a key symptom. These include chronic neurological conditions such as Parkinson's and Alzheimer's diseases, and acute respiratory infections such as that caused by COVID-19. The capsules were fabricated by concentrically dripping oil/alginate droplets, from a coaxial nozzle, into an oppositely charged ionic liquid. This fabrication technique enables full control over the capsule size, the shell thickness and the volume of the encapsulated oil. After formation, liquid capsules were left to dry and form a solid crust surrounding the oil. The prototype test consists of placing a standardized number of capsules between adhesive strips that users crush and pull apart to release the smell. In addition to the fabrication method, a simple mathematical model was developed to predict the volume of encapsulated oil within the capsule in terms of the flow rate ratio and the nozzle size. Tensile tests show that capsule strength is inversely proportional to its size owing to an increase in the shell thickness. By increasing the alginate concentration, the load required to rupture the capsule increases, to the point where capsules are too stiff to be broken by a fingertip grip. Results from a preliminary screening test, within a group of patients with Parkinson's disease, found that smells were detectable using a ‘forced choice’ paradigm.

Alteration in Status of Olfaction amongst COVID 19 Patients: A Descriptive Study in a Dedicated COVID Hospital of Eastern India

Introduction COVID 19 patients present with symptoms of respiratory tract infection as it is caused by SARS Cov-2 which is a β corona virus. A significant number of patients may complain of changes in olfaction either at the onset or later. The incidence, severity and recovery from anosmia/hyposmia varies in different patients. This study was done to investigate the effect of COVID 19 on olfactory dysfunction in the Indian population. Materials & Methods 100 patients admitted with RT-PCR positive reports for SARS Cov-2, in a dedicated COVID hospital in eastern India, were included in this study. Their olfactory function was estimated by pocket smell test (4 items) during ENT examination at bed side. Recovery from anosmia/hyposmia were noted during follow up visits. Results In our study 36% of patients had some alteration in smell. Out of the 36%, 12% had anosmia and 24% had hyposmia. Chances of complete recovery is more in patients suffering from anosmia than hyposmia. Conclusion Changes in smell sensation is a significant marker for screening and diagnosis of cases of COVID 19. Most of the patients recover completely.

Smell, Taste and Covid-19: Testing is Essential

During the Covid-19 pandemic is became clear that smell and taste (chemosensory) disturbance is very common in the early stages of disease. This article addresses: 1) why Covid-19 specifically targets the modalities of smell and possibly taste and what is the mechanism 2) what is the frequency of smell and taste loss and, 3) what is the overall prognosis. It is suggested that mouth breathers may be at particular risk of Covid-19. Symptom-based questionnaires are likely to under-estimate the prevalence of chemosensory impairment by as much as 50%. The prevalence of smell loss is so high that a person who has normal olfaction on formal testing is unlikely to be infected significantly with Cov-2. Furthermore, someone without symptoms who has an abnormal smell test could still be infected and liable to spread the disease. Brief, low cost, olfactory tests are available that would permit a high throughput in field stations and airports. A normal result might obviate the need for a nasopharyngeal swab for the Cov-2 virus

A COMPLEMENTARY APPROACH ON OLFACTORY DYSFUNCTION IN PARKINSONS DISEASE- RETROSPECTIVE OBSERVATIONAL STUDY

Olfactory dysfunction is a frequent non-motor symptom of Parkinson’s disease (PD) that involves deficits in odour detection, discrimination, and identification. Hyposmia may be related to neuronal degeneration with deposition of alpha-synuclein in primary olfactory areas as a very early component of the pathology of PD. Olfactory dysfunction also known as Gandhajnana or Gandhanaasha in Ayurveda is a result of improper functioning of different Vatasdue to either degeneration of Dhathus (Tissues) or obstruction in the normal movement of Vata. We analysed the smell test results within the population of Parkinsons patients admitted in Department of Neurology and Complementary medicine in Evangelical Hospital Hattingen from 2012 till 2017. Patients received the prescribed Allopathy and Ayurveda treatment for their ailments along with Ayurveda diet, Ayurveda massage and purification therapies. The primary and the only outcome measure was to assess the results of smelling sensation of the Parkinson’s patients already conducted by a Smell test with Sniffing Sticks supplied by Burghart Messtechnik. A paired t-test was conducted to compare scores obtained in smell test before and after treatment in each group separately. There was a significant difference in the scores of smell test in two groups. Results suggest that patients, treated first with Vasthi and then Ksheerabala oil Nasya showed significant improvement in the scores of smell test (t=-2.509, p= 0.017). The results of patients, treated with only Vasthi also showed significant improvement in the scores of smell test (t=-2.007, p= 0.053).