Article

Patients and experiences from the first Danish flavour clinic

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Abstract

Introduction: Chemosensory dysfunction is common. Although patients complain of taste loss, the most common cause of a diminished taste experience is olfactory dysfunction. Methods: Since January 2017, patients with complaints about smell and/or taste loss have been referred to the Flavour Clinic by ear, nose and throat (ENT) practitioners. Prior to referral, CT, endoscopy of the nasal cavity and allergy testing were required. Patients underwent full olfactory and gustatory testing, complete ENT and neurological examination and review of medicine and medical history. Patients also completed different questionnaires such as the Mini Mental Status Examination, the Sino-Nasal Outcome Test and the Major Depression Inventory. Results: Among 515 patients, 97% complained of olfactory loss and 82% complained of taste loss. While 89% had a measurable olfactory deficit, only 22% were found to have a gustatory deficit. Conclusions: An accurate distinction between smell and taste requires application of validated chemosensory tests and specialised knowledge. As this is not readily available in all ENT clinics, sensory loss without a clear aetiology should be referred to a more specialisedcentre. Funding: none. Trial registration: not relevant.

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... There was no statistically significant difference in the number of days to improvement/recovery for neither olfaction nor gustation between RT-PCR-confirmed cases and non-RT-PCRconfirmed participants. Furthermore, the average age of patients with smell loss in this cohort (mean 43.0 years) does not differ between RT-PCR status but is substantially lower than the normal age span for Danish patients previously seen with olfactory loss (median 57 years) [24]. ...
... This holds the inherent risk of over-or underestimating the prevalence and duration of CD due to recall bias as well as misinterpretation of symptoms. Many cases of subjective ageusia cannot be substantiated by validated testing, which is most probably caused by people mistaking a loss of retronasal olfaction for ageusia [24]. However, 1 study showed by means of objective testing that dysgeusia can occur in COVID-19 patients independently of dysosmia and should therefore not be neglected, although the subjective prevalence and duration probably are overestimated by most studies [25]. ...
... However, 1 study showed by means of objective testing that dysgeusia can occur in COVID-19 patients independently of dysosmia and should therefore not be neglected, although the subjective prevalence and duration probably are overestimated by most studies [25]. Subjective assessment of olfaction has been shown to predict abnormal olfactory function in COVID-19 patients [26] and generally correlates well with objective testing in anosmic patients [24]. ...
Article
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Introduction: Chemosensory dysfunction (CD) has proven valuable in prediction of COVID-19, as it is a frequent and specific symptom of the disease. The aim of this study was to investigate the duration of CD in patients with sudden subjective olfactory and/or gustatory loss during the SARS-CoV-2 pandemic. The secondary aim was to identify possible prognostic factors for the duration of CD. Methods: An online baseline questionnaire was designed to assess subjective CD. Three rounds of follow-up questionnaires were sent out to any participants with persistent CD in 6-week intervals, prospectively assessing subjective chemosensory function and extending the follow-up time of this cohort significantly. Results: In total, 467 participants completed the baseline questionnaire. The most significant improvement and recovery of chemosensory function was observed within the first month after the initial loss. Rates became stagnant after about 2 months, and only little improvement and recovery was seen after 2-4 months. After a mean follow-up of 95.9 days (olfactory dysfunction) and 94.0 days (gustatory dysfunction), 86.7% of participants reported gustatory improvement and 82.6% reported olfactory improvement, while 55.0% reported full gustatory recovery and 43.8% reported full olfactory recovery. Female gender was associated with better improvement of gustatory function. High subjective severity of chemosensory loss was associated with lower rates of olfactory and gustatory recovery as well as improvement of olfactory function. Young age was not associated with a better prognosis. Discussion/conclusion: Rates of improvement and recovery of chemosensory function decreased after 2-4 months after initial chemosensory loss, possibly indicating that prolonged and perhaps permanent chemosensory loss may be a complication of SARS-CoV-2 infections. High subjective severity of CD may worsen the prognosis for improvement and recovery of chemosensory function.
... Inter estingly, both olfaction, gustation and tr igeminal sensation ar e often affected [6]. This r uns contr ar y to the common clinical char acter istics of patients with chemosensor y loss pr ior to COVID-19, wher e olfactor y loss was the dominating chemosensor y deficit [7,8]. ...
... 15-20% of the gener al population ar e affected by smell loss, 1% to 5% of whom suffer fr om complete smell loss [9,10]. However , befor e the COVID-19 pandemic, age was a key r isk factor for post-vir al chemosensor y loss wher e most patients wer e in their 50s or 60s [8,11,12]. ...
... However , the par ticipants in this study r ated a subjective loss occur r ing in the cour se of a shor t per iod of time. Fur ther mor e, wher eas patients with olfactor y deficits have a tendency to classify their sensor y loss as a taste loss [8], the high fr equency of subjective combined gustator y and olfactor y deficits in this population may indicate a mor e r eliable assessment. At least for the olfactor y loss, this seems to be the case, as the r eliability of subjective olfactor y loss is r elatively high for patients with anosmia. ...
Article
Introduction: Chemosensory loss is a common symptom of coronavirus disease 2019 (COVID-19) and has been associated with a milder clinical course in younger patients. Whereas several studies have confirmed this association, knowledge about the improvement and recovery of olfactory and gustatory loss is lacking. The aim of this study was to investigate the temporal dynamics of improvement and recovery from sudden olfactory and gustatory loss in patients with confirmed and suspected COVID-19. Methods: Subjective chemosensory function, symptoms of COVID-19, COVID-19 tests results, demographics and medical history were collected through a questionnaire. Results: Among the 109 study participants, 95 had a combined olfactory and gustatory loss, five participants had isolated olfactory loss and nine participants has isolated taste loss. The mean age of participants was 39.4 years and 25% of participants were under the age of 30 years. Young age was not associated with a higher recovery rate. After a mean time of > 30 days since the chemosensory loss, participants reported relatively low recovery and improvement rates. For participants with olfactory loss, only 44% had fully recovered, whereas 28% had not yet experienced any improvement of symptoms. After gustatory loss, 50% had fully recovered, whereas 20% had not yet experienced any improvement. Olfactory and gustatory deficits were predominantly quantitative and mainly included complete loss of both olfactory and gustatory function. Conclusions: Chemosensory loss was frequent in young individuals and persisted beyond a month after symptom onset, often without any improvement during this time. Funding: The author wishes to acknowledge research salary funding from Arla Foods (Viby, Denmark) and the Central Region Denmark. The sponsors had no say, roles or responsibilities in relation to the study, including (but not limited to) the study design, data collection, management and analysis. Trial registration: not relevant.
... Adult participants with olfactory dysfunction and smell-related issues with the pleasure of eating or cooking were included primarily from our Taste and Smell Clinic at Gødstrup Regional Hospital, Denmark [14]. Participants with all aetiologies of olfactory dysfunction were included. ...
... (www.preprints.org) | NOT PEER-REVIEWED | Posted: 24 April 2024 doi:10.20944/preprints202404.1624.v114 ...
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Smell loss affects around 15-20% of the population, with a major effect on the quality of life. The most common complaint is the impairment of the eating experience, with around 90% of patients reporting this issue. A study conducted at a specialized taste and smell clinic investigated if food and cooking can have a positive effect on the enjoyment of food, subjective cooking skills, and quality of life in patients with smell loss. The 49 participants in the study received a 5-week cooking school course that focused on emphasizing the other senses to regain the enjoyment of food. Participants gained more confidence in cooking, and their quality of life improved significantly. Positively evaluated recipes were adjusted based on feedback and published as free e-books in Danish, German, and English. Eating and cooking are multisensory experiences, and the perception of food depends on the complex interaction of senses and surroundings. If the olfactory input is reduced or absent, both the enjoyment and cooking experience can be negatively affected. Therefore, focusing on food and cooking can have a positive impact on patients with smell loss.
... Anosmia was found to be a significant predictor of a positive COVID-19 test result with positive COVID-19 reported by 75% of patients with anosmia [10]. Smell disorders (hyposmia, anosmia) occur among 15-20·% of the general population [15]. The term anosmia means complete loss of the ability to smell. ...
... Fragments of olfaction (sense of smell) may be preserved but are generally useless in a social context. The prevalence of anosmia is 2-5% [15,16,17]. Loss of olfactory input has several consequences: we no longer receive information about potential hazards such as smoke, fire, leakage of chemicals and poisonous substances, as well as spoiled food, leading to anxiety and stressful alertness. ...
Article
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Aim: To review the publications subject to the problem of COVID-19 associated anosmia incidence in pediatric patients as well as its pathogenesis, diagnostics, treatment and recovery. The peculiarity of pediatric COVID-19 anosmia is due to children accounting for very low percentage of COVID-19 patients (comparing to one in adults), mostly with milder course of the disease. Awareness of anosmia and its proper diagnostics is crucial in children and adolescents, considering it can be the only manifestation in COVID-19 positive pediatric patients. Materials and Methods: In order to achieve this goal a meta-analysis of information from databases followed by statistical processing and generalisation of the obtained data was carried out. Conclusions: Publications on COVID-19 anosmia in children and adolescents are less numerous than those concerning adult patients, so it is important to use every single trustworthy one. Anosmia/ageusia may be the only symptom, early identifier and the strongest predictor of COVID-19 infection in pediatric patients. Prospects for further scientific researches. Further researches regarding differential diagnostics of COVID-19 and other infections, including seasonal influenza, manifesting with both olfactory and taste dysfunction as well as anosmia diagnostics in children and adolescents with autistic spectrum and different types of mental disorders are possible.
... No differential item functioning was evident, except for item 1 (distorted chemosensory domain) with sex. The study included more women than men, representing the clinical population seen in specialized smell and taste clinics, 35 and similar to other olfactory-related questionnaires. 36 Eighteen items had floor effect, indicating that not all items had clinical relevance to all patients; however, only 7 items had floor effect greater than 50%, and the highest floor effect was found for item 18 (work), indicating that all items had relevance to subgroups of patients. ...
... The sample size was comparable to 205 included in Frasnelli et al, 36 35 54 Another strength of the study is the vigorous development and validation process using the criterion standard of modern psychometrics. ...
Article
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Importance The human senses of taste and smell are essential in everyday life. However, as clinical testing of the senses and patient-reported sensory problems are often diverging, additional validated questionnaires are essential for the evaluation of chemosensory impairments. Objective To develop an instrument with all relevant domains concerning chemosensory dysfunction and quality of life using modern psychometrics. Design, Setting, and Participants The study was designed as a questionnaire study for developing a new instrument. The study started in 2019 and was completed in 2022. Patients with chemosensory dysfunction were recruited from a specialized smell and taste clinic at an ear, nose, and throat department in Denmark. Healthy participants with no history of chemosensory dysfunction were recruited through social media. Main Outcomes and Measures Eight domains were included (distorted chemosensation, emotional, food and meals, social, hygiene, danger, work, and relationship), and 35 items were generated based on review of the existing literature and interviews with patients and experts. Participants were tested with the Major Depression Inventory, 36-Item Short Form Health Survey, Taste Sprays, and Sniffin’ Sticks for chemosensory function. Descriptive statistics were calculated for all items. Reliability, internal consistency, and validity were investigated, and a Rasch model was fitted. Healthy controls (n = 39) filled out the questionnaire for comparison of known-groups validity. Confirmatory factor analysis was performed. Finally, item reduction was performed, resulting in a final version with 21 items in 8 domains. Results The study included responses from 316 patients, 183 women (58%) and 133 men (42%), with a mean (SD) age of 57 (15.1) years. Rasch model fit was acceptable with P > .05 for all items. An 8-dimensional confirmatory factor analysis model showed a better fit than a bifactor confirmatory factor analysis model. Cronbach α ranged from 0.65 to 0.86. Criterion validity with the Sniffin’ Sticks, Taste Sprays, Major Depression Inventory, and the 36-Item Short Form Health Survey was satisfactory. The test-retest reliability was good in all domains, ranging from 0.55 to 0.86. All domains were discriminative, except the social and work domains. Conclusions and Relevance In this survey study, the instrument was validated with 8 domains related to chemosensory dysfunction and quality of life. All items had good internal consistency, test-retest reliability, interitem correlations, item-total correlations, and Rasch model fit. The questionnaire appears suitable for use in clinical and research settings.
... Thus, the prevalence of non-COVID-19 postinfectious olfactory disorders in clinical settings has been found to vary between 18%-45%. [12][13][14] More than half (56%) of these patients were suffering from parosmia in the postinfectious period. 15 In other words, distortion of smell is a phenomenon in post-infectious olfactory disorders. ...
... The database became operational on January 1, 2017; and by October 2021, it contained more than 2,000 patients with various etiologies underlying smell and taste disorders. The database entails all patients seen in our Smell and Taste Clinic, with minor exceptions as a few patients did not wish to sign the consent form for the database, see [12]. A total of 146 pre-COVID cases were selected from three criteria: postinfectious etiology of smell loss, smell loss debut before January 1st 2020, duration of smell loss below longest duration of smell loss in the COVID group (308 days). ...
Article
Introduction: COVID-19 is causing a wide range of clinical manifestations. Severe complications and long-lasting sequelae have been identified. Thus, olfactory disorders are reported in up to 86% of cases in mild and moderate COVID-19 infections. We present the first study comparing simple and complex post-COVID-19 cases with matched non-COVID-19 post-infectious smell and taste disorders. Methods: A total of 328 patients were recruited from the University Clinic for Flavour, Balance and Sleep, Ear-nose-throat Department, Goedstrup Hospital, Denmark. A non-COVID -19 post-infectious population of 148 individuals was identified from the Redcap database, and was matched by duration of smell and taste disorders. Post-COVID-19 patients were divided into 99 patients with simple smell and taste disorders (only suffering from smell and taste disorders after COVID-19); and (81 patients with complex smell and taste disorder plus several other post-COVID-19 complaints). Besides patient-reported outcome measures (PROM) questionnaires and quality of life score (QoL), ear-nose-throat examination, Mini-Mental State Examination (MMSE), orthonasal smell test (Sniffing's sticks), retronasal quick test, and taste screening were performed. Results: Cases with post-COVID-19-related smell and taste disorders deviated from non-COVID-19 post-infectious cases; the patients were younger, had a lower occurrence of anosmia/ageusia, and had higher overall smell test scores. In contrast, patients with post-COVID-19-related smell and taste disorders more frequently complained of distorted senses. Parosmia and phantosmia were more prevalent among patients with simple post-COVID-19 complaints than among complex cases and their QoL were more negatively affected. Conclusion: Smell and taste function differ significantly between post-COVID-19 and other non-COVID-19 post-viral cases. Level of evidence: 3 Laryngoscope, 2022.
... All patients were screened with the Mini-Mental State Examination [22] and Major Depression Inventory (MDI) [23]. After clinical examination, medical history, and olfactory testing with Sniffin' Sticks extended olfactory test (Burghart Messtechnik GmbH, Wedel, Germany) [24], a clinical diagnosis with suspected cause of olfactory loss was established [25]. The diagnoses fell in 6 major categories: sinonasal, post-infectious, post-traumatic, congenital, iatrogenic, or idiopathic. ...
... Fazekas scores were dichotomized into 0-1 and 2-3, considering the beginning confluency of WMHs as a marker of small vessel disease [25]. GCA scores were dichotomized into 0-1 and 2-3, considering a distinction between no/mild atrophy and moderate to severe atrophy, the most appropriate for our study population with a mean age of 57 years [26]. ...
Article
Introduction: While magnetic resonance imaging (MRI) is not included in the current guidelines for diagnosing olfactory disorders in the most recent position paper on olfactory dysfunction, both 1.5T and 3T MRI are commonly used in the diagnostic workup of many patients with olfactory loss. Often, MRI is used to rule out intracranial tumours, but other useful information may be obtained from MRI scans in these patients. The potential of MRI in olfactory loss depends on sufficient knowledge of structural changes in different aetiologies of olfactory loss. We present common clinical MRI findings in olfactory loss and evaluate the usefulness of structural integrity scores in differentiating between aetiologies. Methods: In this study, we investigated if white matter hyperintensities (WMHs, measured by Fazekas score), global cortical atrophy (GCA), and medial temporal lobe atrophy (MTA) are more common in patients with idiopathic olfactory loss than in patients with acquired olfactory loss due to other aetiologies. Furthermore, we compared olfactory bulb (OB) configurations in different olfactory loss aetiologies. Results: In 88 patients with olfactory loss, WMHs, GCA, and MTA were not more significant findings on MRI in idiopathic olfactory loss (n = 51) compared with other causes of acquired olfactory loss (Fazekas score p = 0.2977; GCA score p = 0.6748; MTA score p = 0.7851). Bulb configurations differed in patients suffering from post-traumatic olfactory loss and may aid in identifying the underlying aetiology in patients where trauma is among the suspected causes of olfactory loss. Conclusion: We recommend that structural MRI with an OB sequence is included in the diagnostic evaluation of olfactory loss with suspected congenital and post-traumatic aetiology and should be considered in idiopathic olfactory loss with suspected central aetiology (e.g., tumour).
... [1][2][3] Apart from aging and chronic rhinosinusitis one of the most frequent causes is postinfectious (post-viral) olfactory dysfunction with frequency rates of 31% to 39% of patients presenting at specialized smell and taste clinics. 4,5 Gustatory dysfunction is much less prevalent with a rate up to 5%. 6 This all changed dramatically in early 2020 with the COVID-19 pandemic, as smell and taste dysfunction are among the most common symptoms of the disease-even in absence of other symptoms. ...
... The Sniffin' Sticks are presented in front of both nostrils with intervals of at least 30 seconds and approximately 3 seconds per individual pen. Most sites used the Sniffin' Sticks test consisting of three subtests, which provides scores for odor threshold (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), discrimination (0-16), and identification (0-16). The three scores are combined to a global olfactory function score consisting of threshold, discrimination and identification combined (TDI-score: 1-48). ...
Article
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Objective: With the COVID-19 pandemic chemosensory dysfunction are among the most prevalent symptoms. Most reports are subjective evaluations, which has been suggested to be unreliable. The objective is to test chemosensory dysfunction and recovery based on extensive psychophysical tests in COVID-19 during the course of the disease. Methods: 111 patients from four centres participated in the study. All tested positive for SARS-COV-2 with RT-PCR. They were tested within three days of diagnosis and 28 to 169 days after infection. Testing included extensive olfactory testing with the Sniffin' Sticks test for threshold, discrimination and identification abilities, and with the Taste Sprays and Taste Strips for gustatory function for quasi-threshold and taste identification abilities. Results: There was a significant difference in olfactory function during and after infection. During infection 21% were anosmic, 49% hyposmic and 30% normosmic. After infection only 1% were anosmic, 26% hyposmic and 73% normosmic. For gustatory function there was a difference for all taste qualities, but significantly in sour, bitter and total score. 26% had gustatory dysfunction during infection and 6.5% had gustatory dysfunction after infection. Combining all tests 22% had combined olfactory and gustatory dysfunction during infection. After infection no patients had combined dysfunction. Conclusion: Chemosensory dysfunction is very common in COVID-19, either as isolated smell or taste dysfunction or a combined dysfunction. Most people regain their chemosensory function within the first 28 days, but a quarter of the patients show persisting dysfunction, which should be referred to specialist smell and taste clinics for rehabilitation of chemosensory function.
... Omkr ing 15% af befolkningen lider af nedsat lugtesans [4] og udr edes pr imaer t hos pr aktiser ende ør e-naese-hals-laeger samt i specialiser ede klinikker , hvor af der i Danmar k p.t. kun findes en klinik for lugte-og smagstab [5]. Den hyppigste år sag til lugtetab er sinonasal sygdom, hvor isaer kr onisk r inosinuitis og aller gi før er til bloker ing af VIDENSKAB VIDENSKAB Ugeskr Laeger 2020;182:V06200442 ...
... Omkr ing 15% af befolkningen lider af nedsat lugtesans [4] og udr edes pr imaer t hos pr aktiser ende ør e-naese-hals-laeger samt i specialiser ede klinikker , hvor af der i Danmar k p.t. kun findes en klinik for lugte-og smagstab [5]. Den hyppigste år sag til lugtetab er sinonasal sygdom, hvor isaer kr onisk r inosinuitis og aller gi før er til bloker ing af ...
Article
In the aftermath of COVID-19, the association between SARS-CoV-2 and chemosensory deficits have been well established. Taste and smell loss have been included in the official lists of symptoms worldwide, as it is a common symptom (and for some patients the only symptom) of COVID-19 as described in this review. Patients with COVID-19 often have combined taste and smell loss, have a milder clinical presentation, and are younger than previous patients with postviral olfactory loss. Patients should start olfactory training early and should be seen by an ear, nose and throat physician if they do not experience improvement of the senses within 12 weeks.
... Omkr ing 15% af befolkningen lider af nedsat lugtesans [4] og udr edes pr imaer t hos pr aktiser ende ør e-naese-hals-laeger samt i specialiser ede klinikker , hvor af der i Danmar k p.t. kun findes en klinik for lugte-og smagstab [5]. Den hyppigste år sag til lugtetab er sinonasal sygdom, hvor isaer kr onisk r inosinuitis og aller gi før er til bloker ing af VIDENSKAB VIDENSKAB Ugeskr Laeger 2020;182:V06200442 ...
... Omkr ing 15% af befolkningen lider af nedsat lugtesans [4] og udr edes pr imaer t hos pr aktiser ende ør e-naese-hals-laeger samt i specialiser ede klinikker , hvor af der i Danmar k p.t. kun findes en klinik for lugte-og smagstab [5]. Den hyppigste år sag til lugtetab er sinonasal sygdom, hvor isaer kr onisk r inosinuitis og aller gi før er til bloker ing af ...
Article
In the aftermath of COVID-19, the association between SARS-CoV-2 and chemosensory deficits have been well established. Taste and smell loss have been included in the official lists of symptoms worldwide, as it is a common symptom (and for some patients the only symptom) of COVID-19 as described in this review. Patients with COVID-19 often have combined taste and smell loss, have a milder clinical presentation, and are younger than previous patients with postviral olfactory loss. Patients should start olfactory training early and should be seen by an ear, nose and throat physician if they do not experience improvement of the senses within 12 weeks.
... In total, 49 adult participants with olfactory dysfunction and smell-related issues who took pleasure in eating or cooking were included, primarily from our Taste and Smell Clinic at Gødstrup Regional Hospital, Denmark [14]. Participants with all aetiologies of olfactory dysfunction were included. ...
Article
Full-text available
Smell loss affects around 15-20% of the population, with a major effect on the quality of life. The most common complaint is the impairment of the eating experience, with around 90% of patients reporting this issue. A study conducted at a specialised Taste and Smell Clinic investigated if food and cooking can positively affect the enjoyment of food, subjective cooking skills, and quality of life in patients with smell loss. The 49 participants in the study received a 5-week cooking school course that focused on emphasizing the other senses to regain the enjoyment of food. Participants gained more confidence in cooking, and their quality of life improved significantly. Positively evaluated recipes were adjusted based on feedback and published as free e-books in Danish, German, and English. Eating and cooking are multisensory experiences, and the perception of food depends on the complex interaction of senses and surroundings. If the olfactory input is reduced or absent, both the enjoyment and cooking experience can be negatively affected. Therefore, focusing on food and cooking can have a positive impact on patients with smell loss.
... Postinfectious olfactory dysfunction (PIOD) represents a significant and frequent cause of persistent OD, accounting for 11% of all cases [5]. Notably, up to 47% of cases are reported from specialized smell and taste clinics, frequently involving female patients [4,6,7]. ...
Article
Full-text available
Purpose The Sino-Nasal-Outcome-Test 22 (SNOT-22) questionnaire assesses treatment outcome and health-related quality of life (HRQOL) in patients with chronic rhinosinusitis (CRS). However, given the overlap between CRS and olfaction in terms of nasal function and the definition of CRS, a fundamental question arises: can patients with olfactory dysfunction (OD) stemming from other causes attain SNOT-22 scores similar to those seen in CRS, even in the absence of CRS? Our study aimed to explore whether OD arising from various postinfectious mechanisms challenges the disease-specificity of SNOT-22 for CRS. If so, could focus on scores within specific symptom domains of SNOT-22 prove valuable in distinguishing between different etiologies. Methods The study adopted an observational, retrospective cohort design based on prospectively registered patients and related variables using the REDCap platform. 460 patients experiencing OD due to either (1) simple or (2) complex post-COVID-19, (3) postinfectious non-COVID-19, and (4) CRS, were included in the analysis. Results The study revealed that the total SNOT-22 score lacks disease-specificity for CRS. This is evident, because complex postinfectious mechanisms resulting from COVID-19 can produce similar symptoms in patients. Notably, elevated total scores were primarily driven by high subdomain scores within the “sleep and cognition” domain. Conclusions The application of SNOT-22 as a screening tool needs to be approached with caution, as the total score alone does not provide disease-specific insights. A more thorough exploration of the four symptom domains and the identification of distinctive scoring patterns within the clinical context may prove pivotal in effectively differentiating between various underlying causes.
... Idiopathic OD is a diagnosis of exclusion. Studies suggest that up to 16% to 24% of patients screened at smell and taste centres fall into this category (287,288) . However, care should be employed when making this diagnosis, as some such cases may be due to asymptomatic upper respiratory infections, or in older patients -early neurodegeneration (242) . ...
Article
Full-text available
Background: Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. Conclusions: We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.
... Idiopathic OD is a diagnosis of exclusion. Studies suggest that up to 16% to 24% of patients screened at smell and taste centres fall into this category (287,288) . However, care should be employed when making this diagnosis, as some such cases may be due to asymptomatic upper respiratory infections, or in older patients -early neurodegeneration (242) . ...
Article
Background: Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. Conclusions: We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.
... As from January 2021, patients with long COVID-19 (ICD10 code: DB948A) were referred to the Flavour Clinic, Gødstrup Regional Hospital, Denmark [19], from the two regional long COVID-19 hospital clinics [2,4]. ...
Article
Introduction: Two-thirds of patients with COVID-19 developed smell and taste dysfunction, of whom half experienced improvement within the first month. After six months, 5-15% still suffered from significant olfactory dysfunction (OD). Before COVID-19, olfactory training (OT) was proved to be effective in patients with post-infectious OD. Therefore, the present study aimed to investigate the progress of olfactory recovery with and without OT in patients with long COVID-19. Methods: Consecutive patients with long COVID-19 referred to the Flavour Clinic at Gødstrup Regional Hospital, Denmark, were enrolled. The diagnostic set-up at the first visit and follow-up included smell and taste tests, questionnaires, ENT examination and instructions in OT. Results: From January 2021 to April 2022, 52 patients were included due to long COVID-19-related OD. The majority of patients complained of distorted sensory quality, in particular, parosmia. Two-thirds of the patients reported a subjective improvement of their sense of smell and taste along with a significant decline in the negative impact on quality of life (p = 0.0001). Retesting at follow-up demonstrated a significant increase in smell scores (p = 0.023) where a minimal clinically important difference (MCID) in smell scores was found in 23% of patients. Full training compliance was significantly associated with the probability of MCID improvement (OR = 8.13; p = 0.04). Conclusions: The average effect of OT is modest; however, full training compliance was significantly associated with an increased probability of a clinically relevant olfactory improvement. Funding: none. Trial registration: not relevant.
... As seen in previous patient populations with olfactory dysfunction [26], we found a greater proportion of women among participants with olfactory dysfunction. While the female gender has been shown to be associated with slightly superior olfactory function in a larger study population [27], the gender-related differences in consequences following parosmia have not been well established. ...
Article
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Olfactory dysfunction often has severe consequences on patients’ quality of life. The most common complaint in these patients is their reduced enjoyment of food in both patients with olfactory loss and parosmia. How the different types of olfactory dysfunction differ in relation to food and cooking habits, sensory awareness, and food-related quality of life has not yet received much attention. By applying questionnaires on cooking, food, olfactory function, weight changes, sensory awareness, and food-related quality of life, we investigated how various aspects of eating differ between participants with olfactory loss (n = 271), parosmia (n = 251), and normosmic controls (n = 166). Cooking habits in olfactory dysfunction revealed pronounced differences as compared with normosmic controls. Cooking with olfactory dysfunction was associated with, e.g., a lack of comfort and inspiration for cooking and an inability to make new foods successfully. Significant differences in cooking were also found between olfactory loss and parosmia. Food items were less familiar in participants with olfactory loss and parosmia, while the ratings of liking food items differed between olfactory loss and parosmia, indicating the importance of adapting ingredients in meals separately for olfactory loss and parosmia. Parosmia was associated with a higher incidence of weight loss, but we found no difference in food-related quality of life between participants with olfactory loss and parosmia. While olfactory loss and parosmia have wide-ranging consequences on patients’ cooking and food habits, adapting meals to include ‘safer food items’ and integrating multisensory stimulation may be a possible avenue for improving the enjoyment of food.
... Baggrunden for dette er, at dokumentation for anvendeligheden er svag; frekvensen af spontan genopretning af COVID-19-relateret lugtforstyrrelse er høj; og kortikosteroider har velkendte potentielle bivirkninger (29). Lokal behandling med nasalsteroid kan vaere relevant, såfremt der ved nasal endoskopi er tegn på inflammation af naesens slimhinde, mens der mangler evidens for øvrige former for behandling (30). Der er dog som følge af de omfattende lugtetab efter COVID-19 initieret mange studier med fokus på medicinsk behandling, så der kommer forhåbentlig snart nye medicinske behandlingsmuligheder af lugtetab. ...
... 8 Most patients are diagnosed with an underlying aetiology, but up to 23% remain with no apparent cause and are subsequently classified as idiopathic. 9 Typically, these patients are referred for further investigations with MRI to rule out potentially treatable intracranial disease. However, the hit rate of MRI revealing an underlying treatable central cause of olfactory dysfunction in idiopathic anosmics/hyposmics is as low as 0.08%, according to Rudmik et al. 10 Hoekman et al investigated 130 cases of idiopathic olfactory loss, and only one finding of multiple sclerosis (0.8%) was potentially the cause of olfactory dysfunction. ...
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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.
... Several etiological factors such as sinonasal diseases, head traumas, viral respiratory infections, iatrogenic and congenital mechanisms are known causes of anosmia. In approximately one of four cases, the anosmia is idiopathic, as potential triggers cannot be identified (Fjaeldstad et al., 2020). In these cases, MRI of the brain (MRIc) may be performed in order to exclude cerebral pathology. ...
... Smell disorders (hyposmia, anosmia) occur among 15-20 % of the general population (1)(2)(3). The term anosmia means complete loss of the ability to smell. ...
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Although studies have shown severe Coronavirus disease 2019 (COVID-19) outcomes in patients with pre-existing coronary heart disease (CHD), the prognosis of COVID-19 patients with pre-existing CHD remains uncertain primarily due to the limited number of patients in existing studies. This study aimed to investigate the impacts of pre-existing CHD on the prognosis of COVID-19 patients. Five electronic databases were searched for eligible studies. This article focused on cohort and case-control studies involving the prognosis of COVID-19 patients with pre-existing CHD. The meta-analysis was performed using a random effects model. The odds ratios (ORs) and 95% confidence intervals (CIs) were used as valid indicators. The study was registered in PROSPERO with the identifier: CRD42022352853. A total of 81 studies, involving 157,439 COVID-19 patients, were included. The results showed that COVID-19 patients with pre-existing CHD exhibited an elevated risk of mortality (OR = 2.45; 95%CI: [2.04, 2.94], P < 0.001), severe/critical COVID-19 (OR = 2.57; 95%CI: [1.98, 3.33], P < 0.001), Intensive Care Unit or Coronary Care Unit (ICU/CCU) admission: (OR = 2.75, 95%CI: [1.61, 4.72], P = 0.002), and reduced odds of discharge/recovery (OR = 0.43, 95%CI: [0.28, 0.66], P < 0.001) compared to COVID-19 patients without pre-existing CHD. Subgroup analyses indicated that the prognosis of COVID-19 patients with pre-existing CHD was influenced by publication year, follow-up duration, gender, and hypertension. In conclusion, pre-existing CHD significantly increases the risk of poor prognosis in patients with COVID-19, particularly in those male or hypertensive patients.
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Aims : The first wave of the COVID-19 pandemic generated "risks" and uncertainties as well as organizational changes among French perinatal caregivers. Our study aimed to investigate the psychosocial impact of the first wave on this population. Method : Our participants (N=565) were invited to answer an online questionnaire that included questions on various indices of health and quality of life at work (e.g., ProQoL, perceived stress) and other questions on the impact of the pandemic on work organization. An open-ended question was designed to identify the participants’ three most frequently perceived preoccupations with regard to the health situation. Results : In addition to highlighting the multifactorial nature of participants' preoccupations, our results illustrated the effect of professional status and type of motherhood on the different indices of health and quality of life at work. When it was found that the pandemic had an impact on work organization and on teams, lower health and quality of work life scores were recorded. On the other hand, when positive impacts on organization were reported, mainly in terms of reduced work intensity, they were associated with higher health and quality of work life scores. Conclusion : We explain this last result as either one actual effect of the pandemic on work organization, or as a phenomenon of cognitive rationalization.
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Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.
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Aims. To investigate the self-reported audiological symptoms in a cohort of coronavirus disease 2019(COVID-19) patients and monitor improvement or recovery. Material and methods. Following the STROBE guidelines for observational studies, a retrospective questionnaire concerning audio-vestibular symptoms was conducted in a cohort of Danish COVID-19 patients with self-reported chemosensory loss. Data regarding demographics, symptoms onset, duration and remission were registered in a REDCap database. Results. Of the 225 respondents with chemosensory loss, 59 (26.2%) reported concomitant hearing loss(10.7%) or tinnitus (16.4%). In a follow-up questionnaire focused on ear symptoms, severity, and duration(n = 31), 17 reported hearing loss and 21 reported tinnitus. The debut of hearing loss and tinnitus were on average 10 and 30 days respectively, after the onset of initial symptoms. Among the hearing loss patients, only two patients experienced a full recovery, whereas 15 had partial or no recovery after on average 266days from COVID-19 symptom onset. Among the tinnitus patients, 7/21 had a full recovery, while 14 had partial or no recovery after on average 259 days from COVID-19 symptom onset. Conclusion. In a large Danish cohort of COVID-19 patients, a significant proportion experienced concomitant audiological symptoms which seem long-lasting and with a negative impact on quality of life. This study warrants further investigation of the association between COVID-19 and audio-vestibular symptoms, and the need for rehabilitation among convalescents.
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The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
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The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-analysis, for a total of 2611 patients with at least one episode of VAP. The pooled estimated occurrence of VAP was of 45.4% (95% C.I. 37.8–53.2%; 2611/5593 patients; I2 = 96%). The pooled estimated occurrence of mortality was 42.7% (95% C.I. 34–51.7%; 371/946 patients; I2 = 82%). The estimated summary estimated metric mean ICU LOS was 28.58 days (95% C.I. 21.4–35.8; I2 = 98%). Sensitivity analysis showed that patients with COVID-19 may have a higher risk of developing VAP than patients without COVID-19 (OR 3.24; 95% C.I. 2.2–4.7; P = 0.015; I2 = 67.7%; five studies with a comparison group).
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COVID-19 and sequelae thereof are known to cause chemosensory dysfunction, posing a risk for intake and adequate nutrition for recovery. The overall objective of this study was to investigate the subjective strategies for maintaining appetite applied by patients recovering from COVID-19. The study included 19 in-depth interviews, focusing on patients suffering from long-term effects of COVID-19. The results were analysed using a thematic analysis for qualitative data. Results on strategies for maintaining appetite included four key themes: (1) a focus on well-functioning senses, (2) a focus on familiar foods, (3) a focus on the eating environment, and (4) a focus on post-ingestive well-being. It was found that factors prior to, during and after food intake, as well as the context, could influence desire to eat and pleasure related to food intake. As ageusia and anosmia make characterization of food difficult, being able to recognize and memorize its flavour was important to engage in consumption. Under normal circumstances, the hedonic value of food relies predominantly on the flavour of foods. When suffering from chemosensory dysfunction, shifting focus towards the texture of food, including trigeminal stimulation during consumption, were beneficial for maintaining appetite and food-related pleasure. Furthermore, a focus on the holistic satisfying feelings of choosing healthy food, as well as a focus on other people’s enjoyment during meals were reported to boost well-being around food intake. The study elaborated our understanding of the complex consequences of COVID-19, and can be applied in health promoting initiatives targeted patients recovering from COVID-19.
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Introduction Subjective chemosensory function can differ from measured function. Previous studies on olfactory assessment have found a positive correlation between subjective and measured scores. However, information on gustatory correlation between measured and subjective functions is sparse in patients who have undergone an initial ear, nose and throat (ENT) evaluation. Objectives To evaluate the correlation between subjective and measured olfactory and gustatory dysfunctions in a population complaining of taste and/or smell dysfunction after an initial ENT evaluation without chemosensory testing. Furthermore, we aimed to assess the need for chemosensory testing depending on the type of subjective chemosensory dysfunction. Methods A case series in which subjective chemosensory function was assessed through a questionnaire and measured chemosensory function was assessed by validated clinical tests. Results In total, 602 patients with complaints of olfactory and/or gustatory dysfunction were included. We found that 50% of the patients with normal gustatory function and an olfactory impairment classified their olfactory impairment as a subjective taste disorder. Furthermore, 98% of the patients who rated their olfactory function as absent did have a measurable olfactory impairment, but only 64% were anosmic. Conclusion Subjective gustatory dysfunction was poorly correlated with measured gustatory dysfunction, and was often found to reflect olfactory dysfunction. Contrarily, subjective olfactory dysfunction was positively correlated with measurable olfactory dysfunction. Although subjective anosmia was a strong indicator of measured anosmia or hyposmia, the existence of remaining olfactory function was frequently found in these patients. Validated chemosensory testing should be performed in patients with perceived olfactory or gustatory deficits, as this could help ensure increased diagnostic precision and a relevant treatment.
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Context: Hypoparathyroidism is a rare endocrine disorder whose skeletal features include suppression of bone turnover, greater volume and width of the trabecular compartment. Few and inconsistent data are available on the prevalence of vertebral fractures (VF). Objective: To evaluate the prevalence of VF assessed by vertebral fracture assessment (VFA) in postmenopausal women with chronic post-surgical hypoparathyroidism. Design: Cross-sectional study. Setting: Ambulatory referral center. Patients or other participants: Fifty postmenopausal women (mean age 65.4 ± 9 years) with chronic post-surgical hypoparathyroidism and 40 age-matched healthy postmenopausal women (mean age 64.2 ± 8.6). Main outcome measures: Lumbar spine, femoral neck and total hip BMD were measured by dual X-ray absorptiometry (DXA) (Hologic Inc., USA) in all subjects. Site-matched spine TBS was calculated by TBS iNsight (Medimaps, Switzerland). Assessment of VF was made by VFA (iDXA, Lunar GE, USA) using the semiquantitative method and the algorithm-based qualitative assessment. Results: All-site BMD values were higher in the hypoparathyroid vs the control group. By VFA, we observed a 16% prevalence of VF in hypoparathyroid women vs 7.5% in control subjects. Among those with hypoparathyroidism who fractured, 5 (62.5%) had grade 1 wedge, 2 (25%) had grade 2 wedge, and 1 (12.5%) grade 2 wedge and grade 2 biconcave VF. In the hypoparathyroid group, among those with VFs, 57% had symptoms of hypoparathyroidism 32% among those without VF. Conclusion: We demonstrate for the first time that in postmenopausal women with chronic postsurgical hypoparathyroidism, VFs are demonstrable by VFA despite normal BMD.
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Introduction: Characterisation and management of olfactory dysfunction (OD) can be challenging, especially in patients diagnosed with idiopathic OD. This group of patients is at risk of developing neurodegenerative diseases such as Parkinson's disease, wherefore appropriate guidelines for management of OD are needed. We aimed to identify and characterise patients suffering from idiopathic hyposmia/anosmia. Methods: This prospective study included 515 consecutive patients referred to the Flavour Clinic, Holstebro, Denmark. Patients with idiopathic, sino-nasal or post-infectious OD were compared with regards to symptoms and clinical findings including endoscopy of the upper airways, sino-nasal CT, allergy testing, and olfactory and gustatory assessment. Results: Patients with idiopathic OD were older and a preponderance of females was observed compared with the sino-nasal group (p = 0.0302, and p = 0.0549, respectively). The OD group had a lower prevalence of allergy and longer symptom duration than both the sino-nasal and the post-infectious groups (p Less than 0.0001 and p = 0.0014; p less than 0.0001 and p less than 0.0001, respectively). Conclusions: Patients suffering from idiopathic OD were predominantly females with a long symptom duration. Only few of these patients suffered from allergies or sino-nasal pathologies. Patient history, the Sino-Nasal Outcome Test and threshold discrimination identification scores from the Extended Sniffin Sticks test are the most valuable clinical tools for diagnosing the aetiology behind OD. An ideal workup for idiopathic OD is presented. Funding: none. Trial registration: not relevant.
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Introduction Accurate measurement of chemosensory function is challenging. For assessing olfactory function, the most commonly applied test is the olfactory identification test. The ability to choose the correct descriptor for an odour among different false descriptors is central for the efficacy of these tests. Across several validation studies of the identification tests, the use of closely related descriptors was found to cause low identification rates. We hypothesised that this could be caused by a high chemical resemblance between the odorant and the listed odour descriptor options. By analysing the chemical overlap between the odorant and the odours used as descriptors, we investigated if chemical resemblance could be a possible confounder in olfactory identification tests. Methods We used gas chromatography-mass spectrometry to detect volatile compounds in the falsely identified odorant. The headspace analysis was repeated on three samples to ensure correct chemical compound detection. Compounds previously identified in odours of false descriptors were identified through a literature review. Results This study identified a widespread chemical overlap between citrus odours commonly used as descriptors in clinical olfactory identification tests, which can complicate the distinction between normosmic and anosmic patients. Conclusions These findings emphasise the importance of thorough considerations when selecting new odorant descriptors during the modification of odour identification tests and the importance of revalidation after modifying descriptors. Implications The degree of chemical resemblance between the odours used as descriptors can be used to adjust the level of difficulty in identification tests; contrasted odours will increase the specificity of detecting anosmia in a clinical test, whereas odours with larger chemical resemblance may be more sensitive when evaluating subtle effects of e.g. olfactory training.
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Background: Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies. Conclusions: We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.
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Olfactory identification abilities in adolescents have been reported inferior compared with adults. Though this seems to be the case when comparing identification abilities using tests validated on— and for—adults, odor familiarity has been hypothesized to affect identification abilities in younger participants. However, this has never been thoroughly tested. The aims of this study were to investigate patterns in odor familiarity differences between adolescents and adults, and to investigate if an adolescent familiarity-based modification of an identification test could lead to similar identification scores in adolescents and adults. In total, 411 adolescent participants and 320 adult participants were included in the study. Odor familiarity ratings were obtained for 125 odors. A modified version of the “Sniffin’ Sticks” identification test was created and validated on 72 adolescents based on adolescent familiarity scores. This test was applied to 82 normosmic adults and 167 normosmic adolescents. Results show a lower familiarity for spices and environmental odors, and a higher familiarity for candy odors in adolescents. The identification abilities in adults and adolescents were equal after familiarity-based modification. We conclude that changes in odor familiarity from adolescence to adulthood do not develop evenly for all odors, but are dependent on odor-object category.
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To determine appropriate counseling of patients with olfactory dysfunction. Retrospective analysis. Interdisciplinary Center for Smell and Taste, University of Dresden Medical School, Technical University of Dresden. A total of 361 males and 533 females, aged 11 to 84 years, who twice reported to the Interdisciplinary Center for Smell and Taste. Residual olfactory performance, duration of olfactory loss until first assessment, presence or absence of parosmia or phantosmia, origin of olfactory loss, interval between assessments, age, sex, and smoking habits. Although 431 patients (48.2%) had functional anosmia at the first olfactory assessment, 444 (49.7%) had hyposmia, and 19 (2.1%) had normosmia; at the second assessment, 278 (31.1%) had functional anosmia, 496 (55.5%) had hyposmia, and 120 (13.4%) had normal olfactory function (P < .001). Changes in smell scores depended positively on the initial score and negatively on age and smoking habits. Normosmia was more likely to be restored in females and when residual olfactory function was relatively high. In contrast, the origin of dysfunction had no direct predictive value because it was mostly reflected by initial smell scores. However, in a subanalysis omitting the initial olfactory performance as a potential predictor, the initial presence of parosmia was associated with a lower probability of anosmia as the final outcome. The prognosis of olfactory dysfunction mainly depends on residual function, sex, parosmia, smoking habits, and age, whereas in this statistical model, origin plays only a second-line role, reflected in different degrees of initial olfactory loss.
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As a gatekeeper, taste buds forage chemicals to identify both nutrition and toxins. This can be the decisive difference between initiating the swallow reflex or spitting out the oral contents. In addition to this simple function the sense of taste takes part in more complex relations such as reflexes vs learning, perception vs expectation, and pleasure vs disgust. All relations, which can be perturbed into unbalance, create great discomfort in patients suffering from a dysfunctional sense of taste. This review discusses the most important mechanisms of taste function and dysfunction as well as the possible avenues for treatment of the disorders.
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The sense of taste holds a key integrate role in assessing the flavour of food before swallowing is initiated. If the expectations for taste are not met, palatability and pleasure of the food can decrease. In patients suffering from taste disorders, this may impair appetite and nutritional state. Testing gustatory function can be important for diagnostics and assessment of treatment effects. However, the gustatory tests applied are required to be both sensitive and reliable.In this study, we investigate the re-test validity of popular Taste Strips gustatory test for gustatory screening. Furthermore, we introduce a new sensitive Taste-Drop-Test, which was found to be superior for detecting a more accurate measure of tastant sensitivity.
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Objectives: The applicability of olfactory testing is dependent on cultural adaptation. The aim of this study was to validate the Sniffin' Sticks (Burghart Messtechnik, Wedel, Germany) threshold (T), discrimination (D), and identification (I) olfaction test. This data was subsequently used to investigate external validity of international normative values to separate hyposmia from normosmia. Methods: The study included 388 participants. The first step was a questionnaire study in which 238 adults rated their familiarity with 125 odor descriptors. In the second step, we evaluated the original Sniffin' Sticks (Burghart Messtechnik) in 75 participants. In the third step, we modified our odor descriptors and tested 75 participants with the new version. Results: In the I test, we found that 21 original odor descriptors were unfamiliar and that five odors had I rates < 75%. After modification, all odors had a successful I rate > 75%. By comparing the T, D, and I scores of previous validation studies, we found a significant variation in the scores between countries. Conclusion: The original Sniffin' Sticks (Burghart Messtechnik) was not applicable in Denmark. The modification resulted in improvement of familiarity and rate of I, making the test valid for use in Denmark. Furthermore, the study found a large variation in T and D scores between different countries, which should be considered when using these scores to separate hyposmia and anosmia from normosmia. Level of evidence: 2b. Laryngoscope, 2017.
Article
Previous studies on the relationship between olfaction and depression have revealed mixed results. In addition, few have focused on the reciprocity of this association. The aim of this study is to combine depression and olfactory data in two separate patient populations to further understand their association. A systematic literature review was conducted using 3 online databases to identify studies correlating olfaction and depression in patients presenting with either primary depression or primary olfactory dysfunction. For the depressed population, weighted means and standard deviations for the Sniffin’ Sticks Test and the 40-item Smell Identification Test were combined using 10 studies. For the olfactory dysfunction population, weighted means of Beck’s Depression Inventory were combined using 3 studies. Independent t-tests were used to compare differences between groups. Comparing primary depressed patients with controls, depressed patients showed decreased scores in olfactory threshold (6.31±1.38 vs. 6.78±0.88, P = 0.0005), discrimination (12.05±1.44 vs. 12.66±1.36, P = 0.0073), identification (12.57±0.74 vs. 12.98±0.90, P < 0.0001), and 40-Item Smell Identification Test (35.31±1.91 vs. 37.41±1.45, P < 0.0001). In patients with primary olfactory dysfunction, Beck’s Depression Inventory scores were significantly different between patients classified as normosmics, hyposmics and anosmics (5.21±4.73 vs. 10.93±9.25 vs. 14.15±5.39, P ≤ 0.0274 for all 3 comparisons). In conclusion, patients with depression have reduced olfactory performance when compared with the healthy controls and conversely, patients with olfactory dysfunction, have symptoms of depression that worsen with severity of smell loss.
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Background: Approximately 5% of the general population is affected by functional anosmia. An additional 15% exhibit decreased olfactory function. Many of these individuals ask ENT-doctors or neurologists for help. A cornerstone of the counselling process is the assessment of olfactory function. The aim of this work is to give a differentiated overview about the administration of commonly used psychophysical tests for olfactory and gustatory function including their normative data. Methods: Numerous tests are available for the assessment of olfactory function. Conclusions: The use of standardized, reliable and validated tools is mandatory to provide patients with state-of the-art counseling on treatment options.
Article
Objectives: The Sniffin’ Sticks 12-Identification test (SIT-12) is the most commonly applied Danish olfaction screening tool, however, it has never been validated in a Danish population. The screening score depends on familiarity with descriptors, which is strongly influenced by linguistic and cultural factors, why validation is mandatory. This study aims to validate the SIT-12 in a Danish population. Design: Prospective controlled study. Setting: Otorhinolaryngology department. Participants: The SIT-12 was applied to 100 normosmic, healthy adult Danish participants. Main outcome measures: Choice of descriptors was registered, along with nasal endoscopic examination, screening for cognitive impairment, depression, and sinonasal symptoms. Descriptors of the original version of SIT-12 were evaluated in 50 participants and misleading descriptors were identified. Modifications to these descriptors were subsequently validated in a comparable group of 50 participants. Results: Mean odorant identification score in the evaluation group was 11.0 of a possible 12, and 11.6 in the validation group (p<0.001). Among all odorant identification errors in the evaluation group, 60% were due to two incorrect descriptors having close resemblance to the correct descriptors, lemon and cinnamon. Two additional descriptors were unfamiliar to more than half the participants. There was a significant difference in the distribution of wrong identification answers between odorants in the evaluation group (p<0.001), but not in the validation group. Conclusions: The identified systematically wrong descriptors have been modified and validated in the Danish SIT-12.
Article
Hyposmia is often undiagnosed despite the known negative effect on taste, appetite and life quality. However, a new focus on the first cranial nerve has emerged as a consequence of a discovered connection between neurodegenerative disorders and hyposmia. In Parkinson's disease and Alzheimer's disease hyposmia is not only one of the earliest clinical presentations, the degree of hyposmia also correlates with the later progression of these two conditions. Hyposmia should not be ignored nor accepted; instead it should be integrated in any neurological examination, especially in elderly patients.
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Flavor perception is to a large extent determined by olfaction, and persons who lost their sense of smell consequently complain about strongly reduced enjoyment of food. The retronasal olfactory function is especially important for flavor appreciation. The aim of this study was to compare retronasal function across different cultures and to develop a test that is applicable across cultures. Identification of 39 retronasal applied odor probes was tested in a total of 518 participants of seven countries; 292 of them were healthy, and 226 exhibited a smell disorder. A retest was performed with 224 of the healthy participants. Furthermore, all participants were tested for orthonasal threshold, identification, and discrimination ability. Significant cultural differences in identification ability were found in 92 % of the probes. The 20 probes that could be identified above chance in healthy participants of all countries and that could differentiate between patients and controls were selected for the final retronasal test. This test was well able to differentiate between controls and patients in different countries and showed a good coherence with the orthonasal test (r = 0.80) and a good retest-reliability (r = 0.76). Furthermore, it is age-independent. The strong cultural differences observed in retronasal identification underline the necessity to develop a culturally independent instrument. This retronasal test is easy to apply and can be used across different countries for diagnostics and clinical research.
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Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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A self-rating inventory has been developed to measure DSM-IV and ICD-10 diagnoses of major (moderate to severe) depression by the patients' self-reported symptoms. This Major Depression Inventory (MDI) can be scored both according to the DSM-IV and the ICD-10 algorithms for depressive symptomatology and according to severity scales by the simple total sum of the items. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as index of validity for the clinician's DSM-IV and ICD-10 diagnosis of major (moderate to severe) depression. The sensitivity and specificity of MDI was assessed in a sample of 43 subjects covering a spectrum of depressive symptoms. The sensitivity of the MDI algorithms for major depression varied between 0.86 and 0.92. The specificity varied between 0.82 and 0.86. When using the total score of MDI the optimal cut-off score was estimated 26 and the total score was shown to be a sufficient statistic. The sample of subjects was limited. Patients with psychotic depression were not included. The MDI was found to have a sensitivity and specificity which is acceptable. The questionnaire is brief and can be scored diagnostically by the DSM-IV and ICD-10 algorithms as well as by its simple total score.
Article
Olfactory dysfunction has been reported to affect more than 200,000 patients a year in the USA. The aim of this survey was to obtain comparable epidemiological data and treatment information on olfactory dysfunction in German speaking countries. Questionnaires were sent to all otorhinolaryngology departments in Germany, Austria and Switzerland; 52% of hospitals completed the survey. An average of 46 patients with olfactory dysfunction were treated per hospital every month. Hyp- and anosmia were most commonly caused by inflammatory diseases of the nose/paranasal sinuses (53%), respiratory dysfunction (19%), or postviral conditions (11%). Steroids were used most frequently for pharmacological treatment (topically 82%; orally 65%). Approximately one third of the clinics used B vitamins, or zinc; 80% of the hospitals performed surgery to treat underlying diseases. Acupuncture and smell training was used by approximately 20%. A total of 79,000 patients per year are treated for olfactory dysfunction in German hospitals. The vast majority of these disorders (72%) is caused by sinunasal diseases. The quality control of therapeutic strategies is urgently needed.
Article
Patients with olfactory dysfunction appear repeatedly in ear, nose, and throat practices, but the prevalence of such problems in the general adult population is not known. Therefore, the objectives were to investigate the prevalence of olfactory dysfunction in an adult Swedish population and to relate dysfunction to age, gender, diabetes mellitus, nasal polyps, and smoking habits. Cross-sectional, population-based epidemiological study. A random sample of 1900 adult inhabitants, who were stratified for age and gender, was drawn from the municipal population register of Skövde, Sweden. Subjects were called to clinical visits that included questions about olfaction, diabetes, and smoking habits. Examination was performed with a smell identification test and nasal endoscopy. In all, 1387 volunteers (73% of the sample) were investigated. The overall prevalence of olfactory dysfunction was 19.1%, composed of 13.3% with hyposmia and 5.8% with anosmia. A logistic regression analysis showed a significant relationship between impaired olfaction and aging, male gender, and nasal polyps, but not diabetes or smoking. In an analysis of a group composed entirely of individuals with anosmia, diabetes mellitus and nasal polyps were found to be risk factors, and gender and smoking were not. The sample size of the population-based study was adequate, with a good fit to the entire population, which suggests that it was representative for the Swedish population. Prevalence data for various types of olfactory dysfunction could be given with reasonable precision, and suggested risk factors analyzed. The lack of a statistically significant relationship between olfactory dysfunction and smoking may be controversial.
Article
The diagnosis and management of olfactory disorders is an often neglected topic in otolaryngology. This article evaluates current clinical practice within the United Kingdom, and provides a literature-based review of the diagnosis, management and prognosis of olfactory pathology. A questionnaire was sent to consultant and associate specialist members of the British Association of Otolaryngologists and Head and Neck Surgeons. The responses were documented to gain an impression of how olfactory disorders are managed in the United Kingdom. The literature relating to olfactory dysfunction was then evaluated and the findings summarised. Management of olfactory pathology varies across the United Kingdom. The literature suggests that chemosensory testing is optimal and that both forced-choice and threshold testing should be applied if objective evaluation is required. Imaging can be of value but the appropriate technique should be used. Olfactory function can recover following head injury, viral infection and chronic sinonasal disease, although varying degrees of dysfunction are likely to persist. There is a role for the use of corticosteroids, particularly when administered systemically. More research is needed to establish the appropriate dose and length of treatment.
Article
Although olfaction is often compromised by such factors as head trauma, viruses, and toxic agents, the olfactory epithelium and sectors of the olfactory bulb have the potential for regeneration. This study assessed the degree to which olfactory function changes over time in patients presenting to a university-based smell and taste center with complaints of olfactory dysfunction and the influences of etiology (eg, head trauma, upper respiratory infection), sex, age, smoking behavior, degree of initial dysfunction, and other factors on such change. Well-validated odor identification tests were administered to 542 patients on 2 occasions separated from one another by 3 months to 24 years. Multivariable regression and chi2 analyses assessed the influences of the variables on the longitudinal changes in olfactory test scores. On average, smell test scores improved modestly over time. Patient age, severity of initial olfactory loss, and the duration of dysfunction at first testing were significant predictors of the amount of the change. Etiology, sex, time between the two test administrations, and initial smoking behavior were not significant predictors. The percentage of anosmic and microsmic patients exhibiting statistically significant change in function was 56.72 and 42.86%, respectively. However, only 11.31% of anosmic and 23.31% of microsmic patients regained normal age-related function over time. Some recovery can be expected in a significant number of patients who experience smell loss. The amount of recovery depends on the degree of initial loss, age, and the duration of loss. Etiology, per se, is not a significant determinant of prognosis, in contrast with what is commonly believed.
The association between smoking and smell and taste impairment in the general population
  • M M Vennemann
  • K Berger
Vennemann MM, Berger K. The association between smoking and smell and taste impairment in the general population. J Neurol D Steinkopff-Verlag; 2008;255:1121-6.
MMS -Mini mental status
  • F Rønholt
  • J K Kristensen
  • G Hansen-Nord
Rønholt F, Kristensen JK, Hansen-Nord G. MMS -Mini mental status. Sundhed.dk, 2017:1-3. www.sundhed.dk/sundhedsfaglig/laegehaandbogen/undersoegelser-og-proever/skemaer/geriatri/mms-minimental-status/ (28 Aug 2019).