Olfactory Nomenclature: An Orchestrated Effort to Clarify Terms and Definitions of Dysosmia, Anosmia, Hyposmia, Normosmia, Hyperosmia, Olfactory Intolerance, Parosmia, and Phantosmia/Olfactory Hallucination

The Development and Validation of the Smell-Qx Questionnaire, Based on a Systematic Review of the Literature and the COMET Initiative on the Development of Core Outcome Sets for Clinical Trials in Olfactory Disorders

BACKGROUND

Olfactory dysfunction affects up to 22% of the population. Accurate assessment is vital for diagnosis and tracking outcomes, often using patient-reported outcome measures (PROMs).

AIMS

We aimed to develop and validate a novel questionnaire for assessing olfactory and gustatory dysfunction.

METHODS

A systematic review identified existing smell and taste questionnaires, followed by item generation and selection. After two Delphi cycles and consultation with a large panel of smell and taste experts, the Smell-Qx questionnaire was developed. A validation study recruited patients from smell and taste clinics (cases) and general ENT clinics (controls) to complete the Smell-Qx. Additionally, patients with smell and taste disorders underwent psychophysical testing using Sniffin' Stick Threshold, Discrimination, and Identification (TDI) tests.

RESULTS

The Smell-Qx is an 11-domain instrument, with five core domains used for total score calculation and six history/quality-of-life domains for obtaining a comprehensive history. The validation study recruited 60 participants (32 patients with smell/taste disorders and 28 controls). Items showed acceptable to significant internal consistency (Cronbach's α: 0.64-0.97) and test-retest reliability (ICC: 0.65-0.99, p < 0.001). The Smell-Qx was effective at distinguishing patients with smell and taste disorders from controls (t = 9.99, df = 58, p < 0.0001). Concurrent criterion validity was good with overall SATD-related quality of life (r = 0.43, p = 0.015), as well as with the smell loss domain and overall smell TDI scores (r = -0.54, p = 0.011).

CONCLUSION

The Smell-Qx is a reliable and valid PROM for assessing olfactory and self-reported gustatory disorders, capturing symptom severity and quality-of-life impact. It can integrate into a multi-modal assessment approach alongside psychophysical testing.

Association between olfactory dysfunction and gustatory dysfunction: evidence from the National Health and Nutrition Examination Survey

Background

Olfactory dysfunction (OD) and gustatory dysfunction (GD) are common among adults, with prevalence increasing significantly in older age groups. Both dysfunctions have negative effects on appetite, nutrition, social functioning and even environmental safety. OD and GD frequently coexist, indicating a possible close association between these conditions. At present, there is a lack of large-sample epidemiological studies on the relationship between OD and GD. Our study aims to investigate the relationship between OD and GD using both measurement and questionnaire data from the 2013-2014 NHANES for US adults aged 40 years and older.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES). OD and GD were both assessed by measurements and questionnaires. The association between OD and GD was investigated with logistic regression models by adjusting for demographic characteristics, systemic diseases, and diseases of the nose and pharynx. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are presented.

Results

Participants with complete olfactory and gustatory measurements and questionnaires (n = 2,582) were included. Using whole-mouth measurements, anosmia OD significantly increased the odds of hypogeusia and ageusia GD after adjusting for confounding factors. Similarly, the questionnaire data revealed that OD significantly increased the odds of GD. However, hyposmia OD decreased the odds of hypogeusia GD using the tongue-tip taste measurement.

Conclusion

Our findings highlighted that OD was closely associated with GD in a nationally representative sample of US adults.

Olfactory Dysfunction in Children and Adolescents-A Diagnostic Pathway

Olfactory disorders have so far played a subordinate role in pediatric care, although children can also be affected. Due to a lack of awareness, the diagnosis can often only be made after numerous visits to the doctor, although it can significantly impact the quality of life. Olfactory disorders in adults are usually acquired, while congenital causes dominate in children. To date, there are no specific recommendations for diagnosis in children. This article deals with the prevalence, causes, and diagnostic approaches of olfactory disorders in pediatrics. A structured diagnostic approach is fundamental, including a medical history and psychophysical olfactory tests, supplemented by specific examinations depending on the suspected diagnosis. Therapeutic approaches are limited, with a focus on counseling and olfactory training.

Parosmia: Pathophysiology and Management

PURPOSE OF REVIEW

Parosmia is a qualitative olfactory disorder in which there is a mismatch between the memory of an odor and the actual experience triggered by an odor. There has been a surge in parosmia-related publications since the COVID-19 pandemic. This review summarizes the latest clinical findings, theories on pathophysiology and potential treatment options.

RECENT ADVANCES

Potential models of parosmia include peripheral or central hypotheses, which refer to aberrancies in olfactory neuron regeneration or information processing in central olfactory centers respectively. This leads to an incomplete or disorganized pattern of olfactory information relay. Studies using gas chromatography and functional magnetic resonance imaging have identified molecular triggers and intracranial functional connectivity patterns in parosmia respectively. Parosmia tends to occur in a delayed fashion after virus-induced anosmia. It may run a protracted course, but typically improves over time. Currently there are no generally approved, objective ways to ascertain the presence and measure the extent of parosmia. Evidence-based treatment for parosmia remains elusive. In some people, this can lead to health and quality of life issues.

Development of an rpS6-Based Ex Vivo Assay for the Analysis of Neuronal Activity in Mouse and Human Olfactory Systems

Olfactory sensitivity to odorant molecules is a complex biological function influenced by both endogenous factors, such as genetic background and physiological state, and exogenous factors, such as environmental conditions. In animals, this vital ability is mediated by olfactory sensory neurons (OSNs), which are distributed across several specialized olfactory subsystems depending on the species. Using the phosphorylation of the ribosomal protein S6 (rpS6) in OSNs following sensory stimulation, we developed an ex vivo assay allowing the simultaneous conditioning and odorant stimulation of different mouse olfactory subsystems, including the main olfactory epithelium, the vomeronasal organ, and the Grueneberg ganglion. This approach enabled us to observe odorant-induced neuronal activity within the different olfactory subsystems and to demonstrate the impact of environmental conditioning, such as temperature variations, on olfactory sensitivity, specifically in the Grueneberg ganglion. We further applied our rpS6-based assay to the human olfactory system and demonstrated its feasibility. Our findings show that analyzing rpS6 signal intensity is a robust and highly reproducible indicator of neuronal activity across various olfactory systems, while avoiding stress and some experimental limitations associated with in vivo exposure. The potential extension of this assay to other conditioning paradigms and olfactory systems, as well as its application to other animal species, including human olfactory diagnostics, is also discussed.

Turbinal bones are still one of the last frontiers of the tetrapod skull: hypotheses, challenges and perspectives

Turbinals are bony or cartilaginous structures that are present in the nasal cavity of most tetrapods. They are involved in key functions such as olfaction, heat, and moisture conservation, as well as protection of the respiratory tract. Despite recent studies that challenged long-standing hypotheses about their physiological and genomic correlation, turbinals remain largely unexplored, particularly for non-mammalian species. Herein, we review and synthesise the current knowledge of turbinals using an integrative approach that includes comparative anatomy, physiology, histology and genomics. In addition, we provide synonyms and correspondences of tetrapod turbinals from about 80 publications. This work represents a first step towards drawing hypotheses of homology for the whole clade, and provides a strong basis to develop new research avenues.

The olfactory test established by Henkin: is it reliable and does it correlate to established psychophysical tests?

PURPOSE

This pilot study aimed to determine whether the Henkin olfactory test discriminates between the olfactory function of patients with olfactory loss and healthy individuals, and whether the Henkin test is correlated with a validated psychophysical olfactory test.

METHODS

Participants underwent olfactory testing using the modified Henkin test (including detection [DT] and recognition [RT] thresholds, magnitude estimation [ME], and hedonic ratings [H], for four different odors) and the extended "Sniffin' Sticks" test battery (odor detection, discrimination, identification).

RESULTS

Forty-four individuals (28 women, aged 19-81 years, mean: 39 years) were included. Twenty-three were healthy (mean age: 38 years) and 21 had olfactory dysfunction (OD) (mean age: 40 years). OD patients had worse mean DT, lower composite RT, and lower ME ratings. Mean and individual odor H ratings were not significantly different between the groups. Most individuals were classified as hyposmic when using the prescribed classification by Henkin, with only very few satisfying the stringent criteria of anosmia and normosmia. Modified Henkin subtests were all positively correlated with each other and with the "Sniffin' Sticks", except for Unpleasant Mean H which was only correlated with Pleasant Mean H; and Pleasant mean H which was not correlated with mean DT scores.

CONCLUSION

The Henkin test is able to separate between OD patients and controls. However, modifications to the conduct of this test may be required. Studies that used this test should be carefully interpreted.

LEVEL OF EVIDENCE: 3

Patients with parosmia respond faster to unpleasant odors than patients with hyposmia: Insights from olfactory event-related potentials

BACKGROUND

Diagnosing parosmia is a challenge. The present study aimed to explore the distinctions between hyposmic patients with and without parosmia utilizing electroencephalography-derived olfactory event-related potentials (ERP).

METHODS

Forty-four patients with hyposmia were enrolled and divided into a group with parosmia (n = 23, mean age ± standard deviation = 48 ± 14 years, seven men) and a group without parosmia (n = 21, age = 52 ± 12 years, seven men) based on the clinical interview. Additionally, 21 healthy controls (mean age = 45 ± 14 years, six men) were included. Various measurements were obtained, including the Sniffin' Stick test, threshold tests for the odorants furfural mercaptan and 2,6-nonadienal, a modified Sniffin' Stick parosmia test, and well-being ratings. Chemosensory ERPs were recorded separately for each nostril using high-precision, computer-controlled air-dilution olfactometry.

RESULTS

Patients with parosmia had a decreased olfactory function similar to that observed in patients with hyposmia, although the odor sensitivity of patients with severe parosmia remained relatively unaffected. Patients with parosmia reported a decrease in well-being compared to controls. The severity of parosmia was positively correlated with odor sensitivity. Furthermore, patients with severe parosmia exhibited faster responses to unpleasant odors than patients without parosmia.

CONCLUSION

Overall, the present findings support the idea that parosmia predominantly occurs during olfactory recovery, significantly disturbing patients and warranting the development of effective treatments. Notably, the relatively faster responses of hyposmic patients with severe parosmia suggest that the generation of distorted olfactory responses may involve early stages of the processing of olfactory information.

Case Report: Vasospastic angina presenting as phantom odor perception

Background

Vasospastic angina usually presents with intermittent episodes of chest pain. It can rarely be associated with the perception of phantom odors.

Case summary

A 69-year-old woman presented for evaluation of intermittent shortness of breath and chest pain. She reported that she often experienced an abnormal smell sensation just prior to the event. The patient had abnormal smell sensation and shortness of breath at the initiation of exercise stress echocardiography with transient electrocardiographic changes and new regional wall motion abnormalities. Subsequent invasive coronary angiography showed no obstructive epicardial coronary artery disease. The patient was started on calcium channel blocker therapy with resolution of symptoms.

Conclusion

Phantom odor perception has been rarely reported as an angina-equivalent symptom. Clinicians should have a high index of suspicion in patients presenting with atypical anginal symptoms.

Comparison of Patient Characteristics and Olfactory Sensitivity for Trigger Odorants in Parosmia and Phantosmia

OBJECTIVES

This study aimed to determine the characteristics of patients with qualitative olfactory dysfunction (qualOD) and whether individuals with parosmia exhibit increased olfactory sensitivity to previously reported odorous triggers of parosmia.

METHODS

This study included individuals aged ≥18 years, divided into quantitative OD only, parosmia, and phantosmia groups. Data collected included: clinical-demographic data, "Sniffin' Sticks" scores, questionnaires (depression scale, importance of olfaction), and information about parosmia and phantosmia. A proportion of patients underwent trigger odor threshold testing for 2-Furfurylthiol [FFT] found in coffee and 2,6-nonadienal [Nonadienal] found in cucumber.

RESULTS

Those with parosmia were typically younger women, with shorter OD duration due to post-viral OD (PVOD), hyposmic/normosmic, and experienced parosmia more severely. Parosmia was 3.5 times more likely in PVOD. Those with phantosmia were older, with longer OD duration due to idiopathic OD, hyposmic/anosmic, and experienced phantosmia less severely. There were no significant differences between FFT and Nonadienal threshold scores in patients with parosmia, phantosmia, or only quantitative OD, but all groups had significantly increased olfactory sensitivity for trigger odors compared to phenyl ethyl alcohol (PEA).

CONCLUSION

Parosmia and phantosmia patients have distinct characteristics. This may provide clinicians with a better understanding of possible olfactory outcomes in these patients. The higher olfactory sensitivity of all groups to trigger odors compared to PEA raises interesting points about parosmia triggers and odors in the context of warning for danger, in relation to the pathophysiology of parosmia that may be worth exploring in future studies.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:3277-3285, 2024.

Subjective versus Psychophysical Measures of Chemosensory Alterations following COVID-19

INTRODUCTION

Olfactory dysfunction is a common symptom of COVID-19. However, subjective perception of olfactory function does not always correlate well with more objective measures. This study seeks to clarify associations between subjective and psychophysical measures of olfaction and gustation in patients with subjective chemosensory dysfunction following COVID-19.

METHODS

Adults with persistent COVID-19-associated chemosensory disturbance were recruited for a prospective, longitudinal cohort study at a tertiary care institution. Participants provided subjective measures of olfactory and gustatory function and underwent psychophysical assessment using Sniffin' Sticks olfactory and Monell gustatory tests.

RESULTS

Data analysis (n = 65) showed a statistically significant association between subjective and psychophysical measures of olfaction (p < 0.001). For each one-point increase in subjectively-reported olfactory ability, there is, on average, a 0.11 (95% CI: 0.06, 0.16; p < 0.001) point increase in TDI score while adjusting for age at baseline assessment, sex, and follow-up time. For each one-point increase in subjectively-reported olfactory ability, there is, on average, a 0.04 (95% CI: 0.02, 0.06; p < 0.001) point and 0.05 (95% CI: 0.03, 0.07; p < 0.001) point increase in discrimination and identification scores, respectively, when adjusting for age at baseline assessment, sex, and follow-up time.

CONCLUSION

Subjective olfaction shows a mild to moderate association with psychophysical measures, but it fails to comprehensively assess persistent COVID-19-associated chemosensory deficits. The lack of significant association between subjective olfaction and threshold limits the utility of subjective olfaction in tracking recovery. These findings support the push for more widespread psychophysical chemosensory testing.

Olfactory Dysfunction and Glaucoma

BACKGROUND

Olfactory dysfunction is a well-known phenomenon in neurological diseases with anosmia and hyposmia serving as clinical or preclinical indicators of Alzheimer's disease, Parkinson's disease, and other neurodegenerative disorders. Since glaucoma is a neurodegenerative disease of the visual system, it may also entail alterations in olfactory function, warranting investigation into potential sensory interconnections.

METHODS

A review of the current literature of the last 15 years (from 1 April 2008 to 1 April 2023) was conducted by two different authors searching for topics related to olfaction and glaucoma.

RESULTS

three papers met the selection criteria. According to these findings, patients with POAG appear to have worse olfaction than healthy subjects. Furthermore, certain predisposing conditions to glaucoma, such as pseudoexfoliation syndrome and primary vascular dysregulation, could possibly induce olfactory changes that can be measured with the Sniffin Stick test.

CONCLUSIONS

the scientific literature on this topic is very limited, and the pathogenesis of olfactory changes in glaucoma is not clear. However, if the results of these studies are confirmed by further research, olfactory testing may be a non-invasive tool to assist clinicians in the early diagnosis of glaucoma.

Bilateral hypogeusia and food aversion due to lacunar infarct in the right dorsomedial pontine tegmentum

A 70-year-old right-handed housewife suffered an acute loss of taste, an unpleasant change in the taste of foods and liquids, and a strong aversion to all kinds of food due to a small lacune in the right dorsomedial pontine tegmentum. Eating became so unpleasant that she lost 7 kg in three weeks. Olfaction and the sensibility of the tongue were spared. The right medial longitudinal fascicle, the central tegmental tract, or both, were injured by the tegmental lesion. A discrete right-sided lesion in the upper pontine tegmentum may cause a reversible syndrome consisting of bilateral hypogeusia which is more severe ipsilaterally.

Associations between olfactory dysfunction and cognition: a scoping review

INTRODUCTION

Strong evidence suggests that olfactory dysfunction (OD) can predict additional neurocognitive decline in neurodegenerative conditions such as Alzheimer's and Parkinson's diseases. However, research exploring olfaction and cognition in younger populations is limited. The aim of this review is to evaluate cognitive changes among non-elderly adults with non-COVID-19-related OD.

METHODS

We performed a structured comprehensive literature search of PubMed, Ovid Embase, Web of Science, and Cochrane Library in developing this scoping review. The primary outcome of interest was the association between OD and cognitive functioning in adults less than 60 years of age.

RESULTS

We identified 2878 studies for title and abstract review, with 167 undergoing full text review, and 54 selected for data extraction. Of these, 34 studies reported on populations of individuals restricted to the ages of 18-60, whereas the remaining 20 studies included a more heterogeneous population with the majority of individuals in this target age range in addition to some above the age of 60. The etiologies for smell loss among the included studies were neuropsychiatric disorders (37%), idiopathic cause (25%), type 2 diabetes (7%), trauma (5%), infection (4%), intellectual disability (4%), and other (18%). Some studies reported numerous associations and at times mixed, resulting in a total number of associations greater than the included number of 54 studies. Overall, 21/54 studies demonstrated a positive association between olfaction and cognition, 7/54 demonstrated no association, 25/54 reported mixed results, and only 1/54 demonstrated a negative association.

CONCLUSION

Most studies demonstrate a positive correlation between OD and cognition, but the data are mixed with associations less robust in this young adult population compared to elderly adults. Despite the heterogeneity in study populations and outcomes, this scoping review serves as a starting point for further investigation on this topic. Notably, as many studies in this review involved disorders that may have confounding effects on both olfaction and cognition, future research should control for these confounders and incorporate non-elderly individuals with non-psychiatric causes of smell loss.

Trigeminal Function in Sino-Nasal Health and Disease

The upper airway (nasal passages, paranasal sinuses, pharynx, and glottis) provides the sentinel portion of the human respiratory tract, with the combined senses of olfaction (cranial nerve I) and trigeminal sensation (cranial nerve V) signaling the quality of inspired air. Trigeminal function also complements the sense of taste (in turn mediated by cranial nerves VII, IX and X), and participates in the genesis of taste aversions. The ability of trigeminal stimulation in the upper aero-digestive tract to trigger a variety of respiratory and behavioral reflexes has long been recognized. In this context, the last three decades has seen a proliferation of observations at a molecular level regarding the mechanisms of olfaction, irritation, and gustation. Concurrently, an ever-widening network of physiological interactions between olfaction, taste, and trigeminal function has been uncovered. The objective of this review is to summarize the relatively recent expansion of research in this sub-field of sensory science, and to explore the clinical and therapeutic implications thereof.

Post-COVID-19 Anosmia and Therapies: Stay Tuned for New Drugs to Sniff Out

Background: Anosmia is defined as the complete absence of olfactory function, which can be caused by a variety of causes, with upper respiratory tract infections being among the most frequent causes. Anosmia due to SARS-CoV-2 infection has attracted attention given its main role in symptomatology and the social impact of the pandemic. Methods: We conducted systematic research in a clinicaltrials.gov database to evaluate all active clinical trials worldwide regarding drug therapies in adult patients for anosmia following SARS-CoV-2 infection with the intention of identifying the nearby prospects to treat Anosmia. We use the following search terms: "Anosmia" AND "COVID-19" OR "SARS-CoV-2" OR "2019 novel coronavirus". Results: We found 18 active clinical trials that met our criteria: one phase 1, one phase 1-2, five phases 2, two phases 2-3, three phases 3, and six phases 4 studies were identified. The drug therapies that appear more effective and promising are PEA-LUT and Cerebrolysin. The other interesting drugs are 13-cis-retinoic acid plus aerosolized Vitamin D, dexamethasone, and corticosteroid nasal irrigation. Conclusions: COVID-19 has allowed us to highlight how much anosmia is an important and debilitating symptom for patients and, above all, to direct research to find a therapy aimed at curing the symptom, whether it derives from SARS-CoV-2 infection or other infections of the upper airways. Some of these therapies are very promising and are almost at the end of experimentation. They also provide hope in this field, which not addressed until recently.

An olfactory perceptual fingerprint in people with olfactory dysfunction due to COVID-19

The sense of smell is based on sensory detection of the molecule(s), which is then further perceptually interpreted. A possible measure of olfactory perception is an odor-independent olfactory perceptual fingerprint (OPF) defined by Snitz et al. We aimed to investigate whether OPF can distinguish patients with olfactory dysfunction (OD) due to coronavirus disease (COVID-19) from controls and which perceptual descriptors are important for that separation. Our study included 99 healthy controls and 41 patients. They rated 10 odors using 8 descriptors such as "pleasant," "intense," "familiar," "warm," "cold," "irritating," "edible," and "disgusting." An unsupervised machine learning method, hierarchical cluster analysis, showed that OPF can distinguish patients from controls with an accuracy of 83%, a sensitivity of 51%, and a specificity of 96%. Furthermore, a supervised machine learning method, random forest classifier, showed that OPF can distinguish patients and controls in the testing dataset with an accuracy of 86%, a sensitivity of 64%, and a specificity of 96%. Principal component analysis and random forest classifier showed that familiarity and intensity were the key qualities to explain the variance of the data. In conclusion, people with COVID-19-related OD have a fundamentally different olfactory perception.