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Badi Y, Hammad M, Tawfik AG, Eshag MME, Elhady MM, Ragab KM, Nourelden AZ, Gamal MH, Fathallah AH. Inhaled corticosteroids' effect on COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:154-166. [PMID: 37781348 PMCID: PMC10540159 DOI: 10.29390/001c.84260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
Background More than six million people died due to COVID-19, and 10-15% of infected individuals suffer from post-covid syndrome. Corticosteroids are widely used in the management of severe COVID-19 and post-acute COVID-19 symptoms. This study synthesizes current evidence of the effectiveness of inhaled corticosteroids (ICS) on mortality, hospital length-of-stay (LOS), and improvement of smell scores in patients with COVID-19. Methods We searched Embase, Web of Science, PubMed, Cochrane Library, and Scopus until Aug 2022. The Cochrane risk of bias tool was used to assess the quality of studies. We evaluated the effectiveness of ICS in COVID-19 patients through measures of mortality, LOS, alleviation of post-acute COVID-19 symptoms, time to sustained self-reported cure, and sense of smell (visual analog scale (VAS)). Results Ten studies were included in the meta-analysis. Our study showed a significant decrease in the LOS in ICS patients over placebo (MD = -1.52, 95% CI [-2.77 to -0.28], p-value = 0.02). Patients treated with intranasal corticosteroids (INC) showed a significant improvement in VAS smell scores from week three to week four (MD =1.52, 95% CI [0.27 to 2.78], p-value = 0.02), and alleviation of COVID-related symptoms after 14 days (RR = 1.17, 95% CI [1.09 to 1.26], p-value < 0.0001). No significant differences were detected in mortality (RR= 0.69, 95% CI [0.36 to 1.35], p-value = 0.28) and time to sustained self-reported cure (MD = -1.28, 95% CI [-6.77 to 4.20], p-value = 0.65). Conclusion We concluded that the use of ICS decreased patient LOS and improved COVID-19-related symptoms. INC may have a role in improving the smell score. Therefore, using INC and ICS for two weeks or more may prove beneficial. Current data do not demonstrate an effect on mortality or time to sustained self-reported cure. However, the evidence is inconclusive, and more studies are needed for more precise data.
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Affiliation(s)
- Yasra Badi
- All Saints University School of Medicine
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Schepens EJA, Blijleven EE, Boek WM, Boesveldt S, Stokroos RJ, Stegeman I, Kamalski DMA. Prednisolone does not improve olfactory function after COVID-19: a randomized, double-blind, placebo-controlled trial. BMC Med 2022; 20:445. [PMID: 36384737 PMCID: PMC9667850 DOI: 10.1186/s12916-022-02625-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prednisolone has been suggested as a treatment for olfactory disorders after COVID-19, but evidence is scarce. Hence, we aimed to determine the efficacy of a short oral prednisolone treatment on patients with persistent olfactory disorders after COVID-19. METHODS We performed a randomized, double-blind, placebo-controlled, single-centered trial in the Netherlands. Patients were included if they were > 18 years old and if they had persistent (> 4 weeks) olfactory disorders within 12 weeks after a confirmed COVID-19 test. The treatment group received oral prednisolone 40 mg once daily for 10 days and the placebo group received matching placebo. In addition, all patients performed olfactory training. The primary outcome was the objective olfactory function on Sniffin' Sticks Test (SST) 12 weeks after the start of treatment, measured in Threshold-Discrimination-Identification (TDI) score. Secondary outcomes were objective gustatory function assessed by the Taste Strip Test (TST) and subjective self-reported outcomes on questionnaires about olfactory, gustatory and trigeminal function, quality of life, and nasal symptoms. The CONSORT 2010 guideline was performed. RESULTS Between November 2021 and February 2022, we included 115 eligible patients, randomly assigned to the treatment (n = 58) or placebo group (n = 57). No difference in olfactory function between groups was obtained after 12 weeks. Median TDI score on SST was 26.8 (IQR 23.6-29.3) in the placebo group and 28.8 (IQR 24.0-30.9) in the prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5). There was similar improvement on olfactory function in both groups after 12 weeks. Furthermore, on secondary outcomes, we obtained no differences between groups. CONCLUSIONS This trial shows that prednisolone does not improve olfactory function after COVID-19. Therefore, we recommend not prescribing prednisolone for patients with persistent olfactory disorders after COVID-19. TRIAL REGISTRATION This trial is registered on the ISRCTN registry with trial ID ISRCTN70794078.
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Affiliation(s)
- Emma J A Schepens
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. .,Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Esther E Blijleven
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilbert M Boek
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Digna M A Kamalski
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Vaira LA, Deiana G, Maglitto F, Salzano G. Post-Viral Olfactory Loss: What We Learned from the SARS-CoV-2 Pandemic. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111868. [PMID: 36431003 PMCID: PMC9696542 DOI: 10.3390/life12111868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Viral infections have always been one of the most frequent causes of persistent olfactory dysfunctions accounting for 18% to 45% of all cases [...].
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-3401846168
| | - Giovanna Deiana
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
- Direction, Hygiene and Hospital Infection Control Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, 80131 Naples, Italy
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2022; 9:CD013876. [PMID: 36062970 PMCID: PMC9443431 DOI: 10.1002/14651858.cd013876.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Olfactory dysfunction is a common consequence of COVID-19 infection and persistent symptoms can have a profound impact on quality of life. At present there is little guidance on how best to treat this condition. A variety of interventions have been suggested to promote recovery, including medication and olfactory training. However, it is uncertain whether any intervention is of benefit. This is an update of the 2021 review with one additional study added. OBJECTIVES: 1) To evaluate the benefits and harms of any intervention versus no treatment for people with persisting olfactory dysfunction due to COVID-19 infection. 2) To keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance that had persisted for at least four weeks. We included any intervention compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included two studies with 30 participants. The studies evaluated the following interventions: systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant and palmitoylethanolamide plus luteolin. Systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant compared to no intervention We included a single RCT with 18 participants who had anosmia for at least 30 days following COVID-19 infection. Participants received a 15-day course of oral corticosteroids combined with nasal irrigation (consisting of an intranasal corticosteroid/mucolytic/decongestant solution) or no intervention. Psychophysical testing was used to assess olfactory function at 40 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. Palmitoylethanolamide plus luteolin compared to no intervention We included a single RCT with 12 participants who had anosmia or hyposmia for at least 90 days following COVID-19 infection. Participants received a 30-day course of palmitoylethanolamide and luteolin or no intervention. Psychophysical testing was used to assess olfactory function at 30 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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Graham EL, Koralnik IJ, Liotta EM. Therapeutic Approaches to the Neurologic Manifestations of COVID-19. Neurotherapeutics 2022; 19:1435-1466. [PMID: 35861926 PMCID: PMC9302225 DOI: 10.1007/s13311-022-01267-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
As of May 2022, there have been more than 527 million infections with severe acute respiratory disease coronavirus type 2 (SARS-CoV-2) and over 6.2 million deaths from Coronavirus Disease 2019 (COVID-19) worldwide. COVID-19 is a multisystem illness with important neurologic consequences that impact long-term morbidity and mortality. In the acutely ill, the neurologic manifestations of COVID-19 can include distressing but relatively benign symptoms such as headache, myalgias, and anosmia; however, entities such as encephalopathy, stroke, seizures, encephalitis, and Guillain-Barre Syndrome can cause neurologic injury and resulting disability that persists long after the acute pulmonary illness. Furthermore, as many as one-third of patients may experience persistent neurologic symptoms as part of a Post-Acute Sequelae of SARS-CoV-2 infection (Neuro-PASC) syndrome. This Neuro-PASC syndrome can affect patients who required hospitalization for COVID-19 or patients who did not require hospitalization and who may have had minor or no pulmonary symptoms. Given the large number of individuals affected and the ability of neurologic complications to impair quality of life and productivity, the neurologic manifestations of COVID-19 are likely to have major and long-lasting personal, public health, and economic consequences. While knowledge of disease mechanisms and therapies acquired prior to the pandemic can inform us on how to manage patients with the neurologic manifestations of COVID-19, there is a critical need for improved understanding of specific COVID-19 disease mechanisms and development of therapies that target the neurologic morbidities of COVID-19. This current perspective reviews evidence for proposed disease mechanisms as they inform the neurologic management of COVID-19 in adult patients while also identifying areas in need of further research.
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Affiliation(s)
- Edith L Graham
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Igor J Koralnik
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Eric M Liotta
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA.
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Persisting Smell and Taste Disorders in Patients Who Recovered from SARS-CoV-2 Virus Infection-Data from the Polish PoLoCOV-CVD Study. Viruses 2022; 14:v14081763. [PMID: 36016385 PMCID: PMC9416276 DOI: 10.3390/v14081763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
In the majority of cases, patients infected with the SARS-CoV-2 virus experience a complete resolution of symptoms within six weeks of acquiring the infection, but an increasing number of patients report persistent symptoms. This study aimed to analyse the prevalence of self-reported smell and/or taste disorders (STDs) in a group of convalescent patients after infection with the SARS-CoV-2 virus and to identify risk factors for the disease. The study included 2218 COVID-19 convalescents after both inpatient and outpatient treatment. The sample group was analysed with regard to chronic diseases, place of isolation and clinical symptoms occurring during COVID-19 along with their duration. The assessment also included the most common symptoms of COVID-19 and the severity of the disease course. A total of 98 patients reported persistent smell and taste disorders up to three months after the end of isolation (67.4% of men and 32.6% of women). The mean age of the participants was 53.8 ± 13.5 years (49.19 ± 14.68 in patients with an STD vs. 54.01 ± 13.44 in patients without an STD). The patients treated for COVID-19 at home (p < 0.001) constituted almost the entire group of patients with persistent smell and taste disorders (97%). Among the patients with persistent smell and taste disorders, 57.1% suffered from at least one chronic condition (vs. 71.4% of patients without an STD). In patients with an STD, the number of symptoms per patient was higher than in the other group at 8.87 ± 3.65 (p = 0.018), while the most common clinical symptoms during the acute phase of COVID-19 were smell and taste disorders (84%) (p < 0.001), significant weakness (70%), headache (60%), cough (55%), arthralgia (51%) (p = 0.034) and back muscle pain (51%). Based on the results obtained, the following conclusions were drawn: the risk of developing persistent smell and taste disorders after COVID-19 is greater in younger people with less comorbidities and a higher number of symptoms during the acute phase of COVID-19. The risk is associated with clinical symptoms occurring during the acute phase of COVID-19, i.e., smell and taste disorders and arthralgia. In addition, this risk is higher in patients receiving outpatient treatment for COVID-19.
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7
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Schepens EJA, Boek WM, Boesveldt S, Stegeman I, Stokroos RJ, Kamalski DMA. COCOS trial: COrticosteroids for COVID-19-induced loss of Smell-protocol for a single-centred, double-blind, randomised, placebo-controlled trial. BMJ Open 2022; 12:e060416. [PMID: 35948382 PMCID: PMC9378948 DOI: 10.1136/bmjopen-2021-060416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hyposmia and anosmia are common in COVID-19. Most patients regain normal smell within 4 weeks, but severe loss of smell persists roughly in 20% after 2 months and may last up to a year or longer. These persistent smell disorders greatly influence daily life. It is hypothesised that COVID-19 induces inflammation around the olfactory nerve and in the olfactory pathway, leading to smell disorders. Corticosteroids might reduce this local inflammatory response and improve smell. METHODS AND ANALYSIS We will conduct a single-centre, randomised, placebo-controlled trial to determine the efficacy of a short high-dose treatment of oral prednisolone for persistent loss of smell after COVID-19 in the early phase. We will include 116 patients with persistent (>4 weeks) loss of smell within 12 weeks of COVID-19 diagnosis, based on a positive PCR/antigen test. One group receives 40 mg of prednisolone for 10 days and the other group receives matching placebo treatment. In addition, all patients will perform smell training for 12 weeks. The primary outcome is objective olfactory function measured by means of sniffin' sticks test. Secondary outcomes are objective gustatory function by means of taste strips test and subjective taste and smell ability, trigeminal sensations, quality of life and nasal symptoms, measured by three questionnaires. These outcomes will be measured at inclusion before treatment and 12 weeks later. ETHICS AND DISSEMINATION The Institutional Review Board of the University Medical Center Utrecht approved the research protocol (21-635/G-D, October 2021). The trial results will be shared in peer-reviewed medical journals and scientific conferences. TRIAL REGISTRATION NUMBER NL9635. EUCTR2021-004021-71-NL.
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Affiliation(s)
- Emma J A Schepens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilbert M Boek
- Department of Otorhinolaryngology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Digna M A Kamalski
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Center Utrecht, Utrecht, The Netherlands
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Sousa FAD, Machado AS, da Costa JC, Silva AC, Pinto AN, Coutinho MB, Meireles L, Sousa CAE. Tailored Approach for Persistent Olfactory Dysfunction After SARS-CoV-2 Infection: A Pilot Study. Ann Otol Rhinol Laryngol 2022; 132:657-666. [PMID: 35822286 DOI: 10.1177/00034894221111093] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE So far, no original studies explored non-randomized, standardized protocols for COVID-19 associated olfactory dysfunction. The main objective was to determine the efficacy of a new protocol for post-COVID olfactopathy while assessing the benefit of adding adjuvant therapies to olfactory training. METHODS Patients suffering from long-lasting post-COVID-19 olfactory dysfunction were evaluated. A non-randomized protocol based on individual nasal endoscopy findings and patient's preferences was applied. Patients were assigned for olfactory training alone or olfactory training + adjuvant therapy. Participants performed olfactory objective and subjective evaluations at first consultation and 3 months after treatment, and results were compared. RESULTS A total of 47 patients were enrolled. All groups showed significant improvement in olfactory thresholds at 3-month follow-up suggesting protocol effectiveness (olfactory training group alone showed a mean threshold difference of 2.9, P < .001; Olfactory training + Topical Corticosteroid showed a mean threshold difference of 4, P = .006; Olfactory training + Topical Corticosteroid + Vitamin B complex showed a mean threshold difference of 4.4, P = .006; Olfactory training + Intranasal Vitamin A and E showed a mean threshold difference of 4.4, P < .001). Olfactory training alone showed lower mean olfactory threshold improvement, when compared to patients undergoing olfactory training + adjuvant therapy (olfactory training alone mean improvement 2.9 ± 2.3 vs olfactory training + adjuvants mean improvement 4.3 ± 2.458, P = .03). CONCLUSIONS This is one of the first studies to demonstrate results in the treatment of post-COVID-19 persistent olfactory impairment. A customized approach based on endoscopy findings and patient's preferences may be a valid option for the management of persistent post-COVID-19 olfactory disorder. Adjuvant therapy could be considered in addition to olfactory training, but further studies are needed in order to confirm their effectiveness in this setting. LEVEL OF EVIDENCE 2c (outcomes research).
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Affiliation(s)
- Francisco Alves de Sousa
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André Sousa Machado
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Carvalho da Costa
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Costa Silva
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Nóbrega Pinto
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Bebiano Coutinho
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Meireles
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cecília Almeida E Sousa
- Serviço de Otorrinolaringologia e Cirurgia da Cabeça e Pescoço (Otorhinolaryngology and Head & Neck Surgery), Centro Hospitalar Universitário do Porto, Porto, Portugal
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Olfactory and gustatory disorders in COVID-19. ALLERGO JOURNAL INTERNATIONAL 2022; 31:243-250. [PMID: 35755859 PMCID: PMC9208356 DOI: 10.1007/s40629-022-00216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/28/2022] [Indexed: 12/05/2022]
Abstract
Loss of olfaction is one of the symptoms most commonly reported by patients with coronavirus disease 2019 (COVID-19). Although the spontaneous recovery rate is high, recent studies have shown that up to 7% of patients remain anosmic for more than 12 months after the onset of infection, leaving millions of people worldwide suffering from severe olfactory impairment. Olfactory training remains the first recommended treatment. With the continued lack of approved drug treatments, new therapeutic options are being explored. This article reviews the current state of science on COVID-19-related olfactory disorders, focusing on epidemiology, pathophysiology, cure rates, currently available treatment options, and research on new treatments.
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Narayanan SN, Shivappa P, Padiyath S, Bhaskar A, Li YW, Merghani TH. The Prevalence and Pathophysiology of Chemical Sense Disorder Caused by the Novel Coronavirus. Front Public Health 2022; 10:839182. [PMID: 35734755 PMCID: PMC9207763 DOI: 10.3389/fpubh.2022.839182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 12/27/2022] Open
Abstract
Emerging viral infections are a ceaseless challenge and remain a global public health concern. The world has not yet come back to normal from the devastating effects of the highly contagious and pathogenic novel coronavirus, or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Olfactory and taste dysfunction is common in patients infected by the novel coronavirus. In light of the emergence of different coronavirus variants, it is important to update the prevalence and pathophysiology of these side effects. In this review, articles published on the prevalence of olfactory and taste dysfunction from coronavirus disease (COVID-19) and their possible pathophysiologic mechanisms have been reviewed and reported. The modulatory role of different SARS-CoV-2 variants on the chemical senses is then described. The clinical relevance of chemical sense disorder and its long-term morbidity and management is also discussed.
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Affiliation(s)
- Sareesh Naduvil Narayanan
- Department of Physiology, Ras Al Khaimah College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
- *Correspondence: Sareesh Naduvil Narayanan ; orcid.org/0000-0002-2980-2352
| | - Pooja Shivappa
- Department of Basic Sciences, Ras Al Khaimah College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Sreeshma Padiyath
- Independent Microbiology Researcher, Ras Al Khaimah, United Arab Emirates
| | - Anand Bhaskar
- Department of Biomedical Sciences, Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Yan Wa Li
- Department of Biomedical Sciences, Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Tarig Hakim Merghani
- Department of Physiology, Ras Al Khaimah College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
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Trecca EM, Cassano M, Longo F, Petrone P, Miani C, Hummel T, Gelardi M. Results from psychophysical tests of smell and taste during the course of SARS-CoV-2 infection: a review. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:S20-S35. [PMID: 35763272 PMCID: PMC9137382 DOI: 10.14639/0392-100x-suppl.1-42-2022-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 01/23/2023]
Abstract
Only a few studies have assessed smell and taste in Coronavirus Disease 2019 (COVID-19) patients with psychophysical tests, while the majority performed self-rating evaluations. Given the heterogeneity of the published literature, the aim of this review was to systematically analyse the articles on this topic with a focus on psychophysical testing. A search on PubMed and Web of Science from December 2019, to November 2021, with cross-references, was executed. The main eligibility criteria were English-language articles, investigating the clinical features of olfaction and gustation in COVID-19 patients using self-rating assessment, psychophysical testing and imaging techniques. A total of 638 articles were identified and 66 were included. Self-rating assessment was performed in 31 studies, while psychophysical testing in 30 and imaging techniques in 5. The prevalence of chemosensory dysfunction was the most investigated topic, followed by the recovery time. About the psychophysical assessment, the extended version of the Sniffin’ Sticks was used in 11 articles and the Connecticut Chemosensory Clinical Research Center test in another 11. The olfactory threshold performance was the most impacted compared to the discrimination and identification capacities in accordance with the hypothesis of a tropism of SARS-CoV-2 for the olfactory mucosa. The timing significantly influenced the results of the psychophysical testing with 20% of patients presenting olfactory dysfunction at one month after infection.
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12
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Gamil Y, Ismail RM, Abdou A, Shabaan AA, Hamed MG. Association between Administration of Systemic Corticosteroids and the Recovery of Olfactory and/or Gustatory Functions in Patients with COVID-19: A Prospective Cohort Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study is a prospective cohort study aimed to assess the effect of systemic corticosteroids administration time in the recovery of gustatory and olfactory sensations dysfunction (ageusia and anosmia) in COVID-19 patients.
MATERIALS AND METHODS: Sixty-seven COVID-19 patients with symptoms of ageusia and anosmia were recruited (that their COVID infection was confirmed using polymerase chain reaction). Daily 10 mg of systemic corticosteroids were prescribed in the 1st week and then reduced to 5 mg in the 2nd week to all the patients to observe taste and smell sensation recovery. All data were recorded and then analyzed. Patients were then grouped into two groups (early and late groups) according to the duration of their taste and smell dysfunction.
RESULTS: Regression analysis showed that early corticosteroid administration resulted in a significant decrease in recovery time of ageusia and anosmia (0.27 [0.2–0.35], p < 0.001). Patients in the early administration group (<1 week) showed faster improvement in regaining taste and smell functions than in the late administration group (>1 week) with significant difference (p < 0.001).
CONCLUSIONS: The use of systemic corticosteroids in early phases of covid-19 infection help in faster recovery of ageusia and anosmia.
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13
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Khan AM, Lee J, Rammaha T, Gupta S, Smith H, Kannampallil T, Farrell N, Kallogjeri D, Piccirillo JF. Natural Trajectory of Recovery of COVID-19 Associated Olfactory Loss. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.17.22270551. [PMID: 35194618 PMCID: PMC8863162 DOI: 10.1101/2022.02.17.22270551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
IMPORTANCE Prevalence of post-viral olfactory loss has increased dramatically due to the frequency and severity of olfactory dysfunction associated with infection by the SARS-CoV-2 virus. OBJECTIVE To determine the trajectory of COVID-19 olfactory loss over a six-month period. A key secondary objective is to assess predictive factors associated with the recovery of olfaction. DESIGN Longitudinal repeated-measures study that enrolled from May 5, 2020 to February 2, 2021, with the last date of data collection on June 15, 2021. SETTING Barnes-Jewish HealthCare/Washington University School of Medicine facilities (Saint Louis, Missouri, USA). PARTICIPANTS Individuals who tested positive for SARS-CoV-2 by real-time polymerase chain reaction on nasopharyngeal swab and indicated olfactory loss on COVID-19 screening questionnaire. Individuals were excluded if they had previously diagnosed history of olfactory loss, neurodegenerative disorders, less than 18 years of age, admitted to hospital service, unable to read, write, and understand English, or lacked computer or internet access. INTERVENTIONS/EXPOSURES Watch and wait for spontaneous recovery. MAIN OUTCOMES AND MEASURES Participants completed olfactory assessments every 30 days for six months. Each assessment consisted of the University of Pennsylvania Smell Identification Test (UPSIT), an objective "scratch-and-sniff" test, and Clinical Global Impressions (CGI), a subjective Likert rating scale. RESULTS The mean age was 41 years old (SD = 16). 39 (80%) were female and 42 (86%) white. At baseline assessment of objective olfaction, 18 (36%) participants had anosmia or severe hyposmia. Subjective, complete recovery at six months was 81% (95% CI 74% to 88%). Likelihood of recovery was associated with age less than 50 years (aHR = 8.1 (95% CI 1.1 to 64.1)) and mild olfactory loss at baseline (UPSIT = 30-33 for males and 31-34 for females) (aHR 6.2 (95% CI 1.2 to 33.0)). CONCLUSIONS AND RELEVANCE The trajectory of olfactory recovery among adults with COVID-19 olfactory loss illustrated rapid recovery within 2-3 weeks of infection, and by six months 81% had recovered based on self-report. Age less than 50 years old and mild severity of olfactory loss at baseline were associated with increased likelihood of recovery of olfaction. These findings can be used to inform shared decision-making with patients.
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Abstract
PURPOSE OF REVIEW This article reviews the literature on COVID-19 related anosmia, focusing on the epidemiology, pathophysiology recovery rates, current available treatment options, and research regarding novel treatments. RECENT FINDINGS Loss of sense of smell is one of the most prevalent symptoms reported by patients after COVID-19 infection. Even though there is a high self-reported recovery rate, recent studies have demonstrated that up to 7% of the patients remain anosmic more than 12 months after onset, leaving millions worldwide with severe olfactory dysfunction. Olfactory training remains the first line recommended treatment. Given the paucity of effective medical treatments options researchers are exploring novel therapeutic options. SUMMARY Olfactory dysfunction remains a significant and persistent legacy of the COVID-19 pandemic, but heightened awareness may stimulate research that leads to the development of much-needed treatment options.
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Affiliation(s)
- Katerina Karamali
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Michael Elliott
- Department of Otorhinolaryngology, Guy's and St Thomas NHS Foundation Trust
| | - Claire Hopkins
- Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
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15
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The Effects of Persistent Olfactory and Gustatory Dysfunctions on Quality of Life in Long-COVID-19 Patients. Life (Basel) 2022; 12:life12020141. [PMID: 35207429 PMCID: PMC8878431 DOI: 10.3390/life12020141] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 12/26/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Persistent olfactory (POD) and gustatory (PGD) dysfunctions are one of the most frequent symptoms of long-Coronavirus Disease 2019 but their effect on the quality of life (QoL) of patients is still largely unexplored. (2) Methods: An online survey was administered to individuals who reported to have had SARS-CoV-2 infection at least 6 months prior with persisting COVID-19 symptoms (using the COVID symptom index), including ratings of POD and PGD, and their physical (PCS) and mental (MCS) components of quality of life were assessed using the standardized short form 12 questionnaire (SF-12). (3) Results: Responses from 431 unique individuals were included in the analyses. The most frequent persistent symptoms were: fatigue (185 cases, 42.9%), olfactory dysfunction (127 cases, 29.5%), gustatory dysfunction (96 cases, 22.3%) and muscle pain (83 cases, 19.3%). Respondents who reported persisting muscle pain, joint pain, fatigue, headache, gastrointestinal disturbances, and dyspnea had significantly worse PCS. Those experiencing persistent fatigue and dyspnea also showed significantly lower MCS. Respondents reporting POD or PGD showed significantly worse QoL, but only pertaining to the MCS. Multiple regressions predicted MCS based on olfactory and marginally on gustatory ratings, but not PCS. Age significantly affected the prediction of PCS but not MCS, and gender and temporal distance from the COVID-19 diagnosis had no effect. (4) Conclusions: POD and PGD are frequent symptoms of the long-COVID-19 syndrome and significantly reduce QoL, specifically in the mental health component. This evidence should stimulate the establishment of appropriate infrastructure to support individuals with persistent CD, while research on effective therapies scales up.
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16
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Klimek L, Hagemann J, Döge J, Koll L, Cuevas M, Klimek F, Hummel T. Störungen des Riech- und Schmeckvermögens bei COVID-19. ALLERGO JOURNAL 2022; 31:35-43. [PMCID: PMC9618349 DOI: 10.1007/s15007-022-5602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Der Verlust des Riechvermögens ist eines der Symptome, die von Patienten mit COVID-19 mit am häufigsten angegeben werden. Obwohl die Spontanheilungsrate hoch ist, haben neuere Studien gezeigt, dass bis zu 7 % der Patienten mehr als zwölf Monate nach Beginn der Infektion anosmisch bleiben, sodass weltweit Millionen von Menschen unter schweren Riechstörungen leiden. Riechtraining ist nach wie vor die erste empfohlene Behandlungsform. Angesichts weiterhin fehlender zugelassener medikamentöser Behandlungsmöglichkeiten werden neue therapeutische Optionen erforscht. Dieser Artikel gibt einen Überblick über den aktuellen Stand der Wissenschaft zu COVID-19-bedingten Riechstörungen, wobei der Schwerpunkt auf der Epidemiologie, der Pathophysiologie, den Heilungsraten, den derzeit verfügbaren Behandlungsmöglichkeiten und der Forschung zu neuen Behandlungsmethoden liegt. Zitierweise: Klimek L, Hagemann J, Döge J, Freudelsperger L, Cuevas M, Klimek F, Hummel T. Olfactory and gustatory disorders in COVID-19. Allergo J Int 2022;31:243-50 https://doi.org/10.1007/s40629-022-00216-7
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Affiliation(s)
- Ludger Klimek
- FA für Dermatologie u. Allergologie, Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Jan Hagemann
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Julia Döge
- Klinik f. Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Laura Koll
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| | - Mandy Cuevas
- Klinik u. Poliklinik für Hals- Nasen- und Ohrenheilkunde, Univ.-Klinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - Felix Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183 Wiesbaden, Germany
| | - Thomas Hummel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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17
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Zeraatkar D, Cusano E, Martínez JPD, Qasim A, Mangala S, Kum E, Bartoszko JJ, Devji T, Agoritsas T, Guyatt G, Izcovich A, Khamis AM, Lamontagne F, Rochwerg B, Vandvik P, Brignardello-Petersen R, Siemieniuk RAC. Use of tocilizumab and sarilumab alone or in combination with corticosteroids for covid-19: systematic review and network meta-analysis. BMJ MEDICINE 2022; 1:e000036. [PMID: 36936570 PMCID: PMC9978750 DOI: 10.1136/bmjmed-2021-000036] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Objective To compare the effects of interleukin 6 receptor blockers, tocilizumab and sarilumab, with or without corticosteroids, on mortality in patients with covid-19. Design Systematic review and network meta-analysis. Data sources World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature, and two prospective meta-analyses (up to 9 June 2021). Review methods Trials in which people with suspected, probable, or confirmed covid-19 were randomised to interleukin 6 receptor blockers (with or without corticosteroids), corticosteroids, placebo, or standard care. The analysis used a bayesian framework and assessed the certainty of evidence using the GRADE approach. Results from the fixed effect meta-analysis were used for the primary analysis. Results Of 45 eligible trials (20 650 patients) identified, 36 (19 350 patients) could be included in the network meta-analysis. Of 36 trials, 27 were at high risk of bias, primarily due to lack of blinding. Tocilizumab, in combination with corticosteroids, suggested a reduction in the risk of death compared with corticosteroids alone (odds ratio 0.79, 95% credible interval 0.70 to 0.88; 35 fewer deaths per 1000 people, 95% credible interval 52 fewer to 18 fewer per 1000; moderate certainty of evidence), as did sarilumab in combination with corticosteroids, compared with corticosteroids alone (0.73, 0.58 to 0.92; 43 fewer per 1000, 73 fewer to 12 fewer; low certainty). Tocilizumab and sarilumab, each in combination with corticosteroids, appeared to have similar effects on mortality when compared with each other (1.07, 0.86 to 1.34; eight more per 1000, 20 fewer to 35 more; low certainty). The effects of tocilizumab (1.12, 0.91 to 1.38; 20 more per 1000, 16 fewer to 59 more; low certainty) and sarilumab (1.07, 0.81 to 1.40; 11 more per 1000, 38 fewer to 55 more; low certainty), when used alone, suggested an increase in the risk of death. Conclusion These findings suggest that in patients with severe or critical covid-19, tocilizumab, in combination with corticosteroids, probably reduces mortality, and that sarilumab, in combination with corticosteroids, might also reduce mortality. Tocilizumab and sarilumab, in combination with corticosteroids, could have similar effectiveness. Tocilizumab and sarilumab, when used alone, might not be beneficial.
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Affiliation(s)
- Dena Zeraatkar
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Harvard Medical School, Boston, MA, USA
| | - Ellen Cusano
- Internal Medicine Residency Programme, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Juan Pablo Díaz Martínez
- Institute of Health Policy, Management and valuation, University of Toronto, Toronto, ON, Canada
| | - Anila Qasim
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Elena Kum
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Tahira Devji
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Gordon Guyatt
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ariel Izcovich
- Internal Medicine, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | | | - Bram Rochwerg
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Per Vandvik
- Department of Medicine, Innlandet Hospital Trust-divisjon Gjøvik, Gjøvik, Norway
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18
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Olfactory recovery following infection with COVID-19: A systematic review. PLoS One 2021; 16:e0259321. [PMID: 34752471 PMCID: PMC8577770 DOI: 10.1371/journal.pone.0259321] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/16/2021] [Indexed: 01/05/2023] Open
Abstract
Olfactory loss has been identified as one of the common symptoms related to COVID-19 infection. Although olfactory loss is recognized, our understanding of both the extent of loss and time to olfactory recovery following infection is less well known. Similarly, knowledge of potential impactful patient factors and therapies that influence olfactory recovery is desirable but is not overtly clear in the literature. Our systematic review sought to fill this knowledge gap. We included studies that: involved either an observational or an interventional design that reported data on patients with olfactory dysfunction due to Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnosed COVID-19 infection; and reported data regarding olfactory recovery measured by an objective olfactory test, Likert scale and/or visual analog scale (VAS). The study methods were determined a priori and registered in PROSPERO (Registration Number CRD42020204354). An information specialist searched Medline, Embase, LitCovid and the Cochrane Register of Controlled Trials up to March 2021, and two reviewers were involved in all aspects of study selection and data collection. After screening 2788 citations, a total of 44 studies of assorted observational designs were included. Patients had undergone objective COVID-19 testing, and most were adult patients with mild to moderate COVID-19. Olfactory recovery was found to occur as early as 7 days, with most patients recovering olfaction within 30 days. Few studies included prolonged follow-up to 6 months or longer duration. Poor olfaction at initial presentation was associated with poor recovery rates. Only a small number of studies assessed olfactory retraining and steroid therapy. Additional trials are underway.
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19
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Najafloo R, Majidi J, Asghari A, Aleemardani M, Kamrava SK, Simorgh S, Seifalian A, Bagher Z, Seifalian AM. Mechanism of Anosmia Caused by Symptoms of COVID-19 and Emerging Treatments. ACS Chem Neurosci 2021; 12:3795-3805. [PMID: 34609841 PMCID: PMC8507153 DOI: 10.1021/acschemneuro.1c00477] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
The occurrence of anosmia, the loss or change in sense of smell, is one of the most common symptoms of COVID-19 experienced by almost 53% of those affected. Several hypotheses explain the mechanism of anosmia in patients suffering from COVID-19. This study aims to review the related mechanisms and answer the questions regarding COVID-19-related anosmia as well as propose a new strategy for treatment of long-term anosmia as a result of COVID-19 infection. This paper covers all of the studies investigating olfactory disorders following COVID-19 infection and explains the possible reasons for the correlated anosmia, including olfactory cleft syndrome, local inflammation in the nasal epithelium, early apoptosis of olfactory cells, changes in olfactory cilia and odor transmission, damage to microglial cells, effect on olfactory bulbs, epithelial olfactory injury, and impairment of olfactory neurons and stem cells. The key questions that arise in this field have been discussed, such as why prevalent anosmia is varied among the age categories and among sexes and the correlation of anosmia with mild or severe COVID-19 infection. The angiotensin-converting enzyme 2 receptor is a significant player in the mechanism of anosmia in COVID-19 patients. Based on current studies, a novel approach to treat long-COVID-19 with ongoing anosmia has been proposed. The fields of smart drug delivery, tissue engineering, and cell therapy provide a hypothesized strategy that can minimize the side effects of current treatments and support efficient recovery of the olfactory system.
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Affiliation(s)
- Raziyeh Najafloo
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Jila Majidi
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Alimohamad Asghari
- Skull
Base Research Center, Hazrat Rasoul Akram Hospital, The Five Senses
Health Institute, Iran University of Medical
Sciences (IUMS), Tehran 1445613131, Iran
| | - Mina Aleemardani
- Biomaterials
and Tissue Engineering Group, Department of Materials Science and
Engineering, Kroto Research Institute, The
University of Sheffield, Sheffield S3 7HQ, United Kingdom
| | - Seyed Kamran Kamrava
- ENT
and Head and Neck Research Center and Department, Hazrat Rasoul Akram
Hospital, The Five Senses Health Institute, Iran University of Medical Sciences (IUMS), Tehran 1445613131, Iran
| | - Sara Simorgh
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
| | - Amelia Seifalian
- University
College London Medical School (UCL), London WC1E 6BT, United
Kingdom
- Watford
General Hospital, Watford WD18 0HB, United Kingdom
| | - Zohreh Bagher
- Department
of Tissue Engineering & Regenerative Medicine, Faculty of Advanced
Technologies in Medicine, Iran University
of Medical Sciences (IUMS), Tehran 1449614535, Iran
- ENT
and Head and Neck Research Center and Department, Hazrat Rasoul Akram
Hospital, The Five Senses Health Institute, Iran University of Medical Sciences (IUMS), Tehran 1445613131, Iran
| | - Alexander M. Seifalian
- Nanotechnology
and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London NW1 0NH, United Kingdom
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20
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Treatment and Prognosis of COVID-19 Associated Olfactory and Gustatory Dysfunctions. J Pers Med 2021; 11:jpm11101037. [PMID: 34683178 PMCID: PMC8539133 DOI: 10.3390/jpm11101037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/14/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
Olfactory and gustatory dysfunctions are important initial symptoms of coronavirus disease 2019 (COVID-19). However, the treatment modality for these conditions has yet to be clearly established. Therefore, most physicians have been administering empirical treatments for COVID-19-associated olfactory dysfunction, including topical or systemic steroid supplementation and olfactory training. In this literature review, we summarize the clinical course and effects of various treatments currently being conducted in patients with COVID-19-associated olfactory and gustatory dysfunctions.
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21
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Peterson CJ, Sarangi A, Bangash F. Neurological sequelae of COVID-19: a review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:122. [PMID: 34511868 PMCID: PMC8424148 DOI: 10.1186/s41983-021-00379-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/26/2021] [Indexed: 01/28/2023] Open
Abstract
Background The COVID-19 pandemic has produced a myriad of challenges, including identifying and treating neurological sequelae. Main body COVID-19 can cause olfactory and respiratory dysfunction with average recovery within 1 month and a minority of patients experiencing symptoms at 8-month follow-up. Headaches are also very common (up to 93%) amongst patients with persistent COVID-19 symptoms. COVID-19 illness may also affect cognition, although results are mixed. Conclusion While many studies have focused on acute COVID-19 symptoms, more longitudinal studies will need to assess the neurological sequelae of the disease. Furthermore, care must be taken when attributing sequelae to COVID-19 illness and not an unrelated cause. Finally, there is concern that COVID-19 may be associated with secondary illnesses, such as Guillain–Barre, and may even contribute to the development of diseases, such as Alzheimer’s.
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Affiliation(s)
- Christopher J Peterson
- Menninger Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Ashish Sarangi
- Department of Psychiatry, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430 USA
| | - Fariha Bangash
- SUNY Upstate Medical University, 750E Adams St, Syracuse, NY 13210 USA
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22
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Yuan F, Huang T, Wei Y, Wu D. Steroids and Olfactory Training for Postviral Olfactory Dysfunction: A Systematic Review. Front Neurosci 2021; 15:708510. [PMID: 34456675 PMCID: PMC8387929 DOI: 10.3389/fnins.2021.708510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Postviral olfactory dysfunction (PVOD) is a clinical challenge due to limited therapeutic options and poor prognosis. Both steroids and olfactory training have been proved to be effective for olfactory dysfunction with varied etiologies. We sought to perform a systematic review to summarize the evidence of steroids or olfactory training for patients with PVOD. Methods: A systematic literature review using PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies assessing olfactory change in patients with PVOD receiving steroid or olfactory training. Results: Of the initial 273 abstracts reviewed, 20 articles with data from 2,415 patients with PVOD were included. Treatments including topical steroids, systemic steroids, classical olfactory training (COT), modified olfactory training (MOT), and olfactory training with steroid were analyzed. Both psychophysical olfactory testing and subjective symptom scores were utilized to assess the olfactory function. The routine use of nasal steroid spray alone during the management of PVOD seems to have no positive effect on olfactory dysfunction. Direct injection of steroid or nasal steroid spray into the olfactory cleft significantly improved the olfactory function in patients with PVOD. Olfactory improvement is greater than that of the natural course of the disease with short-term COT. Patients with PVOD would benefit more from long-term COT (>12 weeks). Treatment duration, various odorants, olfactory training devices, changing the types of odors periodically, different molecular odorants, and different concentrations of odorants tended to increase the efficiency of MOT. Clinically significant improvement after olfactory training was defined as an increase of threshold, discrimination, and identification (TDI) score ≥6. From week 24 to week 36, both COT and MOT groups reached the maximum therapeutic effect regarding the number of participants achieving clinically significant improvement. A combination of local or oral steroids with olfactory training is more efficient than COT only. Conclusion: Olfactory function in patients with PVOD was effectively improved through direct steroid administration in the olfactory cleft, COT, or modification of COT. The addition of topical steroids to COT therapy showed a tendency for greater olfactory improvement in patients with PVOD.
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Affiliation(s)
- Fan Yuan
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tianhao Huang
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Otorhinolaryngology Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Dawei Wu
- Department of Otolaryngology, Smell and Taste Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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23
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Specific Therapy of Olfactory Disorders in COVID-19 Patients is Essential for the Prevention of Long-term Dysfunction. Indian J Otolaryngol Head Neck Surg 2021; 74:3102-3103. [PMID: 34458129 PMCID: PMC8380412 DOI: 10.1007/s12070-021-02818-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022] Open
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24
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Lechien JR, Chiesa-Estomba CM, Hans S, Saussez S. Pathophysiological mechanisms and management of patients with long-time anosmia related to COVID-19. J Intern Med 2021; 290:464-465. [PMID: 33527593 PMCID: PMC8014317 DOI: 10.1111/joim.13257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022]
Affiliation(s)
- J R Lechien
- From the, Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - C M Chiesa-Estomba
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - S Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - S Saussez
- From the, Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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25
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Amadu AM, Vaira LA, Lechien JR, Scaglione M, Saba L, Lampus ML, Profili SG, Le Bon SD, Salzano G, Maglitto F, Saussez S, Boscolo-Rizzo P, Hopkins C, De Riu G. Analysis of the correlations between the severity of lung involvement and olfactory psychophysical scores in coronavirus disease 2019 (COVID-19) patients. Int Forum Allergy Rhinol 2021; 12:103-107. [PMID: 34296541 PMCID: PMC8426857 DOI: 10.1002/alr.22869] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy
| | - Jerome R Lechien
- COVID-19 Task Force of the Young Physicians Group of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMons Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Mariano Scaglione
- Diagnostic Imaging 2 Unit, University Hospital of Sassari, Sassari, Italy
| | - Luca Saba
- Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Maria Luisa Lampus
- Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | | | - Serge-Daniel Le Bon
- Department of Otorhinolaryngology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
| | - Fabio Maglitto
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Department of Maxillofacial Surgery, University of Naples "Federico II", Naples, Italy
| | - Sven Saussez
- COVID-19 Task Force of the Young Physicians Group of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMons Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Claire Hopkins
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- ENT Department, King's College, London, UK.,British Rhinological Society (President), London, UK
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26
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Webster KE, O'Byrne L, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the prevention of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013877. [PMID: 34291812 PMCID: PMC8406518 DOI: 10.1002/14651858.cd013877.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loss of olfactory function is well recognised as a cardinal symptom of COVID-19 infection, and the ongoing pandemic has resulted in a large number of affected individuals with abnormalities in their sense of smell. For many, the condition is temporary and resolves within two to four weeks. However, in a significant minority the symptoms persist. At present, it is not known whether early intervention with any form of treatment (such as medication or olfactory training) can promote recovery and prevent persisting olfactory disturbance. OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to prevent persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Individuals who had symptoms for less than four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Our primary outcomes were the presence of normal olfactory function, serious adverse effects and change in sense of smell. Secondary outcomes were the prevalence of parosmia, change in sense of taste, disease-related quality of life and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study of 100 participants, which compared an intranasal steroid spray to no intervention. Participants in both groups were also advised to undertake olfactory training for the duration of the trial. Data were identified for only two of the prespecified outcomes for this review, and no data were available for the primary outcome of serious adverse effects. Intranasal corticosteroids compared to no intervention (all using olfactory training) Presence of normal olfactory function after three weeks of treatment was self-assessed by the participants, using a visual analogue scale (range 0 to 10, higher scores = better). A score of 10 represented "completely normal smell sensation". The evidence is very uncertain about the effect of intranasal corticosteroids on self-rated recovery of sense of smell (estimated absolute effect 619 per 1000 compared to 520 per 1000, risk ratio (RR) 1.19, 95% confidence interval (CI) 0.85 to 1.68; 1 study; 100 participants; very low-certainty evidence). Change in sense of smell was not reported, but the self-rated score for sense of smell was reported at the endpoint of the study with the same visual analogue scale (after three weeks of treatment). The median scores at endpoint were 10 (interquartile range (IQR) 9 to 10) for the group receiving intranasal corticosteroids, and 10 (IQR 5 to 10) for the group receiving no intervention (1 study; 100 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence regarding the efficacy of different interventions at preventing persistent olfactory dysfunction following COVID-19 infection. However, we have identified a small number of additional ongoing studies in this area. As this is a living systematic review, the evidence will be updated regularly to incorporate new data from these, and other relevant studies, as they become available. For this (first) version of the living review, we identified a single study of intranasal corticosteroids to include in this review, which provided data for only two of our prespecified outcomes. The evidence was of very low certainty, therefore we were unable to determine whether intranasal corticosteroids may have a beneficial or harmful effect.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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27
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O'Byrne L, Webster KE, MacKeith S, Philpott C, Hopkins C, Burton MJ. Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction. Cochrane Database Syst Rev 2021; 7:CD013876. [PMID: 34291813 PMCID: PMC8406942 DOI: 10.1002/14651858.cd013876.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Olfactory dysfunction is an early and sensitive marker of COVID-19 infection. Although self-limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post-COVID-19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post-viral anosmia (such as medication or olfactory training). OBJECTIVES To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included one study with 18 participants, which compared the use of a 15-day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low-certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low-certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post-COVID-19 olfactory dysfunction is very uncertain.
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Affiliation(s)
- Lisa O'Byrne
- Department of Otolaryngology Head and Neck Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel MacKeith
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
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28
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Kasiri H, Rouhani N, Salehifar E, Ghazaeian M, Fallah S. Mometasone furoate nasal spray in the treatment of patients with COVID-19 olfactory dysfunction: A randomized, double blind clinical trial. Int Immunopharmacol 2021; 98:107871. [PMID: 34147912 PMCID: PMC8196319 DOI: 10.1016/j.intimp.2021.107871] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/06/2023]
Abstract
The aim of this study was to evaluate the usage of mometasone furoate nasal spray in the recovery of patients with severe microsmia or anosmia induced by COVID-19. This was a prospective clinical trial on non-hospitalized adult patients with COVID-19 (>18 years) who had severe microsmia or anosmia within two weeks. The subjects were randomly assigned to the mometasone furoate group (100 mcg twice daily) or sodium chloride group (0.9%); both groups also received olfactory training for 4 weeks. The primary outcome was the improvement of the olfactory score at the end of the study. Visual analog scale (VAS) and the University of Pennsylvania Smell Identification Test (UPSIT) were used to assess primary outcome. A total of 80 patients were recruited, 77 of them completed the study and were analyzed. There was no statistically significant difference in terms of demographics and baseline clinical characteristics. The olfactory scores (based on VAS) at weekly intervals showed a significant difference between the two groups (P:0.318, <0.001, <0.001, <0.001, respectively). The analyses also showed significant within-group differences from baseline. Nevertheless, the changes were not significant between the two groups (P: 0.444, 0.402, 0.267, 0.329). There was no significant difference between the two groups in terms of the UPSIT results (p > 0.239). However, a significant between-group difference was noted in the severity of loss of smell (P < 0.001). Compared to olfactory training, mometasone furoate nasal spray combination with olfactory training showed a higher improvement in severe chronic anosmia by COVID-19.
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Affiliation(s)
- Hossein Kasiri
- Department of Clinical Pharmacy, Faculty of pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nima Rouhani
- Department of Infectious Disease, Ibne Sina Medical and Educational Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Pharmaceutical Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Ghazaeian
- Pharmaceutical Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Sahar Fallah
- Department of Biostatistic, Ibne Sina Medical and Educational Center, Mazandaran University of Medical Sciences, Sari, Iran
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29
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Prajapati DP, Shahrvini B, Said M, Srinivas S, DeConde AS, Yan CH. Assessment of patient recognition of coronavirus disease 2019 (COVID-19)-associated olfactory loss and recovery: a longitudinal study. Int Forum Allergy Rhinol 2021; 11:1529-1537. [PMID: 34096193 PMCID: PMC8222875 DOI: 10.1002/alr.22820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/21/2022]
Abstract
Background The clinical course of coronavirus disease 2019 (COVID‐19) olfactory dysfunction remains poorly characterized, often limited by self‐reported measures. Given the logistical challenges of psychophysical testing, understanding the longitudinal relationship between self‐reported and quantitative measures can help accurately identify patients with persistent olfactory dysfunction. This study aimed to longitudinally correlate measured and subjective olfactory function in COVID‐19 subjects. Methods A prospective, longitudinal study evaluating subjective and measured olfaction was conducted on ambulatory COVID‐19 subjects. Olfaction scores were obtained using a visual analogue scale (VAS) (0 = anosmia, 10 = normosmia) and the validated 12‐item Brief Smell Identification Test (BSIT). Weekly testing was performed until recovery (BSIT ≥ 9/12 and/or VAS = 10/10) or study completion. Results Eighty‐six polymerase chain reaction (PCR)‐positive COVID‐19 subjects were recruited ≤3 days from diagnosis and 52 completed longitudinal testing. Among those with self‐reported smell loss at recruitment, similar levels (75.8%) of objective (BSIT ≥ 9/12) and subjective recovery were obtained using a VAS cutoff ≥8, yet only 30.3% reported complete subjective recovery (VAS = 10). Median times to objective and complete subjective olfactory recovery were 12 ± 2.3 and 24 ± 3.5 days, respectively. Although both measures showed chemosensory improvement, the distributions of objective and full subjective olfactory recovery differed significantly (log rank test χ2 = 6.46, degrees of freedom [df] = 1, p = 0.011). Overall correlation between BSIT and VAS scores was moderate to strong across longitudinal follow‐up (rs = 0.41–0.65). Conclusion Self‐reported and psychophysically measured COVID‐19 olfactory dysfunction improve at similar levels and are moderately correlated longitudinally, yet there is a significant delay in complete subjective recovery. Psychophysical testing in conjunction with qualitative assessments may be considered for counseling and follow‐up of patients with COVID‐19 smell loss.
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Affiliation(s)
- Divya P Prajapati
- University of California San Diego School of Medicine, University of California San Diego, La Jolla, California, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Bita Shahrvini
- University of California San Diego School of Medicine, University of California San Diego, La Jolla, California, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Mena Said
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Shanmukha Srinivas
- University of California San Diego School of Medicine, University of California San Diego, La Jolla, California, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Carol H Yan
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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30
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Neta FI, Fernandes ACL, Vale AJM, Pinheiro FI, Cobucci RN, Azevedo EPD, Guzen FP. Pathophysiology and possible treatments for olfactory-gustatory disorders in patients affected by COVID-19. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100035. [PMID: 34870148 PMCID: PMC8178068 DOI: 10.1016/j.crphar.2021.100035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022] Open
Abstract
SARS-CoV-2 infects host cells mainly through the interaction between the virus's Spike protein and the viral receptors namely Angiotensin-Converting Enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). Both are highly expressed in the gastrointestinal tract, in the nasal and bronchial epithelium, as well as in the type II alveolar epithelial cells. The aim of this review is to report the evidences from the scientific literature on the pathophysiology and the available treatments for olfactory-gustatory disorders in patients with COVID-19. The mechanisms involved in these disorders are still unclear and studies on specific therapies are scarce. However, it has been hypothesized that a decrease in the sensitivity of the sensory neurons as well as the co-expression of ACE2 and TMPRSS2 in the alveolar epithelial cells are the main causes of olfactory-gustatory disorders. The possible mechanisms described in the literature for changes in taste perception in patients with COVID-19 include olfactory disorders and a competitive activity of COVID-19 on ACE2 receptors in the taste buds. In addition, SARS-CoV-2 can bind to sialic acid receptors in the taste buds. In general, evidences show that there is no specific treatment for olfactory-taste disorders induced by SARS-CoV-2, even though some treatments have been used and have shown some promising results, such as olfactory training, intranasal application of sodium citrate and vitamin A, as well as systemic use of omega-3 and zinc. Corticosteroids have also been used as a pharmacological approach to treat patients with olfactory dysfunction with some contradictory results. The knowledge of the mechanisms by which SARS-CoV-2 influences the sensory systems and how effective therapies can treat the loss of smell and taste will have important implications on the understanding and clinical management of olfactory-taste disorders.
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Affiliation(s)
- Francisca Idalina Neta
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
| | - Amélia Carolina Lopes Fernandes
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
- Nurse Department, Nurse School, State University of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Adson José Martins Vale
- Tocogynecology Department, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Francisco Irochima Pinheiro
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
- Medical School, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Ricardo Ney Cobucci
- Tocogynecology Department, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
- Medical School, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Eduardo Pereira de Azevedo
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
| | - Fausto Pierdoná Guzen
- Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Brazil
- Postgraduate Program in Biotechnology, Laureate International Universities – Potiguar University (UnP), Natal, Brazil
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31
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Short-Term Efficacy and Safety of Oral and Nasal Corticosteroids in COVID-19 Patients with Olfactory Dysfunction: A European Multicenter Study. Pathogens 2021; 10:pathogens10060698. [PMID: 34199734 PMCID: PMC8228154 DOI: 10.3390/pathogens10060698] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The objective of this study was to investigate the efficacy and safety of early administration of oral corticosteroids (OC) or nasal corticosteroids (NC) as an add-on to olfactory training (OT) versus OT alone in patients with olfactory dysfunction (OD) related to coronavirus disease 2019 (COVID-19). Methods: Patients with a positive diagnosis of COVID-19 and OD were prospectively recruited from March 22 to December 15, 2020 from 4 European hospitals. Patients had confirmed OD on psychophysical testing. All patients undertook OT, with add-on 10 days of OC (group 1: OC + OT), or 1 month of NC (group 2: NC + OT) or olfactory training alone (group 3: OT). Olfactory evaluations (Sniffin'Sticks tests) were carried out at the time of inclusion, 1 and 2 months after the start of the therapeutic course. Results: A total of 152 hyposmic or anosmic patients completed the study. Group 1, 2 and 3 included 59, 22 and 71 patients, respectively and all patient groups were comparable regarding baseline Sniffin'Sticks tests. The median Sniffin'Sticks test values significantly improved from pre- to post-intervention in all groups. The increase of Sniffin'Sticks test values was higher in group 1 (OC + OT) compared with groups 2 and 3 (p < 0.001) at one month after treatment but did not remain so at 2 months. Groups 1, 2 and 3, respectively, presented parosmia in 20/71 (28.2%), 9/22 (40.9%) and 42/71 (59.2%) patients. This difference was statistically significant between group 1 and 3 (p < 0.001). There were no patients with a worsening of the disease or an increase of the severity of the COVID-19 symptoms. Conclusions: The use of OCs in patients with OD related to mild COVID-19 is generally well-tolerated without any case of deterioration of symptoms. OC is associated with greater improvement in psychophysical olfactory evaluations at 1-month post-treatment but there was no difference at 2 months. Parosmia may be reduced following treatment with OC and NC. On the basis of these preliminary results, it is possible to state that considering the 2 months efficacy of OC and NC with respect to the OT alone and the risk-benefit ratio, the benefit to start a specific treatment of COVID-19 related OD cannot be demonstrated and there is a need for a randomised controlled trial to assess this further.
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32
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Vaira LA, De Vito A, Deiana G, Pes C, Giovanditto F, Fiore V, Lechien JR, Le Bon SD, Saussez S, Madeddu G, Babudieri S, Pazzola A, Bandiera F, Fois AG, Piana AF, Hopkins C, De Riu G. Correlations between IL-6 serum level and olfactory dysfunction severity in COVID-19 patients: a preliminary study. Eur Arch Otorhinolaryngol 2021; 279:811-816. [PMID: 33983525 PMCID: PMC8117453 DOI: 10.1007/s00405-021-06868-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023]
Abstract
Background Interleukin 6 (IL-6) is a proinflammatory cytokine that is secreted by cells infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it is widely recognized as a negative prognostic factor. The purpose of this study was to analyze the correlations between the olfactory scores determined by psychophysical tests and the serum levels of IL-6 in patients affected by coronavirus disease 2019 (COVID-19) Methods Patients underwent psychophysical olfactory assessment with Connecticut Chemosensory Clinical Research Center test and IL-6 plasma level determination within 10 days of the clinical onset of COVID-19. Results Seventy-four COVID-19 patients were included in this study. COVID-19 staged as mild in 34 patients, moderate in 26 and severe in 14 cases. There were no significant differences in olfactory scores across the different COVID-19 severity groups. In the patient series, the median plasma level of IL-6 was 7.7 pg/mL (IQR 3.7–18.8). The concentration of IL-6 was found to be significantly correlated with the severity of COVID-19 with a directly proportional relationship. The correlation between IL-6 plasma concentrations and olfactory scores was weak (rs = 0.182) and not significant (p = 0.12). Conclusions In COVID-19 patients, psychophysical olfactory scores did not show significant correlations with the plasma levels of a well-recognized negative prognostic factor such as IL-6. This observation casts some shadows on the positive prognostic value of olfactory dysfunctions.
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Affiliation(s)
- Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy. .,Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.
| | - Andrea De Vito
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Deiana
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.,Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara Pes
- Internal Medicine Department, University Hospital of Sassari, Sassari, Italy.,Neuro-COVID Department, University Hospital of Sassari, Sassari, Italy
| | - Federica Giovanditto
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy.,Onco-COVID Department, University Hospital of Sassari, Sassari, Italy
| | - Vito Fiore
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Jerome R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | | | - Sven Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federation of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.,Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Giordano Madeddu
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Babudieri
- Infectious and Tropical Diseases Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Pazzola
- Onco-COVID Department, University Hospital of Sassari, Sassari, Italy
| | - Franco Bandiera
- Internal Medicine Department, University Hospital of Sassari, Sassari, Italy.,Neuro-COVID Department, University Hospital of Sassari, Sassari, Italy
| | | | - Andrea Fausto Piana
- Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Sassari, Italy.,Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43/B, 07100, Sassari, Italy
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Vaira LA, Lechien JR, Khalife M, Petrocelli M, Hans S, Distinguin L, Salzano G, Cucurullo M, Doneddu P, Salzano FA, Biglioli F, Journe F, Piana AF, De Riu G, Saussez S. Psychophysical Evaluation of the Olfactory Function: European Multicenter Study on 774 COVID-19 Patients. Pathogens 2021; 10:pathogens10010062. [PMID: 33445604 PMCID: PMC7827350 DOI: 10.3390/pathogens10010062] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/27/2022] Open
Abstract
Background: The objective evaluation of the olfactory function of coronavirus disease 2019 patients is difficult because of logistical and operator-safety problems. For this reason, in the literature, the data obtained from psychophysical tests are few and based on small case series. Methods: A multicenter, cohort study conducted in seven European hospitals between March 22 and August 20, 2020. The Sniffin-Sticks test and the Connecticut Chemosensory Clinical Research Center orthonasal olfaction test were used to objectively evaluate the olfactory function. Results: This study included 774 patients, of these 481 (62.1%) presented olfactory dysfunction (OD): 280 were hyposmic and 201 were anosmic. There was a significant difference between self-reported anosmia/hyposmia and psychophysical test results (p = 0.006). Patients with gastroesophageal disorders reported a significantly higher probability of presenting hyposmia (OR 1.86; p = 0.015) and anosmia (OR 2.425; p < 0.001). Fever, chest pain, and phlegm significantly increased the likelihood of having hyposmia but not anosmia or an olfactory disturbance. In contrast, patients with dyspnea, dysphonia, and severe-to-critical COVID-19 were significantly more likely to have no anosmia, while these symptoms had no effect on the risk of developing hyposmia or an OD. Conclusions: Psychophysical assessment represents a significantly more accurate assessment tool for olfactory function than patient self-reported clinical outcomes. Olfactory disturbances appear to be largely independent from the epidemiological and clinical characteristics of the patients. The non-association with rhinitis symptoms and the high prevalence as a presenting symptom make olfactory disturbances an important symptom in the differential diagnosis between COVID-19 and common flu.
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Affiliation(s)
- Luigi Angelo Vaira
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy;
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy;
- Correspondence: (L.A.V.); (S.S.); Tel.: +39-340-184-6168 (L.A.V.); +32-485-716-053 (S.S.)
| | - Jerome R. Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium;
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), F92150 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, B1000 Brussels, Belgium
| | - Mohamad Khalife
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Department of Otolaryngology-Head & Neck Surgery, EpiCURA Hospital, B 7000 Baudour, Belgium
| | - Marzia Petrocelli
- Maxillofacial Surgery Operative Unit, Bellaria and Maggiore Hospital, 40100 Bologna, Italy;
| | - Stephane Hans
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), F92150 Paris, France
| | - Lea Distinguin
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), F92150 Paris, France
| | - Giovanni Salzano
- Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, 80131 Naples, Italy;
| | - Marco Cucurullo
- Maxillofacial Surgery Department, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy; (M.C.); (F.B.)
| | - Piero Doneddu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy;
| | - Francesco Antonio Salzano
- Otorhinolaryngology Operative Unit, Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi (Salerno), Italy;
| | - Federico Biglioli
- Maxillofacial Surgery Department, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, 20142 Milan, Italy; (M.C.); (F.B.)
| | - Fabrice Journe
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium;
| | - Andrea Fausto Piana
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy;
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giacomo De Riu
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, 07100 Sassari, Italy;
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy;
| | - Sven Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), F92150 Paris, France; (J.R.L.); (M.K.); (S.H.); (L.D.); (G.D.R.)
- Department of Human and Experimental Oncology, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium;
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, B1000 Brussels, Belgium
- Correspondence: (L.A.V.); (S.S.); Tel.: +39-340-184-6168 (L.A.V.); +32-485-716-053 (S.S.)
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