-
The Journal of Allergy and Clinical... Jun 2022The COVID-19 pandemic has raised awareness about olfactory dysfunction, although a loss of smell was present in the general population before COVID-19. Chronic... (Review)
Review
The COVID-19 pandemic has raised awareness about olfactory dysfunction, although a loss of smell was present in the general population before COVID-19. Chronic rhinosinusitis (CRS) is a common upper airway chronic inflammatory disease that is also one of the most common causes of olfactory dysfunction. It can be classified into different phenotypes (ie, with and without nasal polyps) and endotypes (ie, type 2 and non-type 2 inflammation). However, scientific information regarding CRS within the context of COVID-19 is still scarce. This review focuses on (1) the potential effects of severe acute respiratory syndrome coronavirus 2 infection on CRS symptoms, including a loss of smell, and comorbidities; (2) the pathophysiologic mechanisms involved in the olfactory dysfunction; (3) CRS diagnosis in the context of COVID-19, including telemedicine; (4) the protective hypothesis of CRS in COVID-19; and (5) the efficacy and safety of therapeutic options for CRS within the context of COVID-19.
Topics: Anosmia; COVID-19; Chronic Disease; Humans; Nasal Polyps; Olfaction Disorders; Pandemics; Rhinitis; Sinusitis
PubMed: 35307579
DOI: 10.1016/j.jaip.2022.03.003 -
Cell Nov 2021Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction...
Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure. Here, we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs. Our cohort of 85 cases included COVID-19 patients who died a few days after infection with SARS-CoV-2, enabling us to catch the virus while it was still replicating. We found that sustentacular cells are the major target cell type in the olfactory mucosa. We failed to find evidence for infection of olfactory sensory neurons, and the parenchyma of the olfactory bulb is spared as well. Thus, SARS-CoV-2 does not appear to be a neurotropic virus. We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID-19. Olfactory sensory neurons would become affected without getting infected.
Topics: Aged; Anosmia; Autopsy; COVID-19; Endoscopy; Female; Glucuronosyltransferase; Humans; Immunohistochemistry; In Situ Hybridization; Male; Microscopy, Fluorescence; Middle Aged; Olfaction Disorders; Olfactory Bulb; Olfactory Mucosa; Olfactory Receptor Neurons; Respiratory Mucosa; Respiratory System; SARS-CoV-2; Smell
PubMed: 34798069
DOI: 10.1016/j.cell.2021.10.027 -
Science Translational Medicine Dec 2022SARS-CoV-2 causes profound changes in the sense of smell, including total smell loss. Although these alterations are often transient, many patients with COVID-19 exhibit...
SARS-CoV-2 causes profound changes in the sense of smell, including total smell loss. Although these alterations are often transient, many patients with COVID-19 exhibit olfactory dysfunction that lasts months to years. Although animal and human autopsy studies have suggested mechanisms driving acute anosmia, it remains unclear how SARS-CoV-2 causes persistent smell loss in a subset of patients. To address this question, we analyzed olfactory epithelial samples collected from 24 biopsies, including from nine patients with objectively quantified long-term smell loss after COVID-19. This biopsy-based approach revealed a diffuse infiltrate of T cells expressing interferon-γ and a shift in myeloid cell population composition, including enrichment of CD207 dendritic cells and depletion of anti-inflammatory M2 macrophages. Despite the absence of detectable SARS-CoV-2 RNA or protein, gene expression in the barrier supporting cells of the olfactory epithelium, termed sustentacular cells, appeared to reflect a response to ongoing inflammatory signaling, which was accompanied by a reduction in the number of olfactory sensory neurons relative to olfactory epithelial sustentacular cells. These findings indicate that T cell-mediated inflammation persists in the olfactory epithelium long after SARS-CoV-2 has been eliminated from the tissue, suggesting a mechanism for long-term post-COVID-19 smell loss.
Topics: Animals; Humans; COVID-19; Anosmia; SARS-CoV-2; RNA, Viral; Olfaction Disorders; Olfactory Mucosa; Gene Expression
PubMed: 36542694
DOI: 10.1126/scitranslmed.add0484 -
JAMA Neurology Feb 2023The prodromal phase of Parkinson disease (PD) may last for more than 10 years. Recognition of the spectrum and occurrence of risk factors, comorbidities, and prodromal...
IMPORTANCE
The prodromal phase of Parkinson disease (PD) may last for more than 10 years. Recognition of the spectrum and occurrence of risk factors, comorbidities, and prodromal features of PD can increase understanding of the causes and development of the disease and help identify individuals at risk.
OBJECTIVE
To identify the association of a subsequent diagnosis of PD with a range of risk factors and prodromal features, including lifestyle factors, comorbidities, and potential extracerebral manifestations of PD.
DESIGN, SETTING, AND PARTICIPANTS
This was a case-control study using insurance claims of outpatient consultations of patients with German statutory health insurance between January 1, 2011, and December 31, 2020. Included were patients with incident diagnosis of PD without a previous diagnosis of parkinsonism or dementia and controls matched 1:2 for age, sex, region, and earliest year of outpatient encounter.
EXPOSURES
Exposures were selected based on previous systematic reviews, case-control and cohort studies reporting on risk factors, comorbidities, and prodromal features of PD.
MAIN OUTCOMES AND MEASURES
Previously postulated risk factors and prodromal features of PD, using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coding.
RESULTS
A total of 138 345 patients with incident PD (mean [SD] age, 75.1 [9.8] years; 73 720 male [53.3%]) and 276 690 matched controls (mean [SD] age, 75.1 (9.8) years; 147 440 male [53.3%]) were identified. Study participants were followed up for a mean (SD) of 6.0 (2.0) years. Consistent with previous reports, risk factors and prodromal features associated with PD included traumatic brain injury, odds ratio (OR), 1.62; 95% CI, 1.36-1.92; alcohol misuse, OR, 1.32; 95% CI, 1.21-1.44; hypertension, OR, 1.29; 95% CI, 1.26-1.31; anosmia, OR, 2.16; 95% CI, 1.59-2.93; and parasomnias (including RBD), OR, 1.62; 95% CI, 1.42-1.84. In addition, there were associations with restless legs syndrome (OR, 4.19; 95% CI, 3.91-4.50), sleep apnea (OR, 1.45; 95% CI, 1.37-1.54), epilepsy (OR, 2.26; 95% CI, 2.07-2.46), migraine (OR, 1.21; 95% CI, 1.12-1.29), bipolar disorder (OR, 3.81; 95% CI, 3.11-4.67), and schizophrenia (OR, 4.48; 95% CI, 3.82-5.25). The following diagnoses were also found to be associated with PD: sensory impairments beyond anosmia, such as hearing loss (OR, 1.14; 95% CI, 1.09-1.20) and changes of skin sensation (OR, 1.31; 95% CI, 1.21-1.43). There were also positive associations with skin disorders (eg, seborrheic dermatitis, OR, 1.30; 95% CI, 1.15-1.46; psoriasis, OR, 1.13; 95% CI, 1.05-1.21), gastrointestinal disorders (eg, gastroesophageal reflux, OR, 1.29; 95% CI, 1.25-1.33; gastritis, OR, 1.28; 95% CI, 1.24-1.33), conditions with a potential inflammatory component (eg, seronegative osteoarthritis, OR, 1.21; 95% CI, 1.03-1.43), and diabetes types 1 (OR, 1.32; 95% CI, 1.21-1.43) and 2 (OR, 1.24; 95% CI, 1.20-1.27). Associations even 5 to 10 years before diagnosis included tremor (odds ratio [OR], 4.49; 95% CI, 3.98-5.06), restless legs syndrome (OR, 3.73; 95% CI, 3.39-4.09), bipolar disorder (OR, 3.80; 95% CI, 2.82-5.14), and schizophrenia (OR, 4.00; 95% CI, 3.31-4.85).
CONCLUSIONS AND RELEVANCE
Results of this case-control study suggest that the associations found between PD and certain risk factors, comorbidities, and prodromal symptoms in a representative population may reflect possible early extrastriatal and extracerebral pathology of PD. This may be due to shared genetic risk with PD, medication exposure, or direct causation, or represent pathophysiologically relevant factors contributing to the pathogenesis of PD.
Topics: Humans; Male; Aged; Parkinson Disease; Case-Control Studies; Prodromal Symptoms; Restless Legs Syndrome; Anosmia; Risk Factors
PubMed: 36342675
DOI: 10.1001/jamaneurol.2022.3902 -
Journal of Neurovirology Apr 2022COVID-19 pandemic spreads worldwide, with more than 100 million positive cases and more than 2 million deaths. From the beginning of the COVID-19 pandemic, several... (Review)
Review
COVID-19 pandemic spreads worldwide, with more than 100 million positive cases and more than 2 million deaths. From the beginning of the COVID-19 pandemic, several otolaryngologists described many cases of a sudden loss of smell (anosmia) associated with the disease with or without additional symptoms. Anosmia is often the first and sometimes the only sign in the asymptomatic carriers of COVID-19. Still, this disorder is underestimated, and it is not life-threatening. However, it significantly decreases the quality of life. This olfactory dysfunction continues in several cases even after the nasopharyngeal swab was negative. The occurrence of anosmia can be used as a screening tool for COVID-19 patients and can be used to identify these patients to accomplish the isolation and tracking procedures. In this review, we highlighted the possible mechanisms of anosmia in COVID-19 patients, major pathologies and features of anosmia, implications of anosmia in early diagnosis of COVID-19, evaluation of the smell function during COVID-19, and management and treatment options of COVID-19 anosmia.
Topics: Anosmia; COVID-19; Humans; Olfaction Disorders; Pandemics; Quality of Life; SARS-CoV-2
PubMed: 35249186
DOI: 10.1007/s13365-022-01060-9 -
Oral and Maxillofacial Surgery Mar 2022Dysgeusia and anosmia have been liked to COVID-19 infection. The aim of this study is to study the prevalence of dysgeusia and anosmia in COVID-19 patients treated at...
PURPOSE
Dysgeusia and anosmia have been liked to COVID-19 infection. The aim of this study is to study the prevalence of dysgeusia and anosmia in COVID-19 patients treated at the University of Florida Health Center and establish the odds of having an olfactory and gustatory disorder with a confirmed COVID-19 infection.
METHODS
This is a retrospective cross-sectional study utilizing the University of Florida Health Center patients' registry i2b2 platform to search for ICD 10 diagnoses of COVID-19 infection and taste and smell disturbances. We assessed the odds ratio for patients with dysgeusia and anosmia having a laboratory-confirmed COVID-19 infection using a logistic regression model adjusting for gender, race, age, and comorbidity conditions. P < 0.05 was deemed significant.
RESULTS
Out of 889 individuals that tested positive for COVID-19, 12.88% were diagnosed with taste and smell disturbances. The odds ratio for COVID-19 for people with dysgeusia and anosmia was 39.107. After adjusting for sex, age, and race, it was 41.9, 37, and 34.2, respectively.
CONCLUSION
Taste and smell disturbances in COVID-19 are not anecdotal. It is paramount that oral and maxillofacial surgeons include taste and smell disturbances in the history and physical examination as these symptoms are suspicious of active COVID-19 infection. Patients presenting with an olfactory and gustatory disorder should undergo further evaluations for COVID-19 infection and oral and maxillofacial surgeons should enhance the personal protective equipment used when treating these patients to prevent further spread of the infection and protect other healthcare members.
Topics: Anosmia; COVID-19; Cross-Sectional Studies; Dysgeusia; Humans; Olfaction Disorders; Oral and Maxillofacial Surgeons; Pandemics; Retrospective Studies; SARS-CoV-2
PubMed: 33954852
DOI: 10.1007/s10006-021-00965-9 -
AJNR. American Journal of Neuroradiology Jan 2021
Topics: Anosmia; COVID-19; Humans; Magnetic Resonance Imaging; Olfactory Bulb; SARS-CoV-2
PubMed: 33272952
DOI: 10.3174/ajnr.A6943 -
European Journal of Neurology Dec 2022Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main...
BACKGROUND AND PURPOSE
Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation.
METHOD
Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number.
RESULTS
From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta.
CONCLUSION
Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.
Topics: Humans; Aged; COVID-19; Ageusia; SARS-CoV-2; Anosmia; Multiple Sclerosis
PubMed: 36086905
DOI: 10.1111/ene.15554 -
Otolaryngology--head and Neck Surgery :... Jun 2021This study aimed to investigate the differences in olfactory cleft (OC) morphology in coronavirus disease 2019 (COVID-19) anosmia compared to control subjects and...
OBJECTIVE
This study aimed to investigate the differences in olfactory cleft (OC) morphology in coronavirus disease 2019 (COVID-19) anosmia compared to control subjects and postviral anosmia related to infection other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
STUDY DESIGN
Prospective.
SETTING
This study comprises 91 cases, including 24 cases with anosmia due to SARS-CoV-2, 38 patients with olfactory dysfunction (OD) due to viral infection other than SARS-CoV-2, and a control group of 29 normosmic cases.
METHODS
All cases had paranasal sinus computed tomography (CT), and cases with OD had magnetic resonance imaging (MRI) dedicated to the olfactory nerve. The OC width and volumes were measured on CT, and T2-weighted signal intensity (SI), olfactory bulb volumes, and olfactory sulcus depths were assessed on MRI.
RESULTS
This study showed 3 major findings: the right and left OC widths were significantly wider in anosmic patients due to SARS-CoV-2 (group 1) or OD due to non-SARS-CoV-2 viral infection (group 2) when compared to healthy controls. OC volumes were significantly higher in group 1 or 2 than in healthy controls, and T2 SI of OC area was higher in groups 1 and 2 than in healthy controls. There was no significant difference in olfactory bulb volumes and olfactory sulcus depths on MRI among groups 1 and 2.
CONCLUSION
In this study, patients with COVID-19 anosmia had higher OC widths and volumes compared to control subjects. In addition, there was higher T2 SI of the olfactory bulb in COVID-19 anosmia compared to control subjects, suggesting underlying inflammatory changes. There was a significant negative correlation between these morphological findings and threshold discrimination identification scores.
LEVEL OF EVIDENCE
Level 4.
Topics: Adult; Anosmia; COVID-19; Case-Control Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Cavity; Olfactory Bulb; Olfactory Mucosa; Organ Size; Prospective Studies; Tomography, X-Ray Computed
PubMed: 33045908
DOI: 10.1177/0194599820965920 -
Pediatric Allergy and Immunology :... Jan 2022More than a year and a half after the beginning of the coronavirus disease 2019 (COVID-19) pandemic, symptoms, such as loss of smell and taste (anosmia and ageusia,...
More than a year and a half after the beginning of the coronavirus disease 2019 (COVID-19) pandemic, symptoms, such as loss of smell and taste (anosmia and ageusia, respectively), remain difficult to characterize and quantify, especially in children, since no validated tests to assess these disorders are available. However, these symptoms can also be seen in children, although less frequently than observed in the adult population. In this article, we present the results of a national survey that collected the responses of 267 Italian pediatricians on the presence of anosmia and ageusia in children affected by COVID-19. These data were then compared with existing literature.
Topics: Adult; Ageusia; Anosmia; COVID-19; Child; Humans; Pandemics; SARS-CoV-2
PubMed: 35080301
DOI: 10.1111/pai.13644