Epileptogénesis y corteza piriforme: entendiendo a la epilepsia del lóbulo temporal más allá del hipocampo / Epileptogenesis and the piriform cortex: understanding temporal lobe epilepsy beyond the hippocampus

Introducción: Con la experiencia de los registros electroencefalográficos invasivos y el fracaso quirúrgico después de la cirugía, se ha hecho evidente que la epilepsia del lóbulo temporal es mucho más compleja de lo que se creía, y en la actualidad es considerada una enfermedad de redes anatomofuncionales y no de lesiones estructurales. Contenido: La información neurofisiológica e imagenológica actual permite concluir que en esta epilepsia están involucradas varias redes neuronales temporales y extratemporales que contribuyen a la extensión de la zona epileptógena. Una forma de entender el concepto de red epiléptica en la epilepsia del lóbulo temporal es a partir del conocimiento de la corteza piriforme. Varios estudios clínicos han mostrado que en pacientes con epilepsia del lóbulo temporal asociada a esclerosis hipocampal existe una disfunción interictal del procesamiento olfatorio que es más significativa, en comparación con pacientes con epilepsia focal extrahipocampal y controles sanos. Esta alteración es, probablemente, la consecuencia de una red neuronal disfuncional que se extiende más allá del hipocampo y que afecta a otras estructuras cercanas, incluida la corteza piriforme. Conclusión: En este artículo llevamos a cabo una revisión narrativa de la literatura con el objetivo de establecer un vínculo entre la corteza piriforme y la epileptogénesis del lóbulo temporal, y demostramos que esta enfermedad es la consecuencia de una disfunción de redes neuronales que no depende exclusivamente de una anormalidad estructural en el hipocampo o en estructuras cercanas.

Introduction: With the experience of invasive EEG recordings and surgical failure after surgery, it has become clear that temporal lobe epilepsy is much more complex than previously thought, and currently, is conceptualized as a disease of anatomical networks instead of structural lesions. Content: The current neurophysiological and imaging information allows us to conclude that several temporal and extratemporal anatomical networks are involved in this type of epilepsy. One way of understanding the concept of the epileptic network in temporal lobe epilepsy is from the knowledge of the piriform cortex. Several clinical studies have shown that in patients with temporal lobe epilepsy associated with hippocampal sclerosis exists an interictal dysfunction of olfactory processing that is more significant compared to patients with focal extra-hippocampal epilepsy and healthy controls. This alteration is probably the consequence of a dysfunctional neural network that extends beyond the hippocampus and affects other nearby structures, including the piriform cortex. Conclusion: In this article, we carry out a narrative review of the literature with the aim of establishing a link between the piriform cortex and temporal lobe epileptogenesis, demonstrating that this disease is the consequence of a dysfunctional network that does not depend exclusively of a hippocampal structural abnormality.

OLFATO: forma más antigua de comunicación y sentido preciso que el otorrinolaringólogo debe conocer a profundidad / SMELL: oldest form of communication and precise sense that the otolaryngologist must know in depth

Introducción: el papel clave del olfato, antiguo sistema sensorial, es proporcionar información sobre las sustancias químicas en el medio ambiente. El olfato desempeña un papel en la detección de compuestos peligrosos, el mantenimiento de la nutrición, el comportamiento interpersonal, la salud neurológica y la sensación de placer, entre otras funciones. En consecuencia, la disfunción olfativa puede conducir a un riesgo de lesiones, desnutrición, aislamiento social y una mala calidad de vida. Materiales y métodos: se realizó una exploración bibliográfica y se identificaron artículos de acuerdo con los criterios de inclusión y exclusión definidos y se tomaron aquellos con calidad en la evidencia. Discusión: el sistema olfativo humano tiene diferencias anatómicas, fisiológicas y genéticas considerables con respecto al de otros mamíferos. Conclusiones: las destrezas olfativas varían con factores como la edad, el sexo, la etapa de desarrollo, ciertas enfermedades otorrinolaringológicas y enfermedades generales.

Introduction: The key role of the ancient olfactory sensory system is to provide information about chemicals in the environment. Smell plays a role in the detection of dangerous compounds, the maintenance of nutrition, interpersonal behavior, neurological health, and the sensation of pleasure, among other functions. Consequently, olfactory dysfunction can lead to a risk of injury, malnutrition, social isolation, and a poor quality of life. Materials and methods: A bibliographical exploration was carried out and articles were identified according to the inclusion and exclusion criteria defined and those with quality evidence were taken. Discussion: The human olfactory system has considerable anatomical, physiological, and genetic differences from that of other mammals. Conclusions: Olfactory skills vary with factors such as age, sex, stage of development, certain ear, nose and throat diseases and general diseases.

Effectiveness of platelet-rich plasma on post-COVID chronic olfactory dysfunction

SUMMARY OBJECTIVE: The aim of this study was to investigate the efficacy of platelet-rich plasma injection on the olfactory cleft of patients with post-COVID olfactory dysfunction lasting over 1 year, who were unresponsive to common treatments. METHODS: Patients over 18 years of age with post-COVID olfactory dysfunction over 1 year whose complaints did not improve with intranasal steroids and D-panthenol/vitamin A combination nasal sprays with olfactory rehabilitation training for 1 month were prospectively collected and randomized into two groups: intranasal platelet-rich plasma group and control group. At the end of 1 month, Connecticut Chemosensory Clinical Research Center olfaction test scores of smell detection threshold and smell identification test were compared accordingly. RESULTS: A total of 25 patients were randomized into platelet-rich plasma (n=12) and control (n=13) groups. In the platelet-rich plasma group, the mean smell detection threshold score increased from 5.63 (SD 0.68) to 6.46 (SD 0.45), and the mean smell identification test score increased from 11.42 (SD 1.17) to 15.17 (SD 0.39). In the control group, the mean smell detection threshold score changed from 5.69 (SD 0.66) to 5.77 (SD 0.70), and the mean smell identification test score changed from 11.20 (SD 1.12) to 11.85 (SD 1.57). Post-hoc analysis revealed that similar mean smell detection threshold (mean difference 0.07; p=0.994) and smell identification test (mean difference −0.50; p=0.703) scores were transformed into a significant difference between groups (smell detection threshold mean difference 0.69; p=0.037; smell identification test mean difference 3.32; p<0.001). CONCLUSION: At the end of the first month, there was a significant improvement in olfactory threshold values in the platelet-rich plasma group compared to the control group. No side effect or adverse event related to platelet-rich plasma injection was observed.

Factores asociados a la anosmia y ageusia en pacientes COVID-19 de una provincia peruana

Objetivo: identificar la presentación clínica y los factores asociados a la anosmia y ageusia en pacientes con la COVID-19 en un centro de salud de una provincia del Perú en el período de 2020-2021. Métodos: estudio transversal analítico a través de los datos del programa COVID-19 del Policlínico Essalud de Jauja - Perú. Se detallaron características sociodemográficas, sintomatología y comorbilidades de los pacientes. A través de un análisis bivariado se identificó los factores asociados a la anosmia y ageusia. Resultados: se identificó a 356 pacientes: 53,1 % fueron mujeres, la edad media fue 48,7 años (±17,8) y 261 (73,3 %) con COVID-19 leve. Del total, el 22,2 % presentó anosmia y 19,9 % ageusia; de los cuales la mayoría fueron menores de 65 años y del sexo femenino. Presentaron síntomas asociados un 86,1 % de los pacientes con anosmia y un 83,1% con ageusia. Los principales factores asociados a la anosmia fueron: la edad menor a 65 años (p=0,027), tos (p<0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y fiebre (p<0,001); y a la ageusia: edad menor a 65 años (p=0,006), tos (p=0,001), cefalea (p<0,001), disnea (p<0,001), congestión nasal (p<0,001) y diarrea (p<0,001). Conclusiones: la anosmia y ageusia son síntomas frecuentes de la COVID-19. La mayoría de pacientes presentaron estos síntomas asociados a los síntomas comunes. Gran parte de los que presentaban anosmia presentaron congestión nasal por lo que es recomendable considerar diferenciarlos al momento de realizar el diagnóstico.

Summary Objective: To identify the clinical presentation and factors associated with anosmia and ageusia in patients with COVID-19 in a health center in a province of Peru for the period 2020-2021. Methods: Cross-sectional analytical study through data from the COVID-19 program of the Essalud Polyclinic in Jauja, Peru. Sociodemographic characteristics, symptoms and comorbidities of the patients were detailed. A bivariate analysis identified the factors associated with anosmia and ageusia. Results: 356 patients were identified: 53.1 % were women, mean age was 48.7 years (±17.8) and 261 (73.3%) with mild COVID-19. Of the total, 22.2% had anosmia and 19.9% ageusia; of which the majority were under 65 and female. Associated symptoms were found in 86.1% of patients with anosmia and 83.1% with ageusia. The main factors associated with anosmia were age younger than 65 years (p=0.027), cough (p<0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and fever (p<0.001); and ageusia: age younger than 65 years (p=0.006), cough (p=0.001), headache (p<0.001), dyspnea (p<0.001), nasal congestion (p<0.001) and diarrhea (p<0.001). Conclusion: Anosmia and ageusia are common symptoms of COVID-19. Most patients had these symptoms associated with common symptoms. Many of those who had anosmia had nasal congestion, so it is advisable to consider differentiating them when making the diagnosis.

Alteraciones olfativas y déficits en la capacidad del reconocimiento emocional en pacientes con trauma craneoencefálico

El presente estudio tuvo como objetivo general identificar la asociación entre las alteraciones olfativas y el reconocimiento emocional en un grupo de pacientes con diagnóstico de traumatismo craneoencefálico. Fue desarrollada bajo un enfoque cuantitativo con diseño no experimental, en donde fueron evaluados 10 pacientes con antecedente de trauma craneoencefálico moderado y severo junto a 10 participantes controles sin daño cerebral. Para las variables sexo, edad y escolaridad los resultados fueron muy similares entre los grupos, con edades promedio de 26 años; la población fue predominantemente masculina, y la mayoría tenía grado de educación superior. En las pruebas de reconocimiento emocional, el grupo control logró un desempeño superior al grupo de casos. Adicionalmente, el grupo control logró mejor capacidad en las pruebas olfativas que el grupo de casos. Se encontró una correlación estadísticamente significativa entre los resultados del reconocimiento emocional y la variable olfativa en el grupo de casos, lo que permite identificar el rol que estructuras del sistema cerebral topográfica y funcionalmente pueden estar participando del procesamiento; a su vez, abre perspectivas de estudios a futuro, en especial a modelos de intervención en los grupos clínicos con afectación por el traumatismo craneoencefálico.

The general objective of this study was to "identify the association between emotional recognition and olfactory alterations in a group of patients with SCD". It was developed under a quantitative approach with nonexperimental design, in which 10 patients with a history of moderate and severe cranioencephalic trauma were evaluated along with 10 control participants without brain damage. For the variables sex, age and schooling the results were very similar among the groups, with average ages of 26 years, the population was predominantly male and most had higher education. In the tests of emotional recognition the control group achieved a superior performance to the group of cases. In addition, the control group achieved better capacity in olfactory tests than the group of cases. A statistically significant correlation was found between the emotional recognition results and the olfactory variable in the group of cases, which allows the identification of the role that topographic and functional brain system structures may be involved in processing; In turn, it opens prospects for future studies especially to intervention models in clinical groups affected by head trauma.

Adaptation of the Pediatric Smell WheelTM to evaluate olfactory function in Brazilian children

Abstract Objective: Olfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell WheelTM (PSW) to evaluate olfactory function in Brazilian children. Methods: We modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases. First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test's ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. Results: Eleven odors were identified for inclusion in the test. The test-retest reliability was modest (r = 0.54, p < 0.001), although likely attenuated based on the inclusion of only data from children with normal function. The test clearly differentiated the olfactory function of children with adenoid hypertrophy from that of healthy children and demonstrated the return of function after adenoidectomy. An overall score <7 was found useful in defining hyposmia, although additional age-related cut-points were also defined. Conclusion: A Brazilian version of the PSW was developed and validated and found to be efficacious in detecting smell dysfunction in children ranging in age from 5 to 12 years. Level of evidence: 1b (Diagnosis).

Danish Validation of a Retronasal Olfactory Powder Test and Development of a Novel Quick Retronasal Olfactory Test

Abstract Introduction Quality of life is closely linked to retronasal olfactory function. Familiarity with odors vary, so tests need validation. Testing can be time-consuming, so a quick test and a thorough test are needed for clinical and research settings. Objectives The objectives of this study were to validate the original retronasal powder olfactory test in a Danish population and to develop a novel quick retronasal test for easy application. Methods Ninety-seven participants were included in the study, 59 healthy controls and 38 patients with olfactory impairment. The retronasal test was modified by substituting unfamiliar odors and descriptors and validated with a criterion of correct identification rate of 50% in the original test and 90% in the quick test. Items with over 90% correct identification rate in the modified original test were included in the quick test, resulting in a 10-item test. Results The modified retronasal olfactory test achieved good test characteristics, with a 10th percentile cut-off value of 13: sensitivity was 88.9%, specificity 83.0%, positive predictive value 78%, negative predictive value 91.7%, and the receiver operating characteristics area under the curve (ROC-AUC) was 0.86. The quick test achieved acceptable test characteristics, with a 10th percentile cut-off value of 8.2: sensitivity was 72.2%, specificity 90.6%, positive predictive value 83.9%, negative predictive value was 82.8%, and ROC-AUC 0.81. Conclusion Validation of both tests demonstrated satisfactory accuracy. We recommend the quick test for screening purposes, and the modified original version for a thorough evaluation. The tests are easily implemented as they are easy to understand and very affordable.

Correlation and agreement of olfactory perception assessed by the Connecticut Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test / Correlação e concordância da percepção olfativa avaliada pelos testes olfativos chemosensory clinical research center e brief-smell identification test,

Abstract Introduction: Assessing olfactory perception in olfactory disorders is of utmost importance in therapy management. However, the University of Pennsylvania Smell Identification Test and the Sniffin' Sticks are the only tests validated in Brazil. Objectives: To evaluate the correlation and agreement between the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test - University of Pennsylvania Smell Identification Test - in healthy participants and in participants with olfactory disorders based on the results and technical aspects of both tests. Methods: Fifty participants without olfactory complaints and 50 participants with olfactory disorders who underwent the Chemosensory Clinical Research Center olfactory test and the Brief-Smell Identification Test were included. The following tests were used for statistical analysis: Mann-Whitney U test, Spearman's correlation, intraclass correlation coefficient and Bland-Altman plot. An alpha error (significance level) of 0.05 was considered in the statistical analysis. Results: Both tests were effective in distinguishing the groups without the presence of overlapping values for the measured markers. Additionally, there was a strong correlation between Spearman's correlation and intraclass correlation coefficient between the tests and for both nostrils. However, the correlations were lower when the groups were individually evaluated. The Bland-Altman plot showed no bias when all participants were simultaneously evaluated. Conclusions: The tests to assess olfactory perception presented a high level of agreement. In our sample, we could infer that the Connecticut Chemosensory Clinical Research Center olfactory test is similar to the Brief-Smell Identification Test and can be used in the routine diagnosis of patients with complaints of olfactory disorders, considering the advantage of its low cost.

Resumo Introdução: Avaliar a percepção olfativa em distúrbios olfativos é de extrema importância para a correta conduta terapêutica. No entanto, apenas o teste University of Pennsylvania smell identification test e o teste sniffin'sticks são validados no Brasil. Objetivos: Avaliar a correlação e concordância entre os testes Connecticut chemosensory clinical research center e do brief-smell identification test e University of Pennsylvania smell identification test em participantes saudáveis e em participantes com distúrbios olfativos de acordo com os resultados e aspectos técnicos dos dois testes. Método: Cinquenta participantes sem queixas olfativas e 50 participantes com distúrbios olfativos submetidos ao teste Connecticut chemosensory clinical research center e ao brief-smell identification test foram incluídos. Os seguintes testes foram usados para análise estatística: teste U de Mann-Whitney, correlação de Spearman, coeficiente de correlação intraclasse e plotagem de Bland-Altman. Um erro alfa (nível de significância) de 0,05 foi considerado nas análises estatísticas feitas no estudo. Resultados: Ambos os testes foram eficazes para diferenciar os grupos sem a presença de valores sobrepostos para os marcadores medidos. Além disso, houve uma forte correlação entre a correlação de Spearman e o coeficiente de correlação intraclasse entre os testes e para as duas narinas. Entretanto, as correlações foram menores quando os grupos foram avaliados individualmente. O gráfico de Bland-Altman não mostrou viés quando todos os participantes foram avaliados simultaneamente. Conclusões: Os testes para avaliar a percepção olfativa apresentaram um elevado nível de concordância. Em nossa amostra, podemos inferir que o Connecticut chemosensory clinical research center é equivalente ao brief-smell identification test e pode ser usado no diagnóstico de rotina de pacientes com queixas de distúrbios olfativos, considerando a vantagem de seu baixo custo.

Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction? / Biópsia do epitélio olfatório do septo nasal superior: é possível obter neurônios sem prejudicar o olfato?

Abstract Introduction Olfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established. Objective This study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum. Methods During nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure. Results Olfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT®]) between means before biopsy: 32.3 vs. postoperative: 32.5, p= 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p= 0.46). None out of the 56 different odorant identification significantly diminished (p> 0.05). Conclusion The technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact.

Resumo Introdução A biópsia do epitélio olfatório tem sido útil para estudar diversas doenças otorrinolaringológicas e neurológicas, incluindo seu potencial para melhor compreender a fisiopatologia por trás das manifestações olfatórias na COVID‐19. No entanto, a segurança e eficácia da técnica de obtenção de epitélio olfatório humano ainda não estão totalmente estabelecidas. Objetivos Este estudo teve como objetivo determinar a segurança e eficácia da coleta de células do epitélio olfatório, feixes nervosos e epitélio olfatório adequados para análise morfológica, no septo nasal superior. Método Durante a cirurgia nasal, 22 indivíduos sem queixas olfatórias foram submetidos a biópsias de epitélio olfatório do septo nasal superior. A eficácia da obtenção de epitélio olfatório, a verificação de epitélio olfatório íntegro e a presença de feixes nervosos nas biópsias foram avaliadas por imunofluorescência. A segurança da função olfatória foi testada psicofisicamente usando testes unilaterais e bilaterais antes e um mês após o procedimento cirúrgico. Resultados Epitélio olfatório foi encontrado em 59,1% dos sujeitos. Das amostras, 50% apresentaram a qualidade necessária para a caracterização morfológica e 90,9% continham feixes nervosos. Não houve diferença nos escores psicofísicos obtidos no teste olfatório bilateral (University of Pennsylvania Smell Identification Test [UPSIT®]) entre as médias antes da biópsia: 32,3 vs. pós‐operatório: 32,5, p = 0,81. Além disso, nenhuma diminuição significante ocorreu no teste unilateral (escore médio do teste unilateral 6 vs. 6,2, p = 0,46). Não houve redução significante na identificação de nenhum dos 56 odorantes diferentes (p > 0,05). Conclusão A técnica descrita para biópsia de epitélio olfatório é altamente eficaz na obtenção de tecido olfatório neuronal, mas tem eficácia moderada na obtenção de amostras adequadas para análise morfológica. A capacidade olfativa permaneceu intacta.

Pathophysiological relationship between COVID-19 and olfactory dysfunction: A systematic review / Relação fisiopatológica entre Covid‐19 e disfunção olfativa: uma revisão sistemática

Abstract Introduction SARS-CoV-2 is the pathogen of COVID-19. The virus is composed of the spike, membrane and envelope. On physiological smell, odoriferous substances bind to proteins secreted by sustentacular cells in order to be processed by olfactory receptor neurons. Olfactory disorder is one of the main manifestations of COVID-19, however, research is still required to clarify the mechanism involved in SARS-CoV-2 induced anosmia. Objective This article aims to analyze current scientific evidence intended to elucidate the pathophysiological relationship between COVID-19 and the cause of olfactory disorders. Methods Pubmed, Embase, Scopus and ScienceDirect were used to compose this article. The research was conducted on November 24th, 2020. Original articles with experimental studies in human, animal and in vitro, short communications, viewpoint, published in the English language and between 2019 and 2020 were included, all related to the pathophysiological relationship between olfactory disorders and COVID-19 infection. Results Both human cell receptors ACE2 and TMPRSS2 are essential for the SARS-CoV-2 entrance. These receptors are mostly present in the olfactory epithelium cells, therefore, the main hypothesis is that anosmia is caused due to damage to non-neuronal cells which, thereafter, affects the normal olfactory metabolism. Furthermore, magnetic resonance imaging studies exhibit a relationship between a reduction on the neuronal epithelium and the olfactory bulb atrophy. Damage to non-neuronal cells explains the average recovery lasting a few weeks. This injury can be exacerbated by an aggressive immune response, which leads to damage to neuronal cells and stem cells inducing a persistent anosmia. Conductive anosmia is not sufficient to explain most cases of COVID-19 induced anosmia. Conclusion Olfactory disorders such as anosmia and hyposmia can be caused by COVID-19, the main mechanism is associated with olfactory epithelium damage, targeting predominantly non-neuronal cells. However, neuronal cells can also be affected, worsening the condition of olfactory loss.

Resumo Introdução SARS‐CoV‐2 é o patógeno da Covid‐19. O vírus é composto pela proteína spike (espigão), a membrana e o envelope. No olfato fisiológico, as substâncias odoríferas se ligam a proteínas secretadas pelas células sustentaculares para serem processadas pelos neurônios receptores olfativos. O distúrbio olfativo é uma das principais manifestações da Covid‐19; entretanto, pesquisas ainda são necessárias para esclarecer o mecanismo envolvido na anosmia induzida pela SARS‐CoV‐2. Objetivos Este artigo tem como objetivo analisar as evidências científicas atuais destinadas a elucidar a relação fisiopatológica entre a Covid‐19 e a causa dos distúrbios olfativos. Método As bases de dados Pubmed, Embase, Scopus e ScienceDirect foram usadas para compor este artigo. A pesquisa foi feita em 24 de novembro de 2020. Foram incluídos artigos originais com estudos experimentais em seres humanos, animais e estudos in vitro, comunicações breves, pontos de vista, publicados na língua inglesa e entre 2019 e 2020, todos relacionados à relação fisiopatológica entre distúrbios olfativos e infecção por Covid‐19. Resultados Ambos os receptores de células humanas ACE2 e TMPRSS2 são essenciais para a penetração do SARS‐CoV‐2. Esses receptores estão presentes principalmente nas células do epitélio olfativo; portanto, a principal hipótese é que a anosmia é causada por lesão de células não neuronais que, a partir daí, afeta o metabolismo olfativo normal. Além disso, estudos de ressonância magnética mostram uma relação entre a redução do epitélio neuronal e a atrofia do bulbo olfatório. Danos às células não neuronais explicam o tempo médio de recuperação, que demora algumas semanas. Essa lesão pode ser exacerbada por uma resposta imune agressiva, que leva a danos às células neuronais e células‐tronco, induz uma anosmia persistente. A anosmia condutiva não é suficiente para explicar a maioria dos casos de anosmia induzida por Covid‐19. Conclusão Distúrbios olfativos como anosmia e hiposmia podem ser causados pela Covid‐19 e o principal mecanismo está associado à lesão do epitélio olfativo, tem como alvo células predominantemente não neuronais. Porém, células neuronais também podem ser afetadas, o que piora o quadro de perda olfativa.

Evaluation of the complete Sniffin Sticks Test versus its subtests in differentiating Parkinson's disease patients from healthy controls / Avaliação do Sniffin Sticks Test completo versus seus subtestes na diferenciação de pacientes com doença de Parkinson de controles sem a doença

Abstract Background Hyposmia is one of the most common, as well as the first nonmotor condition in Parkinson disease (PD). The sniffin sticks test (SST) evaluates three different aspects of olfactory function: threshold (T), discrimination (D), and identification (I). The sum of the scores of these three subtests produce a global score of olfaction, the Threshold-Discrimination-Identification (TDI) score. Objective The aim of this study was to investigate if the TDI score or one of its subtests is better to discriminate PD patients from controls. Methods We recruited 27 PD patients and 17 healthy age-matched controls (HC) who were evaluated through a clinical interview, the Montreal Cognitive Assessment and Movement Disorders Society - Unified Parkinson Disease Rating Scale. The olfaction was assessed using the complete SST. Results The performance of PD patients on the olfactory test was significantly worse when compared with the HC (T: 3.0 vs. 6.5, p < 0.001; D: 8.1 vs. 11.2, p <0.001; I: 7.3 vs. 11.7, p < 0.001; TDI: 18.8 vs. 29.9, p < 0.001). The prevalence of olfaction impairment in our study (PD: 100%, and HC: 56%) was greater than that found in the literature. Cognition influenced the performance on TDI. The olfactory subtests were impaired proportionally between patients and controls. Furthermore, D and I were correlated, but only in PD patients. The TDI showed a tendency to better discriminate PD patients from HC, when compared with its subtests. Conclusions Although the complete olfactory evaluation is time consuming, it seems to be a superior tool to identify olfaction impairment in PD patients, when compared with the isolated subtests.

Resumo Antecendentes Hiposmia é um dos sintomas mais comuns da doença de Parkinson (DP), além de ser um de seus primeiros sintomas não-motores. O Sniffin Sticks Test avalia três diferentes aspectos da função olfatória: limiar (L), discriminação (D) e identificação (I). A soma dos escores desses três subtestes produz um escore global do olfato, o Threshold-Discrimination-Identification (TDI). Objetivo O objetivo deste estudo foi investigar se oTDI ou um de seus subtestes seria melhor em discriminar pacientes com DP de controles saudáveis. Métodos Foram recrutados 27 pacientes com DP e 17 controles saudáveis de mesma faixa etária, que foram avaliados através de uma entrevista clínica, a Montreal Cognitive Assessment e Movement Disorders Society - Unified Parkinson Disease Rating Scale. O olfato foi examinado através da bateria completa do Sniffin Sticks Test (SST). Resultados Os pacientes com DP tiveram pior performance no teste olfatório quando comparados com os controles (L: 3,0 vs. 6,5; p < 0,001; D: 8,1 vs. 11,2; p <0,001; I: 7,3 vs. 11,7; p <0,001; TDI: 18,8 vs. 29,9; p < 0,001). A prevalência de comprometimento olfatório no nosso estudo (DP: 100%, e controles: 56%) foi maior do que a reportada na literatura. A cognição influenciou a performance no TDI. Os subtestes olfatórios foram afetados proporcionalmente entre pacientes e controles. Além disso, D e I se correlacionaram, mas apenas em pacientes de DP. O TDI mostrou uma tendência em melhor discriminar pacientes de DP dos controles, quando comparado com os seus subtestes. Conclusões Embora a avaliação olfatória completa consuma tempo, ela parece ser superior aos subtestes isolados para identificar comprometimento olfatório em pacientes com DP.

Psicología y olfato hacia un abordaje interdisciplinar frente a la COVID-19 / Psychology and smell towards an interdisciplinary approach against Covid-19 / Psicologia e cheiro por uma abordagem interdisciplinar contra o Covid-19

La psicología frente al olfato puede constituirse en una alternativa para mejorar la calidad de vida de las personas que han sufrido trastornos olfativos a causa de la pandemia de la Covid-19, en tal sentido a nivel mundial se van conformando equipos interdisciplinares para brindar alternativas científicas globales con diferentes perspectivas profesionales, es así que esta disciplina tiene la oportunidad y el reto de vincularse a estos equipos de alto nivel, fortaleciendo la perspectiva del entrenamiento olfativo clásico del área médica, y matizarlo con los criterios técnicos de la psicología del tercer milenio, y así tratar de disminuir las secuelas de esta enfermedad y ampliar las esperanzas de las personas de cualquier parte del mundo que sufren estos deterioros sensoriales.

Psychology against smell can become an alternative to improve the quality of life of people who have suffered olfactory disorders due to the Covid-19 pandemic, in this sense, interdisciplinary teams are being formed worldwide to provide scientific alternatives groups with different professional perspectives, so this discipline has the opportunity and the challenge of being linked to these high-level teams, strengthening the perspective of classical olfactory training in the medical area, and qualifying it with the technical criteria of the psychology of the third millennium, and thus try to reduce the consequences of this disease and expand the hopes of people from any part of the world who suffer from these sensory impairments.

A psicologia contra o olfato pode se tornar uma alternativa para melhorar a qualidade de vida de pessoas que sofreram distúrbios olfativos devido à pandemia de Covid-19, nesse sentido, equipes interdisciplinares estão sendo formadas em todo o mundo para fornecer alternativas científicas a grupos com diferentes perspectivas profissionais. disciplina tem a oportunidade e o desafio de estar vinculada a essas equipes de alto nível, fortalecendo a perspectiva da formação olfativa clássica na área médica, e qualificando-a com os critérios técnicos da psicologia do terceiro milênio, e assim tentar reduzir o consequências desta doença e ampliar as esperanças de pessoas de qualquer parte do mundo que sofrem com essas deficiências sensoriais.

Subjective assessment of taste and smell disfunction in patients with COVID-19 in Paraguay / Evaluación subjetiva de las alteraciones del sentido del gusto y del olfato en pacientes con COVID-19 en Paraguay

The alteration of the senses of taste and smell in relation to COVID-19 is a widely known phenomenon; however, this alteration has not been exhaustively characterized in the international literature. The following study is proposed with the aim of describing the alterations in the senses of taste and smell in relation to COVID-19 by means of their subjective evaluation. The nature of the study is observational, descriptive and cross-sectional, and was applied to patients who sought medical attention via remote consultations carried out on virtual platforms of the Service of Otorhinolaryngology and Head and Neck Surgery of the Clínicas Hospital, San Lorenzo, between the months of March and October of 2021. We included 440 patients aged 31.3 ± 9.9 years (18 to 60 years), 308 (70%) female, 388 (88%) from urban areas, with evidence of infection by SARS-CoV-2 by RT-PCR in 260 (59%), predominantly without comorbidities 232 (53%), with fever as the most frequently reported symptom 352 (80%), treated more frequently with NSAIDs 208 (47%) and/or Paracetamol 216 (49%). Both taste and smell alterations in patients who have had COVID-19 have been shown to appear more frequently 1 to 7 days after the onset of symptoms (207 for smell, 184 for taste), occurring more frequently with a total decrease of both senses (anosmia 302 and ageusia 216), recovering completely in most cases (214 and 216) and within a period of 1 to 4 weeks (140 and 130).

La alteración de los sentidos del gusto y del olfato en relación con el COVID-19 es un fenómeno ampliamente conocido, sin embargo, esta alteración no ha sido caracterizada de forma exhaustiva en la literatura internacional. Se plantea el siguiente estudio con el objetivo de describir las alteraciones del sentido del gusto y del olfato en relación con el COVID-19 a través de la evaluación subjetiva del mismo. El mismo es observacional, descriptivo, de corte transversal, aplicado a pacientes que consultaron a través de teleconsultas realizadas sobre plataformas virtuales de la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital de Clínicas, de San Lorenzo, durante los meses de marzo a octubre del 2021. Fueron incluidos 440 pacientes de 31,3 ± 9,9 años (18 a 60 años), 308 (70%) de sexo femenino, 388 (88%) provenientes de zona urbana, con evidencia de infección por SARS-CoV-2 por RT-PCR en 260 (59%), predominantemente sin comorbilidades 232 (53%), con fiebre como síntoma asociado al COVID-19 más frecuentemente reportado 352 (80%), tratados más frecuentemente con AINES 208 (47%) y/o Paracetamol 216 (49%). Tanto la alteración del gusto como del olfato en pacientes que han cursado con COVID-19 ha demostrado ser aparecer más frecuentemente en 1 a 7 días del inicio del cuadro (207 para el olfato. 184 para el gusto), cursando más frecuentemente con disminución total de ambos sentidos (anosmia 302 y ageusia 216), recuperándose más frecuentemente de forma total (214 y 216) y en un plazo de 1 a 4 semanas (140 y 130).

Psicología y Olfato Hacia un Abordaje Interdisciplinar Frente a la Covid-19

La psicología frente al olfato puede constituirse en una alternativa para mejorar la calidad de vida de las personas que han sufrido trastornos olfativos a causa de la pandemia de la Covid-19, en tal sentido a nivel mundial se van conformando equipos interdisciplinares para brindar alternativas científicas globales con diferentes perspectivas profesionales, es así que esta disciplina tiene la oportunidad y el reto de vincularse a estos equipos de alto nivel, fortaleciendo la perspectiva del entrenamiento olfativo clásico del área médica, y matizarlo con los criterios técnicos de la psicología del tercer milenio, y así tratar de disminuir las secuelas de esta enfermedad y ampliar las esperanzas de las personas de cualquier parte del mundo que sufren estos deterioros sensoriales.

Psychology against smell can become an alternative to improve the quality of life of people who have suffered olfactory disorders due to the Covid-19 pandemic, in this sense, interdisciplinary teams are being formed worldwide to provide scientific alternatives groups with different professional perspectives, so this discipline has the opportunity and the challenge of being linked to these high-level teams, strengthening the perspective of classical olfactory training in the medical area, and qualifying it with the technical criteria of the psychology of the third millennium, and thus try to reduce the consequences of this disease and expand the hopes of people from any part of the world who suffer from these sensory impairments.

A psicologia contra o olfato pode se tornar uma alternativa para melhorar a qualidade de vida de pessoas que sofreram distúrbios olfativos devido à pandemia de Covid-19, nesse sentido, equipes interdisciplinares estão sendo formadas em todo o mundo para fornecer alternativas científicas a grupos com diferentes perspectivas profissionais. disciplina tem a oportunidade e o desafio de estar vinculada a essas equipes de alto nível, fortalecendo a perspectiva da formação olfativa clássica na área médica, e qualificando-a com os critérios técnicos da psicologia do terceiro milênio, e assim tentar reduzir o consequências desta doença e ampliar as esperanças de pessoas de qualquer parte do mundo que sofrem com essas deficiências sensoriais.

Olfactory dysfunction in COVID-19: a marker of good prognosis? / Disfunção de olfato na Covid-19: marcador de bom prognóstico?

Abstract Introduction In May 2020, the World Health Organization recognized olfactory dysfunction as a COVID-19 symptom. The presence of hyposmia/anosmia may be a marker of good prognosis in COVID-19. Objective To associate the presence of olfaction disorder to the clinical condition severity in patients with COVID-19. Methods Individuals with the flu syndrome caused by SARS-CoV-2, diagnosed from March to June 2020, were recruited. They were divided into three groups: mild flu syndrome, severe flu syndrome (admitted to hospital wards) and critical illness (admitted to the ICU). Inpatients were interviewed by telephone contact after hospital discharge and their medical records were also evaluated regarding complementary test results. Outpatients answered an electronic questionnaire containing only clinical information. Results A total of 261 patients participated in the study: 23.75% with mild flu syndrome, 57.85% with severe flu syndrome and 18.40% with critical illness. A total of 66.28% patients with COVID-19 had olfaction disorders. In approximately 56.58% of the individuals the smell alterations lasted between 9 days and 2 months. There was a significantly higher proportion of individuals with olfactory dysfunction in the group with mild flu syndrome than in the severe flu syndrome group (mild × severe - p< 0.001; Odds Ratio = 4.63; 95% CI [1.87-10.86]). This relationship was also maintained between patients with mild flu syndrome and critically-ill patients (mild × critical - p< 0.001; Odds Ratio = 9.28; 95% CI [3.52-25.53]). Conclusion Olfaction dysfunction was significantly more prevalent in patients with mild flu syndrome in COVID-19. It may be a predictor of a good prognosis for this infection. New population-based studies must be carried out to corroborate these findings.

Resumo Introdução Em maio de 2020, a Organização Mundial da Saúde reconheceu a disfunção do olfato como um sintoma da C-19. A presença de hiposmia/anosmia pode ser um marcador de bom prognóstico na Covid-19. Objetivos Relacionar a presença do transtorno do olfato à gravidade do quadro clínico nos pacientes com Covid-19. Método Foram recrutados indivíduos com síndrome gripal causada pelo SARS-CoV-2, diagnosticados de março a junho de 2020. Eles foram divididos em três grupos: síndrome gripal leve; síndrome gripal grave (internados em enfermarias) e doença crítica (internados em UTI). Os doentes internados foram entrevistados por ligação telefônica após alta hospitalar e também tiveram seus prontuários avaliados para registro de exames complementares; os ambulatoriais responderam a um questionário eletrônico com somente informações clínicas. Resultados Participaram do estudo 261 pacientes: 23,75% com síndrome gripal leve, 57,85% com síndrome gripal grave e 18,40% com doença crítica. Ocorreu alteração do olfato em 66,28% doentes com Covid-19. Dos indivíduos, 56,58% apresentaram duração da alteração do olfato entre 9 dias e 2 meses. Houve significativamente maior proporção de indivíduos com disfunção olfatória no grupo com síndrome gripal leve do que nos graves (leves × graves - p < 0,001; odds ratio = 4,63; 95% IC [1,87-10,86]). Essa relação também se manteve entre os doentes leves e críticos (leves × críticos - p < 0,001; odds ratio = 9,28; 95% IC [3,52-25,53]). Conclusão A disfunção do olfato foi significantemente mais prevalente nos doentes com síndrome gripal leve na Covid-19. Pode ser um preditor de bom prognóstico dessa infecção. Novos estudos populacionais devem ser feitos para corroborar esses achados.

Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap / Avaliação da função olfatória nos pacientes submetidos à cirurgia endoscópica da base do crânio com realização de retalho nasosseptal

Abstract Introduction Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique. Objectives The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap. Methods A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1st, 3rd and 6th postoperative months. Results The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p < 0.05), but there was no mean difference in the Connecticut score classification between the other moments (p > 0.05); that is, patients showed worsening in the 1st month and returned to the preoperative mean after the 3rd month of follow-up. Conclusion The present study showed that the postoperative decrease in olfaction is transient, since the patient's sense of smell returns to pre-surgical values in the 3rd postoperative month.

Resumo Introdução O acesso transnasal endoscópico à base do crânio, tanto no tratamento quanto na reconstrução, pode ocasionar morbidade olfatória. Conhecer as principais consequências dessa intervenção é fundamental para se dispor de elementos objetivos para a decisão da técnica cirúrgica adequada. Objetivo Determinar o impacto na função olfatória do acesso endoscópico endonasal à base do crânio com confecção do retalho nasosseptal. Método Foi feita pesquisa prospectiva na qual foram incluídos 22 pacientes submetidos à cirurgia endoscópica transnasal à base do crânio com confecção de retalho nasosseptal. Foi aplicado o teste Connecticut chemosensory clinical research center antes e após o 1°, 3° e 6° meses da cirurgia. Resultados Os resultados evidenciaram que apenas no 1° mês de seguimento a classificação média dos pacientes foi estatisticamente pior do que nos demais momentos de avaliação (p < 0,05), mas entre os demais momentos não houve diferença média na classificação do escore de Connecticut (p >0,05), ou seja, os pacientes pioraram no 1° mês e voltaram à média pré-operatória a partir do 3° mês de seguimento. Conclusão No presente estudo, demonstramos que a diminuição do olfato pós-operatória é transitória, já que, no 3° mês depois da cirurgia, o olfato do paciente retorna aos valores pré-cirúrgicos.

Olfactory nerve: from ugly duckling to swan / Nervo olfatório: de patinho feio a cisne

ABSTRACT Background: The olfactory nerve has never been the shining star of neurological examination. Quite the contrary, examining the first cranial nerve is often an overlooked step. As cases of anosmia secondary to COVID-19 infection continue to rise, the 2020 pandemic has shed new light on this much-forgotten nerve, its value as an aid to diagnosis of several diseases and its central role in our daily lives. Objective: We aimed to emphasize how essential and simple clinical examination of the olfactory system can be by highlighting practical techniques and clinical tips for its assessment. We also share pearls and pitfalls in localization and differential diagnosis, which may prove valuable to busy clinicians. Methods: A broad review of the literature was conducted by searching PubMed, Cochrane and Google Scholar for articles and books containing topics regarding examination of the olfactory nerve and its anatomy, physiology and pathology. No particular inclusion or exclusion criteria were used. Results: Forty different works were found, between books and articles, from which 20 were selected after careful analysis. Conclusions: Despite the tragedy and adversity that followed the COVID-19 pandemic, its legacy has taught us a crystal-clear lesson: olfaction should no longer be neglected in clinical practice.

RESUMO Antecedentes: O nervo olfatório nunca foi a estrela do exame neurológico. Pelo contrário, o exame desse nervo craniano é um passo frequentemente ignorado. No entanto, o aumento exponencial de casos de anosmia secundária a COVID-19 o colocou sob os holofotes, tanto em relação á sua função para o ser humano em sociedade, como seu papel no auxílio do diagnóstico de diversas patologias. Objetivos: Enfatizar quão importante é examinar o nervo olfatório e compreender as desordens do seu sistema. Ressaltamos pérolas clínicas e erros comuns no exame deste nervo, além dicas que possam auxiliar no diagnóstico de uma série de doenças neurológicas e sistêmicas. Métodos: Uma ampla revisão da literatura foi conduzida por meio de busca no PubMed, Cochrane e Google Acadêmico por artigos e livros relacionados aos tópicos do exame físico, fisiologia, anatomia e patologia do nervo olfatório. Não foram utilizados critérios específicos de inclusão ou exclusão. Resultados: Foram encontrados 40 artigos itens relacionados na língua inglesa, dentre os quais livros e artigos, tendo sido analisados e selecionados um a um até o total de 20 referências. Conclusões: Apesar da tragédia e adversidade trazidas pela pandemia de COVID-19, uma lição clara permanece: o olfato não deve mais ser negligenciado na prática clínica.

Quality of life among SARS-CoV-2 (COVID-19) positive patients with anosmia using the short version questionnaire of olfactory disorders - Negative statements translated in Filipino (sQOD-NS Ph)

@#<p><strong>Objective:</strong> To determine the quality of life among SARS-CoV-2 (COVID-19) positive patients with anosmia using the Short Version Questionnaire of Olfactory Disorders - Negative Statements translated in Filipino (sQOD-NS Ph).</p><p><strong>Methods: </strong><strong>Design:</strong> Cross-Sectional Study</p><p><strong>                 Setting:</strong> Tertiary Government Training Hospital</p><p><strong>                 Participants:</strong> SARS-CoV-2 (COVID-19) RT-PCR positive patients aged 18 years old and above with COVID-19 symptoms and anosmia in a tertiary government hospital who consulted from March 2020 to August 2021 answered the short version of sQOD-NS Ph.</p><p><strong>Results:</strong> Out of 108 participants with positive SARS-CoV-2 (COVID-19) RT-PCR test, 72 (66%) presented with anosmia, and sQOD-NS Ph scores ranged from 1 to 21 with a mean of 14.78. Thirty two (44%) encountered problems in eating while 21 (29%) had feelings of isolation due to loss of smell. There was an inverse correlation of -0.478 between recovery time of olfaction and QoL score, hence the longer the recovery time, the lower the QoL score, while the shorter the recovery time, the higher the QoL score (p < .0001).</p><p><strong>Conclusion:</strong> Majority of COVID-19 patients with anosmia had mild or negligible impairment, while a small percentage had impaired quality of life. The low percentage may be due to high number of patients who may have recovered their sense of smell along the course of the disease.</p>

Características y prevalencia de las alteraciones del olfato y el gusto en pacientes con infección por COVID-19 / Characteristics of smell and taste alteration in patients with COVID-19

Introducción: La identificación de los síntomas o sus combinaciones con un alto valor predictivo para la enfermedad, es una estrategia crucial para el control de las enfermedades transmisibles. Las alteraciones en el olfato y el gusto han surgido como síntomas de alta prevalencia y un confiable predictor temprano de la enfermedad. El objetivo de este estudio fue caracterizar la prevalencia de las alteraciones del gusto y del olfato en pacientes con antecedente de infección por SARS-CoV-2 en la población colombiana. Materiales y métodos: estudio descriptivo de corte transversal. Se realizó una encuesta telefónica y electrónica a pacientes adultos con antecedente de infección por SARS-CoV-2 confirmado por PCR. Resultados: se incluyeron 182 pacientes en el estudio. El 59% manifestó alteraciones del olfato y 54% alteraciones del gusto. De estos, el 77% y 82%, respectivamente, presentaron mejoría de sus síntomas. El 14% de los participantes percibió las alteraciones del olfato antes del inicio de otros síntomas de COVID-19. El 9% reportó que la alteración del olfato fue el único síntoma de la infección. Para el gusto, 8% informó que fue el primer síntoma de COVID-19, mientras que el 6% reportó que fue el único síntoma. Conclusiones: las alteraciones del gusto y del olfato son síntomas de alta prevalencia en pacientes con infección por COVID-19 y en algunos casos pueden ser el síntoma de presentación de la infección o el único síntoma de la infección

Introduction: Identifying symptoms or symptom combinations with a high predictive value for diagnosing a disease is a crucial strategy for controlling transmissible diseases. Smell and taste alterations have been identified as highly prevalent symptoms of COVID-19 and have been used as a reliable early predictor of the disease. The objective in this study was characterizing the prevalence of smell and taste alterations in patients with COVID-19 in the Colombian population. Materials and methods: Cross-sectional, descriptive study. A telephonic and electronic survey was applied to adult patients with SARS-CoV-2 infection confirmed by PCR. Results: 182 patients were included. 59% presented with smell alterations and 54% with taste symptoms. Among these patients, 77% and 82% respectively perceived symptomatic improvement. 14% of patients presented smell alterations before the onset of other COVID-19 symptoms. 9% reported smell alterations to be the only symptom of the disease. 8% of patients perceived taste alterations as a first symptom and 6% reported it to be the only symptom of the disease. Conclusion: Taste and smell alterations are highly prevalent symptoms in Colombian patients with Covid-19 and in some cases they can be the either the first or the only perceived symptoms of the disease.

Smell disorders evolution after chronic rhinosinusitis with polyps surgery

: The effects of chronic rhino sinusitis with polyps (CRSWP) surgery on smell symptoms have not been sufficiently studied. The aim of this study was to evaluate the impact of CRSWP surgery on smell symptoms over short and long-term follow-up and to identify the factors that might influence their evolution. Patients and methods: This was a retrospective study about 184 patients operated endoscopically for CRSWP. In post operative period, long-term local steroids were prescribed systematically. The sense of smell was evaluated preand post-operatively according to a subjective score (1: good smell, 2: hyposmia, 3: anosmia). Some factors, related to the patient, the CRSWP and the treatment, were tested in order to identify predictors of smell outcome after surgery.. Results: Before surgery, the anosmia and the hyposmia were noted in 90.8% and in 8.7% of cases, respectively. At six months after surgery, the improvement of olfactory score was significant: 84% of patient had the score 1 compared with 0.5% preoperatively (p < 0.0001). This improvement was maintained during the 2 first years and decreased significantly at 3 years, although an average delay of polyps recurrence was 23.4 months. Among the factors studied in our series, only the observance of postoperative corticosteroids was retained as a predictor of smell recovery after surgery (p = 0,011). Conclusion: CRSWP surgery can significantly improve the smell sense, especially during the two first years. This effect can be sustainable if good post operative compliance for local corticosteroid are achieved