Real-Life Study of Patient Preference for Dupilumab or Revision Surgery for Recurrent Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high rate of recurrence in patients, despite therapy with local corticosteroids and functional endoscopic sinus surgery. Dupilumab, a recombinant monoclonal human IgG4 antibody directed against the IL-4 receptor α that inhibits both IL-4 and IL-13 signal transduction, is available for symptomatic therapy. Patient preference between repeated surgery and injection therapy with Dupilumab is not known. (2) Methods: Patients who had experienced at least one surgical intervention for nasal polyps and were treated with Dupilumab for at least 3 months completed a retrospective patient questionnaire. (3) Results: In a cohort of 75 previously operated CRSwNP patients, 91.5% preferred therapy with Dupilumab to repeated surgery for nasal polyps. Preference for Dupilumab in the subgroups of patients with concomitant Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease (N-ERD) (n = 32), patients with concomitant asthma (n = 25), and patients without concomitant disease (n = 18) was 100%, 96%, and 72%, respectively. (4) Conclusions: Patient preference for Dupilumab over repeat surgery is strongest in previously operated CRSwNP patients with concomitant asthma or N-ERD, but remains very high in patients without concomitant disease.

Seasonal Variations in Public Inquiries into Laryngitis: An Infodemiology Study.

OBJECTIVES: Acute laryngitis is a common disease with self-limiting nature. Since the leading cause is attributed to viral infections and thus self-limiting, many affected individuals do not seek professional medical help. However, because the major symptom of hoarseness imposes a substantial burden in everyday life, it might be speculated that web-based search interest on this condition follows incidence rates, with highest peaks during winter months. The aim of this study was to evaluate global public health-information seeking behaviour on laryngitis-related search terms. METHODS: We utilized Google Trends to assess country-specific, representative laryngitis-related search terms for English and non-English speaking countries of both hemispheres. Extracted time series data from Australia, Brazil, Canada, Germany, the United Kingdom, and the United States of America, covering a timeframe between 2004 and 2019 were first assessed for reliability, followed by seasonality analysis using the cosinor model. RESULTS: Direct comparisons revealed different, representative laryngitis-related search terms for English- and non-English speaking countries. Extracted data showed a trend of higher reliability in countries with more inhabitants. Subsequent graphical analysis revealed winter peaks in all countries from both hemispheres. Cosinor analysis confirmed these seasonal variations to be significant (all P < 0.001). CONCLUSION: Public interest in laryngitis-related, online health information displayed seasonal variations in countries from both hemispheres, with highest interest during winter months. These findings emphasize the importance to optimize the distribution of reliable, web-based health education in order to prevent the spread of misinformation and to improve health literacy among general populations.

Retronasal olfactory testing in early diagnosed and suspected COVID-19 patients: a 7-week follow-up study.

OBJECTIVES: Olfactory dysfunction (OD) constitutes a major symptom in Coronavirus Disease 2019 (COVID-19). Yet, most data on smell loss rely on the evaluation of orthonasal olfactory performance. Therefore, we aimed to assess retronasal olfactory function (ROF) over a period of several weeks in proven and suspected COVID-19 patients. METHODS: One hundred and one subjects with suspected or laboratory-proven COVID-19 participated in this study. In patients with OD no longer than 4 weeks after initial symptom onset, ROF was measured with the 7-item Candy Smell Test ten times over 7 weeks. RESULTS: Olfactory function was decreased in the investigated patients and remained decreased over the course of 7 weeks. One-way repeated-measures ANOVA revealed no significant difference of ROF between different measurement time points. However, self-assessment of smell and flavour improved significantly (p = 0.013 and p = 0.043), but did not show complete recovery. CONCLUSION: The current investigation revealed significant improvements in subjective smell and flavour perception over the course of 7 weeks in proven and suspected COVID-19 patients suffering from acute OD. However, objectively measured ROF based on a screening test revealed no improvements within the same time period.

Smell loss as initial symptom of olfactory groove meningioma.

Approximately 20% of the general population suffer from olfactory dysfunction (OD). Until today, olfactory function (OF) receives less attention than other human senses despite its significance for quality of life. The main causes of OD are upper respiratory tract infections, traumatic brain injuries and sinonasal diseases. Here, we report the case of a 28-year-old woman, who started to suffer from OD during pregnancy. Smell loss was attributed to pregnancy-induced rhinitis and initiated no further examinations. Nevertheless, OD persisted post partum and undulating headache occurred 1 year later. Only after visual impairment and one more year passing by, diagnosis of olfactory groove meningioma was made using MRI. With this case report, we want to highlight the importance of the symptom of smell loss. Patients reporting OD should undergo thorough anamnesis, endoscopy of the nasal cavity, psychophysical smell testing and radiographic imaging in unclear cases to determine diagnosis.

Decrease and Recovery of Olfactory and Gustatory Function in a Case of SARS-CoV-2 Infection.

Self-reported chemosensory dysfunction in severe acute respiratory syndrome coronavirus 2 patients is common. We present a case of reversible smell loss in a young patient with mild coronavirus disease 2019 infection assessed with established testing methods over a period of 8 weeks.

Odor Mixtures in Identification Testing Using Sniffin' Sticks: The SSomix Test.

Clinical tests assessing olfactory performance have become indispensable for diagnosing olfactory dysfunction. As time and personnel resources are limited, it would be advantageous to have shorter protocols focusing on singular aspects of olfactory performance, such as odor identification. However, such a unidimensional approach is often inconclusive and needs further tests (and tools). Hence, new testing methods with high levels of sensitivity, specificity, and reproducibility are required for clinical practice. Here, we developed a Sniffin' Sticks odor mixture identification test method (SSomix), with emphasis on resource efficiency and simplicity of administration. SSomix consists of mixtures of two and three odors applied onto a piece of paper using 11 out of 16 items from the original Sniffin' Sticks identification test kit. A total of 66 healthy subjects and 22 patients with olfactory dysfunction were included in the study. SSomix showed good to excellent test-retest reliability and validity. The area under the receiver operating characteristics curves indicated good diagnostic accuracy in identifying patients with reduced and severely impaired olfactory function. SSomix was a suitable downsizing of the original kit, especially regarding resource efficiency.

Retronasal olfactory function in patients with smell loss but subjectively normal flavor perception.

OBJECTIVES: The human sense of smell constitutes the main part of flavor perception. Typically, patients with loss of olfactory function complain of diminished perception during eating and drinking. However, some patients with smell loss still report normal enjoyment of foods. The aim of the present study was to compare orthonasal and retronasal olfactory function in patients with non-sinonasal smell loss and subjectively normal flavor perception. METHODS: Nineteen patients (mean age [range] 52.0 [8-83 years]) with self-reported olfactory impairment but subjective normal flavor perception were included. Olfactory performance was assessed using the Sniffin' Sticks (TDI) for orthonasal and the Candy Smell Test (CST) for retronasal function. Visual analogue scales were used for self-assessment of odor (SOP), taste (STP), and flavor perception (SFP), ranging from 0 (no perception) to 10 (excellent perception). RESULTS: Mean (SD) SFP was 8.0 (1.8). Mean (SD) orthonasal TDI-score of all patients was 14.4 (5.3, range 6-25.3) with 11 patients classified as anosmic and eight as hyposmic. Mean/SD retronasal CST-score was 8.8 (2.7, range 3-13) within the range of anosmia/hyposmia. No correlation was found between SFP and the CST (P = .62). CONCLUSION: The present results showed that despite claiming normal flavor perception, our patients were ortho- and retronasally dysosmic using standard tests for olfactory function. Although other explanations could be possible, we suggest that this subjective flavor perception might be due to unconscious memory recall from previously experienced cross-modal sensory interactions. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1629-1633, 2020.

Clinical test of gustatory function including umami taste.

OBJECTIVES: Assessment of gustatory function is a central part of the diagnosis of patients with chemosensory dysfunctions. The taste of monosodium glutamate was described as umami taste a century ago by Ikeda. The aim of this study was to extend a validated gustatory test with 4 concentrations of monosodium glutamate. METHODS: The investigation included 96 subjects who reported having a normal sense of taste and smell. Taste function was assessed by 4 concentrations of sweet, sour, salty, bitter, and umami tastes (extended version) and compared to results obtained in a control group (n = 139) not presented with umami. In a subgroup of 46 participants, the complete test was repeated within 7 days to obtain retest values. RESULTS: Group comparisons exhibited no differences in taste sensitivity for each of the 4 taste qualities (p > 0.3) and no deviation with regard to the sum of correctly identified tastants (p = 0.81). Test-retest data from the extended version revealed a high correlation of scores (r46 = 0.77; p < 0.001). CONCLUSIONS: The results indicate that the extended version of the gustatory test is applicable for experimental and clinical settings.

Clinical significance of smell and taste disorders in patients with diabetes mellitus.

Chemosensory dysfunction has been reported in patients with diabetes mellitus (DM). However, the clinical significance in relation to the disease stage remains unclear. The aim of this investigation was to assess olfactory and gustatory function with valid clinical tests in patients with DM types 1 and 2 with and without accompanying diseases. Seventy-six patients with DM were divided into three groups according to disease stage. Taste function was tested by means of impregnated paper strips and smell function was screened using a five-item smell identification test. The results of the patients with uncomplicated DM were compared with the results from 29 healthy subjects. The results showed no significant differences in smell and taste function between patients with uncomplicated DM and healthy subjects. However, patients with additional diseases exhibited decreased smell acuity. Moreover, patients with DM type 2 showed impaired smell function compared with patients with DM type 1.

"Taste Strips" - a rapid, lateralized, gustatory bedside identification test based on impregnated filter papers.

OBJECTIVE: To elaborate normative values for a clinical psychophysical taste test ("Taste Strips"). BACKGROUND: The "Taste Strips" are a psychophysical chemical taste test. So far, no definitive normative data had been published and only a fairly small sample size has been investigated. In light of this shortcoming for this easy, reliable and quick taste testing device, we attempted to provide normative values suitable for the clinical use. SETTING: Normative value acquisition study, multicenter study. METHODS: The investigation involved 537 participants reporting a normal sense of smell and taste (318 female, 219 male, mean age 44 years, age range 18-87 years). The taste test was based on spoon-shaped filter paper strips ("Taste Strips") impregnated with the four (sweet, sour, salty, and bitter) taste qualities in four different concentrations. The strips were placed on the left or right side of the anterior third of the extended tongue, resulting in a total of 32 trials. With their tongue still extended, patients had to identify the taste from a list of four descriptors, i. e., sweet, sour, salty, and bitter (multiple forced-choice). To obtain an impression of overall gustatory function, the number of correctly identified tastes was summed up for a "taste score". RESULTS: Taste function decreased significantly with age. Women exhibited significantly higher taste scores than men which was true for all age groups. The taste score at the 10(th) percentile was selected as a cut-off value to distinguish normogeusia from hypogeusia. Results from a small series of patients with ageusia confirmed the clinical usefulness of the proposed normative values. CONCLUSION: The present data provide normative values for the "Taste Strips" based on over 500 subjects tested.