Frequency of Oral Lesions, Olfactory, and Gustatory Disorders and Xerostomia in Patients with COVID-19.

COVID-19, a respiratory illness with a global impact on millions, has recently been linked to manifestations affecting various bodily systems, including the oral cavity. Studies highlight oral issues, like ulcers, blisters, and white patches, alongside olfactory and gustatory dysfunction, influencing an individual's quality of life. In this context, our study aimed to assess the frequency of oral lesions, olfactory and gustatory disorders, and xerostomia resulting from COVID-19. An observational study was conducted with 414 patients to evaluate the frequency of oral symptoms resulting from COVID-19. Patients were diagnosed with mild symptoms and evaluated through clinical examination of the oral cavity and a questionnaire to assess functional alterations. The findings showed that 139 out of 414 patients presented clinical manifestations, with oral lesions being the most prevalent (19.1%), followed by gustatory disorders (18.1%), xerostomia (14.2%), and olfactory dysfunction (14%). The most prevalent oral lesions were ulcerations (n = 51), candidiasis (n = 8), and erythema or red plaques (n = 7). Unfortunately, 50 (12.1%) patients died during this study. Therefore, oral lesions, olfactory and gustatory dysfunctions, and xerostomia are common symptoms associated with COVID-19.

Effects of Endoscopic Sinus Surgery on Olfactory Function.

PURPOSE OF REVIEW: To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS: Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients. Endoscopic sinonasal surgical procedures may impact olfaction. Optimizing olfactory function requires proper surgical techniques, gentle handling of tissue, and perioperative care. Surgeons must discuss objectives and manage patient expectations. Routine olfactory assessment is crucial in surgical work-up and follow-up. Preserving anatomical structures while addressing the obstruction of the olfactory cleft helps to prevent decreased olfactory threshold. However, smell identification and discrimination do not always correlate with sinonasal anatomy.

Changes in olfaction and taste in patients hospitalized for COVID-19 and their relationship to patient evolution during hospitalization

Abstract Objectives: During the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. Methods: 248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. Results: The most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (p < 0.05). Both symptoms were associated with less need for intensive care admission (p = 0.001 for dysgeusia and p = 0.021 for dysosmia) and a negative correlation with length of hospital stay (dysosmia: r= −0.175, p < 0.05; dysgeusia: r = −0.29, p < 0.001) and length of stay in the ICU (dysosmia: r = −0.136, p < 0.05; dysgeusia: r = −0.215, p < 0.05). The absence of taste disorders was also associated with a greater need for mechanical ventilation (p < 0.001). Conclusion: Changes in taste and olfaction were reported by a large number of patients in the acute phase of COVID-19. In this study, both were markers of better clinical patient evolution. Level of evidence: 1B.

Changes in olfaction and taste in patients hospitalized for COVID-19 and their relationship to patient evolution during hospitalization.

OBJECTIVES: During the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. METHODS: 248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. RESULTS: The most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (p < 0.05). Both symptoms were associated with less need for intensive care admission (p = 0.001 for dysgeusia and p = 0.021 for dysosmia) and a negative correlation with length of hospital stay (dysosmia: r = -0.175, p < 0.05; dysgeusia: r = -0.29, p < 0.001) and length of stay in the ICU (dysosmia: r = -0.136, p < 0.05; dysgeusia: r = -0.215, p < 0.05). The absence of taste disorders was also associated with a greater need for mechanical ventilation (p < 0.001). CONCLUSION: Changes in taste and olfaction were reported by a large number of patients in the acute phase of COVID-19. In this study, both were markers of better clinical patient evolution. LEVEL OF EVIDENCE: 1B.

Pleasant parosmia with regard to own stool after SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19) has had a significant global impact due to the millions of deaths it has caused secondary to respiratory failure. However, the disease has also been associated with a wide array of manifestations in other organ systems. Among them, the presence of anosmia, which occurs in up to half the patients, has become a new sign of alarm to suspect the infection. Although up to 90% of affected patients will experience an improvement of their olfactory alterations within a month after the infection, the variety and severity of olfactory disturbances clearly cannot be summarized by the dichotomy of having anosmia or not. Parosmias are a type of olfactory dysfunction characterized by altered perception of odors, which can reflect both damage at some level of the olfactory tract, as well as the possibility of reversibility of said damage. The present manuscript describes possible olfactory disturbances associated with COVID-19, their pathophysiology, and potential clinical significance.

La enfermedad por coronavirus 2019 (COVID-19) ha tenido un impacto mundial trascendente por los millones de muertes que ha causado secundarias a insuficiencia respiratoria. Sin embargo, la enfermedad también se ha asociado a una amplia gama de manifestaciones en otros sistemas. Entre ellas, la presencia de anosmia, la cual ocurre en hasta mitad de los pacientes, se ha vuelto un nuevo dato de alarma para sospechar la infección. Aunque hasta el 90% de los pacientes afectados presentarán mejoría de sus alteraciones olfatorias dentro del mes posterior a su cuadro, la variedad y gravedad de alteraciones olfatorias claramente no pueden resumirse en la dicotomía de tener o no anosmia. Las parosmias son un tipo de alteración olfatoria caracterizadas por percepciones alteradas de los olores, las cuales pueden reflejar tanto daño a algún nivel del tracto olfatorio, así como la posibilidad de reversibilidad de dicho daño. En el presente manuscrito se describen las posibles alteraciones olfatorias asociadas a COVID-19, su fisiopatología, y potencial significancia clínica.

Olfactory and taste disorders in COVID-19: a systematic review / Desordens olfativas e gustativas na COVID-19: uma revisão sistemática

Abstract Introduction: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. Objective: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. Methods: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. Inclusion criteria: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. Exclusion criteria: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. Results: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. Conclusion: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.

Resumo Introdução: O vírus SARS-CoV-2 causa a COVID-19 e é responsável pela maior pandemia desde o surto de influenza H1N1 de 1918. Os sintomas clássicos da doença já foram bem definidos pela Organização Mundial da Saúde; entretanto, distúrbios olfativo-gustativos têm sido relatados em alguns estudos, mas ainda com várias lacunas no entendimento e no consenso sobre a condução clínica desses casos. Objetivo: Identificar evidências na literatura científica sobre os distúrbios olfativo-gustativos acerca da apresentação clínica, prevalência e possíveis tratamentos específicos associados à COVID-19. Método: Revisão sistemática de artigos publicados até 25 de abril de 2020 nas bases de dados: Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus e Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine e Research Gate. Foram critérios de inclusão: 1) Estudos com indivíduos com COVID-19; 2) Registro dos sinais/sintomas da COVID-19 e das funções olfativo-gustativa. Foram critérios de exclusão: 1) Estudos sobre coronavírus não humano; 2) Artigos de revisão; 3) Estudos experimentais (em animais ou in vitro); 4) Distúrbios olfativos-gustativos iniciados previamente à infecção pelo SARS-CoV-2. A avaliação de risco de viés dos estudos selecionados foi feita por meio da escala de Newcastle-Ottawa. Resultados: Seis artigos dos 1.788 registros foram selecionados. Um total de 1.457 pacientes de diversas etnias foi avaliado; desses, 885 (60,7%) apresentaram perda do olfato e 822 (56,4%) perda do paladar, sendo as mulheres as mais afetadas. Os distúrbios olfativo-gustativos estiveram presentes mesmo sem obstrução nasal/rinorreia e com início mesmo antes dos sinais/sintomas clínicos da COVID-19; a recuperação do olfato/paladar, quando ocorre, geralmente se dá nas duas primeiras semanas após a resolução da doença. Há evidências de que os distúrbios olfativo-gustativos sejam fortes preditores de infecção pelo SARS-CoV-2, podendo-se recomendar o isolamento do paciente, já a partir da consulta médica, para evitar a disseminação do vírus. Não foram identificadas evidências científicas para tratamentos eficazes para qualquer dos distúrbios. Conclusão: Podem ocorrer distúrbios olfativo-gustativos em intensidades variáveis e prévios aos sintomas gerais da COVID-19, devem ser considerados como parte dos sintomas da doença, mesmo em quadros leves. Não há ainda evidências científicas de tratamentos específicos para tais distúrbios na COVID-19.

Olfactory Dysfunction in a Mexican Population Outside of COVID-19 Pandemic: Prevalence and Associated Factors (the OLFAMEX Study).

PURPOSE OF REVIEW: To study the prevalence of olfactory loss and its associated factors in a Mexican population a cross-sectional analytical study based on a population interviewed about health, epidemiologic aspects, and sense of smell (tested with four scents: rose, banana, perfume, and gas) was conducted to evaluate olfactory detection, memory, and identification. Levels of sense of smell perception were determined when the participants detected, recognized, or identified all (normosmia), 1-3 (hyposmia), or none (anosmia) of the odorants. Associated factors of olfactory dysfunction were identified by multivariate analysis (odds ratio, 95%CI). RECENT FINDINGS: Olfactory dysfunction is a prevalent disorder affecting up to 20% of the general population. In addition to viral infection, including COVID-19, a number of other causes and factors may also be involved. 1,956 surveys were conducted and 1,921 were analyzed. Most of the participants (62.1%) were women. The general prevalence of olfactory dysfunction, regarding detection, was 7.2% (7.1% hyposmia, 0.1% anosmia). Age-related olfactory deterioration was observed in both sexes from the 5th decade of life (OR 2.74, p = 0.0050). Women showed better olfactory identification (OR 0.73, p = 0.0010). Obesity (OR 1.97, p = 0.0070), low educational level, bad/very bad self-perceived olfactory function (OR 2.74, p = 0.0050), olfactory loss for less than one week (OR 1.35, p = 0.0030), exposure to toxics/irritants (OR 1.31, p = 0.0030), active smoking (OR 1.58, p < 0.0010), and type 2 diabetes mellitus (OR 2.68, 95%CI 1.74-4.10, p < 0.0001) were identified as factors associated with olfactory dysfunction. These results in a Mexican population suggest better olfactory identification (verbalization) in females. Age was a determining factor in the olfactory deterioration process and obesity and diabetes mellitus were also associated with olfactory disorders. Finally, these findings reinforce the differential diagnosis with other potential causes of sense of smell loss, during the COVID-19 outbreak.

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19 / Recuperação incompleta e tardia da perda súbita do olfato na COVID-19

Abstract Introduction Sudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate. Objective To characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data. Methods An online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period. Results 253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p = 0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p = 0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p = 0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p = 0.04). Conclusion Positive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.

Resumo Introdução A perda súbita do olfato é um novo sintoma relacionado à COVID-19, porém com poucos dados sobre sua duração ou resolução. Objetivo Caracterizar pacientes que apresentaram perda súbita do olfato durante a pandemia da COVID-19 e em especial a sua recuperação. Método Pesquisa online desenvolvida pela Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial e Academia Brasileira de Rinologia direcionado aos médicos que atenderam pacientes com perda súbita do olfato com início após 1° de fevereiro de 2020. Os participantes foram questionados posteriormente por e-mail, para verificar os dados sobre a recuperação da perda súbita do olfato e teste para COVID-19, no final do período de coleta de dados. Resultados Foram incluídos 253 pacientes com perda súbita de olfato, 59,1% mulheres e idade mediana de 36 anos, acompanhados por 31 dias (mediana). Testagem para COVID-19 foi feita em 183 (72,3%) pacientes, 145 (79,2%) positivos e 38 (20,8%) negativos. COVID-19 positivos apresentaram sintomas inflamatórios inespecíficos mais frequentemente (89,7% vs. 73,7%; p = 0,02); menor taxa de recuperação total da perda súbita do olfato (52,6% vs. 70,3%; p = 0,05) e maior tempo para atingir a recuperação total (15 dias vs. 10 dias; p = 0,0006) comparados aos COVID-19 negativos. Considerando somente COVID-19 positivos, hiposmia súbita apresentou melhoria total mais frequentemente do que anosmia súbita (68,4% vs. 50,0%; p = 0,04). Conclusão A perda súbita do olfato em pacientes COVID-19 positivos apresentou menor taxa de recuperação total e duração mais prolongada do que em Covid-19 negativos. E a hiposmia súbita apresentou recuperação total mais frequentemente do que a anosmia súbita em COVID-19 positivos.

Olfactory and taste disorders in COVID-19: a systematic review.

INTRODUCTION: The SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases. OBJECTIVE: To identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19. METHODS: A systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. INCLUSION CRITERIA: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. EXCLUSION CRITERIA: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale. RESULTS: Six articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders. CONCLUSION: Olfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19.

INTRODUCTION: Sudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate. OBJECTIVE: To characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data. METHODS: An online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period. RESULTS: 253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p=0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p=0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p=0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p=0.04). CONCLUSION: Positive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.

Olfactory dysfunction in Alzheimer's disease Systematic review and meta-analysis.

Alzheimer's disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly. OBJECTIVE: To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis. METHODS: Databases were searched using the terms "olfactory OR smell OR olfaction AND alzheimer" for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out. RESULTS: Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis. CONCLUSION: Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

Neurodegenerativa, a doença de Alzheimer (DA) é um dos tipos mais prevalentes de demência, com frequência dobrando a cada 5 anos em idosos. OBJETIVO: Verificar a correlação entre DA e alterações olfatórias, identificando os domínios mais afetados e a possibilidade de utilização de testes olfatórios como complemento de diagnóstico precoce. MÉTODOS: Bases de dados foram acessadas utilizando os termos "olfactory OR smell OR olfaction AND alzheimer" buscando artigos relacionados ao tema proposto. Os estudos selecionados foram categorizados e avaliados em separado a depender do método de análise olfatória: identificação de odores, discriminação e reconhecimento e uma meta-análise foi realizada. RESULTADOS: Cinquenta e um artigos foram selecionado para análise. O tamanho do efeito da maioria dos estudos foi grande, assim como os valores sumários de cada categoria de análise olfatória. CONCLUSÃO: Entre os domínios olfatórios, excetuando memória, a identificação parece ser a mais alterada em DA. É possível explorar a possibilidade de adição de testes específico para avaliação de identificação de odores como um item na avaliação diagnóstica precoce. Registro PROSPERO: CRD42018089076.

Olfactory dysfunction in Alzheimer's disease: systematic review and meta-analysis / Alterações olfatórias em Doença de Alzheimer: revisão sistemática e meta-análise

Abstract Alzheimer's disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly. Objective: To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis. Methods: Databases were searched using the terms "olfactory OR smell OR olfaction AND alzheimer" for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out. Results: Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis. Conclusion: Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

Resumo Neurodegenerativa, a doença de Alzheimer (DA) é um dos tipos mais prevalentes de demência, com frequência dobrando a cada 5 anos em idosos. Objetivo: Verificar a correlação entre DA e alterações olfatórias, identificando os domínios mais afetados e a possibilidade de utilização de testes olfatórios como complemento de diagnóstico precoce. Métodos: Bases de dados foram acessadas utilizando os termos "olfactory OR smell OR olfaction AND alzheimer" buscando artigos relacionados ao tema proposto. Os estudos selecionados foram categorizados e avaliados em separado a depender do método de análise olfatória: identificação de odores, discriminação e reconhecimento e uma meta-análise foi realizada. Resultados: Cinquenta e um artigos foram selecionado para análise. O tamanho do efeito da maioria dos estudos foi grande, assim como os valores sumários de cada categoria de análise olfatória. Conclusão: Entre os domínios olfatórios, excetuando memória, a identificação parece ser a mais alterada em DA. É possível explorar a possibilidade de adição de testes específico para avaliação de identificação de odores como um item na avaliação diagnóstica precoce. Registro PROSPERO: CRD42018089076.

Quantitative instruments used to assess children's sense of smell: a review article / Instrumentos quantitativos para avaliação do olfato na população infantil: artigo de revisão

Purpose: To systematically gather from the literature available the quantitative instruments used to assess the sense of smell in studies carried out with children. Research strategy: The present study included a survey in the Pubmed and Bireme platforms and in the databases of MedLine, Lilacs, regional SciELO and Web of Science, followed by selection and critical analysis of the articles found and chosen. Selection criteria: We selected original articles related to the topic in question, conducted only with children in Portuguese, English, and Spanish. We excluded studies addressing other phases of human development, exclusively or concurrently with the pediatric population; studies on animals; literature review articles; dissertations; book chapters; case study articles; and editorials. Data analysis: A book report protocol was created for this study, including the following information: author, department, year, location, population/sample, age, purpose of the study, methods, and main results. Results: We found 8,451 articles by typing keywords and identifiers. Out of this total, 5,928 were excluded by the title, 2,366 by the abstract, and 123 after we read the full text. Thus, 34 articles were selected, of which 28 were repeated in the databases, totalizing 6 articles analyzed in this review. Conclusion: We observed a lack of standardization of the quantitative instruments used to assess children's sense of smell, with great variability in the methodology of the tests, which reduces the effectiveness and reliability of the results. .

Objetivo: Levantar na literatura, de forma sistemática, os instrumentos quantitativos utilizados para a avaliação do olfato em estudos com crianças. Estratégia de pesquisa: O presente estudo incluiu pesquisa nas plataformas Pubmed e Bireme e nas bases de dados MedLine, Lilacs, SciELO regional e Web of Science, seguindo etapas de seleção e análise crítica dos periódicos encontrados e escolhidos. Critérios de seleção: Foram selecionados artigos originais relacionados ao tema, realizados somente com a população infantil nas línguas portuguesa, inglês e espanhol. Foram excluídos estudos abordando outras fases do desenvolvimento humano, exclusivamente, ou concomitantemente com a população pediátrica; estudos com animais; artigos de revisão de literatura; dissertações; capítulos de livros; artigos de estudo de caso e editoriais. Análise dos dados: Foi criado um fichamento protocolar para este estudo contemplando os seguintes pontos: autor, departamento, ano, local, população/amostra, idade, objetivo do estudo, métodos utilizados e resultados principais. Resultados: Foram encontrados 8.451 artigos a partir da busca de descritores e termos livres. Desse total, 5.928 foram excluídos pelo título, 2.366 pelo resumo e 123 pela leitura do texto completo, sendo selecionados 34, dos quais 28 estavam repetidos nas bases de dados. Ao final, seis artigos foram analisados nesta revisão. Conclusões: Foi observada ausência de padronização dos instrumentos quantitativos utilizados para a avaliação do olfato na população infantil, com grande variabilidade na metodologia dos testes, diminuindo, portanto, a efetividade e a confiabilidade dos resultados encontrados. .

Conductive olfactory losses in chronic rhinosinusitis? A computational fluid dynamics study of 29 patients.

BACKGROUND: Besides sensorineural factors, conductive impediments likely contribute to olfactory losses in chronic rhinosinusitis (CRS) patients, yet no conclusive evidence exists. We aimed to examine possible conductive factors using computational fluid dynamics (CFD) models. METHODS: A total of 29 CRS patients were assessed via odorant detection thresholds (ODTs), rhinomanometry (nasal resistance [NR]), acoustic rhinometry (minimum-cross-sectional area [MCA]) and computed tomography (CT) staging. CFD simulations of nasal airflow and odorant absorption to olfactory region were carried out based on individual CTs. Biopsies of olfactory epithelium (OE) were collected, cryosectioned, stained, and scored for erosion. RESULTS: Significant correlations to ODTs were found for 3 variables: odor absorption in the olfactory region (r = -0.60, p < 0.01), MCA (r = -0.40, p < 0.05), and CT staging (r = 0.42, p < 0.05). However, significant findings were limited to ODTs of the highly soluble l-carvone. Multiple regression analysis revealed that these variables combined, with the addition of NR, can account for 65% of the total variance in ODTs. CT staging correlated significantly with OE erosion (r = 0.77, p < 0.01) and can replace the latter in the regression with comparable outcomes. Partial correlations suggest the contributions of both conductive and sensorineural variables are more prominent if adjusted for the effects of the other. Olfactory loss and inflammatory factors have strong bilateral involvement, whereas conductive factors are independent between sides. As validation, CFD-simulated NRs significantly correlated with rhinomanometrically assessed NRs (r = 0.60, p < 0.01). CONCLUSION: Both conductive and sensorineural mechanisms can contribute to olfactory losses in CRS. CFD modeling provides critical guidance in understanding the role of conductive impediments in olfactory dysfunction in CRS.

Alteraciones olfatorias en rinitis alérgicas / Olfactory alterations in allergic rhinitis

Los trastornos del olfato pueden causar serias consecuencias por la incapacidad de detectar señales olorosas de riesgo (humo, gases, alimentos en mal estado), y pueden afectar significativamente la nutrición y aun el comportamiento sexual. Estos trastornos tienen un impacto significativo en la calidad de vida de los pacientes. La hiposmia es una queja común entre los pacientes afectados por rinitis alérgica o no alérgica de larga data. En la consulta clínica por estas afecciones la pérdida del olfato es raramente explorada, centrándose la atención en los estornudos, rinorrea, congestión y prurito nasal. En la rinitis alérgica parece haber un continuo en la duración y severidad de la afección y la pérdida olfatoria, paralelo al grado de afectación rinosinusal. La pérdida olfatoria es mayor en los pacientes con rinitis no alérgica que en los afectados por rinitis alérgica estacional o perenne. En general los estudios no encuentran correlación entre la medición del grado de congestión nasal y la pérdida de olfato. En cambio existe mejor correlación con la inflamación eosinofílica. Los mecanismos subyacentes por los cuales la rinitis /rinosinusitis afectan el olfato probablemente sean multifactoriales, y podrían incluir la alteración del flujo aéreo y depósito de las sustancias olorosas, cambios en la composición del moco, y efectos de los mediadores inflamatorios en la diferenciación, maduración y función de las células receptoras. Las terapias actuales son efectivas en revertir la pérdida olfatoria solo parcial o transitoriamente. Los corticoides inhalados o sistémicos han probado ser parcialmente efectivos en mejorar el olfato en pacientes con rinitis alérgica.(AU)

Olfactory disorders can cause serious consequences from the inability to detect many olfactory warning signals (eg, smoke, spoiled food, and gas leaks) and can significantly impact nutritional status and even sexual behavior. Disorders of olfaction have significant quality of life impact. Hyposmia is a fairly common complaint in patients with long-continuing allergic or nonallergic rhinitis. Smell loss is often overlooked in the clinical setting of rhinitis, with attention instead focused on the respiratory complaints of nasal obstruction, hypersecretion, sneezing and nasal pruritus. There appears to be a continuum of duration and severity of olfactory loss in allergic rhinitis that parallels increasing severity of nasal-sinus disease. The nonallergic rhinitis patients' sense of smell was poorer than that of seasonal or perennial allergic rhinitis patients. Associations are generally lacking between measures of airway patency and olfactory function in this patients. The eosinophilic inflammation has a better correlation with the olfactory loss. The underlying mechanisms by which rhinitis/rhinosinusitis impact olfactory ability are likely to be multifactorial and might include altered air flow and odor deposition, changes in mucus composition, and effects of inflammatory mediators on receptor cell differentiation, maturation, or function. Current therapies are only partially or transiently effective in reversing olfactory loss. Inhaled and systemic steroids have been proved partially effective in improving olfactory function in patients with allergic rhinitis (AU)