Hyposmia: a possible biomarker of Parkinson's disease

Hyposmia, identified as reduced sensitivity to odor, is a common non-motor symptom of Parkinson＇s disease （PD） that antedates the typical motor symptoms by several years. It occurs in -90% of early-stage cases of PD. In addition to the high prevalence, the occurrence of hyposmia may also predict a higher risk of PD. Investigations into hyposmia and its relationship with PD may help elucidate the underlying pathogenic mechanisms. This review provides an update of olfactory dysfunction in PD and its potential as a biomarker for this devastating disease.

Effects of rhidosin on expression of fibroblast growth factor onolfactory bulb in rats and its relation with senile hyposmia

Objectives To determine the expression of fibroblast growth factor (FGF) on olfactory bulb in rats and its relation with senile hyposmia, and to discuss the effects of rhidosin on expression of FGF on olfactory bulb in senile rats and its significance Methods Four groups of rats, ie, young group, senile group, rhidosin group, and physiological saline control group were used in this study After the removal of the heads of these rats, olfactory mucosa and olfactory bulbs were immediately fixed with neutral formalin, followed with paraffin embedding, serial sectioning, immunohistochemical staining and light microscopic observation Results The positive expression rate of FGF on olfactory bulb in young group was significantly higher than that in senile group (P<0 01) The positive expression rate of FGF on olfactory bulb in rhidosin group was significantly higher than that in physiological saline control group (P<0 01) No positive expression of FGF on olfactory mucosa was observed in these four groups Conclusion These results suggest that the expression of FGF on olfactory bulb gradually decline with aging The decrease of expression of FGF on olfactory bulb may play a key role in the occurrence of senile hyposmia Rhidosin can increase the expression of FGF on olfactory bulbs in senile rats and this may be one of the mechanisms by which rhidosin promotes the growth of olfactory cells and inhibits aging effects on the olfactory system

男性Kallmann综合征与特发性低促性腺激素性性腺功能减退症的性腺轴功能评价

目的评价男性Kallmann综合征(KS)与特发性低促性腺激素性性腺功能减退症(IHH)的性腺轴功能。方法分析我科2013年至2021年50例KS及61例IHH患者的临床表现及GnRH、HCG兴奋试验特点。结果两组患者均表现为性发育不良,第二性征缺失,睾丸阴茎小及低促性腺激素性性腺功能减退。KS患者伴嗅觉减退或缺失。KS组平均睾丸体积、基础FSH及LH值均低于IHH组,组间比较差异有统计学意义。GnRH兴奋试验:KS组的LH峰值3.13 IU/L,FSH峰值3.31 IU/L。IHH组的LH峰值4.76 IU/L,FSH峰值3.68 IU/L。HCG兴奋试验:T峰值在72 h,KS组的T峰值62.82 ng/dl,IHH组的T峰值118.44 ng/dl。KS组的LH及T峰值均低于IHH组,组间比较差异有统计学意义。隐睾组的GnRH兴奋试验与HCG兴奋试验的峰值均低于与正常睾丸组,两组间差异有统计学意义。结论KS与IHH患者均表现为低促性腺激素性性腺功能减退,KS患者伴嗅觉减退或缺失,两组在基础FSH、LH值及GnRH及HCG兴奋试验中的峰值差异有统计学意义。睾丸的状态一定程度反映了性腺轴的储备功能。

静息态fMRI对抑郁症伴嗅觉功能减退患者功能连接的研究

目的:应用功能连接(FC)分析方法探讨抑郁症伴嗅觉功能减退患者的双侧杏仁核功能连接情况。方法:纳入37例抑郁症患者(MDD组)和38例性别年龄及受教育程度相匹配的健康人(NC组)进行70%异丙醇吸入测试法进行嗅觉测试,根据嗅觉测试结果将抑郁症组分为伴嗅觉减退的抑郁症a组和不伴嗅觉减退的抑郁症b组,然后均接受脑静息态fMRI检查,选取双侧杏仁核做全脑FC分析。结果:抑郁症伴嗅觉减退患者嗅觉减退程度与HDRS-24得分(r=-0.519,P=0.033)存在负相关关系。以左侧杏仁核为种植点,抑郁症组较正常组在右侧梭状回、左侧颞下回、左侧中央后回、左侧中央前回、双侧内侧旁扣带回功能连接减弱,抑郁症a组在右侧丘脑、右侧内侧旁扣带回功能连接减弱,与左侧距状回、右侧岛叶、左侧颞上回、右侧中央沟盖、左侧楔叶、左侧内侧旁扣带回、双侧中央前回、右侧额中回、左侧补充运动区、Cerebelum_Crus1_R功能连接增强。以右侧杏仁核为种植点,抑郁症组较正常组在右侧颞下回、左侧颞上回、左侧三角部额下回、左侧内侧旁扣带回、左侧中央前回、左侧中央后回、右侧中央旁小叶功能连接减弱,左侧海马功能连接增强。抑郁症a组在右侧内侧旁扣带回功能连接增强。抑郁症a组左侧杏仁核与左侧颞上回(r=-0.603,P=0.038)、左侧楔叶(r=-0.671,P=0.017)以及Cerebelum_Crus1_R(r=-0.608,P=0.036)功能连接与嗅觉测试距离呈负相关。结论:抑郁症伴嗅觉减退的患者双侧杏仁核功能连接存在改变,这些改变可能提示了抑郁症患者嗅觉减退和情绪调节失控之间的关系。

重视帕金森病非运动症状

随着对帕金森病（PD）认识的加深，非运动症状已成为PD症状学的重要组成部分。PD患者嗅觉下降发生率高，并可用来鉴别PD与非典型性和继发性帕金森综合征；对PD患者消化道症状的研究发现，便秘患者PD发病风险增加5倍，且肠道神经中发现了α-突触核蛋白和Lewy体的沉积；精神症状如快速动眼期睡眠行为障碍（RBD）、抑郁、焦虑及幻觉妄想等显著降低了患者生活质量，且RBD转化为PD等神经变性疾病的概率显著增高。非运动症状有可能成为PD早期诊断的突破点，需给予更大关注，加强研究。

帕金森病患者嗅觉减退的临床特点及影响因素分析

目的探讨帕金森病(PD)患者嗅觉减退的临床特点及影响因素。方法回顾性分析2019年2月至2020年5月在湖州市中心医院神经内科门诊及住院的PD患者84例,其中PD伴嗅觉减退组44例,PD不伴嗅觉减退组40例。比较两组患者统一PD评定量表第Ⅲ部分评分、Hoehn-Yahr(H-Y)分期、便秘、快速眼动期睡眠行为障碍(RBD)、焦虑、抑郁及认知障碍、血清尿酸、载脂蛋白A1及总谷胱甘肽的差异。采用Spearman等级相关分析PD患者嗅觉减退与其他非运动症状及血清生化指标之间的相关性,采用二分类logistic回归分析PD患者嗅觉减退的影响因素。结果PD伴嗅觉减退组患者便秘、RBD、焦虑和认知障碍发生率均高于PD不伴嗅觉减退组,血清总谷胱甘肽水平低于PD不伴嗅觉减退组,差异均有统计学意义(均P<0.05)。Spearman等级相关分析显示,PD患者嗅觉减退与便秘、RBD、焦虑、认知障碍发生率均呈正相关(r=0.290、0.285、0.241、0.342,均P<0.05)。二分类logistic回归分析发现认知障碍是PD嗅觉减退的影响因素(OR=13.449,95%CI:1.590~113.736,P<0.05)。结论PD伴嗅觉减退患者更易出现便秘、RBD、焦虑、认知障碍及低水平血清总谷胱甘肽,其中认知障碍是PD嗅觉减退的影响因素。

A Case Series of Olfactory Dysfunction in Imported COVID-19 Patients:A 12-Month Follow-Up Study

Objective The scientific community knows little about the long-term influence of coronavirus disease2019(COVID-19) on olfactory dysfunction(OD). With the COVID-19 pandemic ongoing worldwide, the risk of imported cases remains high. In China, it is necessary to understand OD in imported cases.Methods A prospective follow-up design was adopted. A total of 11 self-reported patients with COVID-19 and OD from Xi’an No. 8 Hospital were followed between August 19, 2021, and December 12, 2021.Demographics, clinical characteristics, laboratory and radiological findings, and treatment outcomes were analyzed at admission. We surveyed the patients via telephone for recurrence and sequelae at the1-, 6-, and 12-month follow-up.Results Eleven patients with OD were enrolled;of these, 54.5%(6/11) had hyposmia and 45.5%(5/11)had anosmia. 63.6%(7/11) reported OD before or on the day of admission as their initial symptom;of these, 42.9%(3/7) described OD as the only symptom. All patients in the study received combined treatment with traditional Chinese medicine and Western medicine, and 72.7%(8/11) had partially or fully recovered at discharge. In terms of OD recovery at the 12-month follow-up, 45.5%(5/11) reported at least one sequela, 81.8%(9/11) had recovered completely, 18.2%(2/11) had recovered partially, and there were no recurrent cases.Conclusions Our data revealed that OD frequently presented as the initial or even the only symptom among imported cases. Most OD improvements occurred in the first 2 weeks after onset, and patients with COVID-19 and OD had favorable treatment outcomes during long-term follow-up. A better understanding of the pathogenesis and appropriate treatment of OD is needed to guide clinicians in the care of these patients.

Idiopathic Hypogonadotropic Hypogonadism— An Update on the Aetiopathogenesis, Management of IHH in Both Males and Females—An Exhaustive Review

Methods: Asystematic literature search was performed using PUBMED for all English articles up to April 2014. Although this review mainly focuses on published human studies, it also draws attention to where future research should be directed based on animal studies. Results: Besides the 9 known mutations widely quoted for KS namely KAL1, Fibroblast growth factor 8 (FGF8), fibroblast growth factor receptor 1 (FGFR1), prokineticin 2 (PROK2), PROK receptor 2 (PROKR2), WDR11, heparin sulfate-6-O-Transferase (HS6T1), chromodomain helicase DNA binding protein 7 (CHD7) and semaphorin 3A (SEMA 3A), additional mutations in “FGF8 synexpression” group e.g., FGF 17, ILRD, DUSP 6, SPRY4 and FLRT3 have been shown to be involved in CHH, mostly KS besides SEMA 7A. Although traditionally division has been based on anosmic/normosnic criteria, further genes found to cause so called nIHH like Gonadotropin releasing hormone receptor (GNRHR). KISS1, TAC3, TACR3 have also been found to be associated with hyposmia on detailed testing on UPSIT and MRI for olfactory structures revealed absent OB. Further detailed examination of transcription factor genes have revealed involvement of HESX1, TSHZ1, AXL, SOX10 with a strong overlap of in transcription factors in development of septooptic dysplasia (SOD), combined pituitary hormone deficiency (CHPD) and KS. Treatment with rFSH/-hCG gives almost similar results to pulsatile GnRH therapy and should be based on cost factor, availability and in occasional cases specific treatment like kisspeptin therapy. Conclusions: Contrary to the traditional thinking, one shoud reconsider classifying cases of IHH simply on basis of anosmia/normosmia. Deafness calls for looking for mutations in Sox 10/CHD7/ILRD7 considering 38% association of former. Therapy should be individualized based on availability of pulsatile GnRH, cost factor and in recalcitrant cases kp therapy may be of use with kp mutations and NKB mutations.

The balance between efficient anti-inflammatory treatment and neuronal regeneration in the olfactory epithelium

The sense of smell is important for human quality of life. This sophisticated sensorial system relies on the detection of odorant molecules that engage receptors expressed in the cilia of dedicated neurons that constitute the olfactory epithelium（OE）. Importantly, the OE is a highly active site of adult neurogenesis where short-lived neurons are efficiently replenished, even after massive neuronal cell loss. It is suggested that the degree of olfactory function recovery after OE injury may depend on the nature of the lesion（traumatic, chemical, infectious or inflammatory）, as well on the velocity of cellular regeneration. Topical steroidal anti-inflammatory drugs, such as glucocorticoids, are routinely prescribed for treating upper airway inflammatory conditions, such as chronic rhinosinusitis. While the therapeutic strategy aims to minimize the inflammatory damage and dysfunction to nasal air conduction, new evidences raise concerns if such drugs may impair neuronal regeneration in the OE. In consequence, new directions are necessary in terms of drug development or prescription, in order to preserve olfactory function through lifelong repeated episodes of chronic inflammation in the upper respiratory tract. Here we discuss mechanisms involved in glucocorticoid deleterious effects to OE regeneration and possible therapeutic alternatives considering relevant side effects.

鼻内镜手术治疗成人变应性鼻炎伴嗅觉减退的临床研究

目的探讨鼻内镜手术治疗成人变应性鼻炎伴有上鼻道窦口复合区病变的嗅觉减退的疗效。方法对35例变应性鼻炎伴嗅觉减退患者进行鼻内镜手术,开放上鼻道窦口复合区并彻底清除病变。术后门诊定期鼻内镜复查,比较分析术前及术后1月、3月、12月的T&T嗅觉识别阈平均值和治疗有效率。结果术后1月、3月和12月平均T&T嗅觉识别阈值明显低于术前,差异均有统计学意义(t分别=19.07、17.26、13.32,P均<0.05);术后3月T&T嗅觉识别阈值高于术后1月,术后12月T&T嗅觉识别阈值高于术后3月,差异均有统计学意义(t分别=7.11、5.98,P均<0.05)。患者术后1月、3月、12月治疗有效率分别为:97.14%、94.29%、80.00%,术后1月治疗有效率明显高于术后12月(χ2=5.08,P<0.05)。结论鼻内镜手术治疗变应性鼻炎伴有上鼻道窦口复合区病变的嗅觉减退的短期疗效明显,长期效果需待进一步观察。

TRPC6与OMP在慢性鼻-鼻窦炎患者嗅上皮中的表达及与嗅觉功能相关性分析

目的研究瞬时受体电位通道6(TRPC6)与嗅觉标记蛋白(OMP)在慢性鼻-鼻窦炎(CRS)引起的嗅觉减退患者嗅上皮中的表达以及与嗅觉减退的关系。方法收集20例CRS伴嗅觉减退的患者为实验组,10例鼻中隔偏曲且嗅觉正常患者为对照组。T&T嗅觉计测试检测两组患者的嗅觉,取手术中切除的嗅区黏膜作为研究对象。免疫组化和蛋白印迹分析(Western Blot)检测TRPC6与OMP在嗅上皮中的表达,并比较CRS伴不同程度嗅觉功能减退患者嗅上皮中TRPC6与OMP的表达水平,同时分析TRPC6与OMP表达量与嗅觉功能相关性。结果实验组嗅觉T&T评分明显高于对照组,表明入组的CRS患者存在嗅觉功能减退(P<0.001)。免疫组化和Western Blot结果表明:与对照组相比,实验组TRPC6与OMP阳性细胞数和蛋白表达量明显减少(P<0.001)。此外,T&T评估得分与嗅上皮组织中TRPC6和OMP表达水平呈现负相关(TRPC6,R2=0.91,P<0.001;OMP:R2=0.853 8,P<0.001)。结论 TRPC6在CRS引起的嗅觉减退患者的嗅上皮中表达下调,且嗅觉功能减退程度与TRPC6含量呈负相关性,OMP作为嗅觉的客观反应,同样表达下调,故我们推断TRPC6的表达下调可能是导致CRS引起嗅觉减退的生物学机制之一。

Long-term olfactory loss post-COVID-19:Pathobiology and potential therapeutic strategies

An acute loss of smell emerged as a striking symptom present in roughly half of the people infected with the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus in the early phases of the COVID-19 pandemic.In most COVID-19 patients,olfaction recovers over the course of a few weeks.However,a lasting partial or complete loss of smell,often associated with distorted olfactory perceptions termed parosmia,has emerged as a widespread problem impacting at least 5%-10%of those who experience anosmia due to COVID-19.Our inability to offer effective therapies to this hyposmic or anosmic population,comprising millions of patients,highlights an enormous unmet need for the medical system.Here,we summarize the current understanding of the pathobiology causing acute olfactory loss due to SARS-CoV-2 infection,focusing on how the virus interacts with the peripheral olfactory system,a major site of viral infection.We also explore the problem of long-COVID olfactory dysfunction,which may accompany other persistent systemic disorders collectively termed postacute sequelae of COVID-19.Specifically,we discuss an emerging model focused on unresolved immune cell activity driving ongoing dysfunction.Finally,we review current and future therapeutic approaches aimed at restoring olfactory function.

嗅觉识别测验在帕金森病患者中的应用

目的 建立我国嗅觉识别测验材料与方法，测查帕金森病患者的嗅觉功能，验证测验的有效性，分析其影响因素。方法 选取诊断明确的原发性非痴呆帕金森病患者55例以及与其人口学资料相匹配的健康对照55名作为研究对象，采用中国科学院心理研究所研发的基于中国人群的嗅觉识别测验方法，进行嗅觉识别测验。结果 帕金森病组嗅觉识别测验的正确选择数（19.3±5.4）显著少于健康对照组（26.5±5.7），差异有统计学意义（t＝-6.827，P〈0.01）；依据不同年龄段的参考值进行分段比较，发现63.6%的帕金森病患者存在显著嗅觉减退，Hoehn-Yahr分级2～3级显著嗅觉减退的发生率为77.8%；通过帕金森病组与健康对照组受试者工作特征（ROC）曲线分析显示，嗅觉识别测验正确识别数取界值为22.5时，诊断嗅觉减退的敏感度为74.6%，特异度为70.9%；帕金森病患者嗅觉识别测验正确数不受年龄、教育年限、Hoehn-Yahr分级、病程、统一帕金森病评定量表的第三部分得分、MMSE评分的影响（均P〉0.05）。结论 帕金森病患者存在嗅觉识别能力的减退，中国人群的嗅觉识别测验能够有效地测查帕金森病患者的嗅觉功能。

帕金森病患者嗅觉减退的相关因素分析

目的探讨帕金森病患者嗅觉减退的发生率以及相关因素。方法收集463例帕金森病(PD)患者基本信息,并通过量表系统性评估运动及非运动症状,PD非运动量表"是否有嗅觉减退"项回答"是"者纳入嗅觉减退组,回答"否"者纳入非嗅觉减退组。结果帕金森病患者嗅觉减退发生率为33.9%,86%的患者嗅觉减退出现在运动症状之前,并且与性别、年龄、起病年龄、运动症状、疾病严重程度无明显关系。伴有嗅觉减退患者的情绪障碍如焦虑、抑郁、淡漠较重,并且睡眠和认知功能较差。高质量的睡眠及吸烟是PD嗅觉减退的保护因素,淡漠是危险因素。结论合并嗅觉减退患者可能合并更加严重的情绪、睡眠及认知障碍。

Premotor Diagnosis of Parkinson's Disease

Typical Parkinsonian symptoms consist of bradykinesia plus rigidity and/or resting tremor. Some time later postural instability occurs. Pre-motor symptoms such as hyposmia, constipation, REM sleep behavior disorder and depression may antecede these motor symp- toms for years. It would be ideal, if we had a biomarker which would allow to predict who with one or two of these pre-motor symptoms will develop the movement disorder Parkinson＇s disease （PD）. Thus, it is interesting to learn that biopsies of the submandibular gland or colon biopsies may be a means to predict PD, if there is a high amour of abnormally folded alpha-synuclein and phosphorylated alpha-synuclein. This would be of relevance if we would have available means to stop the propagation of abnormal alpha-synuclein which is otherwise one of the reasons of this spreading disease PD.

Chronic rhinosinusitis and endoscopic sinus surgery

Olfactory dysfunction is a major symptom reported by patients with chronic rhino-sinusitis (CRS). Surgical treatment of this disease requires close surveillance of such dysfunc-tion because of wide ranging implications for safety, quality of life, and impact on the flavor of foods and beverages. This review highlights key findings regarding the influences of endoscopic sinus surgery (ESS) on olfactory function across the unique presentations of CRS. Such findings provide information useful for informing patients of potential complications and for obtaining informed consent prior to surgical intervention. ESS has been shown to improve olfaction across all types of CRS as assessed through quantitative testing and subjective reports. The presence of nasal polyposis (NP) and eosinophilia have been identified as predictors of signif-icant postoperative olfactory improvement. When indicated, judicious partial resection of the middle turbinate may result in improved olfactory function without a risk of long term compli-cation. Careful attention to the olfactory cleft and frontal sinus recess are important in limiting olfactory complications by avoiding indiscriminate disruption of olfactory epithelium. Given the chronic nature of the disease, surveillance of olfactory function in patients with CRS is a lifelong activity that will evolve as emerging technologies become available.

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disor-ders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and de-cisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is crit-ical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkin-son's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.

Combination of olfactory test and substantia nigra transcranial sonopraphy in the differential diagnosis of Parkinson’s disease:a pilot study from China

Objectives:Both hyposmia and substania nigra(SN)hyperechogenicity on trascranial sonography(TCS)were risk markers for idiopathic Parkinson’s disease(PD),which was beneficial to the differential diagnosis of the disease.However,each of their single diagnostic value is often limited.The purpose of present study was to explore whether the combination of olfactory test and TCS of SN could enhance the differential diagnostic power in Chinese patients with PD.Methods:Thirty-seven patients with PD and twenty-six patients with essential tremor(ET)were evaluated on 16-item odor identification test from extended version of sniffin’sticks and TCS of SN.The frequency of hyposmia and SN hyperechogenicity in each group was compared.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the two clinical biomarkers were analyzed.Results:The frequency of hyposmia in patients with PD was significantly higher than in patients with ET(62.2%VS.3.8%,P=0.000).The frequency of SN hyperechogenicity in patients with PD was significantly higher than in ET subjects(48.6%VS.15.4%,P=0.006).The combination of hyposmia and SN hyperechogenicity(if either one or both present)discriminated patients with PD from ET with a sensitivity of 78.4%and 29.7%,specificity of 80.8%and 100%,PPV of 85.3%and 100%,and NPV of 72.4%and 50.0%,respectively.Conclusions:Our preliminary data suggested that the combination of hyposmia and SN hyperechogenicity could improve the diagnostic potential for discriminating Chinese patients with PD from ET.

The human olfactory system in two proteinopathies: Alzheimer’s and Parkinson’s diseases

Alzheimer’s and Parkinson’s diseases are the most prevalent neurodegenerative disorders.Their etiologies are idiopathic,and treatments are symptomatic and orientated towards cognitive or motor deficits.Neuropathologically,both are proteinopathies with pathological aggregates(plaques of amyloid-β peptide and neurofibrillary tangles of tau protein in Alzheimer’s disease,and Lewy bodies mostly composed of α-synuclein in Parkinson’s disease).These deposits appear in the nervous system in a predictable and accumulative sequence with six neuropathological stages.Both disorders present a long prodromal period,characterized by preclinical signs including hyposmia.Interestingly,the olfactory system,particularly the anterior olfactory nucleus,is initially and preferentially affected by the pathology.Cerebral atrophy revealed by magnetic resonance imaging must be complemented by histological analyses to ascertain whether neuronal and/or glial loss or neuropil remodeling are responsible for volumetric changes.It has been proposed that these proteinopathies could act in a prion-like manner in which a misfolded protein would be able to force native proteins into pathogenic folding(seeding),which then propagates through neurons and glia(spreading).Existing data have been examined to establish why some neuronal populations are vulnerable while others are resistant to pathology and to what extent glia prevent and/or facilitate proteinopathy spreading.Connectomic approaches reveal a number of hubs in the olfactory system(anterior olfactory nucleus,olfactory entorhinal cortex and cortical amygdala)that are key interconnectors with the main hubs(the entorhinal–hippocampal–cortical and amygdala–dorsal motor vagal nucleus)of network dysfunction in Alzheimer’s and Parkinson’s diseases.

Olfactory outcomes in the management of aspirin exacerbated respiratory disease related chronic rhinosinusitis

Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.