Evaluation of children and adults with post-COVID-19 persistent smell,taste and trigeminal chemosensory disorders:A hospital based study

BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients.METHODS Assessment was done to 185 patients(adults=150,age:31.41±8.63 years;children=35;age:15.66±1.63 years).Otolaryngology and neuropsychiatric evaluations were done.Measurements included:A clinical questionnaire(for smell and taste);sniffin'odor,taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements(sQOD-NS).RESULTS Duration of disorders was 11.53±3.97 ms(6-24 ms).Parosmia(n=119;64.32%)was developed months after anosmia(3.05±1.87 ms).Objective testing showed anosmia in all,ageusia and flavor loss in 20%(n=37)and loss of nasal and oral trigeminal sensations in 18%(n=33)and 20%(n=37),respectively.Patients had low scoring of sQOD-NS(11.41±3.66).There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults.CONCLUSION The course of small and taste disorders are supportive of the nasal and oral neuronal compromises.Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders.Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders.There were no demographics,clinical variables at onset or specific profile of these disorders in children compared to adults.

Post-COVID-19 persistent olfactory,gustatory,and trigeminal chemosensory disorders:Definitions,mechanisms,and potential treatments

The nose and the oral cavities are the main sites for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entry into the body.Smell and taste deficits are the most common acute viral manifestations.Persistent smell disorders are the most common and bothersome complications after SARS-CoV-2 infection,lasting for months to years.The mechanisms and treatment of persistent post-coronavirus disease 2019(COVID-19)smell and taste disorders are still challenges.Information sources for the review are PubMed,Centers for Disease Control and Prevention,Ovid Medline,Embase,Scopus,Web of Science,International Prospective Register of Systematic Reviews,Cumulative Index to Nursing and Allied Health Literature,Elton Bryson Stephens Company,Cochrane Effective Practice and Organization of Care,Cooperation in Science and Technology,International Clinical Trials Registry Platform,World Health Organization,Randomized Controlled Trial Number Registry,and MediFind.This review summarizes the up-to-date information about the prevalence,patterns at onset,and prognoses of post-COVID-19 smell and taste disorders,evidence for the neurotropism of SARS-CoV-2 and the overlap between SARSCoV-1,Middle East respiratory syndrome coronavirus,and SARS-CoV-2 in structure,molecular biology,mode of replication,and host pathogenicity,the suggested cellular and molecular mechanisms for these post-COVID19 chemosensory disorders,and the applied pharmacotherapies and interventions as trials to treat these disorders,and the recommendations for future research to improve understanding of predictors and mechanisms of these disorders.These are crucial for hopeful proper treatment strategies.

嗅觉障碍患者生活质量影响因素分析

目的调查不同病因嗅觉障碍(olfaction disorders,OD)患者生活质量的差异,并确定影响嗅觉相关生活质量的有关因素。方法本研究为横断面研究。前瞻性纳入2024年2—6月就诊于复旦大学附属眼耳鼻喉科医院以嗅觉障碍为主诉并诊断为OD的患者。采用基于中国人群的嗅觉测试方法(Chinese Smell Identification Test,CSIT)进行嗅觉心理物理测试,TDI值为阈值(T)、辨别(D)、识别(I)测试总分。采用简短版嗅觉障碍问卷(brief version of the Questionnaire of Olfactory Disorders,bQOD)评估嗅觉相关生活质量,包含类型(QOD-P)、生活质量(QOD-Q)和视觉模拟量表(QOD-VAS)三项分量表,同时,采用视觉模拟量表(VAS)进行主观嗅觉下降程度评分。采用SPSS 25.0软件统计分析不同病因、年龄、性别、发病时间、嗅觉心理物理测试及主观评估对嗅觉障碍相关生活质量的影响。结果共纳入符合要求的患者419例,其中男性220例,女性199例,年龄(39.72±14.31)岁(5~76岁)。419例患者中,380例填写了bQOD及嗅觉下降程度VAS评分。结果显示,不同病因导致的嗅觉障碍患者的QOD-P及QOD-Q评分存在组间差异(P值分别为0.001及0.003),QOD-P的评分与年龄呈负相关(P<0.05),与TDI总分呈正相关(P<0.01);QOD-Q评分与病程呈负相关(P<0.05),与患者主观嗅觉下降程度VAS评分呈正相关(P<0.01),与嗅觉心理物理测试结果无明显相关性;女性较男性QOD-Q评分更差(P<0.05);QOD-VAS评分与患者主观嗅觉下降程度呈正相关(P<0.01),与嗅觉心理物理测试无明显相关性,女性较男性QOD-VAS评分更差(P<0.05)。结论相比于嗅觉心理物理测试,患者的主观嗅觉下降程度VAS评分与生活质量相关性更为明显。不同病因、病程、性别对嗅觉相关的生活质量有不同程度的影响。

Recovery rates and long-term olfactory dysfunction following COVID-19 infection

Objectives:Olfactory dysfunction is one of the most recognized symptoms of COVID-19,significantly impacting quality of life,particularly in cases where recovery is prolonged.This review aims to explore patterns of olfactory recovery post-COVID-19 infection,with particular focus on delayed recovery.Data Sources:Published literature in the English language,including senior author's own work,online and social media platforms,and patients'anecdotal reports.Method:A comprehensive review of the literature was undertaken by the authors with guidance from the senior author with expertise in the field of olfaction.Results:Based on self-report,an estimated 95%of patients recover their olfactory function within 6 months post-COVID-19 infection.However,psychophysical testing detects higher rates of persistent olfactory dysfunction.Recovery has been found to continue for at least 2 years postinfection;negative prognostic indicators include severe olfactory loss in the acute phase,female sex,and older age.Variability in quantitative and qualitative disturbance in prolonged cases likely reflects both peripheral and central pathophysiological mechanisms.Limitations of many of the reviewed studies reflect lack of psychophysical testing and baseline olfactory assessment.Conclusions:Post-COVID-19 olfactory dysfunction remains a significant health and psychosocial burden.Emerging evidence is improving awareness and knowledge among clinicians to better support patients through their olfactory rehabilitation,with hope of recovery after several months or years.Further research is needed to better understand the underlying pathogenesis of delayed recovery,identify at risk individuals earlier in the disease course,and develop therapeutic targets.

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.

基于《黄帝内经》“鼻闻焦臭”病机的嗅觉倒错初探

嗅觉倒错是上呼吸道感染、鼻-鼻窦疾病等的并发症,目前相关的研究少,发病机制不甚明确,临床治疗手段有限。新型冠状病毒肺炎部分患者以嗅觉障碍为首发或孤立症状表现,引起了临床的重视。历代文献对嗅觉倒错症状的论述较少,笔者从《黄帝内经》着手,通过梳理古今诸家对《黄帝内经》“鼻闻焦臭”经文的理解与阐释,结合鼻司嗅觉的生理机制来初步探讨嗅觉倒错的中医病因病机,提出嗅觉倒错累及脏腑不仅局限于肺脏,而是肺、脾、胃三脏腑不能化生充养宗气的临床表现。