The Effect of Chinese Herbal Medicine on Traumatic Anosmia: A Prospective, Randomized Clinical Trial.

OBJECTIVE: Chinese herbal medicine (CHM) has been implemented as a form of treatment for olfactory dysfunction. In this study, we aimed to use a tailored Guizhi decoction for the treatment of traumatic olfactory dysfunction. METHODS: Patients who had lost olfactory function after experiencing head trauma and whose olfactory function was anosmic were selected. The eligible patients were randomly assigned to two groups. In the CHM group, a tailored Guizhi decoction was prescribed, with patients also undergoing olfactory training (OT). In the OT group, patients performed OT only. The olfactory function of each patient was evaluated by both the phenyl ethyl alcohol (PEA) odor detection threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test (TC-UPSIT), at both 3 and 6 months after the completion of treatment. RESULTS: A total of 38 patients in the CHM group and 40 in the OT group completed the study. The TC-UPSIT scores of patients slightly rose after treatment in both the CHM and OT groups. Nevertheless, there were no significant differences in TC-UPSIT scores before and after treatment in both groups. However, the PEA thresholds improved significantly in both CHM and OT groups (p = 0.005 and 0.016, respectively). Of note, there were no significant differences in threshold or identification scores between the CHM and OT groups. CONCLUSION: Our results show that adding a tailored Guizhi decoction to OT conferred a limited benefit to the olfactory function of patients experiencing traumatic anosmia. LEVEL OF EVIDENCE: 2 Laryngoscope, 133:1473-1479, 2023.

Efficacy of Combined Visual-Olfactory Training With Patient-Preferred Scents as Treatment for Patients With COVID-19 Resultant Olfactory Loss: A Randomized Clinical Trial.

Importance: The number of olfactory dysfunction cases has increased dramatically because of the COVID-19 pandemic. Identifying therapies that aid and accelerate recovery is essential. Objective: To determine the efficacy of bimodal visual-olfactory training and patient-preferred scents vs unimodal olfactory training and physician-assigned scents in COVID-19 olfactory loss. Design, Setting, and Participants: This was a randomized, single-blinded trial with a 2-by-2 factorial design (bimodal, patient preferred; unimodal, physician assigned; bimodal, physician assigned; unimodal, patient preferred) and an independent control group. Enrollment occurred from February 1 to May 27, 2021. Participants were adults 18 to 71 years old with current olfactory loss defined as University of Pennsylvania Smell Identification Test (UPSIT) score less than 34 for men and less than 35 for women and duration of 3 months or longer. Olfactory loss was initially diagnosed within 2 weeks of COVID-19 infection. Interventions: Participants sniffed 4 essential oils for 15 seconds with a 30-second rest in between odors for 3 months. Participants in the physician-assigned odor arms trained with rose, lemon, eucalyptus, and clove. Participants randomized to the patient-preferred arms chose 4 of 24 available scents. If assigned to the bimodal arm, participants were shown digital images of the essential oil they were smelling. Main Outcomes and Measures: The primary end point was postintervention change in UPSIT score from baseline; measures used were the UPSIT (validated, objective psychometric test of olfaction), Clinical Global Impressions Impression-Improvement (CGI-I; self-report improvement scale), and Olfactory Dysfunction Outcomes Rating (ODOR; olfaction-related quality-of-life questionnaire). Results: Among the 275 enrolled participants, the mean (SD) age was 41 (12) years, and 236 (86%) were female. The change in UPSIT scores preintervention to postintervention was similar between the study arms. The marginal mean difference for change in UPSIT scores preintervention to postintervention between participants randomized to patient-preferred vs physician-assigned olfactory training was 0.73 (95% CI, -1.10 to 2.56), and between participants randomized to bimodal vs unimodal olfactory training was 1.10 (95% CI, -2.92 to 0.74). Five (24%) participants in the control arm had clinically important improvement on UPSIT compared with 18 (53%) in the bimodal, patient-preferred arm for a difference of 29% (95% CI, 4%-54%). Four (19%) participants in the control group self-reported improvement on CGI-I compared with 12 (35%) in the bimodal, patient-preferred arm for a difference of 16% (95% CI, -7% to 39%). The mean change in ODOR score preintervention to postintervention was 11.6 points (95% CI, 9.2-13.9), which was not deemed clinically important nor significantly different between arms. Conclusions and Relevance: Based on the change in UPSIT scores, this randomized clinical trial did not show any difference between intervention arms, but when exploring within-patient change in UPSIT as well as self-reported impression of improvement, active interventions were associated with larger improvement than controls with a potential advantage of bimodal intervention. While not definitive, these results suggest that patients with COVID-19 olfactory loss may benefit from bimodal visual-olfactory training with patient-preferred scents. Trial Registration: ClinicalTrials.gov Identifier: NCT04710394.

Tailored Approach for Persistent Olfactory Dysfunction After SARS-CoV-2 Infection: A Pilot Study.

OBJECTIVE: So far, no original studies explored non-randomized, standardized protocols for COVID-19 associated olfactory dysfunction. The main objective was to determine the efficacy of a new protocol for post-COVID olfactopathy while assessing the benefit of adding adjuvant therapies to olfactory training. METHODS: Patients suffering from long-lasting post-COVID-19 olfactory dysfunction were evaluated. A non-randomized protocol based on individual nasal endoscopy findings and patient's preferences was applied. Patients were assigned for olfactory training alone or olfactory training + adjuvant therapy. Participants performed olfactory objective and subjective evaluations at first consultation and 3 months after treatment, and results were compared. RESULTS: A total of 47 patients were enrolled. All groups showed significant improvement in olfactory thresholds at 3-month follow-up suggesting protocol effectiveness (olfactory training group alone showed a mean threshold difference of 2.9, P < .001; Olfactory training + Topical Corticosteroid showed a mean threshold difference of 4, P = .006; Olfactory training + Topical Corticosteroid + Vitamin B complex showed a mean threshold difference of 4.4, P = .006; Olfactory training + Intranasal Vitamin A and E showed a mean threshold difference of 4.4, P < .001). Olfactory training alone showed lower mean olfactory threshold improvement, when compared to patients undergoing olfactory training + adjuvant therapy (olfactory training alone mean improvement 2.9 ± 2.3 vs olfactory training + adjuvants mean improvement 4.3 ± 2.458, P = .03). CONCLUSIONS: This is one of the first studies to demonstrate results in the treatment of post-COVID-19 persistent olfactory impairment. A customized approach based on endoscopy findings and patient's preferences may be a valid option for the management of persistent post-COVID-19 olfactory disorder. Adjuvant therapy could be considered in addition to olfactory training, but further studies are needed in order to confirm their effectiveness in this setting. LEVEL OF EVIDENCE: 2c (outcomes research).

Seizure treatment with olfactory training: a preliminary trial.

OBJECTIVE: Epilepsy is a chronic condition characterized by recurrent seizures. Despite miscellaneous antiseizure medications, resistance to treatment is still approximately 30%. This resistance brings forward the multidisciplinary approach and complementary treatments. In this study, we aimed to investigate the effect of olfactory training on epileptic seizures with special aromas having antiseizure effects in patients diagnosed with drug-resistant epilepsy. METHODS: A total of 24 patients (14 pediatric and 10 adults) with drug-resistant epilepsy were recruited for the study. Participants were asked to inhale the standardized bottle filled with lavender aroma (Lavandula Angustifolia) twice a day (morning and evening) for 30-45 s (2 cm in front of nose; 10-15 s to right and left nostril and 10-15 s to both nostrils) for 3 months. The type, frequency, duration of seizures, the quality of life (SF-36 and PedsQL 4.0), and olfactory functions (Sniffin' Sticks Test and Pediatric Smell Wheel) were re-assessed. RESULTS: Statistical analysis showed that olfactory training decreased the seizure frequency (p < 0.001) and the seizure duration (p = 0.02). A global 50% seizure reduction was seen among patients. Moreover, olfactory training increased the quality of life (p = 0.003) and improved the olfactory function in both the pediatric and adult groups (p = 0.017, p = 0.05, respectively). There was no adverse reaction and no increase in seizure frequency. SIGNIFICANCE: The observations of the present investigation suggest that olfactory training is a successful complementary therapy with no adverse reaction in patients with drug-resistant epilepsy. Large cohort studies and longer follow-up periods are needed for providing olfactory training as a therapy modality in patients with epilepsy.

COVID-19 Induced Taste Dysfunction and Recovery: Association with Smell Dysfunction and Oral Health Behaviour.

Background and Objectives: Disruption to taste and smell are common symptoms of COVID-19 infection. The current literature overlooks taste symptoms and tends to focus on the sense of smell. Persisting cases (>28 days) of taste dysfunction are increasingly recognised as a major future healthcare challenge. This study focuses on the severity and recovery of COVID-19 induced taste loss and association with olfactory symptoms, lifestyle and oral health factors. Materials and Methods: This study was a cross-sectional survey comparing 182 rapid taste recovery participants (≤28 days) with 47 participants with prolonged taste recovery >28 days. Analyses of taste loss in association with smell loss, age, sex, illness severity, diet, BMI, vitamin-D supplementation, antidepressants, alcohol use, smoking, brushing frequency, flossing, missing teeth, appliances and number of dental restorations were conducted. Differences in the severity of the loss of sour, sweet, salt, bitter and umami tastes were explored. Results: Both the severity and the duration of taste and smell loss were closely correlated (p < 0.001). Salt taste was significantly less affected than all other taste qualities (p < 0.001). Persisting taste loss was associated with older age (mean ± 95% CI = 31.73 ± 1.23 years vs. 36.66 ± 3.59 years, p < 0.001) and reduced likelihood of using floss (odds ratio ± 95% CI = 2.22 (1.15−4.25), p = 0.047). Conclusions: Smell and taste loss in COVID-19 are closely related, although a minority of individuals can experience taste or smell dysfunction in the absence of the other. The taste of salt may be less severely affected than other taste qualities and future work exploring this finding objectively is indicated. The association of flossing with rapid taste recovery adds to the growing evidence of a link between good periodontal health and favourable COVID-19 outcomes.

Olfactory dysfunction in type II diabetes: Therapeutic options and lessons learned from other etiologies - A scoping review.

INTRODUCTION: Olfactory dysfunction (OD) is highly prevalent amongst type 2 diabetes mellitus (DM2) patients and has many associated health risks. For example, OD can lead to poor nutrition, safety issues related to diminished hazard detection, and increased mortality rates. While limited research exists about therapeutics for DM2-associated OD, recovery of olfactory function is better studied in other pathologic states. The objectives of this scoping review are to synthesize the existing data on interventions for DM2-associated OD and present the evidence for therapies that have been utilized for non-DM2-associated causes of OD. Additionally, the potential therapeutic opportunities for patients with DM2 are explored. METHODS: A scoping review was conducted with a medical librarian to identify studies investigating treatments of DM2-related OD. 6 databases were searched (Embase, CINAHL, the Cochrane Library, Google Scholar, OVID Medline, and Web of Science). Studies were eligible if the primary discussion involved treatment of olfactory deficits in the context of DM2. All publication dates were included, and studies published in languages other than English were excluded. RESULTS: 3631 articles were identified; 3 articles met inclusion criteria and underwent full text review. Hyperbaric oxygen (HBO), the DPP-4 inhibitor Linagliptin and the GLP-1 agonists Exenatide and Liraglutide are the only therapeutics that have been used in the context of DM2. Only HBO and GLP-1 agonists produced statistically significant improvements in olfactory identification. The literature regarding non-DM2-associated OD supports interventions such as olfactory training, dietary supplements, and intranasal insulin. Specifically, olfactory training was very effective in many contexts such as post-viral and traumatic OD while being affordable and non-invasive. CONCLUSION: This scoping review of olfactory rehabilitation options for DM2-induced OD demonstrates a paucity of prospective investigations of plausible therapeutics. Additionally, treatments for OD related to non-DM2-associated etiologies, such as olfactory training, are well-studied, efficacious, and should be investigated in the context of DM2. Future investigation has the potential to enhance the quality of clinical intervention for OD and improve short- and long-term outcomes for DM2 patients.

Omega-3 supplementation in postviral olfactory dysfunction: a pilot study.

BACKGROUND: This study aimed to examine whether omega-3 supplementation would support olfactory recovery among postviral olfactory dysfunction patients. METHODOLOGY: Patients with postviral olfactory dysfunction were included in this non-blinded, prospective pilot study. Structured medical history was taken from the patients, including the following: age, sex, history of COVID-19 infection, and duration of symptoms. Patients were randomly assigned to receive olfactory training only (control group) versus olfactory training with omega-3 supplementation (treatment group). All patients exposed themselves twice a day to four odours (phenyl ethyl alcohol [rose], eucalyptol [eucalyptus], citronellal [lemon], and eugenol [cloves]). Olfactory function was measured before and after training using 'Sniffin' Sticks', comprised of tests for odour threshold, discrimination, and identification. The average interval between olfactory tests was 3 months. RESULTS: Fifty-eight patients were included in the study, 25 men and 33 women. Generally, an improvement in olfactory scores was observed. Compared to the control group, the improvement in odour thresholds was more pronounced in the omega-3 group. Age, sex, and duration of symptoms had no effect on olfactory scores among both control and treatment groups. CONCLUSION: Overall, the present results indicate that omega-3 supplementation may be an option for adjunct therapy with olfactory training in patients with postviral olfactory dysfunction.

Acupuncture is associated with a positive effect on odour discrimination in patients with postinfectious smell loss-a controlled prospective study.

INTRODUCTION: Smell disorders are common in the general population and occur e.g., after infections, trauma or idiopathically Treatment strategies for smell loss range from surgery, medication to olfactory training, depending on the pathology, but they are limited This study examined the effect of acupuncture on olfactory function. METHODS: Sixty patients with smell loss following infections of the upper respiratory tract were included in this investigation Half of the study group were randomly assigned to verum acupuncture and the other half to sham acupuncture Olfaction was measured by means of the "Sniffin' Sticks" test battery (odour threshold, discrimination and identification). RESULTS: Compared to sham acupuncture, verum was associated with an improvement of smell function as measured by the TDI score (p = 0.039) The improvement was largely determined by improvement in odour discrimination, and was significantly better in patients with a shorter duration of the disorder. CONCLUSION: The present results suggest that acupuncture is an effective supplementary treatment option for patients with olfactory loss.

Use of coffee grounds to test olfaction for predicting cognitive dysfunction and decline.

INTRODUCTION: Our objective was to determine whether non-standardized testing of olfaction may provide useful information for predicting cognitive dysfunction and decline in patients with neurobehavioral disorders. METHODS: We conducted cross-sectional and longitudinal analyses of 82 patients who presented to a Memory Clinic with a chief complaint of cognitive deficits using non-standardized odor identification testing (nSOIT). Each patient was classified as having intact or impaired olfaction based on the ability to identify and name the odor of coffee grounds. The cross-sectional study used Student's t-test to examine whether nSOIT results were related to cognitive dysfunction as approximated by Montreal Cognitive Assessment (MoCA) scores. The longitudinal study used mixed effects multiple regression with an interaction term to investigate whether nSOIT results were predictive of cognitive decline over a period of follow-up testing (0.4 to 4.0 years [mean 1.4, SD 0.8]) to compare patients who exhibited cognitive decline over the evaluation period (decliners) and those who did not (non-decliners). RESULTS: Analysis of the initial use of nSOIT in the cross-sectional study demonstrated no association between nSOIT performance and objective cognitive dysfunction. In the longitudinal study, impairment in follow-up nSOIT testing was found to be a sensitive but nonspecific predictor of cognitive decline. CONCLUSION: These results suggest that routine olfactory testing may serve as a convenient and readily available method that can be used by clinicians to better predict cognitive dysfunction and decline in patients with a variety of neurobehavioral disorders.

Remote psychophysical evaluation of olfactory and gustatory functions in early-stage coronavirus disease 2019 patients: the Bologna experience of 300 cases.

BACKGROUND: An objective evaluation of coronavirus disease 2019 in the first days of infection is almost impossible, as affected individuals are generally in home quarantine, and there is limited accessibility for the operator who should perform the test. To overcome this limitation, a recently validated psychophysical self-administered test was used, which can be performed remotely in the assessment of early-stage coronavirus disease 2019 patients. METHODS: Olfactory and gustatory functions were objectively assessed in 300 patients in the first 7 days from coronavirus disease 2019 symptom onset. RESULTS: Seventy per cent of the patients presented olfactory and/or gustatory disorders. The dysfunctions detected were mainly complete anosmia (47 per cent) or ageusia (38 per cent). A significant correlation was found between taste dysfunction and female gender (odds ratio = 1.936, p = 0.014) and fever (odds ratio = 2.132, p = 0.003). CONCLUSION: The psychophysical evaluation protocol proposed is an effective tool for the fast and objective evaluation of patients in the early stages of coronavirus disease 2019. Chemosensitive disorders have been confirmed to be frequent and early symptoms of the coronavirus infection, and, in a significant number of cases, they are the first or only manifestation of coronavirus disease 2019.

Micronutrients as immunomodulatory tools for COVID-19 management.

COVID-19 rapidly turned to a global pandemic posing lethal threats to overwhelming health care capabilities, despite its relatively low mortality rate. The clinical respiratory symptoms include dry cough, fever, anosmia, breathing difficulties, and subsequent respiratory failure. No known cure is available for COVID-19. Apart from the anti-viral strategy, the supports of immune effectors and modulation of immunosuppressive mechanisms is the rationale immunomodulation approach in COVID-19 management. Diet and nutrition are essential for healthy immunity. However, a group of micronutrients plays a dominant role in immunomodulation. The deficiency of most nutrients increases the individual susceptibility to virus infection with a tendency for severe clinical presentation. Despite a shred of evidence, the supplementation of a single nutrient is not promising in the general population. Individuals at high-risk for specific nutrient deficiencies likely benefit from supplementation. The individual dietary and nutritional status assessments are critical for determining the comprehensive actions in COVID-19.

Inability to Smell Peppermint Is Related to Cognitive Decline: A Prospective Community-Based Study.

BACKGROUND: A few studies have demonstrated the association of poorer olfactory identification (OI) with poorer cognition in population-based cohorts. None of them considered the outcome associated with the inability to smell a certain odor. OBJECTIVE: To verify the hypothesis that at least one specific odor is associated with incident cognitive decline among older adults. METHODS: In the Shanghai Aging Study, a sub-cohort of 948 dementia-free participants who had baseline OI measurements were prospectively followed for 5 years. RESULTS: An inability to smell peppermint (ß = -0.44, p < 0.001), rose (ß = -0.14, p = 0.040), or coffee (ß = -0.37, p = 0.002) was inversely related to the annual rate of change in the Mini Mental State Examination score, and an inability to smell peppermint was associated with a higher risk for incident dementia (hazard ratio 2.67, 95% CI 1.44-4.96) after adjustment for confounders. CONCLUSION: Our study suggests that some odors, especially peppermint, might be considered as a potential predictor for dementia in older populations.

Intravenous olfactory test latency correlates with improvement in post-infectious olfactory dysfunction.

CONCLUSION: This cohort study showed that onset latency in the intravenous olfactory test (IVO) may help predict when olfaction in patients with post-infectious olfactory dysfunction (PIOD) improves. OBJECTIVES: To identify factors that predict the olfactory improvement period in patients with PIOD. METHODOLOGY/PRINCIPAL: All consecutive patients presenting with PIOD in 1994-2014 who were followed up for 2 years were identified retrospectively. The ability of demographic/clinical factors (age, sex, body mass index, presence/absence of allergic rhinitis, treatment/non-treatment with herbal medicines, patient dependence on herbal medicine treatment, presence/absence of diabetes mellitus, and smoking status) and olfactory test factors (response/no response and onset latency and duration in the IVO test, and detection and recognition scores on the T&T olfactory test) to predict the olfactory improvement period (defined respectively as the time from PIOD onset or olfactory testing to the first self-report of olfaction improvement) was analyzed by univariate and multivariate regression. RESULTS: Of the 187 PIOD patients, the prognostic ability of demographic/clinical factors was analyzed in 65. None predicted the olfactory improvement period. Of the 65 patients, 20 did not respond in the IVO test. In the remaining 45 patients, onset latency (but not the other olfactory test factors) was a significant prognosticator of olfactory improvement period (R2=0.24, p = 0.003).

Olfactory Loss Management in View of Avicenna: Focus on Neuroprotective Plants.

BACKGROUND: Loss of olfaction can cause noticeable reduction in general quality of life. Only a small portion of patients with olfactory loss respond to current medications. Thus, development of novel therapeutic strategies seems to be necessary. Looking into traditional medical knowledge can be of great value in addressing useful remedies. Traditional Persian Medicine (TPM) has been practiced in Persia for more than 2000 years. Avicenna is the most eminent Persian physician. OBJECTIVE: To survey Avicenna's views on etiology and management of olfactory loss and to search for relevant modern pharmacological data. METHODS: Avicenna's views on etiology and management (including suggested medicinal plants) of olfactory loss were obtained from "Canon of Medicine". In addition, a detailed search in ScienceDirect, PubMed, Scopus and Google Scholar databases was performed to elucidate relevant pharmacological actions and mechanisms of the plants and their major compounds with special focus on neuroprotective activity. RESULTS: Acorus calamus L., Allium cepa L., Allium sativum L., Aloe spp., Cinnamomum cassia (L.) J.Presl, Lavandula stoechas L., Mentha longifolia (L.) L., Nigella sativa L., Peganum harmala L., Piper nigrum L. and Zingiber officinale Roscoe were found to be the most emphatic plants for the treatment of olfactory loss. Pharmacological studies revealed biological activities including neuroprotective, anti-inflammatory, free radical scavenging activities and promoting endogenous antioxidant capacity for these plants and their major components. CONCLUSION: regarding the lack of effective treatments for recruiting normal smell in many cases, treatments suggested by Avicenna worth entering pharmacologic experiments and clinical trials.

Ocular myasthenia gravis accompanied by anosmia.

We report a case of ocular myasthenia gravis (MG) accompanied by anosmia. A 76-year-old man had idiopathic anosmia of 2-year duration. Four months before consultation, he began to have drooping in the right upper eyelid along with muscle soreness, distension, and pain in the nape. His tongue was dark-red with a thin and white coating; his pulse was wiry and slippery. According to Traditional Chinese Medicine, eyelid drooping and anosmia are the main signs of liver constraint and spleen deficiency. In Western Medicine, the diagnosis was ocular MG and idiopathic anosmia. Our patient, along with the literature, suggests that anosmia may be an early symptom before MG. MG accompanied by anosmia could be a special subtype of MG according to antibody production and symptoms.

Olfactory dysfunction in narcolepsy with and without cataplexy.

BACKGROUND: Not only patients in whom REM behavior disorder (RBD) is associated with narcolepsy, but also those with narcolepsy alone are reported to have olfactory dysfunction. We investigated if hyposmia is specific to narcolepsy with cataplexy (N-C) or if narcolepsy without cataplexy (NwC) is also associated with olfactory dysfunction. METHODS: We studied olfactory function in two groups of patients: N-C group (n=66, 26 men and 40 women; mean age 41+/-18 years), and NwC group (n=17, 7 men and 10 women; mean age 46+/-20 years). As a control group we used published normative data for particular smell tests. RESULTS: Both patients with N-C and patients suffering from NwC had a significantly higher olfactory threshold (N-C group, p<0.0001; NwC group, p<0.0001) and impaired odor identification (N-C group, p<0.0001; NwC group, p<0.0001). Our results show for the first time that narcolepsy without cataplexy, where the majority of cases have normal CSF hypocretin levels, is associated with olfactory dysfunction. CONCLUSIONS: It appears that also a partial loss of hypothalamic hypocretin neurons without a clear CSF level decrease can affect smell projection.

[Olfactory alterations in allergic rhinitis to pollens and mites]. / Alteraciones olfativas en las rinitis alérgicas a pólenes y ácaros.

INTRODUCTION: In the last 80 years, the presence of allergies has increased among Europeans from 0.28% to 14.2%. Allergic rhinitis is the main presentation, rising from 18% to 40% of cases. The aim of this study is to demonstrate that allergic rhinitis due to pollen and mites has an effect on the olfactory system. MATERIAL AND METHODS: We describe the impairment of olfactory function in two groups of individuals with allergic rhinitis due to mites or pollen (n = 76; 42 with allergy to pollen [48.9%], and 34 with allergy to mites [39%]), compared with a group of healthy volunteers (n = 120). Olfactory ability was measured by the BAST-24 (Barcelona Smell Test) olfactometer comprising 20 odours tested by the forced choice method to compare the levels of odour detection (knowing if there is odour in the environment), and efficacy (identifying what was smelt). RESULTS: The results show firstly that people with allergic rhinitis have a clear, definitive, and significant impairment (P >.05) in olfactory levels; secondly, there is a tendency towards greater olfactory loss in the case of people with pollen-related allergic rhinitis than in those allergic to mites; and thirdly, the different odours are affected differently in the 2 groups. CONCLUSIONS: We propose consideration of the study of olfactory status in the assessment of patients with allergic rhinitis.

Alteraciones olfativas en las rinitis alérgicas a pólenes y ácaros / Olfactory alterations in allergic rhinitis to pollens and mites

Introducción: En los últimos 80 años, las alergias han pasado de afectar al 0,28 % al 14,2 % de la población europea. La rinitis alérgica es la principal de todas ellas con un progreso que va de un 18 a un 40 %. El objetivo de este trabajo es demostrar que la rinitis alérgica por pólenes o ácaros reduce las capacidades olfativas. Material y métodos: Se describe el estado olfativo de dos grupos de personas con rinitis alérgica a polen o ácaros (n = 76): alérgicos al polen, 42 (48,9 %) casos; alérgicos a ácaros 34 (39 %). La exploración del olfato se realiza con el olfatómetro BAST-24 (Barcelona Smell Test), constituido por 20 olores controlados por el método de respuesta forzada, para valor la capacidad de percibir un olor (detección) y la eficacia olfativa (identificar correctamente el olor percibido). Estos resultados se comparan con los obtenidos en un grupo control de voluntarios sanos (n = 120). Resultados: El estudio muestra: a) que en los dos tipos de rinitis alérgica hay un deterioro claro, definitivo y significativo (p > 0,05) del olfato, y b) que las personas con rinitis alérgica a pólenes presentan una tendencia de mayor pérdida olfativa que aquellas con rinitis alérgica a ácaros, y que los distintos olores se afectan de forma distinta según el tipo de rinitis alérgica se padezca. Conclusiones: Se propone que se tenga en cuenta el estudio del estado olfativo en la valoración de las rinitis (AU)

Introduction: In the last 80 years, the presence of allergies has increased among Europeans from 0.28 % to 14.2 %. Allergic rhinitis is the main presentation, rising from 18% to 40 % of cases. The aim of this study is to demonstrate that allergic rhinitis due to pollen and mites has an effect on the olfactory system. Material and methods: We describe the impairment of olfactory function in two groups of individuals with allergic rhinitis due to mites or pollen (n = 76; 42 with allergy to pollen [48.9 %], and 34 with allergy to mites [39 %]), compared with a group of healthy volunteers (n = 120). Olfactory ability was measured by the BAST-24 (Barcelona Smell Test) olfactometer comprising 20 odours tested by the forced choice method to compare the levels of odour detection (knowing if there is odour in the environment), and efficacy (identifying what was smelt). Results: The results show firstly that people with allergic rhinitis have a clear, definitive, and significant impairment (P >.05) in olfactory levels; secondly, there is a tendency towards greater olfactory loss in the case of people with pollen-related allergic rhinitis than in those allergic to mites; and thirdly, the different odours are affected differently in the 2 groups. Conclusions: We propose consideration of the study of olfactory status in the assessment of patients with allergic rhinitis (AU)

[Olfaction and neurological diseases: a review of the literature]. / Olfaction et pathologies neurologiques: revue de la littérature.

Olfactory disorders are often misjudged and rarely rated in the clinical setting. They are nevertheless described in a wide range of neurological disorders, and their evaluation can be useful for diagnosis. Usually irreversible olfactory dysfunction is a well-known complication after head trauma. Severe changes in olfactory tests are observed in Parkinson's disease. Dysfunction is present at disease onset and evidenced with all behavioral tests. Regarding other parkinsonian syndromes, olfactory performances are severely impaired in Lewy body disease, less pronounced in multiple system atrophy and usually preserved in corticobasal degeneration. Olfactory deficits are an early feature in Alzheimer's disease and worsen with disease progression. Rarely reported by patients, they must be searched for with olfactory tests. Though epilepsy is mainly known for its olfactory hallucinatory disorders, alterations of olfactory abilities are also described, especially in mesial temporal epilepsy. Disorders of olfactory perception are finally reported in patients with multiple sclerosis and migraine. After a reminder of anatomical data on the olfactory system, and the different methods of testing used to rate olfactory performances, the current review focuses on the type of olfactory dysfunction and damaged brain areas of the olfactory system encountered in the main neurological diseases.