Position paper on olfactory dysfunction: 2023

BACKGROUND: Since publication of the original Position Paper on Olfactory Dysfunction in 2017 (PPOD-17), the personal and societal burden of olfactory disorders has come sharply into focus through the lens of the COVID-19 pandemic. Clinicians, scientists and the public are now more aware of the importance of olfaction, and the impact of its dysfunction on quality of life, nutrition, social relationships and mental health. Accordingly, new basic, translational and clinical research has resulted in significant progress since the PPOD-17. In this updated document, we present and discuss currently available evidence for the diagnosis and management of olfactory dysfunction. Major updates to the current version include, amongst others: new recommendations on olfactory related terminology; new imaging recommendations; new sections on qualitative OD and COVID-19 OD; updated management section. Recommendations were agreed by all co-authors using a modified Delphi process. CONCLUSIONS: We have provided an overview of current evidence and expert-agreed recommendations for the definition, investigation, and management of OD. As for our original Position Paper, we hope that this updated document will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency, and generalisability of work in this field.

Developing a core outcome set for clinical trials in olfactory disorders: a COMET initiative.

STATEMENT OF PROBLEM: Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major barrier is heterogeneity of outcomes in such studies. Core outcome sets (COS) - standardized sets of outcomes that should be measured/reported as determined by consensus-would help overcome this problem and facilitate future meta-analyses and/or systematic reviews (SRs). We set out to develop a COS for interventions for patients with OD. METHODS: A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders' views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed patients and healthcare practitioners to individually rate the outcomes in terms of importance on a 9-point Likert scale. RESULTS: After 2 rounds of the iterative eDelphi process, the initial outcomes were distilled down to a final COS including subjective questions (visual analogue scores, quantitative and qualitative), quality of life measures, psychophysical testing of smell, baseline psychophysical testing of taste, and presence of side effects along with the investigational medicine/device and patient's symptom log. CONCLUSIONS: Inclusion of these core outcomes in future trials will increase the value of research on clinical interventions for OD. We include recommendations regarding the outcomes that should be measured, although future work will be required to further develop and revalidate existing outcome measures.

Clinical Validation and Extension of an Automated, Deep Learning-Based Algorithm for Quantitative Sinus CT Analysis.

BACKGROUND AND PURPOSE: Sinus CT is critically important for the diagnosis of chronic rhinosinusitis. While CT is sensitive for detecting mucosal disease, automated methods for objective quantification of sinus opacification are lacking. We describe new measurements and further clinical validation of automated CT analysis using a convolutional neural network in a chronic rhinosinusitis population. This technology produces volumetric segmentations that permit calculation of percentage sinus opacification, mean Hounsfield units of opacities, and percentage of osteitis. MATERIALS AND METHODS: Demographic and clinical data were collected retrospectively from adult patients with chronic rhinosinusitis, including serum eosinophil count, Lund-Kennedy endoscopic scores, and the SinoNasal Outcomes Test-22. CT scans were scored using the Lund-Mackay score and the Global Osteitis Scoring Scale. CT images were automatically segmented and analyzed for percentage opacification, mean Hounsfield unit of opacities, and percentage osteitis. These readouts were correlated with visual scoring systems and with disease parameters using the Spearman ρ. RESULTS: Eighty-eight subjects were included. The algorithm successfully segmented 100% of scans and calculated features in a diverse population with CT images obtained on different scanners. A strong correlation existed between percentage opacification and the Lund-Mackay score (ρ = 0.85, P < .001). Both percentage opacification and the Lund-Mackay score exhibited moderate correlations with the Lund-Kennedy score (ρ = 0.58, P < .001, and ρ = 0.58, P < .001, respectively). The percentage osteitis correlated moderately with the Global Osteitis Scoring Scale (ρ = 0.48, P < .001). CONCLUSIONS: Our quantitative processing of sinus CT images provides objective measures that correspond well to established visual scoring methods. While automation is a clear benefit here, validation may be needed in a prospective, multi-institutional setting.

A Prospective Study on Temporal Bone Involvement in Polytrauma Patients and the Effect of Early Diagnosis on Hearing Loss.

As polytrauma cases are on the rise, a large number of patients presents with temporal bone fractures, which can result in various types of injuries varying from trivial to more serious injuries. Early diagnosis and appropriate management in required in case of serious injuries for a better outcome. The aim of my study is to study the incidence, the different injuries occurring and the effect of early diagnosis on hearing loss. Patients coming to our emergency department with polytrauma are studied and clinically evaluated for any temporal bone injuries. Based on the type of injuries audiological and radiological studies are done. And if required, biochemical tests like CSF analysis will be done. Also hearing assessment will be done as early as possible and appropriate treatment required will be started. The outcome is then assessed and followed up on a regular basis. In our study there were 90 patients with temporal bone fracture out of the 2748 polytrauma cases. The incidence was calculated to be 32 per 1000 cases. 69 patients (76.7%) had longitudinal fracture of temporal bone; 13 patients (14.4%) had transverse fracture; 2 patients (2.2%) had oblique fractures and 6 patients (6.6%) had comminuted fractures. Hearing loss was found to be the most common injury seen in 56 patients (62.2%). Of which 30 (53.5%) had conductive hearing loss (CHL); 9 (16%) had sensorineural hearing loss (SNHL); 17 had mixed hearing loss (MHL). 27 (90%) out of 30 patients with CHL showed improvement in hearing. Out of the 26 patients with SNHL and MHL, 22 patients (84.61%) showed improvement. 5 out of 6 with immediate onset facial palsy and 6 out of 8 with late onset facial palsy showed improvement. The hearing outcome in our study was found to be much better than the previous year which shows that the difference might be due to the early diagnosis and management. In our study hearing improvement was noted in most patients with hearing loss when compared to the previous year, which may have been due to the detection of the injuries at the earliest and managing the same with appropriate treatment modalities.

A small angle x-ray scattering study of a rhodopsin-lipid complex in hexane.

A small angle x-ray scattering study of a rhodopsin-lipid complex in hexane demonstrates the presence of two distinct particle populations with corresponding radii of gyration of approximately 22 and 160 A. A model based on the existence of inverted lipid micelles surrounding the protein polar moieties while the protein hydrophobic domains act as cross-links between the inverted micelles is presented. It accounts for the results herewith reported and explains most of the properties hitherto characterized for the rhodopsin-lipid complex in hexane.

Effects of sphincter of Oddi bypass on bile acid metabolism in fed and fasted intact and cholecystectomized dogs.

The effects of cholecystectomy and sphincter of Oddi bypass on bile acid (BA) metabolism in dogs have been studied. Cholecystectomy and sphincter bypass decreased the BA pool half-life and increased the percent of taurodeoxycholic acid in the pool. A 48-hour fast had no effect on total BA pool size of intact and intact sphincter-of-Oddi-bypassed dogs but caused a marked decrease in cholecystectomized dogs. It was concluded that while the sphincter of Oddi is unnecessary to maintain bile acid pool size in fasting dogs, the gallbladder is. Alimentation is necessary to maintain pool size in cholecystectomized dogs.

Modification of kidney immunogenicity with standard Concanavalin A and its subfractions.

Pretreatment of kidneys with purified Concanavalin A (25 mg/L) allowed for a significant prolongation of survival after allotransplantation in minimally immunosuppressed mongrel dogs. Kidneys pretreated with standard Concanavalin A, impure fraction or the lipopolysaccharide had no prolongation of survival. In fact, the impure fraction and the lipopolysaccharide showed a diminished transplant kidney survival. These studied confirm the beneficial effect of Concanavalin A when the purified form is utilized in modifying kidney allograft survival.

Study of the protective effect of methylprednisolone, furosemide, and mannitol on ischemically damaged kidneys.

Canine kidneys subjected to 90 min of warm ischemia (37 degrees C) were protected by the administration of methylprednisolone but not by furosemide or mannitol. There was no protective effect observed through the vasodilating or diuretic effect of furosemide in the ischemic canine kidney. Mannitol-induced diuresis before warm ischemia also did not prove to be beneficial for severely ischemic kidneys. Methylprednisolone (30 mg/kg) given 2 h prior to warm ischemia prevented irreversible kidney damage observed in the control and experimental groups. By day 8 the serum creatinine and creatinine clearance returned to normal levels.