{"id":387383,"date":"2023-09-11T10:11:00","date_gmt":"2023-09-11T08:11:00","guid":{"rendered":"https:\/\/medizinonline.com\/options-against-the-loss-of-smell\/"},"modified":"2024-10-02T11:11:04","modified_gmt":"2024-10-02T09:11:04","slug":"options-against-the-loss-of-smell","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/options-against-the-loss-of-smell\/","title":{"rendered":"Options against the loss of smell"},"content":{"rendered":"\n

The sense of smell plays an important role in everyday life: it warns us of sometimes life-threatening dangers such as spoiled food, smoke or fires as well as toxins.\nThis warning function is lost in patients with a long-term loss of smell [1].\nTreatment options are limited, depending on the cause.\nThis makes it all the more important to diagnose and educate patients. <\/strong><\/p>\n\n\n\n

If you have no perception of smell, you are more insecure, miss out on a lot of social information and have difficulties eating and drinking or enjoying food, explained Prof. Dr. Thomas Hummel from the Interdisciplinary Center for Smell and Taste, Department of Otorhinolaryngology, Carl Gustav Carus University Hospital in Dresden (Germany).\nAs a consequence, a loss of smell can also lead to a severe impairment of quality of life and even depression [2,3].\nThe prevalence of anosmia, i.e. a severe reduction or even complete lack of olfactory perception, is reported in European studies to be around 5%, with around 15% of the population suffering from a mild to moderate reduction (hyposmia) [4,5].\nThe reasons for olfactory dysfunction can be manifold, ranging from age-related disorders to sinonasal problems, consequences of traumatic experiences and post-infectious effects, explained Dr. Julien Hsieh from the Department of Clinical Neurosciences, University of Geneva.\nOne of the most common causes of olfactory loss of function is a disease of the paranasal sinuses, such as chronic rhinosinusitis with or without nasal polyposis. <\/p>\n\n

Post-traumatic anosmia and post-infectious loss of smell <\/h4>\n\n

Up to 56% of patients can suffer from loss of smell after a traumatic brain injury.\nOlfactory training is initially recommended for this group: Different odors such as rose, eucalyptus, lemon or clove are presented three times a day over a period of 12 weeks for olfactory testing.\nIn a randomized control study, an improvement was observed after 3 months.\nHowever, this effect was lost again after a further 12 weeks, so that the two groups had the same values again after a total of 24 weeks [6].\nIn a position paper, olfactory training is nevertheless recommended for these patients with head injuries, as it can improve neuroregeneration and neuroplasticity and has no side effects [7].\nPost-infectious loss of smell has come into focus in connection with the COVID-19 pandemic, but it has also been observed in other diseases such as influenza that all symptoms usually recover after the infection has subsided, but the loss of smell can persist for years or even for life.\nOlfactory training is also the first measure in such cases: The likelihood of clinically significant improvement is three times higher if olfactory training is carried out in post-infectious olfactory disorders [8\u201311].\nCorticosteroids are not recommended in the position paper on olfactory dysfunction [7]. <\/p>\n\n

Diagnosis of the olfactory disorder <\/h4>\n\n

The olfactory test is the cornerstone in the treatment of olfactory disorders.\nThe quantitative determination of olfactory performance can be carried out by subjective assessment, psychophysical tests or electrophysiological methods.\nAlthough subjective assessment is the quickest and simplest method for assessing olfactory function, it is often inaccurate – probably due to differences in suffering and self-esteem – and usually does not correspond to objective olfactory ability, as Prof. Dr. Basile Landis, Head of the Department of Rhinology and Olfactology at the H\u00f4pitaux Universitaires Geneva, has shown in a paper (Fig. 1) [12,13].\nThere are many different odor tests worldwide, which can be divided into three categories:Threshold<\/em> tests enable the determination of the lowest concentration at which an odorant can be detected [14,15].\nThediscrimination<\/em> test assesses the ability to distinguish odors: Subjects are given, for example, three different odor samples, two of which are identical, and must state which sample does not match the other two.\nIn the identification <\/em>test, odours are usually characterized using four terms [15].\nThe participant must select the term that corresponds to the odor.\nAccording to Dr. Hsieh, it is always better to test than to just ask.\nHe recommends testing different odor categories, among other things for a better quantification of the odor function and to differentiate between etiologies. <\/p>\n\n

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Clinical clarification <\/h4>\n\n

An idiopathic loss of smell is rather unusual and can be an early sign of Parkinson’s disease [16] and also of dementia [17].\nIdiopathic loss of smell may also indicate increased mortality.\nOver 90% of men and women with idiopathic Parkinson’s disease (IPD) have an olfactory disorder, which is used as a supporting diagnostic criterion in the clinical diagnosis of IPD.\nThe olfactory disorder can occur more than 10 years before the onset of motor symptoms [16].\nSevere olfactory disturbances can also occur in various forms of dementia [18,19].\nThey are considered an early symptom of Alzheimer’s disease and occur in patients whose cognitive abilities are not yet severely impaired. <\/p>\n\n

Therapeutic measures <\/h4>\n\n

Drug treatment options are available for underlying sinonasal diseases.\nUnderlying chronic inflammation such as chronic rhinosinusitis with nasal polyposis (CRSwNP) can be treated with topical steroids, which also has a significant effect on olfactory function [20].\nThe administration of systemic oral corticosteroids over a period of two weeks can achieve a temporary improvement in odor, but the hyposmia or anosmia slowly returns after about 50 days [21].\nIf corticosteroids do not work for CRS, the expert recommended functional endoscopic sinus surgery (FESS) as an alternative.\nMonoclonal antibodies (biologics) offer a third treatment option for CRSwNP.\nCRSwNP patients who meet at least three of the criteria listed in Figure 2 – one of which should be a significant loss of the sense of smell as measured by an olfactory test – may be eligible for biologic therapy.\nFor CRSwNP or nasal polyps, 3 biologics are currently approved in Switzerland: Dupilumab, mepolizumab and omalizumab [23\u2013 25].\nMost of the studies analyzed the identification of odors.\nThere is a need for further real-life studies with more robust tests to investigate the effects on odor sensitivity and discrimination, explained Dr. Hsieh.\nIf an olfactory disorder is not due to a sinonasal disease, there are few treatment options and recommendations [26, 27].\nOnly olfactory training, i.e. consciously smelling different odors several times a day, has been shown to have therapeutic value [28]. <\/p>\n\n

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Literature: <\/strong><\/p>\n\n

1 Nordin S, et al: Effects of smell loss on daily life and adopted coping strategies in patients with nasal polyposis with asthma. Acta Otolaryngol 2011; 131: 826-832. 2. Temmel AF, et al.: Characteristics of olfactory disorders in relation to major causes of olfactory loss. Arch Otolaryngol Head Neck Surg 2002; 128(6): 635-641. 3. Croy I, et al: Olfactory disorders and quality of life – an updated review. Chem Senses 2014; 39: 185-194. 4. Landis BN, Hummel T: New evidence for high occurrence of olfactory dysfunctions within the population.\nAm J Med 2006; 119: 91-92. 5 Vennemann MM, et al: The association between smoking and smell and taste impairment in the general population. J Neurol 2008; 255: 1121-1126. 6 Langdon C, et al: Olfactory Training in Post- Traumatic Smell Impairment: Mild Improvement in Threshold Performances: Results from a Randomized Controlled Trial. J Neurotrauma 2018; 35(22): 2641-2652. 7 Whitcroft KL, et al: Position paper on olfactory dysfunction: 2023, Rhinology 2023; 61(33): 1-108. 8 Kattar N, et al: Olfactory training for postviral olfactory dysfunction: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2021; 164(2): 244-254. 9 Altundag A, et al: Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study. Laryngoscope 2015; 125(8): 1763-1766. 10 Damm M, et al: Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study. Laryngoscope 2014; 124(4): 826-831. 11 Hummel T, et al: Effects of olfactory training in patients with olfactory loss. Laryngoscope 2009; 119(3): 496-499. 12 Landis BN, et al: Ratings of overall olfactory function. Chem Senses 2003; 28(8): 691-694. 13 L\u00f6tsch J, Hummel T.: Clinical usefulness of self-rated olfactory performance – a data science-based assessment of 6000 patients. Chem Senses 2019; 44: 357-364. 14 Croy I, et al: Comparison between odor thresholds for phenyl ethyl alcohol and butanol. Chem Senses 2009; 34: 523-527. 15 Doty RL: Measurement of chemosensory function.\nWorld J Otorhinolaryngol Head Neck Surg 2018; 4: 11-28. 16 Haehner A, et al: Incidence of Parkinson’s disease in a large patient cohort with idiopathic smell and taste loss. Journal of Neurology 2019; 266: 339-345. 17 Laukka EJ, et al: Markers of olfactory dysfunction and progression to dementia: A 12-year population-based study. Alzheimer’s & Dementia 2023; 19(7): 3019-3027. 18 Driver-Dunckley E, et al: Olfactory dysfunction in incidental Lewy body disease and Parkinson’s disease. Parkinsonism Relat Disord 2014; 20: 1260-1262. 19 Pardini M, et al: Olfactory function in corticobasal syndrome and frontotemporal dementia. Arch Neurol 2009; 66: 92-96. 20 Damm M, et al: Diagnostics and therapy of olfactory disorders. HNO 2019; 67: 274-281. 21 Van Zele, et al: Oral steroids and doxycycline: Two different approaches to treat nasal polyps. Allergy and Clinical Immunology 2010; 125(5): 1069-1076. 22 Fokkens WJ, et al: EPOS\/EUFOREA update on indication and evaluation of Biologics in Chronic Rhinosinusitis with Nasal Polyps 2023. Rhinology 2023; 61(3): 194-202. 23. technical information Dupixent\u00ae, \nwww.swissmedicinfo.ch24. Information for healthcare professionals Nucala\u00ae, www.swissmedicinfo.ch <\/a>25. Information for healthcare professionals Xolair\u00ae, www.swissmedicinfo.ch <\/a>26. Patel ZM, et al.: International consensus statement on allergy and rhinology. Olfaction. Int Forum Allergy Rhinol 2022; 12: 327-680. 27 Doty RL: Treatments for smell and taste disorders: a critical review. Handb Clin Neurol 2019; 164: 455-479. 28 Hummel T, et al: Position paper on olfactory dysfunction. Rhinology 2017; Suppl. 25: 1-30. 1<\/a><\/sup><\/p>\n\n

Professionals can request the references from the company at any time. <\/p>\n\n

<\/p>\n\n

Short Subject Information<\/strong><\/p>\n\n

Dupixent\u00ae.\nW: Dupilumab.\nI: In children <12 years (J.) only indicated as a prefilled syringe.\nDupixent is approved for: Patients (Pat.) \u2265 6 months (M.) with moderate\/severe atopic dermatitis (AD) and (u.) for the treatment (Behlg.) of adults (Erw.) with moderate-severe prurigo nodularis (PN), if therapy with prescription topical Behlg.\ndoes not provide adequate disease control or (o.) is not recommended.\nDupixent can be used with or without topical corticosteroids (TC).\nAs add-on maintenance therapy for pat.\n\u2265 6 yrs. with severe asthma and the following criteria: *Eosinophil count in blood \u2265 150 cells\/\u00b5L, inadequate asthma control and \u2265 1 severe exacerbation in the last 12 m (despite inhaled CS and long-acting bronchodilators); *o. Long-term treatment with systemic CS. As add-on therapy with intranasal CS in adults with severe chronic rhinosinusitis with nasal polyps (CRSwNP), which cannot be adequately controlled with systemic CS and\/or surgical intervention, as well as in patients \u2265 12 yrs, \u2265 40 kg with eosinophilic esophagitis (EoE) who are inadequately treated with conventional drug therapy, cannot tolerate it or for whom such treatment is not an option. D: Dupixent is injected subcutaneously. AD\/PN: Adults: initial dose (AnfDos.) 600 mg, then 300 mg every 2 weeks (q2w). AD: Children\/adolescents (6-17 yrs.): 15 kg – <30 kg: AnfDos.\n300 mg (day 1) and 300 mg (day 15), then 300 mg every 4 weeks (q4w); 30 kg – <60 kg: AnfDos.\n400 mg, then 200 mg q2w; \u2265 60 kg: AnfDos.\n600 mg, then 300 mg q2w.\nAD: Children (6 m.-5 yrs.): 5 kg – <15 kg:200 mg q4w; 15 kg – <30 kg: 300 mg q4w. Asthma: adults\/young people (\u2265 12 yrs): *In severe asthma, under inhaled CS and long-acting bronchodilators: AnfDos. 400 mg, then 200 mg q2w. *In severe asthma, under oral CS: AnfDos. 600 mg, then 300 mg q2w. Children (6-11 yrs): 15 kg – <30 kg: 300 mg q4w; 30 kg – <60 kg: 200 mg q2w or 300 mg q4w; \u2265 60 kg: 200 mg q2w. CRSwNP: Adults: 300 mg q2w. EoE: adults\/young people (\u2265 12 years) 300 mg qw. Other indications: see Information for healthcare professionals. AI: Hypersensitivity to active substance\/excipient. VM: contains sodium ( <1 mmol\/dose). Hypersensitivity reactions: In case of general systemic hypersensitivity (immediate or delayed), discontinue use of Dupixent immediately and initiate appropriate treatment. Hypereosinophilia: Cases of eosinophilic pneumonia and vasculitis associated with eosinophilic granulomatosis with polyangitis have been reported with Dupixent therapy. In patients with hypereosinophilia, the physician should pay particular attention to the occurrence of vasculitic skin rash, worsening of pulmonary symptoms, cardiac complications and\/or neuropathy. Pre-existing helminthosis: treat before Dupixent therapy. In case of infection during Dupixent treatment and non-response to helminthosis treatment, Dupixent must be discontinued until the infection has subsided. Conjunctivitis\/keratitis: Conjunctivitis and keratitis have been reported with Dupixent in patients with AD. Patients and persons caring for small children must report new or worsening eye symptoms to a doctor. Patients (including infants and young children) who develop conjunctivitis with Dupixent treatment that does not resolve after standard treatment or who develop signs of keratitis should undergo an ophthalmologic examination if necessary. Patients with asthma: Adjustment of asthma treatment only in consultation with a doctor. Monitor patient carefully after discontinuation of treatment. IA: Avoid simultaneous use of live vaccines. NW: Reactions\/oedema at injection site, conjunctivitis, herpes labialis, other infections with herpes simplex viruses (except herpes eczema), (hyper-)eosinophilia, arthralgia, insomnia, gastritis, enterobiasis, headache and toothache. P: Dupixent, 2 prefilled syringes\/pens each, 200 mg or 300 mg. AK: B. ZI: sanofi-aventis (schweiz) ag, 3, route de Montfleury, 1214 Vernier. Further information at www.swissmedicinfo.ch.<\/a> Status of the information: January 2024<\/p>\n\n

<\/p>\n\n

Imprint<\/strong>Text\/editing:<\/strong> Jens Dehn<\/p>\n\n

This report was realized with the kind support of Sanofi (Suisse) S.A.<\/p>\n\n

Source:<\/strong> Symposium “Oh what a smell!” as part of the SGORL\/SSORL Spring Meeting 2024, Lugano, 13.06.2024; Organizer: Sanofi.\nsanofi-aventis (switzerland) ltd, 3, route de Montfleury, 1214 Vernier <\/p>\n\n

MAT-CH-2401401_1.0_09\/2024\u00a9 Prime Public Media AG, Zurich 2024 <\/p>\n","protected":false},"excerpt":{"rendered":"

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