2019新型冠状病毒变异株奥密克戎感染后嗅觉、味觉和听觉障碍的发病率和预后：一项基于网络的调查

目的 了解2019新型冠状病毒变异株奥密克戎（Omicron）感染后嗅觉、味觉及听觉障碍发病率及预后。方法 基于线上问卷的横断面研究,采用视觉模拟量表（VAS）评价嗅觉、味觉及听觉功能。结果 （1）共获得869份有效调查问卷,Omicron感染后耳鼻咽喉科相关症状总体发生率达96.8%,嗅觉、味觉及听觉障碍发生率分别为44.4%、44.2%和10.7%。（2）全体受调查者感染前后嗅觉、味觉、听觉障碍VAS评分,及出现嗅觉、味觉及听觉障碍的受调查者感染前后相应VAS评分均具有统计学差异（P<0.001）。（3）嗅觉、味觉及听觉障碍持续的中位时间分别为5 d、4 d和3 d。结论 Omicron感染后嗅觉、味觉、听觉障碍发生率高,多数可快速自发改善,对于症状长期存在者,耳鼻咽喉科医师需积极干预。     

新型冠状病毒感染后嗅觉功能障碍患者焦虑抑郁状况及其影响因素分析

目的 分析奥密克戎变异株感染后嗅觉功能障碍患者的焦虑、抑郁现状及其相关因素,为制定有效的心理干预措施提供理论依据。方法 于2022年12月—2023年1月重庆新型冠状病毒(SARS-CoV-2)奥密克戎变异株流行期间,通过问卷收集信息,采用广泛性焦虑障碍量表(GAD-7)和患者健康问卷(PHQ-9)评定焦虑、抑郁情绪,采用视觉模拟量表(VAS)评定嗅觉功能。采用χ²检验、多因素Logistic回归分析影响患者焦虑、抑郁情绪的相关因素。结果 共纳入患者367例,其中感染后嗅觉功能障碍患者182例,无嗅觉功能障碍患者185例。嗅觉功能障碍患者焦虑、抑郁情绪的检出率分别为46.7%、63.2%,均高于无嗅觉功能障碍的患者。多因素Logistic回归分析显示,嗅觉下降持续时间长(OR=1.660)、嗅觉功能VAS评分高(OR=8.993)是产生焦虑情绪的危险因素。女性(OR=2.964)、嗅觉功能VAS评分高(OR=4.423)是产生抑郁情绪的危险因素。结论 SARS-CoV-2感染后患者均出现一定程度的焦虑、抑郁情绪,伴有嗅觉功能障碍患者的焦虑、抑郁情绪的检出率更高,应加强对此类患者的心理疏导和人文关怀,以改善和促进其心理健康。     

特发性嗅觉障碍的研究进展

特发性嗅觉障碍(IOD)是一种发病原因尚不明确的嗅觉疾病,以嗅觉下降或完全丧失为主要临床表现。嗅觉是人的基本感知觉之一,在识别气味、预警危险及影响情绪等方面有着重要作用。嗅觉功能一旦受损,对人的饮食、生活质量等方面有着严重影响,嗅觉疾病逐渐被各国学者关注。IOD是一种较为常见的嗅觉疾病,尽管目前在IOD的诊断及发病机制上有所研究,但其临床诊疗工作仍十分具有挑战性。目前国内关于IOD的理论及临床研究较少,本文通过总结目前国内外关于IOD的文献报道,对其发病情况、可能发病机制、诊断、治疗进行综述,以期为IOD的临床诊疗工作提供参考。     

SARS-CoV-2感染后嗅觉功能障碍治疗的研究进展

嗅觉功能障碍(olfactory dysfunction, OD)被认为是新型冠状病毒肺炎的主要症状之一。目前,COVID-19相关的OD的发病机制尚不明确,对其患者暂无特异性治疗手段。论文通过回顾近年来OD的相关文献,结合目前COVID-19及COVID-19相关的OD的治疗方法,从安全咨询、嗅觉训练、药物治疗、针灸、中医药、日本汉方药等方面对相关治疗方案进行总结和比较,探讨其在临床应用和开发新的治疗方法方面的挑战,以期为临床治疗COVID-19相关的OD提供参考和帮助。     

嗅觉训练治疗嗅觉障碍的研究进展

嗅觉障碍是一种可对患者的生活质量产生严重影响的疾病,同时也被证明与多种疾病存在一定的相关性。传统的嗅觉障碍治疗手段主要包括通过手术治疗和应用药物治疗,但往往有时并不能取得期待的效果。近年来嗅觉训练作为一种全新的治疗嗅觉障碍的手段得到了众多专家及学者的关注。本文综述了应用嗅觉训练治疗嗅觉障碍的最新研究进展,为其基础研究与临床应用提供一定的参考。     

嗅觉障碍的研究

永久性嗅觉丧失发病率约为1.2%,暂时性嗅觉障碍为62.4%(Frank ME等报道).嗅觉障碍可影响人的内脏反应和情绪活动,患者生活质量都有不同程度的下降.本文着重介绍嗅觉障碍的病因研究及相应诊治进展.     

上呼吸道感染后嗅觉障碍预后因素分析

目的:分析上呼吸道感染后嗅觉障碍(PVOD)患者主客观嗅觉功能测试结果,评估预后因素,为临床诊疗提供依据.方法:回顾性分析就诊于首都医科大学附属北京安贞医院门诊的PVOD患者,给予嗅觉训练治疗4个月,对患者治疗前后进行Sniffin'Sticks嗅觉测试,根据嗅觉功能改善情况分为嗅觉功能改善组和嗅觉功能无改善组,分析患...     

新型冠状病毒肺炎患者的嗅觉障碍[综述]

新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）是由严重急性呼吸综合征相关冠状病毒2（severe acute respiratory syndrome coronavirus 2,SARS-CoV-2）引起的疾病。该疾病可能导致从轻度到严重的急性呼吸系统综合征。COVID-19的临床表现包括发热、干咳、乏力、咳痰、气短、咽喉痛、头痛等。伴随着COVID-19的大流行,世界各地的耳鼻咽喉科医师报道相当数量的COVID-19轻症或无症状患者出现嗅觉功能障碍。撰写本文的目的是回顾现有的文献和整理分析文献中COVID-19患者嗅觉减退的症状特点,并分析潜在机制和应对措施。对出现不明原因嗅觉减退的患者予以重视,以指导临床医师的实践。     

外伤性嗅觉障碍

与其他动物相比,人类的嗅觉功能已经退化。然而,嗅觉功能对我们仍有重要意义,如感受气味、参与记忆、调节情感等,更重要的是,它可以让我们捕捉某些危险信息,如煤气泄漏、火灾等,从而减少灾害造成的不良后果。     

嗅觉障碍的治疗及预后

引起嗅觉功能改变的因素很多，如鼻腔鼻窦炎症、头外伤、病毒感染等，临床上常用的治疗方式有药物治疗和手术治疗。不同治疗方式对不同原因导致的嗅觉障碍的疗效有很大差异．医务人员应针对嗅觉障碍的病因选择适当的治疗方式。     

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19

IntroductionSudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate.ObjectiveTo characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data.MethodsAn online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period.Results253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p = 0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p = 0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p = 0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p = 0.04).ConclusionPositive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.     

上呼吸道感染后嗅觉障碍患者脑形态学与嗅觉功能相关性分析

目的 通过探究上呼吸道感染后嗅觉障碍脑灰质形态变化,得出上呼吸道感染后嗅觉障碍患者嗅觉中枢结构的影像学特点。方法 选取上呼吸道感染后嗅觉障碍的患者24例与嗅觉功能正常的健康对照受试者20例,通过基于体素的大脑皮质形态学体积测量(VBM)比较患者的大脑灰质和白质体积与对照组的差异。结果 上呼吸道感染后嗅觉障碍组患者TDI[气味察觉阈(T)、气味辨别能力(D)、气味识别能力(I)]总分(16.45±5.62)分,T为(2.33±0.93)分,D为(6.54±2.60)分,I为(7.58±3.22)分;嗅觉障碍平均时长为(19.00±6.33)个月;视觉模拟量表评分(VAS)为(7.79±2.41)分,与对照组比较均存在统计学差异(P<0.05)。上呼吸道感染后嗅觉障碍患者的大脑灰质总体积和嗅皮质体积明显小于对照组(P<0.05),大脑灰质总体积占全脑体积的比例和皮质厚度与嗅觉功能评分TDI值呈正相关(r=0.71,P<0.000 1;r=0.69,P=0.000 9)。结论 上呼吸道感染后嗅觉障碍患者大脑灰质总体积和嗅皮质体积减少,且嗅觉功能与大脑灰质体积比例及皮质厚度呈...     

Pathophysiological relationship between COVID-19 and olfactory dysfunction: A systematic review

IntroductionSARS-CoV-2 is the pathogen of COVID-19. The virus is composed of the spike, membrane and envelope. On physiological smell, odoriferous substances bind to proteins secreted by sustentacular cells in order to be processed by olfactory receptor neurons. Olfactory disorder is one of the main manifestations of COVID-19, however, research is still required to clarify the mechanism involved in SARS-CoV-2 induced anosmia.ObjectiveThis article aims to analyze current scientific evidence intended to elucidate the pathophysiological relationship between COVID-19 and the cause of olfactory disorders.MethodsPubmed, Embase, Scopus and ScienceDirect were used to compose this article. The research was conducted on November 24th, 2020. Original articles with experimental studies in human, animal and in vitro, short communications, viewpoint, published in the English language and between 2019 and 2020 were included, all related to the pathophysiological relationship between olfactory disorders and COVID-19 infection.ResultsBoth human cell receptors ACE2 and TMPRSS2 are essential for the SARS-CoV-2 entrance. These receptors are mostly present in the olfactory epithelium cells, therefore, the main hypothesis is that anosmia is caused due to damage to non-neuronal cells which, thereafter, affects the normal olfactory metabolism. Furthermore, magnetic resonance imaging studies exhibit a relationship between a reduction on the neuronal epithelium and the olfactory bulb atrophy. Damage to non-neuronal cells explains the average recovery lasting a few weeks. This injury can be exacerbated by an aggressive immune response, which leads to damage to neuronal cells and stem cells inducing a persistent anosmia. Conductive anosmia is not sufficient to explain most cases of COVID-19 induced anosmia.ConclusionOlfactory disorders such as anosmia and hyposmia can be caused by COVID-19, the main mechanism is associated with olfactory epithelium damage, targeting predominantly non-neuronal cells. However, neuronal cells can also be affected, worsening the condition of olfactory loss.     

A clinical study of olfactory dysfunction in patients with Mikulicz's disease

Objective

Mikulicz's disease (MD) is differentiated from Sjögren's syndrome as an immunoglobulin G4 (IgG4) systemic disease. MD patients often report olfactory dysfunction (OD). To analyze cases of OD associated with MD, we studied clinicopathological and serological findings of MD patients.

Methods

A total of 44 MD patients (17 males and 27 females) were examined for OD. We evaluated clinicopathological and serological findings of these patients by dividing them into OD (+) and OD (−) groups.

Results

The mean IgG4 concentration (SD) in such cases was 950.5 (797.5) mg/dl. Of the 44 patients, 20 (45%) had OD even though no abnormalities, such as obstructive and inflammatory disease, were detected in their nasal cavities and sinuses. The two groups did not show significant differences in background characteristics, such as age, sex, IgG4 concentration, presence or absence of allergic rhinitis, and presence or absence of extrasalivary gland lesions. We found abundant IgG4-positive plasmacytes in the nasal mucosa specimens of the OD (+) group but not in that of the OD (−) group.

Conclusions

Nasal mucosa in the MD patients with OD was infiltrated with IgG4-positive plasmacytes. We concluded that OD may be associated with infiltration by IgG4-positive cells.     

鼻窦CT评分在评估慢性鼻-鼻窦炎嗅觉障碍中的应用

目的探讨分析鼻窦CT评分在慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者嗅觉功能评估的价值。方法回顾性分析92 例确诊为CRS患者的临床资料,其中嗜酸性粒细胞性慢性鼻-鼻窦炎（eosinophi chronic rhinosinu sitis,ECRS）组患者28 例,非嗜酸性粒细胞性慢性鼻-鼻窦炎（non eosinophi chronic rhinosinu sitis,nECRS）组患者64 例。排除鼻部手术史和其他可能影响嗅觉功能的因素,进行病史采集、嗅觉功能检测和鼻窦CT评分,采用χ2和t检验比较两组间患者临床资料;采用Mann Whitney U检验比较两组鼻窦CT评分;采用Spearman相关分析对鼻窦CT评分和嗅觉功能进行相关性分析;采用ROC曲线分析鼻窦CT评分在嗅觉障碍中的预测评估价值。 结果ECRS组双侧炎症(26/28),筛窦上额窦总和差,（EM 差）值3.32±2.25;nECRS组双侧炎症(48/64),EM差值1.81±2.33,两组患者比较差异均具有统计学意义(P<0.05)。在CT评分方面,CRS患者的EM 差值与嗅觉功能相关性更强(r=0.634),具有更高的预测评估价值,其曲线下面积为0.827。当EM差截断值取2.5时,诊断嗅觉障碍的敏感度为76.9%,特异度为79.2%。结论与其他鼻窦CT评分相比,筛窦上颌窦总和差值对于CRS患者嗅觉障碍有更好的预测诊断价值。     

新型冠状病毒肺炎患者合并鼻部症状临床分析及诊疗建议

目的调查新型冠状病毒肺炎（COVID-19）患者鼻部相关症状及其临床特点。方法收集2020年2月10日—3月20日华中科技大学同济医院327例确诊COVID-19患者的病例资料,采集鼻塞、流涕、嗅觉改变等鼻部相关症状、全身伴随症状及基础疾病等情况,分析其临床特点。结果在327例纳入研究的COVID-19患者中,轻型、普通型、重型、危重型病例分别为33例（10.1%）、62例（19.0%）、146例（44.6%）、86例（26.3%）;54例（16.5%）COVID-19患者合并鼻部相关症状,按不同症状发生的总例数统计,其中鼻塞35例（10.7%）、鼻腔干燥29例（8.9%）和嗅觉下降21例（6.4%）,鼻痒 17例（5.2％）、喷嚏16例（4.9％）、鼻出血14例（4.3％）和流清涕11例（3.4％）。在各不同病情分型患者间,鼻部症状的发生率没有统计学意义（P>0.05)。192例（58.7%）COVID 19患者有高血压、糖尿病等基础疾病存在,经过积极的综合治疗244例（74.6%）痊愈出院。结论COVID-19患者除了发热、咳嗽、咳痰等症状之外,鼻塞、嗅觉下降等鼻腔局部症状并不少见。鼻部疾病的治疗不仅可以改善患者生活质量,同时可以提高患者的治疗效果。因此,临床医师不能忽视COVID-19患者鼻部疾病的处理