Showing posts with label parosmia. Show all posts
Showing posts with label parosmia. Show all posts

Tuesday, November 28, 2023

Hope for Long Covid Parosmia Sufferers


Not one but two:

New Treatment Restores Sense of Smell in Patients with Long COVID
Nov 2023, Radiological Society of North America

Parosmia, a condition where the sense of smell no longer works correctly, is a known symptom of COVID-19. Recent research has found that up to 60% of COVID-19 patients have been affected. While most patients do recover their sense of smell over time, some patients with long COVID continue to have these symptoms for months, or even years, after infection.

The research team used a stellate ganglion block, which includes injecting anesthetic directly into the stellate ganglion on one side of the neck to stimulate the regional autonomic nervous system. The minimally invasive procedure takes less than 10 minutes, and no sedation or intravenous analgesia is necessary. CT guidance was used to position a spinal needle at the base of the neck for injection into the stellate ganglion. The researchers added a small dose of corticosteroid to the anesthetic in the pharmacologic preparation, suspecting that the COVID virus may be causing nerve inflammation. 

Follow-up was obtained for 37 patients (65%), with 22 (59%) of the 37 reporting improved symptoms at one week post-injection. No complications or adverse events were reported…

via the Radiological Society of North America and Jefferson Health in Philadelphia: New Treatment Restores Sense of Smell in Patients with Long COVID (press release). Nov 20 2023.


New clinical-trial data suggest that an antiviral pill called ensitrelvir shortens the duration of two unpleasant symptoms of COVID-19: loss of smell and taste
Nov 2023, Nature

From Japan - The medication is among the first to alleviate these effects and, unlike other COVID-19 treatments, is not reserved only for people at high risk of severe illness. The antiviral drug molnupiravir speeds recovery of these senses, but generally only the most vulnerable people can take it.

That is not true for ensitrelvir. In Japan, where it received emergency approval last year, the drug is available to  individuals with mild to moderate symptoms, regardless of their risk  factors. Its developer, Shionogi in Osaka, Japan, is continuing to conduct clinical trials of the drug, which has not yet been approved outside Japan.

In one such trial, people with mild or moderate COVID-19 symptoms were given either 125 or 250 milligrams of ensitrelvir or a placebo. At the start of  the study, 20% of participants reported some level of smell or taste loss. After the third day of treatment, the proportion of participants reporting such symptoms in the ensitrelvir groups started dropping more sharply than 
did the proportion in the placebo group.

“Most people will eventually recover on their own, but we know that some people have had 
long-term issues with smell and taste” 

via Shionogi in Osaka, and Fujita Health University: Nature. New pill helps COVID smell and taste loss fade quickly. Oct 17 2023. doi: https://doi.org/10.1038/d41586-023-03244-7 

Partially unrelated image credit: AI Art - The Human Condition is a Paradox - 2023

Further Reading:
Smell for Life: The Campaign to Tackle Smell and Taste Disorders
Apr 2023, Monell Center for Advancing Discovery in Taste and Smell

Friday, February 10, 2023

Hyper-Hypo-Nose


Sounds like a big deal. Also sounds like a great explanation for the phantom "Iso E Super" anosmia that isn't a full anosmia.

Researchers reveal an added layer of nuance in our sense of smell
Jan 2023, phys.org

They've discovered something called a depolarization lock to add to the standard combinatorial coding model used for odor detection, and it turns off the receptors when presented with high concentrations of an odor. 

You might already be familiar with this phenomenon for odors like violet and hydrogen sulfide (H2S). In the case of H2S, this receptor-deactivating behavior can be life-threatening, which is why you're supposed to wear a supplemental gas monitor, in addition to your nose, when entering areas suspected to contain high concentrations of the gas. 

^This write-up does a good job of explaining the fruit fly experiment that led to this discovery, as well as possible reasons why this would be needed for olfaction. 

via UC Santa Barbara: David Tadres et al, Depolarization block in olfactory sensory neurons expands the dimensionality of odor encoding, Science Advances (2022). DOI: 10.1126/sciadv.ade7209


Post Script:
In addition to Iso E Super, Hedione is another perplexing odorant that's in almost every fragrance formulation from floor cleaners to face cream, and yet most people can't actually smell it. Well, you can smell when it's NOT there, but you can't smell when it is. (Old post mentioning Hedione)

And if I'm reading this correctly, it sounds like someone with a hypersensitive nose might be more likely to lose their sensitivity altogether. I seem to have some kind of hyperosmia myself, and yet when I go out to sample perfume, I often can't smell anything at all. Take the same perfume, put it on a strip of paper and leave it on a table in my house for the next 3 weeks, and I will smell the whole bouquet revealed one at a time as the mixture breaks down. The theory being that if you're hypersensitive to a specific odorant, or all odorants for that matter, your "depolarization lock" will kick in at low concentrations. 

Post Post Script:
Hella synonyms for the musky odorant referred to above, in fact so many that I just wanted to list them here: Iso E Super, Tetramethyl acetyloctahydronaphthalenes is a synthetic ketone fragrance also known as octahydrotetramethyl acetophenone (OTNE) and by other commercial trade names such as: Iso E Super, Iso Gamma Super, Anthamber, Amber Fleur, Boisvelone, Iso Ambois, Amberlan, Iso Velvetone, Orbitone, Amberonne. It is a synthetic woody odorant and is used as a fragrance ingredient in perfumes, laundry products and cosmetics.
-Hall, John B. & Sanders, James Milton, "Perfume composition and perfume articles containing one isomer of an octahydrotetramethyl acetonaphthone", issued 1975

Friday, January 13, 2023

Smells Like Covid Part 2


It's been a couple years since the world learned the word "anosmia," so here's some updates:
(but don't forget this post about how parosmia worked with covid)

The first mass screening system for COVID cases has been developed with a sensitivity of 97%
Dec 2022, phys.org

Washing your hands with hydroalcoholic gel, smelling it and using a QR code to answer a short questionnaire. These very simple actions make up the world's first patented mass screening system for COVID cases.

Citrus fruits and apples are two of the first aromas that people with the SARS-CoV-2 virus stop detecting.

"Citrus" -- I don't remember seeing this at all, so I looked further into the report: "Based on the literature and habits of our Mediterranean study population, it was determined that the most suitable odoriferous substance was lemon." via Institute for Research in Fundamental Sciences in Iran and R DOty at U Penn: Moein, S. T. et al. Smell dysfunction: A biomarker for COVID-19. Int. Forum Allergy Rhinol. 10, 944–950 (2020). https://pubmed.ncbi.nlm.nih.gov/32301284/  -- This study used the University of Pennsylvania Smell Identification Test (UPSIT) which has 40 odorants; I can't read the paper because paywall, but I guess "citrus" or "lemon" is one of those odors. The paper wasn't meant to find the most prevalent non-detectable odor, but I guess it was just sitting there in the data?

"The antigen tests on the market have an average sensitivity of 80%, which means that the number of false negatives is 20%. What we have developed is not a diagnostic test, but a screening system that aims to detect the maximum possible number of positives and prevent false negatives," explained the researchers.

via Youcef Azeli et al, A machine learning COVID-19 mass screening based on symptoms and a simple olfactory test, Scientific Reports (2022). DOI: 10.1038/s41598-022-19817-x

Image credit: Stainless steel climate chamber at the Technical University of Denmark, Mikal Schlosser, 2022


Loss of smell following COVID linked to a person's immune reaction to the infection
Dec 2022, phys.org

They studied antibody levels in people infected during the early days of the pandemic—in all, they studied blood samples of 306 people who had donated blood for study after recovering from a COVID-19 infection. In comparing the antibody levels with other data provided by the donors and their doctors, the researchers determined that those people who had higher antibody levels tended to be the same people who had reported losing their sense of smell or taste. They found that such patients were twice as likely to lose one or the other sense as those who did not have higher-than-average levels of antibodies in their blood.

via Columbia University Irving Medical Center, the University of Pennsylvania, the National Institute of Alcohol Abuse and Alcoholism and the New York State Psychiatric Institute: Jonathan B. Overdevest et al, Chemosensory deficits are best predictor of serologic response among individuals infected with SARS-CoV-2, PLOS ONE (2022). DOI: 10.1371/journal.pone.0274611


Scientists find key reason why loss of smell occurs in long COVID-19
Dec 2022, phys.org

The reason some people fail to recover their sense of smell after COVID-19 is linked to an ongoing immune assault on olfactory nerve cells and an associated decline in the number of those cells, a team of scientists led by Duke Health report.

via Duke University Medical Center: John Finlay et al, Persistent post-COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium, Science Translational Medicine (2022). DOI: 10.1126/scitranslmed.add0484.

Post Script:
Nasal injections could treat long-term COVID-19–related smell loss
Jan 2023, phys.org

Using injections of platelet-rich plasma derived from a patient's own blood. In a trial of 26 participants, those who received the treatment were 12.5 times more likely to improve than patients who received placebo injections. 

"It's a nerve damage and nerve regeneration issue that we're dealing with," she said.

via Stanford: Carol H. Yan et al, Use of platelet‐rich plasma for COVID‐19–related olfactory loss: a randomized controlled trial, International Forum of Allergy & Rhinology (2022). DOI: 10.1002/alr.23116


Thursday, June 9, 2022

Covid's Parosmia Uncovered


Covid has a smell. Not that you can smell sick people, although you can actually. Dogs have proven that it's possible; only that humans have never been trained, and for obvious reasons.

Instead, we mean that things "smell like Covid." That's because everyone who got pre-Omicron Covid also got hit with a neuroplastic time bomb where their olfactory neurons got attacked and then reconfigured. Half the people who got Covid, and its anosmic introduction, knew they had it, and the other half didn't. (This according to a May 2022 study, linked here, and repasted below.)

Lost of people would argue with that stat. And I would have to argue back. The absolute worst source of data for testing anosmia etc is the subjective reporting of the people themselves. We don't even know we have a sense of smell in the first place, nevermind detecting that it's been removed. There are congential anosmics (can't smell from birth) who don't realize they're anosmic until they're teenagers! How do you not realize that? Because we don't talk about smells. They're outright lingua-phobic. And so when we lose it, especially in the midst of a respiratory infection that messes with our breathing, we don't even notice. We also think it's our sense of taste, so when someone asks "have you experienced any change in your sense of smell," you say no, but I did lose my sense of taste. In that study, they used Sniffin' Sticks, so an objective measure, and so they got the 100% stat. 

Next, things "smell like Covid" because after a bout of anosmia, your olfactory system needs to reboot, retrain, pick your computer analogy, and in the process, there's some bugs in the code. Eggs smell like Covid, coffee smells like Covid. Shit? Smells like biscuits. Wait, what? Yes, the Faeces Paradox, see below, it's all been explained for us. Thanks, Flavor Center at University of Reading:

Researchers find cause of disordered smell
May 2022, phys.org

Among the 29 volunteers with post-viral parosmia, scientists found 15 commonly identified compounds that triggered parosmia. They also found reduced sensitivity in some people, via lower TDI scores from Sniffin’ Sticks, although some who were considered functionally anosmic could still detect some of the trigger smells...

Some of the most cited food and drinks that set off parosmia in sufferers include:
  • Coffee
  • Onions
  • Garlic
  • Chicken
  • Green peppers

The most common trigger molecules are grouped into four distinct categories based on structure: 
  • thiols
  • trisubstituted pyrazines
  • methoxypyrazines
  • disulfides
  • (and as always with smell-things: some less common triggers did not fall into any one of these categories)
  • (these molecules tend to be potent, have very low olfactory detection thresholds and, in isolation, are neither distorted nor unpleasant for nonparosmics)

Trigger Molecules and their Parosmic Descriptions:
  • 2-furanmethanethiol ("coffee") is the most frequently reported trigger. Whereas NONPAR (non-parasmics) used a range of food-related terms to describe it (coffee, roasty, popcorn, smoky), PAR (parosmics) often struggled to find suitable descriptors, as they were unable to relate it to anything they had smelled before. PAR typically used words describing its hedonic quality (disgusting, repulsive, and dirty) or new coffee (relating to the altered smell of coffee since onset of parosmia) as described previously. Four PAR described it in the same way as NONPAR (biscuit, toasty or roasty) indicating that it is not universally parosmic, but certainly an important and frequent molecular trigger of parosmia.
  • 2-methyl-3-furanthiol and its corresponding methyl disulfide  ("meaty") were detected but reported less frequently as distorted. 
  • 2-Ethyl-3,6-dimethylpyrazine (also "coffee") was the second most frequent trigger in coffee; described with a variety of food terms by NONPAR, but by “new coffee”, “unpleasant” and “distorted” by PAR.
  • 2,3-diethyl-5-methylpyrazine, 2-ethyl-3,5-dimethylpyrazine and trimethylpyrazine (found in roasted, fried and baked goods) were common triggers. These compounds also triggered a parosmic response to cocoa, grilled chicken, and peanut butter
  • 2-Ethyl-3-methoxypyrazine, 2-isobutyl-3-methoxypyrazine and 2-isopropyl-3-methoxyprazine (green peppers) were common triggers in coffee.
  • 3-methyl-2-butene-1-thiol (pungent and weedy) was reported as a trigger 9/29 times.
  • 3-mercapto-3-methylbutanol and its formyl ester are potent aroma compounds in coffee, and were detected in half the cases, but only reported as distorted 5 or 6 times.

Exceptions:
  • The unknown compound has been tentatively identified as 4-methylthio-4-methyl-pentan-2-one, but this is yet unconfirmed. (What the heck is "the unknown compound?)
  • Although thiols and disulfides seem to effectively trigger a parosmic response, there are two notable exceptions.
  • Methanethiol, detected by some NONPAR, was not detected by any PAR. Likewise, dimethyl trisulfide is detected by 12/15 NONPAR but only by 4 PAR, and only reported once as a trigger.
  • A few compounds were detected but never reported as triggers.
  • 4-Ethylguaiacol was detected by 7 PAR and always described as spicy, sweet and smoky, but never parosmic.
  • Similarly, (E)-β-Damascenone, a key odour-active compounds in coffee, was detected by 6 PAR and always described as jammy and fruity.

The Faeces Paradox
  • Foods smell of faeces yet faeces smell of food (biscuity or pleasant)
  • Two parosmic researchers did not detect these compounds in a faecal slurry and were unaware of any foul smells.
  • However, they detected several other compounds, many of which they had also detected in coffee, and only some of which triggered parosmia.
  • In comparison, a normosmic scored the intensity of indole and skatole as close to the strongest imaginable. 
  • This provides a neat explanation as to why the changes in valence for faecal samples is reversed. 

How did they do it?
They GCMSd different sources, like coffee or onions, so that the individual molecules could be separated and presented one-at-a-time to the volunteers, so they could detect the specific molecules in the source that repulses them.

Why did they do it?
Prior to the global pandemic caused by COVID-19, parosmia was a rare condition known to occur after infections such as cold, flu or sinus infections, with very little awareness about the causes and treatments for the disease.

During the pandemic COVID-19 symptoms included loss of smell and taste in 50–60% of cases, of which about 10% developed parosmia. Since the omicron variant, loss of smell and taste has become a less common symptom (estimated to occur in about 10–20% of cases) and parosmia cases are likely to be fewer in number, parosmia is still estimated to affect 2 million people in Europe.
Not exactly. See below.

via the Flavor Center at University of Reading: Jane K. Parker et al, Insights into the molecular triggers of parosmia based on gas chromatography olfactometry, Communications Medicine (2022). DOI: 10.1038/s43856-022-00112-9


Study finds sensory loss in ~100% of active COVID infections, which is twice as high as self-reports
May 2022, phys.org

In participants with active infections during the delta surge, a majority (22 of 25) had been vaccinated. Objective screenings found that 100% were experiencing a diminished or lost sense of smell—but only 54.5% self-reported any problem with odor detection.

via Ohio State University: Kym Man et al, Chemosensory losses in past and active likely Delta variant break-through COVID-19 cases, Med (2022). DOI: 10.1016/j.medj.2022.05.004

Image credit: Free Photos at img freepic dot com [link]

Post Script:
Can 'smell' trigger tumors?
May 2022, phys.org
 
"Now that glioma preferentially emerges in the OB, will neuronal activity in the olfactory circuit affect the emergence of glioma?" the researchers wondered. This "mind-blowing" flash of inspiration became a turning point in this study. The research team attested to this hypothesis through a series of experiments.

In this study, they employed a cutting-edge chemogenetic technology to specifically manipulate the neuronal excitability of ORNs. They found that inhibiting the activity of ORNs reduced the size of the tumor significantly, whereas activating their activity increased the size of the tumor. It was therefore concluded that the neuronal excitability of ORNs was the root of gliomagenesis.

To further verify this conclusion, the researchers suppressed olfactory inputs through naris occlusion by using small plugs. They found that with naris occlusion, tumors were significantly hindered in the olfactory bulb, indicating that olfactory stimuli could regulate gliomagenesis.

via Zhejiang University: Pengxiang Chen et al, Olfactory sensory experience regulates gliomagenesis via neuronal IGF1, Nature (2022). DOI: 10.1038/s41586-022-04719-9

Post Post Script:
Clinical trial led by Thomas Jefferson University Hospital paves the way for innovative topical treatment
Mar 2022, Jefferson Hospital

Platelet-rich plasma (PRP) is a common restorative therapy used to regenerate cells, heal tissue, and address an array of medical conditions from healing injured muscles and tendons to increasing hair growth and reducing the appearance of scars. Animal studies have shown that PRP helps regenerate the olfactory epithelium, which may be the site affected in COVID-19 induced olfactory dysfunction (OD). As smell and taste are closely interrelated, improved sense of smell can help with sense of taste as well. Until now, PRP has been used as a nasal injectable in several small clinical trials for smell loss. Although the results were promising, nasal injections can be uncomfortable and invasive for patients.

A recent phase I clinical trial of eight patients who had at least six months of olfactory disturbance has shown preliminary success with 50 percent of participants (4 people) experiencing clinically significant improvements in smell and taste.

Also:
Autopsies suggest COVID’s smell loss is caused by inflammation, not virus
Apr 2022, Ars Technica

via Johns Hopkins: Ho C, Salimian M, Hegert J, et al. Postmortem Assessment of Olfactory Tissue Degeneration and Microvasculopathy in Patients With COVID-19. JAMA Neurol. Published online April 11, 2022. doi:10.1001/jamaneurol.2022.0154

Friday, September 10, 2021

Olfactory Training for Olfactory Dysfunction


Parking this here for future reference, and for anyone still having trouble getting their sense of smell back:

Hura N, Xie DX, Choby GW, Schlosser RJ, Orlov CP, Seal SM, Rowan NR. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2020 Sep;10(9):1065-1086. doi: 10.1002/alr.22624. Epub 2020 Jun 25. PMID: 32567798; PMCID: PMC7361320. https://pubmed.ncbi.nlm.nih.gov/32567798/

Background: Post-viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence-based recommendations for their use.

Methods: A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence-based review with recommendations.

Results: From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin' Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non-steroidal oral medications, and acupuncture.

Conclusion: Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short-term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high-quality studies limits the ability to make meaningful evidence-based recommendations for the use of these therapies for the treatment of PVOD.

And don't forget:
Monell Center Scientists Find that Insulin is Necessary for Repairing Olfactory Neurons: Findings Point to Possible Treatment for Smell Loss
May 2021 - Monell Center

Thursday, July 4, 2019

The Olfactocracy


No, you don't have to eat your broccoli.

In an experiment that sounds like something we should have done like 70 years ago, we discover that all noses are not created equal. We all smell things differently, perceiving particular odor-features with varying levels of intensity.

I take it back; we didn't have the ability to do this kind of genetics testing 70 years ago. This new experiment showed that of the ~400 genes that control our ~400 different olfactory receptors, the variability is on high. In other words, let's say broccoli has a bunch of different chemicals that make it smell like "broccoli," and that there's a bunch of different receptor-genes that code for those chemicals -- you and I have slightly different versions of those receptors, which make one of us more sensitive to the bad parts of the smell, and maybe even the other of us more sensitive to the good parts.

What you get is one person who doesn't mind eating broccoli, and one of us who gets less ice cream after dinner everytime broccoli's on the menu.

What you also get is an entire sense which lacks in consensus. At the genetic level, what smells good to you won't necessarily smell good to me. So how do we agree?

As groundbreaking a breakthrough as this is, it doesn't even begin to scratch the surface as to how different each of our olfactory experiences are. Each one of us really does live an olfactory world all to ourselves.

We know then that genetics separates us, but it goes even further. Genetics is the hardwiring, but what about the softwiring? If you, for example, were force-fed broccoli while at the same time you're also forced to watch, with your eyes pried open, footage of people trying to peel the foil off a Nutella jar but it rips halfway through, then you might become traumatized by the smell of hot broccoli, and hence highly sensitive, and highly averse to it.

And the reverse can also happen. Don't like Flowerbomb? Wait until you have a few too many romantic encounters with a woman who wears it, and you'll change, you'll see.  That's softwiring. Humans are special because of our neural plasticity, so you can bet we're susceptible to these kinds of changes.

The final note here needs to be on the way we talk about smells. If we all smell a bit different, then how can we really communicate our experiences to each other with any fidelity? 


Notes:
C. Trimmer, A. Keller, N. R. Murphy, L. L. Snyder, J. R. Willer, M. H. Nagai, N. Katsanis, L. B. Vosshall, H. Matsunami, and J. D. Mainland
PNAS May 7, 2019 116 (19) 9475-9480; first published April 30, 2019

Heather Murphy for the New York Times, May 2019