Clinical-epidemiological characteristics and diagnostics of peripheral olfactory disorder following viral diseases
Keywords:
peripheral olfactory dysfunction, post-viral anosmia, hyposmia, olfactometry, cone-beam computed tomography, endoscopy, Keros classificationAbstract
According to the World Health Organization, olfactory and gustatory disorders affect 1-2% of the general population, with viral infections - particularly coronavirus, adenovirus and rhinovirus infections - being among the most common etiological factors of peripheral olfactory dysfunction. To study the clinical and epidemiological characteristics of patients with post-viral peripheral olfactory dysfunction and to evaluate structural changes of the olfactory analyzer using modern diagnostic methods (endoscopy, cone-beam computed tomography). The study included 80 patients with post-viral peripheral olfactory dysfunction treated at the Republican Specialized Scientific-Practical Medical Center of Otorhinolaryngology and Head and Neck Diseases in 2024-2025, and 20 healthy controls. Patients were divided into four groups according to disease duration. All patients underwent standard otorhinolaryngological examination, nasal endoscopy and cone-beam computed tomography (CBCT). Among patients presenting with nasal disease during 2024-2025, olfactory dysfunction was detected in 256-345 cases, of which 35-45 were confirmed to be of post-viral peripheral origin. Disease duration was up to 6 months in 39% of patients, 6 months to 1 year in 21%, 1-3 years in 25%, and more than 3 years in 15%. Coronavirus infection was the leading etiological factor (34 cases across all groups), followed by adenovirus (23 cases) and rhinovirus (16 cases) infections. Endoscopy revealed mucosal hyperemia in 88.2-95.5% of cases and inferior turbinate hypertrophy in 88.2-95.0%. CBCT demonstrated predominance of Keros type II and III olfactory fossa configurations (68.05% and 20.7% respectively), with statistically significant differences compared to controls (p≤0.05). No correlation was found between olfactory cleft width and the degree of olfactory dysfunction. Post-viral peripheral olfactory dysfunction frequently follows a prolonged course and is most commonly associated with coronavirus infection. Cone-beam computed tomography is a highly informative method for evaluating olfactory analyzer structures and is of considerable value for diagnosis and treatment planning.
References
World Health Organization. Deafness and hearing loss and sensory disorders reports. Geneva: WHO; 2020.
Hopkins C, Surda P, Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology. 2020;58(3):295-8.
Vaira LA, Salzano G, Deiana G, De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020;130(7):1787.
Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19: diagnosis and management. JAMA. 2020;323(24):2512-4.
Boscolo-Rizzo P, Borsetto D, Fabbris C, et al. Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19. JAMA Otolaryngol Head Neck Surg. 2020;146(8):729-32.
Parma V, Ohla K, Veldhuizen MG, et al. More than smell - COVID-19 is associated with severe impairment of smell, taste, and chemesthesis. Chem Senses. 2020;45(7):609-22.
Reden J, Mueller A, Mueller C, et al. Recovery of olfactory function following closed head injury or infections of the upper respiratory tract. Arch Otolaryngol Head Neck Surg. 2006;132(3):265-9.
Hummel T, Whitcroft KL, Andrews P, et al. Position paper on olfactory dysfunction. Rhinol Suppl. 2017;54(26):1-30.
Damm M, Pikart LK, Reimann H, et al. Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study. Laryngoscope. 2014;124(4):826-31.
Doty RL. Epidemiology of smell and taste dysfunction. Handb Clin Neurol. 2019;164:3-13.
Seiden AM, Duncan HJ. The diagnosis of a conductive olfactory loss. Laryngoscope. 2001;111(1):9-14.
Rombaux P, Huart C, Deggouj N, et al. Olfaction in patients with sudden hearing loss and correlation to olfactory bulb volume. Otolaryngol Head Neck Surg. 2012;147(2):318-23.
Rombaux P, Potier H, Bertrand B, et al. Olfactory bulb volume in patients with sinonasal disease. Am J Rhinol. 2008;22(6):598-601.
Yousem DM, Geckle RJ, Bilker WB, Doty RL. Olfactory bulb and tract and temporal lobe volumes: normative data across decades. Ann N Y Acad Sci. 1998;855:546-55.
Keros P. Uber die praktische Bedeutung der Niveauunterschiede der Lamina cribrosa des Ethmoids. Laryngol Rhinol Otol. 1962;41:809-13.
Konstantinidis I, Tsakiropoulou E, Constantinidis J. Long term effects of olfactory training in patients with post-infectious olfactory loss. Rhinology. 2016;54(2):170-5.
Kollndorfer K, Fischmeister FP, Kowalczyk K, et al. Olfactory training induces changes in regional functional connectivity in patients with long-term smell loss. Neuroimage Clin. 2015;9:401-10.
Hura N, Xie DX, Choby GW, et al. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2020;10(9):1065-86.
Le Bon SD, Konstantinidis I, Wysocki J, et al. Efficacy and safety of oral corticosteroids and olfactory training in the management of COVID-19-related loss of smell. Eur Arch Otorhinolaryngol. 2021;278(8):3113-7.
Addison AB, Wong B, Ahmed T, et al. Clinical olfactory working group consensus statement on the treatment of postinfectious olfactory dysfunction. J Allergy Clin Immunol. 2021;147(5):1704-19.
Gudziol V, Lotsch J, Hahner A, et al. Clinical significance of results from olfactory testing. Laryngoscope. 2006;116(10):1858-63.
Mueller CA, Grassinger E, Naka A, et al. A self-administered odor identification test procedure using the Sniffin' Sticks. Chem Senses. 2006;31(6):595-8.
Hummel T, Kobal G, Gudziol H, Mackay-Sim A. Normative data for the Sniffin' Sticks including tests of odor identification, odor discrimination, and olfactory thresholds. Eur Arch Otorhinolaryngol. 2007;264(3):237-43.
Landis BN, Hummel T, Hugentobler M, et al. Ratings of overall olfactory function. Chem Senses. 2003;28(8):691-4.
Croy I, Nordin S, Hummel T. Olfactory disorders and quality of life - an updated review. Chem Senses. 2014;39(3):185-94.
Philpott CM, Boak D. The impact of olfactory disorders in the United Kingdom. Chem Senses. 2014;39(8):711-8.
Neuland C, Bitter T, Marschner H, et al. Health-related and specific olfaction-related quality of life in patients with chronic functional anosmia or severe hyposmia. Laryngoscope. 2011;121(4):867-72.
Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med Care. 1992;30(6):473-83.
Whitcroft KL, Ezzat M, Cuevas M, et al. The effect of intranasal sodium citrate on olfaction in post-infectious loss. Rhinology. 2016;54(4):368-74.
Jiang RS, Twu CW, Liang KL. Medical treatment of traumatic anosmia. Otolaryngol Head Neck Surg. 2015;152(5):954-8.
Fjaeldstad A, Fernandes HM, Van Hartevelt TJ, et al. Brain fingerprint of olfactory dysfunction. Sci Rep. 2017;7:42360.
Пискунов Г.З., Пискунов С.З. Клиническая ринология. М.: Литтерра; 2017.
Лопатин А.С. Обонятельные расстройства: диагностика и лечение. Российская ринология. 2019;27(1):3-11.
Крюков А.И., Кунельская Н.Л., Изотова Г.Н. и др. Постинфекционная дисфункция обоняния. Вестник оториноларингологии. 2020;85(4):74-9.
Юсупов Ф.А., Каримов Ш.И. Носовое дыхание и функция обонятельного анализатора при риносинуситах. Медицинский журнал Ўзбекистана. 2021;3:45-9.
