Vagelos College of Physicians and Surgeons, 5798Columbia University, New York, NY, USA.
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
Am J Rhinol Allergy. 2023 Jan;37(1):95-101. doi: 10.1177/19458924221120117. Epub 2022 Aug 11.
Nearly 40% of patients who experience smell loss during SARS-CoV-2 infection may develop qualitative olfactory dysfunction, most commonly parosmia. Our evidence-based review summarizes the evolving literature and offers recommendations for the clinician on the management of patients experiencing parosmia associated with COVID-19.
We performed a systematic search using independent queries in PubMed, Embase, Ovid, and Cochrane databases, then categorized articles according to themes that emerged regarding epidemiology, effect on quality of life, disease progression, prognosis, pathophysiology, diagnosis, and treatment of parosmia.
We identified 123 unique references meeting eligibility and performed title and abstract review with 2 independent reviewers, with 74 articles undergoing full-text review. An inductive approach to thematic development provided 7 central themes regarding qualitative olfactory dysfunction following COVID-19.
While other respiratory viruses are known to cause qualitative olfactory disturbances, the incidence of parosmia following COVID-19 is notable, and correlates negatively with age. The presence of parosmia predicts persistent quantitative olfactory dysfunction. Onset can occur months after infection, and symptoms may persist for well over 7 months. Affected patients report increased anxiety and decreased quality of life. Structured olfactory training with essential oils is the preferred treatment, where parosmia predicts recovery of aspects of quantitative smell loss when undergoing training. There is limited evidence that nasal corticosteroids may accelerate recovery of olfactory function. Patients should be prepared for the possibility that symptoms may persist for years, and providers should guide them to resources for coping with their psychosocial burden.
将近 40%在 SARS-CoV-2 感染期间经历嗅觉丧失的患者可能会出现定性嗅觉障碍，最常见的是嗅觉异常。我们的循证综述总结了不断发展的文献，并为临床医生提供了与 COVID-19 相关嗅觉异常患者管理的建议。
我们在 PubMed、Embase、Ovid 和 Cochrane 数据库中使用独立查询进行了系统搜索，然后根据出现的与流行病学、对生活质量的影响、疾病进展、预后、病理生理学、诊断和嗅觉异常治疗相关的主题对文章进行分类。
我们确定了符合条件的 123 篇独特参考文献，并由 2 名独立评审员进行标题和摘要审查，其中 74 篇文章进行了全文审查。采用归纳法进行主题开发，提供了 COVID-19 后定性嗅觉障碍的 7 个中心主题。
虽然已知其他呼吸道病毒会引起定性嗅觉障碍，但 COVID-19 后嗅觉异常的发生率显著，且与年龄呈负相关。嗅觉异常的存在预示着持续的定量嗅觉障碍。发病可在感染后数月发生，症状可持续超过 7 个月。受影响的患者报告焦虑增加和生活质量下降。用精油进行结构化嗅觉训练是首选的治疗方法，嗅觉异常预示着在接受训练时恢复定量嗅觉丧失的部分方面。有限的证据表明鼻用皮质类固醇可能会加速嗅觉功能的恢复。患者应做好症状可能持续数年的准备，并且提供者应指导他们应对其心理社会负担的资源。
