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Oral Nutritional Supplements and Appetite Stimulation Therapy
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The olfactory system encompasses the nasal passages, olfactory bulb, olfactory neuroepithelium and receptor cells (see Figure 16.4). Olfactory signals are then transmitted to the piriform cortex, amygdaloid, hippocampus and thalamus (see Figure 16.5).
History Stations
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Some useful terms to begin with are as follows: Anosmia – Absence of smell functionHyposmia – Decreased sensitivity to odorantsHyperosmia – Increased sensitivity to odorantsCacosmia – Sensation of foul smellsPhantosmia – Olfactory hallucination
Chemosensory Disorders and Nutrition
Published in Alan R. Hirsch, Nutrition and Sensation, 2023
Carl M. Wahlstrom, Alan R. Hirsch, Bradley W. Whitman
In a parallel fashion are those who complain of hyperosmia. While true hyperosmia has been described with adrenal insufficiency states and during the headache phase of those with cluster-like headaches, usually this complaint is not actual hyperosmia, but rather, a hedonic change toward specific odors—cacosmia (with or without the associated severe behavioral responses) (Henkin 1971). It even can be seen in those with true hyposmia or anosmia (hyposmic hyperosmia) (Hirsch 2009a). However, olfactory testing almost never demonstrates true hyperosmia, but rather, normosmia, or actual reduction in olfactory ability—possibly representing a disinhibition phenomenon—instead of detecting all of the notes in an odor chord, both stimulatory and inhibitory, the sufferer detects only a portion, losing more inhibitory than excitatory smells, allowing the remainder to be perceived as more intense than normal.
Encephalomyelitis associated with Covid-19 infection: case report
Published in British Journal of Neurosurgery, 2023
Gulden Demirci Otluoglu, Ulas Yener, Mustafa Kemal Demir, Baran Yilmaz
Human coronaviruses commonly affect the respiratory tract; however, they have the potential to invade the CNS. Typical symptoms are fever, cough, myalgia, and/or fatigue. Almost every patient demonstrated chest computed tomography abnormalities. It has been postulated that neuroinvasion and neurotropism is a common feature of human coronaviruses.2,3 The current outbreak has been associated with neurological manifestations, including febrile seizures, convulsions, change in mental status, and encephalitis.3,4,5,6 Preliminary, Mao et al. reported in their retrospective series in 214 Covid-19 patients that were hospitalized in Wuhan, 36.4% presented with neurological symptoms. Furthermore, autopsy reports demonstrated partial neuronal degeneration coupled with brain tissue edema in deceased patients.7 Current knowledge on the pathogenesis of COVID-19 is still unclear and limited. But It has been hypothesized that upon nasal infection, coronavirus might enter the CNS through the olfactory bulb, causing inflammation and demyelination.3 Supporting this hypothesis, altered olfactory function, such as anosmia, has been reported as a clinical presentation.8 On the other hand, angiotensin-converting enzyme 2 (ACE2) could be a receptor for 2019-nCoV. This may cause indirect injury to the central nervous system thorough affected blood vessels due to the disruption of the blood-brain barrier.
Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps
Published in Expert Review of Clinical Immunology, 2022
Juan Carlos Ceballos Cantu, Isam Alobid, Joaquim Mullol
The EUFOREA working group [67,69] established five criteria, subsequently endorsed by the EPOS 2020 [18] in the assessment of response to biologic therapy in CRSwNP (Figure 4). These criteria are mainly based on the improvement of CRSwNP and asthma outcomes. They are: 1) reduction in nasal polyp size (≥1 point); 2) reduction in the need for systemic corticosteroid use (≥1 course per year); 3) improvement in quality of life (≥8.9 SNOT-22 points); 4) improvement in sense of smell (improvement of anosmia to hyposmia or normosmia), assessed using an olfactory test; and 5) reduction in asthma impact (improvement in asthma control or severity or reduction in drug consumption). The response was categorized based on the number of achieved criteria: excellent (5 criteria), moderate (3–4 criteria), poor (1–2 criteria), or no (0 criteria) response. They recommended a first assessment to assess initial response at 16 weeks (4 months) after initiation of biologic therapy, with possible future modification of this assessment at 6 months. The second assessment should be performed one year after starting treatment. If at either of these two assessment points the patient does not show improvement (no response) in any of the criteria, treatment with biologics should be discontinued.
Loss of Ocular Surface Sensation in a Covid-19 Patient–a Novel Finding
Published in Ocular Immunology and Inflammation, 2022
Sertaç Argun Kivanç, Berna Akova
Syn-ropanethial-S-oxide, released when the onion is cut, is known as the lacrimator factor and it stimulates the ocular surface and the lacrimal gland without damaging it and allows this substance to move away from the eye surface by irrigating the eye.3 Therefore, it is expected to increase tearing in a normal ocular surface. However, our patient had no response to onion. He had decreased ocular surface sensation, loss of smell and taste. It has been reported that the coronavirus impairs the smell and taste.4 In COVID-19 autopsy cases, presence of high amount of high SARS CoV-2 was detected in the olfactory mucosa underneath the cribriform plate, olfactory bulb, trigeminal ganglion, and medulla oblongata.5 In another study, the virions of SARS CoV-2 were identified in the olfactory nerve, gyrus rectus and brain stem of COVID 19 patients and ultrastructural damage to the axons was shown.6 The anosmia or hyposmia is likely to be associated with the SARS CoV-2 damage to the neurons of olfactory nerve and bulb.