Search

Objective: The prevalence of long-/post-COVID-associated chemosensory symptoms is reported in the literature to be significantly higher than clinical reality reflects., Methods: 1. N= 4062 adults acutely infected with SARS-CoV-2 and their symptoms transmitted by the Jena health office to the Robert Koch Institute between March 2020 and September 2021 were evaluated. 2. Part of the same cohort (N = 909 of 4062) answered an extensive questionnaire at least 3 months after the start of the infection, including existing chemosensory post-COVID-associated complaints. 3. Fourteen post-COVID Jena patients with chemosensory symptoms who had become acutely infected during the same period were diagnosed, treated and advised in our ENT specialist outpatient clinic., Results: The prevalence of chemosensory symptoms at the onset of infection was 19% (600/3187). About every second written respondent of the formerly acutely infected (441/890) remembered chemosensory symptoms during their COVID-19 infection. Of these, around 38% (167/441) complained of persistent chemosensory post-COVID symptoms after an average of 14.5 months. Only 2.3% (14/600) of the previously acutely infected patients with chemosensory symptoms sought medical help in a special consultation. Quantitative chemosensory damage could only be objectified in half, i.e. 1.2% (7/600) of the total cohort., Conclusions: Despite a high prevalence of subjective chemosensory symptoms in acutely and formerly SARS-CoV-2 infected people, there is only a low need for specialized treatment, so that, unlike other post-COVID-associated complaints, the healthcare system as a whole appears to be less significantly burdened., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The diagnostic of peripheral pulmonary nodules (PPN) is a particular challenge in interventional bronchology, which is why navigation systems such as electromagnetic navigation (ENB) are increasingly being used. The 4D-ENB represents the most current development of the ENB. It utilizes inspiratory and expiratory CT scans for mapping and thus helps compensate for respiratory movements-induced CT-to-body divergence. The aim of this work was to present the first clinical data and experiences using the 4D-ENB method for diagnosis of PPNs., Methods: We retrospectively describe the results of the first nine consecutive patient cases diagnosed at Klinikum Braunschweig using 4D-ENB in a unimodal diagnostic procedure., Results: Of the first 9 PPNs examined by 4D-ENB, navigation and puncture of the lesion was successful in 8 patients (89%). Diagnostic biopsy was could be carried out in six out of nine patients (67%). There were no significant procedure-related complications., Conclusion: Our preliminary data suggest that 4D-ENB is a promising new alternative for the diagnosis of PPNs. To further improve diagnostic yield, 4D-END, which lacks real-time visualization, should be embedded in a multimodal diagnostic procedure with rEBUS and/or fluoroscopy., Competing Interests: Thomas Bitter erhält Vortragshonorare und Reisekostenunterstützung von Olympus Europe. Die anderen Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Olfactory disorders are among the four most common post-COVID-19 complaints. The aim of our prospective study from a university ENT post-COVID consultation (PCS) was to substantiate the symptoms with psychophysical test results., Methods: After an ENT examination, 60 post-COVID-19 patients (41 women) were asked in writing about their medical history. Their ability to smell was tested using the extended Sniffin' Sticks test battery and their ability to taste was determined using the 3-drop test. From these data, three quantitative olfactory (RD) and gustatory (SD) diagnoses could be defined from normal value tables. Every second patient took part in a control examination., Results: Up to the first examination, 60 patients reported smell and 51 taste disorders; their average duration was 11 months in both cases. Objectified pathologic RD and SD had 87% and 42% of the total cohort, respectively. Every third patient suffered from an objectified combination of olfactory and gustatory damage. About every second patient complained of parosmia. Parosmic patients with two visits came earlier for a check-up. Six months after the initial examination, the detection thresholds, the TDI and the RD had improved in these patients. The self-assessment of olfactory ability had not changed., Conclusions: Objectified pathologic RD persisted in our PCS for a mean of 1.5 years from the onset of infection. Parosmics had a better prognosis. For the healthcare system and especially for the patients affected, they continue to be a burden even after the pandemic., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Disorders of the sense of smell and taste are often complained as a long-COVID symptom. In a special long-COVID consultation (ENT-LCS), we wanted to figure out how large the proportion of pathological olfactory or gustatory diagnoses actually is in this cohort., Methods: 48 adult patients who visited the ENT-LCS because of their own suffering were asked about their history, rated their ability to smell (SER) and taste (SES) with school grades and completed the extended Sniffin' Sticks test and the 3-drop test as a taste test. Diagnoses were made from the SDI smell score and the total taste score using normative values. Correlations were calculated between the measured scores and the self-assessment and between SER and SES., Results: Pathological chemosensory diagnoses were present in 90%. Pathological olfactory diagnoses were twice as common as gustatory ones. No pathological diagnosis could be verified in 10% of the cohort. Anosmia-ageusia syndrome was diagnosed in six patients. SER correlated strongly with SDI. SES correlated moderately with SScore-total. SER correlated strongly with SES., Conclusions: There is a risk of smell-taste confusion when interpreting reported chemosensory symptoms. This is another reason why reference is made to the importance of quantifying the chemical senses with validated tests., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Cardiac olfactory stimulus reactions could expand the range of objectifying test methods for testing olfactory function. In a pilot study, it was investigated whether and how pleasant and unpleasant odors change the heart rate (HR) and its variability., Methodology: 32 healthy people with normal smell function inhaled nasally for seven minutes the smell of four Sniffin' Sticks (banana, fish, garlic and rose) alternating with blanks. At the same time, the ECG was recorded and offline the NN intervals (distance of the R-waves) and six parameters of the heart rate variability were determined and compared with the values of a blank irritation using generalized estimation equations (GEE). In addition, the values of the subjective assessment of intensity and hedonic valence of the four odors were correlated with the heart rate., Results: The unpleasant odor fish smell increased the heart rate slightly but significantly in the first stimulus minute. The fish smell increased a single heart rate variability parameter (LF/HF) during the continuous stimulation, too, and showed a significant moderate correlation between HR and the scaling of intensity and hedonics in the first stimulus minute. The pleasant and the garlic odors did not affect the analyzed cardiac parameters., Conclusions: Olfactory evoked changes in HR should be further investigated as an indicator of the integrity of olfactory function. The most promising and time- and cost-effective is probably an 1-minute irritation with the unpleasant fishy smell from the identification set of the Sniffin' Sticks during the ECG recording., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Introduction: Breathing changes induced by repeated short olfactory stimuli are used as an objective indicator of the integrity of the olfactory system. Until now, it has not been investigated whether chemosensorically induced changes in inspiratory and expiratory time parameters can be suppressed intentionally. The same applies to breathing changes due to weak CO 2 stimuli., Methodology: 34 healthy adult normosmics were stimulated during relaxed regular nasal breathing using a flow olfactometer with nine differently concentrated H 2 S and three weak CO 2 stimulation pulses. They were instructed to intentionally maintain regular nasal breathing during the stimulation. A significant breathing change was present if the duration of the inspiration (DIN) or the expiration (DEX) of the first stimulatory breath was outside the double standard deviation of the mean of five prestimulatory regular breaths. These could be shortened or extended the DIN or DEX., Results: Despite high motivation, the chemosensorically induced breathing changes could not be suppressed intentionally. Rest breathing reacted to both stimulants by changes in both the inspiratory and the expiratory time parameters. However, it outweighed the expiratory reactions. CO 2 evoked more breathing changes than H 2 S. The frequency of reaction rate of H 2 S stimuli was not concentration-dependent. Strong H 2 S stimuli induced more frequent shortening than prolongation of DEX., Conclusions: Chemosensorically triggered breathing changes cannot be suppressed intentionally. They therefore provide an additional objective tool to check the functionality of nasal chemosensory afferents., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The detection rate of olfactory chemosensory event-related EEG Potentials (oCSERP) and trigeminal chemosensory event-related EEG Potentials (tCSERP) is also dependent on the stimulants and the evaluator of the averaged EEG curves., Methods: In 45 subjects with age-appropriate normal olfactory capacity (NP) and 20 anosmics (AN), oCSERP (stimulation by hydrogen sulphide, H 2 S 6 ppm and phenylethyl alcohol, PEA 30 % v/v,) and tCSERP (irritation with CO 2 20-60 % v/v, intensity standardized) were derived by default. Two investigators categorized the averaged EEG curves in: CSERP recognizable, no CSERP recognizable and artefact. Investigator 1 knew whether the subject was a NP or an AN, and which stimulants was used, whereas investigator 2 lacked this information., Results: AN needed higher trigeminal stimulus concentrations but showed same intensity ratings compared to NP. The attention (tracking game) did not deteriorate in the course of test. The detection rate of H 2 S-CSERP was higher than that of PEA-CSERP. The match of H 2 S-CSERP detection rates between the two investigators was higher than that of PEA-CSERP and CO 2 -CSERP., Conclusion: For the standard derivation of oCSERP, stimulation with H 2 S is usually sufficient. Stimulation with PEA and CO 2 as well as a blinded investigator is not necessary., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: In the attentive waking state, pleasant odours often prolong inhalation while unpleasant odours often shorten the exhalation. It should be checked whether this induced breathing pattern is maintained even during sleep., Methodology: 23 healthy normosmic adults were examined by polysomnography for one night and randomized pulsed either with H 2 S, phenylethyl alcohol (PEA) or CO 2 via a flow olfactometer. The determination of the sleep stages was based on the standard polysomnography curves. From the breathing curves (respiratory nasal pressure breathing, thoracic or abdominal belt breathing) a low-artefact curve was selected and seven breaths were measured from their breathing signal around the trigger impulse. The duration of inspiration (DIN) and the duration of the expiration (DEX) were determined from the six prestimulatory breaths and from breath with the stimulus onset and thus defined a reaction index (RI) indicating whether there is a significant change in shortening or prolonging DIN and/or DEX. These different RI were corrected by the spontaneous baseline RI and analysed according to the type of stimulus and the sleep stages., Results: Reaction indices with reductions of DEX were larger than spontaneous RI and RI for PEA and H 2 S stimulation. In the case of CO 2 irritation, RI with reductions of DIN and DEX were larger than with olfactory stimulation. All RI were equal in their amount between sleep stages. In REM, the difference between olfactory RI with shortened DEX between H 2 S and PEA stimulation was greatest., Conclusion: When stimulated with an unpleasant smell in sleep, the respiratory reaction pattern from the awake state is preserved. RI with shortened DEX can be considered as an imperfect arousal., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The active butanol detection thresholds (B-DT), determined using the sniffin' sticks, show a high intra- and inter-individual test-retest reliability, although the internal stimulus concentration may vary considerably depending on the dilution of the external stimulus concentration with odorless ambient air during active sniffing. There are various hypotheses for this surprising result. In this study, it should be tested whether a larger respiratory effort (vigor) under physical stress changes the active B-DT., Methods: In 28 young, healthy, normosmic adults, sitting on a stationary bicycle ergometer at rest phase, during aerobic exercise and in the recovery phase, the monorhinal B-DT using Sniffin' Sticks were determined. Various vital parameters such as blood pressure, heart frequency, body temperature, respiratory frequency and blood lactate characterized the three test phases. The individual stress perception was estimated according to the Borg scale., Results: The B-DT did not change in the three test phases. All examined vital parameters were significantly larger in the loading phase than in the resting phase. In the case of a moderate to severe stress sensation (Borg-scale: 13-15), an aerobic physical stress could be confirmed on the basis of the vital parameters., Conclusions: The investigations support the hypothesis that vigor is not the decisive factor for a constant olfactory perception of external equal stimulus concentrations. The integration of internal stimulus concentration and nasal flow velocity and the empirical evaluation of the current odor concentration probably play a greater role., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)