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Olfaction plays a priming role in both the anticipation and consumption phases of eating behavior. Olfactory dysfunction can therefore lead to changes in various aspects of eating behavior, such as food choice, appetite, and food intake. In light of the increasing prevalence of persistent olfactory dysfunction among patients affected by Covid-19, providing proper care and dietary advice to individuals with olfactory dysfunction is imperative. Therefore, this scoping review seeks to gain a better understanding of the impact of olfactory dysfunction on eating behavior. Following the PRISMA guidelines, 49 papers were included, the outcomes were presented by dividing them into two categories: 1) anticipatory eating behavior, including (anticipatory) food liking, appetite and craving, food preferences, food neophobia, and cooking habits; and 2) consummatory behavior, including, food intake, consumption frequency, adherence to dietary guidelines, (experienced) food liking, food enjoyment, and eating habits. Our results show that in the anticipatory phase of eating behavior, food liking, and, food preferences, and in the consummatory phase, food enjoyment is most affected in people who experienced a sudden change in olfactory function rather than a gradual decline. Moreover, changes in food flavor perception due to olfactory dysfunction, result in a shift of food preferences towards more “taste-based” preferences, such as salty or savory (i.e., umami) foods. Subsequently, changes in preferences can affect food intake and adherence to dietary guidelines, but only to a limited extent. Appetite is more likely to be low in individuals with short-term olfactory dysfunction compared to those with long-term changes. Generally, eating behavior is more impacted in individuals with a distorted sense of smell than in those with smell loss, and the effect becomes more pronounced over time. Due to the heterogeneity of methods used to measure different aspects of eating behavior, this r

IntroductionThe current study evaluated the use of platelet-rich plasma (PRP), an autologous blood product with supraphysiologic concentrations of growth factors, in the treatment of prolonged coronavirus disease 2019 (COVID-19)-related smell loss.MethodsThis multi-institutional, randomized controlled trial recruited patients with COVID-19 who had objectively measured smell loss (University of Pennsylvania Smell Identification Test [UPSIT] ≤ 33) between 6 and 12 months. Patients were randomized to three intranasal injections of either PRP or sterile saline into their olfactory clefts. The primary outcome measure was change in Sniffin' Sticks score (threshold, discrimination, and identification [TDI]) from baseline. The secondary end point measures included responder rate (achievement of a clinically significant improvement, ≥5.5 points TDI), change in individual TDI olfaction scores, and change in subjective olfaction via a visual analog scale.ResultsA total of 35 patients were recruited and 26 completed the study. PRP treatment resulted in a 3.67-point (95% CI: 0.05-7.29, p = 0.047) greater improvement in olfaction compared with the placebo group at 3 months and a higher response rate (57.1% vs 8.3%, odds ratio 12.5 [95% exact bootstrap confidence interval, 2.2-116.7]). There was a greater improvement in smell discrimination following PRP treatment compared with placebo but no difference in smell identification or threshold. There was no difference in subjective scores between PRP and placebo. No adverse effects were reported.ConclusionOlfactory function following COVID-19 can improve spontaneously after 6 months and can improve to a greater extent with PRP injection. These data build on the promise of PRP to be a safe potential treatment option for patients with COVID-19-related smell loss, and larger-powered studies will help further assess its efficacy.

This project explores opportunities in designing hybrid digital/physical smell rehabilitation video games using no unique game peripherals. During a 13-week process, three major iterations were created and externally tested on a small user group. The first two iterations contained five simple minigames that served to explore different types of game concepts. For the final iteration, two minigames were fully developed, a slow- and fast-paced game. The main findings were that slow-paced better-facilitated smell training than fast-paced games; aesthetics increased the player’s focus on small training; not utilising unique game peripherals limited the design opportunities and implementation of smell mechanics.

BackgroundRapid spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and concern for viral transmission by ambulatory patients with minimal to no symptoms underline the importance of identifying early or subclinical symptoms of coronavirus disease 2019 (COVID-19) infection. Two such candidate symptoms include anecdotally reported loss of smell and taste. Understanding the timing and association of smell/taste loss in COVID-19 may help facilitate screening and early isolation of cases.MethodsA single-institution, cross-sectional study evaluating patient-reported symptoms with a focus on smell and taste was conducted using an internet-based platform on adult subjects who underwent testing for COVID-19. Logistic regression was employed to identify symptoms associated with COVID-19 positivity.ResultsA total of 1480 patients with influenza-like symptoms underwent COVID-19 testing between March 3, 2020, and March 29, 2020. Our study captured 59 of 102 (58%) COVID-19-positive patients and 203 of 1378 (15%) COVID-19-negative patients. Smell and taste loss were reported in 68% (40/59) and 71% (42/59) of COVID-19-positive subjects, respectively, compared to 16% (33/203) and 17% (35/203) of COVID-19-negative patients (p < 0.001). Smell and taste impairment were independently and strongly associated with COVID-19 positivity (anosmia: adjusted odds ratio [aOR] 10.9; 95% CI, 5.08-23.5; ageusia: aOR 10.2; 95% CI, 4.74-22.1), whereas sore throat was associated with COVID-19 negativity (aOR 0.23; 95% CI, 0.11-0.50). Of patients who reported COVID-19-associated loss of smell, 74% (28/38) reported resolution of anosmia with clinical resolution of illness.ConclusionIn ambulatory individuals with influenza-like symptoms, chemosensory dysfunction was strongly associated with COVID-19 infection and should be considered when screening symptoms. Most will recover chemosensory function within weeks, paralleling resolution of other disease-related symptoms.

BackgroundRapid spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus has left many health systems around the world overwhelmed, forcing triaging of scarce medical resources. Identifying indicators of hospital admission for coronavirus disease 2019 (COVID-19) patients early in the disease course could aid the efficient allocation of medical interventions. Self-reported olfactory impairment has recently been recognized as a hallmark of COVID-19 and may be an important predictor of clinical outcome.MethodsA retrospective review of all patients presenting to a San Diego Hospital system with laboratory-confirmed positive COVID-19 infection was conducted with evaluation of olfactory and gustatory function and clinical disease course. Univariable and multivariable logistic regression were performed to identify risk factors for hospital admission and anosmia.ResultsA total of 169 patients tested positive for COVID-19 disease between March 3 and April 8, 2020. Olfactory and gustatory data were obtained for 128 (75.7%) of 169 subjects, of which 26 (20.1%) of 128 required hospitalization. Admission for COVID-19 was associated with intact sense of smell and taste, increased age, diabetes, and subjective and objective parameters associated with respiratory failure. On adjusted analysis, anosmia was strongly and independently associated with outpatient care (adjusted odds ratio [aOR] 0.09; 95% CI, 0.01-0.74), whereas positive findings of pulmonary infiltrates and/or pleural effusion on chest radiograph (aOR 8.01; 95% CI, 1.12-57.49) was strongly and independently associated with admission.ConclusionNormosmia is an independent predictor of admission in COVID-19 cases. Smell loss in COVID-19 may be associated with a milder clinical course.

BackgroundOlfactory dysfunction is a prevalent problem with a significant impact on quality of life and increased mortality. Limited effective therapies exist. Platelet-rich plasma (PRP) is an autologous biologic product with anti-inflammatory and neuroprotective effects. This novel pilot study evaluated the role of PRP on olfactory neuroregeneration in patients with hyposmia.MethodsSeven patients who had olfactory loss greater than 6 months in duration, no evidence of sinonasal inflammatory disease, and no improvement with olfactory training and budesonide topical rinses were enrolled in this preliminary study. Patients received a single intranasal injection of PRP into the mucosa of the olfactory cleft. The Sniffin' Sticks olfactory test consisting of threshold, discrimination, and identification measurements (TDI) was administered at the beginning of the study and at 1 and 3 months.ResultsAll patients reported a subjective improvement of their smell shortly after injection but then stabilized. At 3-month post-treatment, two patients with functional anosmia (TDI < 16) did not improve significantly. Five patients with hyposmia (TDI > 16 but <30) showed an improvement with 60% achieving normosmia (TDI > 30) at 3-month follow-up. On average, patients with baseline TDI > 16 improved by 5.85 points with the most significant improvement in the threshold subcomponent. There were no adverse outcomes from intranasal PRP injections.ConclusionPRP appears safe for use in the treatment of olfactory loss, and preliminary data suggest possible efficacy, especially for those with moderate yet persistent loss. Further studies will help determine optimal frequency and duration of use.Level of evidence 2b

The association of smell and taste loss with COVID-19 has been well demonstrated with high prevalence rates. In certain cases, chemosensory loss may be the only symptom of COVID-19 and may linger while other symptoms have resolved. The significance of persistent smell and taste loss and its relationship to ongoing viral shedding has yet to be investigated. In this cross-sectional study, of the 316 laboratory test-confirmed COVID-19 cases at our institution, 46 had subsequent test-based confirmation of viral clearance with 2 consecutive negative RT-PCR test results (reverse transcriptase polymerase chain reaction). Olfactory dysfunction was reported by 50% of the patients (23 of 46), with 78% (18 of 23) having subjective persistent smell loss despite negative RT-PCR test results. These preliminary data demonstrate the persistence of self-reported smell loss despite otherwise clinical resolution and undetectable nasal viral RNA.

Olfaction plays a major role in food intake regulation. Losing the sense of smell might therefore affect eating behavior. This study investigated food preferences and intake in individuals suffering from self-reported smell loss with an online survey. Members of the Dutch Anosmia Foundation (DAF) performed the Macronutrient and Taste Preference Ranking Task (n = 71) to measure preference for foods high in fat, carbohydrates or protein and low energy foods, and for sweet and savory tastes. To assess dietary intake, adherence to the Dutch Dietary Guidelines for consumption of vegetables, fruit, fiber, fish, saturated fat, trans fatty acids, salt and alcohol was measured (n = 105). Results of the DAF participants were compared to local cohort groups. Both the control and DAF participants showed the lowest preference for carbohydrate-rich foods and highest preference for low-energy foods. Participants suffering from congenital smell loss showed an aberrant pattern, with a higher preference for fat. The total adherence score to the Dutch Dietary Guidelines was similar for the control and DAF group, but adherence scores for fiber, trans fatty acids and alcohol were lower in DAF participants. Overall, no major significant differences in food preferences and intake were found for participants who lost their sense of smell during life. Participants suffering from congenital smell loss did show changes in food preferences, suggesting they are potentially more taste-oriented during eating. Together these results show the importance of tailored advice on dietary intake for this patient group.