xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

contrast to weight loss, which is more likely in patients with hyposmia. 1642 Further research on eating alterations as a conse quence of OD is needed, utilizing validated tools. Although a questionnaire-based score has been proposed in OD research for the detection of eating alterations with excel lent reliability, 1643,1646 future investigators should con sider methods used in larger populations regardless of chemosensory function. 1644,1645 Besides these “assess ment” aspects, monitoring and counseling will need stan dardization. At this stage, patient counseling with dietary diaries on a daily basis for the duration of 4 weeks after first consultation regarding OD should be recommended. Moreover, it is suggested to at least document weight loss or gain. Patients with smell loss should be advised to control salt intake, and monitoring through general practitioners (eg, blood pressure and renal function) should be recom mended. Although it has been shown that many patients will learn to adjust and cope with OD in the long run, 1646 intermittent nutritive counseling by experts should be considered. Beyond monitoring, flavor enhancement of food may play a role in the future to improve palatabil ity and/or intake of dishes in patients with chemosensory complaints. 1647 The importance of physical activity, suffi cient hydration, and regular sleep should be part of patient management and counseling. Last, in case of a specific eat ing disorder accompanying OD, in addition to chemosen soric counseling, strategies that have shown to be effec tive in this selected field may be applicable and should be considered, such as cognitive behavioral therapy or psy chotherapy in binge-eating disorder. 1632 While a number of studies exist evaluating medical treat ment (for a review, see Boesveldt et al 11 ), to our knowledge no information on psychological interventions in the con text of olfactory disorders is yet available. In view of the negative side effects of the sensory loss on emotional state and general well-being reported by affected patients (see section The Individual Burden of OD), this seems strik ing. The following paragraph thus shortly elucidates avail able treatment approaches with regard to the psychological effects of OD. Psychological interventions should focus on three aspects in order to enable the best suitable therapeutic approach. First, as in every psychotherapeutic routine, a detailed diagnosis should be peformed to assess subjec tive suffering and impairments of categorical life areas in 3 Counseling or therapy for psychologic effects

order to capture different aspects of mental health. There fore, a standardized diagnostic interview (eg, Structured Clinical Interview [SCID] 1648 ) can be performed. The indi vidual diagnoses then should be treated with evidence based psychotherapeutic interventions (eg, for depressive disorders 1649 ). Besides these management strategies, par ticular effects of the olfactory loss on mental state have to be examined. The subjective importance of olfaction has to be explored in detail to: (1) evaluate the extent of individual impairment, and (2) develop suitable strate gies for detachment processes, eg, gaining acceptance of the situation. The individual significance of olfaction can be assessed by a questionnaire, 34 which comprises appli cation, association, and consequences of olfaction and thus gains insight in affected life areas. In that context, it is important to carefully explore and modify coping strategies 34 as currently used by the patient to ensure adap tive adjustment to the deficits. 38 Many patients with olfac tory disorders exhibit adequate emotionally focused cop ing strategies, eg, “trying to make the best of the situation” or “comparing one’s problems with those who are worse off,” 36,70 as well as gradually attributing less importance to the sense of smell in their daily life. 71 This allows emo tional detachment, which, in turn, serves maintenance of mental well-being despite the sensory loss. 1650 In gen eral, strategies to enable emotional acceptance, eg, prac ticing mindfulness, 1651,1652 are a valuable tool to sustain life quality and self-esteem. 1653–1655 Beyond that, commu nication strategies, eg, how willing the patient is to talk about the loss, should be targeted, as this has been shown to ease individual burden and help patients deal with the deficit. 1656 AND RESEARCH OPPORTUNITIES A Etiology 1 still characterized as idiopathic Current classification of OD is mainly based on the under lying etiology, such as rhinosinusitis, upper respiratory viral infection, and head trauma. If the cause of OD can not be specified, OD is classified as idiopathic. 246 Thediag nostic modalities for OD include careful history taking, endoscopic inspection of the nasal cavity, CT and MRI, and olfactory tests. Previous studies have demonstrated such diagnostic methods are useful to differentiate idiopathic olfactory loss from the OD of specific causes. For exam ple, CT imaging is useful for the diagnosis of OD associated Better delineate cause—many patients XI SUMMARY OF KNOWLEDGE GAPS