IP: 94.158.23.46 On: Fri, 08 Nov 2019 22:34:04 Copyright: American Scientific Publishers Delivered by Ingenta Copyright © 2018 American Scientific Publishers All rights reserved Printed in the United States of America RESEARCH ARTICLE Advanced Science Letters Vol. 24, 6941–6944, 2018 The Effectiveness of Olfactory Training in Elderly with Anosmia Evidence Base Case Report Febriani Endiyarti 1 ∗ and Pukovisa Prawiroharjo 2 1 Otorhinolaryngology Department, Faculty of Medicine, Universitas Indonesia, Indonesia 2 Neurology Department, Faculty of Medicine, Universitas Indonesia, Indonesia Background: Olfactory disturbance increases with age and should not be ignored. Olfactory training (OT) is cheap, easy to perform and considered as a treatment to overcome anosmia in the elderly. The aim of this case study was to found the effectiveness of olfactory training in elderly by evidence report. Methods: This literature review was conducted using EBSCOhost, PubMed, and ProQuest. Clinical question used in this paper was “does olfactory training give advantages for olfaction in elderly?” Search was performed using keywords ((“olfactory training” AND (elderly OR Older OR old age)). Inclusion criteria were published in 2007–2017, ther- apeutic study, cohort method, in vivo, human sample, English language and available in full text. Exclusion criteria were studies that performed additional examinations such as histopathology or imaging procedure, or sample had neurodegenerative diseases. Results: From the searching method, we found two relevant arti- cles. The first article was a randomized controlled trial, not blinded, and enrolled 91 subjects (60 OT groups, 31 control groups); significant improvement on olfactory function was found in OT groups after 5 months. The second article enrolled 91 subjects (43 OT groups, 48 control groups) but didn’t find significant improvement of olfactory function after 3 months follow-up. Conclusion: Olfactory training may be an option to treat olfactory disturbance in elderly, but requires more researches with blinded, randomized controlled trial methods, and on longer period. Keywords: Elderly, Olfaction, Olfactory Training. 1. INTRODUCTION A literature stated that olfactory disturbance presents in over half people with age of 65 to 80 years and in over three- quarters of those over the age of 80 years. 1 Olfaction plays important role in social and emotional aspect. Deteriorating olfaction can decrease appetite, causes emotional problem and self-insecurity, decreases self-confidence, and predicts neurode- generative diseases. 2 3 Pathophysiology of olfactory disturbance in elderly involves multiple factors, including structural changes, nose disorders (nasal airflow patterns, mucous composition, sympathetic-parasympathetic regulation), olfactory epithelium disorders (decreased number of receptors and thinning of the epithelium), ossification and reduction of the cribriform plate foramina, bulb problems (atrophy, loss of neuronal element and increasing astroglia), brain alteration (changes in suprachiasmatic nucleus that control a number of biological rhythms, decreased brain weight, cortical thickness, white matter integrity and trans- mitter activity), increased tendency for nasal disease (chronic rhinosinusitis, nasal polyposis), cumulative damage to the olfac- tory epithelium (exposures to airborne environmental agents ∗ Author to whom correspondence should be addressed. including air pollution, cigarette-smoke, viruses, bacteria and other xenobiotics), decreasing mucosal metabolizing enzymes, changes in neurotransmitter and neuromodulator systems, and abnormal deposits ( synuclein, Lewi bodies or -amyloid) that are associated with neurodegenerative disease. 1 Several times ago, there was no specific medication to treat olfactory disturbance in general, especially anosmia in elderly. Nowadays, olfactory training was investigated in many litera- tures and gives advantages in anosmia due to trauma and post- infection. Olfactory training is an exercise to improve the ability to smell by sniffing frequently. It should be performed on four different odors; flowery, fruity, spicy, and resinous. It should be performed twice a day for a certain time period. Olfactory train- ing can promote the growth of olfactory receptors. 4 This paper aimed to investigate the effectiveness of olfactory training in elderly. Olfactory training was assumed to be able to increase olfactory performance in anosmia. 1.1. Case Resume 64 years old female came to ENT outpatient clinic with deteri- orating olfaction since three years prior. It gradually worsened until she could not smell anything anymore. She didn’t complain Adv. Sci. Lett. Vol. 24, No. 9, 2018 1936-6612/2018/24/6941/004 doi:10.1166/asl.2018.12891 6941