REEDUCATION OF OLFACTORY DISORDERS AFTER A CEREBRAL VASCULAR ACCIDENT IN ADULTS
REEDUCATION OF OLFACTORY DISORDERS AFTER A CEREBRAL VASCULAR ACCIDENT IN ADULTS
Study context:

 The literature identifies more and more research revealing olfactory disorders, with a high
 frequency after an acquired brain injury. So far, studies have mainly focused on
 post-traumatic and post-infectious olfactory disorders of the upper airways. There is scarcer
 data available on the olfactory disorders occurring after stroke. A recent study found 43.6%
 of patients with a loss of olfactory function after a stroke (2). This type of disorder can
 have repercussions in everyday life and endanger people, not being able to smell a burning
 odor or gas fumes. In addition, patients frequently describe loss of pleasure associated with
 these olfactory disorders (3). Tests allowing the evaluation of these difficulties exist but
 remain little used in clinical routine (4). These psychophysical tests allow a quantitative
 analysis of the olfactory capacities of subjects through various measures such as the
 detection threshold (T SST sub-score), discrimination (D SST sub-score) or the identification
 of an odor. (SST sub-score I). Some studies have shown a reduction in olfactory disturbances
 following specific training. Thus, Hummel et al. proposed a self-stimulation protocol to
 patients whose olfactory dysfunction was due to various aetiologies (post-infectious,
 post-traumatic or idiopathic) (5). People were to smell 4 scents twice a day for 12 weeks.
 The results show an improvement in the olfaction of the patients, while no change was noted
 in the subjects who did not perform the training. Lehrer et al. obtained similar results in
 patients with head trauma (CT) after 3 months of training (6). However, no study has looked
 at the effect of specific olfaction training in post-stroke patients. The few data available
 in the literature suggest that these disorders are common after stroke.

 Objectives :

 We propose an open, randomized controlled study, comparing the SST score between the group of
 patients who received olfactory training and the group who received standard rehabilitation.

 Material and methods :

 In the treatment of post-stroke olfactory disorders, we will suggest to patients hospitalized
 in SSR or followed in consultation to participate in a controlled, randomized open study.

 All included patients will be assessed using the SST and the modified ASOF quality of life
 questionnaire (7). After randomization, patients in the treatment group will benefit from a
 presentation of specific olfaction training. This training consists of smelling 4 scents
 twice a day using scent sticks, for 12 weeks. At the end of these 12 weeks, a post-protocol
 evaluation including the SST, the modified ASOF quality of life questionnaire and a
 measurement of any side effects related to training will be offered.

 Hypothesis tested:

 The aim of this work is to evaluate the effectiveness of a specific olfaction training
 protocol in patients with olfaction disorders following stroke.
Inclusion Criteria:

 -  Adult patient under 65 in order to avoid presbyosmia bias,

 -  Patient suffering from an ischemic and / or hemorrhagic stroke dating at least 3
 months,

 -  Patient followed in the SRH department and / or in post-stroke consultation,

 -  French-speaking patient,

 -  Patient affiliated to the social security scheme,

 -  Patient having signed the informed consent.

 Exclusion Criteria:

 -  Patient with a TDI score greater than 30.5 on the SST,

 -  Patient with global aphasia: score <25 on the oral comprehension subtest of MT86
 sentences (1),

 -  Person under legal protection (guardianship, curatorship, safeguard of justice),

 -  Patient treated with corticosteroids, corticosteroids, steroids, antihistamines and
 antibiotics which may have repercussions on olfaction,

 -  History of trauma to the face,

 -  History of ENT surgery,

 -  Chronic rhinitis,

 -  Infection of the ENT sphere in the 15 days preceding inclusion,

 -  Neurodegenerative pathology,

 -  Parosmia, phantosmia or cacosmia,

 -  History of systemic chemotherapy or radiotherapy to the head.