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The process of olfaction, also known as the sense of smell, is a sophisticated chemical response system. The specialized sensory neurons that facilitate this process, known as olfactory receptor neurons, are situated in an upper segment of the nasal cavity, known as the olfactory epithelium. Olfactory sensory neurons are bipolar, with their dendrites extending from the epithelium's apex into the mucus that lines the nasal cavity. Airborne molecules, when inhaled, traverse the olfactory...
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The sense of smell is achieved through the activities of the olfactory system. It starts when an airborne odorant enters the nasal cavity and reaches olfactory epithelium (OE). The OE is protected by a thin layer of mucus, which also serves the purpose of dissolving more complex compounds into simpler chemical odorants. The size of the OE and the density of sensory neurons varies among species; in humans, the OE is only about 9-10 cm2.
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Humans detect odors with the help of specialized cells located in the upper part of the nasal cavity, called olfactory receptor neurons (ORNs). ORNs possess hair-like structures called cilia, which are receptive to sensations from the inhaled air. When an odorant molecule binds to a specific receptor on the cell of the cilia, it leads to a series of events that ultimately cause the ORN to send electrical signals to the olfactory bulb in the brain through the olfactory nerves.
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The nose is composed of an observable exterior segment (external nose) and an internal segment within the skull known as the nasal cavity (internal nose). The external nose, visible on the face, consists of a framework of bone and hyaline cartilage enveloped in skin and muscle and lined with a mucous membrane. This structure is supported by the frontal bone, nasal bones, and maxillary bone and is supplemented by a cartilaginous framework comprising the septal nasal cartilage, lateral nasal...
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Updated: Jan 15, 2026

High-Speed Human Temporal Bone Sectioning for the Assessment of COVID-19-Associated Middle Ear Pathology
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Olfactory cleft adhesion in post-COVID-19 olfactory dysfunction.

H Tanaka1, E Kubota1, N Otori2

  • 1Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, Japan; Department of Otorhinolaryngology, The Jikei University Kashiwa Hospital, Chiba, Japan.

European Annals of Otorhinolaryngology, Head and Neck Diseases
|October 14, 2025
PubMed
Summary
This summary is machine-generated.

Persistent post-COVID-19 olfactory dysfunction may stem from olfactory cleft adhesions. Endoscopic sinus surgery to release these adhesions offered significant improvement in smell for long-COVID patients.

Keywords:
AdhesionComputed tomographyEndoscopic sinus surgeryOlfaction disordersOlfactory cleftPost-COVID-19 olfactory dysfunction

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Area of Science:

  • Otolaryngology
  • Neurology
  • Infectious Diseases

Background:

  • Post-COVID-19 olfactory dysfunction (PCOD) affects a significant minority of patients long-term.
  • Persistent PCOD beyond one year suggests underlying mechanisms beyond acute viral damage.
  • Olfactory cleft adhesions may contribute to conductive olfactory loss in Long-COVID.

Purpose of the Study:

  • To investigate the role of olfactory cleft adhesions in prolonged PCOD.
  • To evaluate endoscopic sinus surgery (ESS) as a treatment for PCOD unresponsive to medical therapy.

Main Methods:

  • Retrospective analysis of four PCOD patients with persistent symptoms (>1 year) and CT-identified olfactory cleft obstruction.
  • Patients underwent ESS to divide adhesions and insert silicone plates to prevent reattachment.
  • Outcomes assessed via subjective olfaction reports, objective olfactory testing, and postoperative CT scans.

Main Results:

  • All four patients reported significant subjective olfactory improvement within one week of silicone plate removal.
  • Objective olfactory test scores showed continued improvement in the months following surgery.
  • Postoperative CT scans confirmed improved ventilation of the olfactory cleft.

Conclusions:

  • Adhesions in the olfactory cleft can cause conductive olfactory dysfunction in persistent PCOD, distinct from sensorineural mechanisms.
  • ESS may be a viable treatment for carefully selected patients with long-term PCOD and confirmed olfactory cleft obstruction.
  • Further research is needed to optimize surgical management and discuss risks like mucosal damage and potential lack of improvement.