xRead - Olfactory Disorders (September 2023)

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PATEL et al.

TABLE IX.2 (Continued) Study

Year LOE Design

Study groups

Clinical end point

Conclusions

Corticosteroids may

T&T olfactometer outcomes: 1 of 12 (8%) improved by topical betamethasone 3 of 5 (60%) improved by oral prednisolone PEA threshold outcomes: 16% improved by oral steroids

Ikeda

1995

4

Retrospective 17 patients with PTOD 12 of 17 topical nasal drop of 0.1% betamethasone 5of 12oral administration of prednisolone Retrospective 116 patients with PTOD Oral prednisolone (60 mg/day for 3 days, tapered every 3 days for 15 days)

induce regeneration of OR cell axons and reestablishment of contact with cells in theOB

Jiang

2010 4

Oral steroid

administration is effective in limited

patients with posttraumatic dysfunction

Vitamin A is not useful in the treatment of PTOD

SS-TDI outcomes No significant improvement

Reden

2012 1

Prospective

19 patients with PTOD 10 of 19 vitamin A 10,000 IU/day oral administration for 3 months 9 of 19 placebo controls

Altundag 2021

4

Retrospective 52 patients with PTOD OT

SS-TDI outcomes: 16 of 52 (31%) responders toOT 36 of 52 (69%) nonresponders SS-TDI outcomes Greater threshold improvement in anosmic patients Better identification ability in hyposmic patients

Good prognosticators were no cribriform plate fracture, no OB encephalomalacia, no siderosis, deep olfactory fossa, and largeOBV OT is effective for both anosmia and hyposmia

Pellegrino 2019 2

Prospective

42 patients with PTOD 18 of 42 hyposmia 24 of 42 anosmia

LOE = level of evidence; OB = olfactory bulb; OR = olfactory receptor; OT = olfactory training; PEA = phenylethyl alcohol; PTOD = posttraumatic olfactory dysfunction; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination; T&T = Toyoda and Takagi; TSS = Toki-shakuyaku-san.

looking at psychophysical metrics are needed. Dupilumab and omalizumab have been studied in patients with severe CRSwNP and, based on grade A evidence that includes studies assessing subjective and psychophysical metrics, these medications are recommended for OD related to severe CRSwNP after failure of other medical and surgi cal treatment options, as part of a patient-centered shared decision-making process. There is limited grade B evidence for mepolizumab, with available evidence demonstrating benefit in subjective measures of OD only. 1361 Oral antibi otics and antileukotriene therapy have been studied with RCTs, but they do not appear to provide clear benefit in regards to olfaction, which therefore precludes their rou tine use specifically for OD in patients with CRSwNP. In patients with CRSwNP caused by AERD, aspirin desensiti zation, and daily aspirin therapy may be considered, partic ularly as an option following sinus surgery. There are few randomized controlled clinical trials investigating aspirin

use, and the benefit on olfaction is unclear with mixed study results. Further studies are needed. Topical steroids are the mainstay of medical treatment of OD in patients with CRSwNP and should be used as maintenance therapy in light of their minimal side-effect profiles. Benefits have been noted as early as after 1 week of regular use. Oral steroids may be recommended, but should be administered infrequently and for short durations because of systemic side effects. Studied dura tion of oral steroid treatment in patients with CRSwNP ranges from 1 to 2 weeks with evidence suggesting that there is an initial benefit with return to baseline symptoms within 3 months following treatment. 1362 For biologics, available evidence suggests that subjective and psychophysical scores decline as early as 8 weeks after cessation of therapy. 219 Assessing the comparative effectiveness of topical steroids, oral steroids, and biologics is challenging because of the variable patient populations