xRead - Olfactory Disorders (September 2023)

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563

PATEL et al.

TABLE IX-9 Evidence for CRSwNP-related olfactory loss management with anti-leukotriene therapy

Clinical end point B-SIT Data collection

Study

Year LOE Study design

Study groups

Conclusions

Compared with baseline, there was no significant benefit in B-SIT There was no significant

Stryjewska Makuch et al 1417

2019 2

RCT

AERD(N = 33) Following surgery: study arms:

point: month 12

MFNS200 μ g twice daily Montelukast 10 mg once daily MFNS200 μ g twice daily + montelukast 10 mg oncedaily CRSwNP (N = 72) Following surgery: study arms: MFNS300 μ g3 times daily (n = 36) MFNS300 μ g3 times daily + montelukast 10 mg once daily (n = 36)

difference in B-SIT score at month 12

VanGerven et al 1418

2018 2

Randomized,

BAST-24 VAS (0–4) Data collection

Compared with baseline, there was significant improvement in BAST score for both groups at all time points Compared with baseline, the MF NS only arms demonstrated significant benefit in VAS No significant difference in VAS scores at month 12 Compared with placebo, there was a significant improvement in zileuton group on VAS atweek6

postoperative open-label

point: month 3, month 6, month 12

Dahlén

VAS (0–10) Data collection

1998 2

RCT, crossover

AERD(N = 40) Oral zileuton 600 mg 4 times daily + baseline standard therapy (n = 40)

et al 1419

points: week 6

Placebo + baseline

standard therapy (n = 40)

AERD = aspirin-related respiratory disease; BAST-24 = Barcelona Smell Test-24; B-SIT = Brief Smell Identification Test; LOE = level of evidence; MF = mometa sone furoate; NS = nasal spray; RCT = randomized controlled trial; VAS = visual analog scale.

Macrolide antibiotics for OD in patients with CRSsNP Aggregate grade of evidence : B (Level 2: five studies). Benefit : No clear benefit in subjective or objective mea sures of olfaction. Some studies demonstrate improvement in endoscopy and other CRS-related symptom scores. Harm : GI side effects, ototoxicity, hepatotoxicity, car diotoxicity, and drug-drug interactions; potential microbial resistance. Cost : Direct: Low monetary cost. Indirect: Minimal. Benefits-harm assessment : Balance of benefit and harm. Value judgments : Optimal drug, dosage, and treat ment duration are not known. Policy level : No recommendation. Intervention : Lack of available data precludes a rec ommendation on macrolide therapy used specifically for olfaction.

Benefit : The data are mixed with many studies failing to show a difference and a few showing modest improve ment in subjective olfaction. There are very limited data on objective measures of olfaction. Harm : Relatively low with epistaxis, nasal irritation, headache possible side effects. Cost : Direct: Low to moderate monetary cost depending on formulation. Indirect: Minimal. Benefits-harm assessment : Balance of benefit and harm. Value judgments : Data to support efficacy are sig nificantly less robust compared with in patients with CRSwNP. Policy level : Option for the management of OD in patients with CRSsNP. Intervention : Topical nasal corticosteroids are an option for OD in patients with CRSsNP before or after sinus surgery.