xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-10 Evidence for CRSwNP-related olfactory loss management with aspirin desensitization therapy

Clinical end point

Study Larivee

Year LOE Study design

Study groups

Conclusions

15 studies with smell data, the majority indicating significant improvement compared with control Compared with placebo, the aspirin desensitization group demonstrated significantly greater improvement in VAS at month 1 and month 6only Compared with placebo, no significant benefit in the aspirin desensitization group was noted on SS-ID at year 3 Compared with baseline, significant improvement in subjective symptom score in all groups There was no significant difference between groups Compared with baseline, subjective symptom score significant improvement at month 1 and was sustained at month 30

2020 1

Systematic review 24 total studies (RCTs, case-control, cohort) and 1272 patients undergoing desensitization

et al 1420

Swierczynska Krepa et al 1421

2014 2

RCT

AERD(N = 20) Aspirin desensitization followed by aspirin 624 mg (n = 12) Placebo (n = 8)

VAS (0–10) Data collection

point: month 1, month2, month3, month4, month5, month6

Fruth

SSl-ID Data collection: year 3

2013 2

RCT

AERD(N = 31) Following surgery: Study arms: Aspirin desensitization with 100 mg aspirin over 3 years (n = 18) AERD(N = 137) Following aspirin desensitization: Discontinuation group Aspirin 325 mg twice daily Aspirin 650 mg twice daily Placebo (n = 11)

et al 1422

Lee 1423

2007 2

RCT

Subjective

symptom score (0–5)

Data collection point: year 1

Cho 1424

Subjective

2014 4

Retrospective cohort AERD (N = 30) Following surgery patients underwent desensitization 1 month postoperatively Maintenance dosing at

symptom score (0–5) point: month 1, month6, month12, month18, month24, month30

Data collection

either aspirin 650 mg once daily in the am and 325 mg at bedtime Aspirin 325 mg twice daily

AERD = aspirin-related respiratory disease; ESS = endoscopic sinus surgery; LOE = level of evidence; RCT = randomized controlled trial; SS-ID = SS-ID = Sniffin’ Sticks identification only; VAS = visual analog scale.

Topical antifungals for OD in patients with CRSsNP Aggregate grade of evidence : A (Level 2: three stud ies). Benefit : No apparent benefit from using topical antifun gals. Harm : Treatment generally well tolerated with poten tial for local irritation; possible epistaxis and headache less common. Cost : Direct: Moderate monetary cost. Indirect: Minimal.

Benefits-harm assessment : Minimal risk of harm but no apparent potential for benefit. Value judgments : The role in invasive fungal disease is not considered here. Policy level : Strong recommendation against. Intervention : Topical antifungal agents are not recom mended for OD related to CRSsNP. Medical therapy for OD in patients with AR. Antihistamines for OD in patients with AR Aggregate grade of evidence : B (Level 1: one study; Level 2: three studies; Level 3: two studies).