xRead - Olfactory Disorders (September 2023)

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565

PATEL et al.

TABLE IX-11 Evidence for CRSsNP-related olfactory loss management with oral corticosteroid therapy

Study design Study groups

Study

Year LOE

Clinical end point

Conclusions

Liuet al 1425

Loss of smell (yes or no) Combination antibiotic and steroid

2018 Case series,

4

Oral antibiotics, mean 19 days (n = 17) Oral methylprednisolone for 6 days OR prednisone for 20days (n = 28) Both oral antibiotics and oral steroids (n = 55) Oral prednisolone, starting dose between 40 mg and 60 mg for 10 to 14 days with a quick taper

retrospective

demonstrated the best improvement in subjective loss of smell improvement of olfactory detection and recognition

Ikedaet al 1426 1995 Case series

4

T&T olfactometer

Significant

CRSsNP = chronic rhinosinusitis without nasal polyps; LOE = level of evidence; T&T = Toyoda and Takagi.

Benefit : There is limited evidence that antihistamines improve OF in AR, with most studies showing no benefit. Further studies are needed. Harm : Relatively low with dry mouth, drowsiness, dizziness, nausea, mood disturbance, confusion, urinary retention, and blurred vision possible side effects. Side effects are greater with first-generation antihistamines and in elderly patients. Cost : Direct: Low to moderate monetary cost depending on formulation. Indirect: Minimal. Benefits-harm assessment : Balance of benefit and harm. Value judgments : Second-generation antihistamine recommended over first-generation given central/sedating effects of first-generation antihistamines. Policy level : Option for treatment of OD related to AR. Intervention : Antihistamines are an option for use in treatment of OD related to AR. Intranasal topical corticosteroids for OD in patients with AR Aggregate grade of evidence : B (Level 1: one study; Level 2: six studies; Level 3: two studies). Benefit : Data are mixed with some studies demon strating benefit of intranasal corticosteroids over placebo in subjective and objective measures of OF related toAR. 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 : Preponderance of benefit overharm. Value judgments : Increasing dosage of topical intranasal corticosteroid should be considered if the magnitude of observed clinical benefit is partial/limited. Policy level : Recommendation. Intervention : Use of topical nasal corticosteroids is rec ommended for OD related to AR. Immunotherapy for OD in patients with AR Aggregate grade of evidence : B (Level 1: one study; Level 2: one study; Level 3: four studies). Benefit : Improvement in subjective measures of OD related to AR among most studies. Data are limited with regard to objective measures. Harm : Rare risk of severe anaphylactic reaction, higher in asthmatics and those taking β -blockers. Local reactions may be more frequent. Cost : Direct: Moderate cumulative monetary cost depending on regimen. Indirect: Highly variable depending on fre quency/duration of treatment and inconvenience to patient’s daily life. Benefits-harm assessment : Variable for each individ ual patient. Value judgments : The decision to begin immunother apy is highly individualized and often driven by risks, direct costs, and convenience. A shared decision-making process is particularly important. Policy level :Option. Intervention : Immunotherapy is an option for OD related to AR, particularly those unresponsive to more conservative medical management measures and deemed lowrisk.