xRead - Olfactory Disorders (September 2023)

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PATEL et al.

TABLE IX-12 (Continued)

Clinical end point VAS (0–100)

Study

Year 2004

LOE Study design

Study groups CRS (N = 162) FPNS400 μ g

Conclusions Compared with

Djikstra

2

RCT

et al 1398

preoperative levels, therewas significant improvement in VAS in all groups placebo, there was no significant benefit in either FP groups placebo, there was no significant benefit in subjective symptom score in the FP group baseline, there was significant improvement in subjective symptom and objective test scores.

twice daily × 1 year (n = 53) twice daily × 1 year (n = 53)

FPNS800 μ g

Compared with

Placebo twice

daily × 1 year (n = 56)

Parikh

2001

2

RCT

CRS (N = 22) FPNS (n = 9) Placebo (n = 13)

Subjective

Compared with

et al 1399

symptom score (0–3)

Compared with

Mott

Subjective

1997

3

Cohort

CRS (both polyp and nonpolyp patients) Flunisolide nasal drops twice daily (n = 45)

et al 1403

symptom score (0–3)

Objective CCCRC

olfactory test Data collection:

between week 8 and week 26

CCCRC = Connecticut Chemosensory Clinical Research Center; CRS = chronic rhinosinusitis; CRSsNP = chronic rhinosinusitis without nasal polyps; CRSwNP = chronic rhinosinusitis with nasal polyps; FP = fluticasone propionate; LOE = level of evidence; MF = mometasone furoate; NS = nasal spray; RCT = randomized controlled trial; VAS = visual analog scale.

2 Surgical treatment for CRS or AR-related olfactory loss Surgical treatment of OD related to CRS and AR is pri marily designed to improve the nasal airway, such that odorant-containing air can reach the OC. Additionally, surgery might allow for more effective delivery of top ical medications that reduce mucosal inflammation. 1357 Most of the available surgical literature focuses on olfac tory outcomes following endoscopic sinus surgery (ESS) in CRS. Although there are various surgical therapies for management of allergic nasal symptoms refractory to medical management, the available postsurgical olfac tory outcomes data exist primarily for inferior turbinate surgery. 1441–1445 In patients with CRS, OD is associated with the presence of polyps, asthma, DM, and older age. 1358 ESS is usually considered after appropriate medical therapy has failed to control bothersome symptoms. 4 In most CRS stud ies investigating olfaction following ESS, patients are also

treated with maintenance medical therapy (eg, intranasal corticosteroid). Therefore, it is important to remember that recommendations for surgery assume ongoing medi cal therapy in most instances. The available clinical studies assess OF through subjective measures (eg, VAS and sub jective symptom scores) and objective psychophysical tests that include parameters such as forced-choice identifica tion, smell discrimination, and olfactory thresholds. There are few RCTs investigating olfactory outcomes fol lowing surgical intervention in CRS/AR. Much of the avail able olfactory literature is composed of prospective cohort studies or retrospective case series that focus on OF fol lowing ESS. Recent meta-analyses found that sinus surgery improves nearly all subjective and objective measures of olfaction in patients with CRS. 1446,1447 This benefit was most notable in patients with nasal polyposis and preop erative OD. While further high-level studies are needed, ESS may be recommended in patients with OD related to CRS in whom medical management has failed (Tables IX-19-IX-41 and Figure IX).