xRead - Olfactory Disorders (September 2023)

20426984, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22929, Wiley Online Library on [04/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

568

INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-13 Evidence for CRSsNP related olfactory loss management with oral macrolide antibiotic therapy Study Year LOE Study design Study groups Clinical end point

Conclusions

VAS (0–10)

Compared with baseline, there was significant improvement in both groups No difference between treatment groups

Deng

2018 2

RCT

CRSsNP (n = 32), CRSwNP (n = 42) 3months Oral clarithromycin 0.25 g/day and budesonide NS256 μ g once daily Budesonide NS 256 μ g oncedaily CRS Oral erythromycin 250 mgdaily (n = 29) Placebo (n = 29) Total (N = 58) 3months CRSsNP (n = 29) and CRSwNP(n = 31) Medical group (n = 30): oral azithromycin 500 mg once daily × 3 days, then weekly for 11 weeks Placebo (n = 30)11 weeks CRSsNP (n = 43) MFNS200 μ g once daily × 12weeks Oral clarithromycin 250 mg tablet once daily × 12weeks Data collection point: week 4, week 8, week12 CRSsNP without ESS Oral roxithromycin 150 mg once daily (n = 29) Placebo (n = 35)

et al 1430

Haxel

2014 2

RCT

SS-ID (12 odors)

Compared with placebo, there was no

et al 1363

significantly greater improvement in the erythromycin group

SS-ID (12 odors) VAS (0-3)

Compared with placebo, there was no

Videler

2011 2

RCT

et al 1366

significantly greater improvement in the azithromycin group

Zeng

2011 2

RCT

Subjective symptom score (0–3)

Compared with baseline, the mometasone group demonstrated significant improvement at week 4only There was no significant improvement in the clarithromycin group Compared with baseline, neither group demonstrated significant improvement There was no difference between roxithromycin and placebo

et al 1427

Wallwork 1431

SS-TDI

2006 2

RCT

CRS = chronic rhinosinusitis; CRSsNP = chronic rhinosinusitis without nasal polyps; CRSwNP = chronic rhinosinusitis with nasal polyps; ESS = endoscopic sinus surgery; LOE = level of evidence; MF = mometasone furoate; NS = nasal spray; RCT = randomized controlled trial; SS-ID = Sniffin’ Sticks identification only; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination; VAS = visual analog scale.

The available evidence on OF following inferior turbinate surgery in AR is very limited and is composed of prospective cohort studies and retrospective case series. Additionally, many of the included studies look broadly at patients with CRS, but the majority of these CRS cohorts include patients with AR. While these studies demonstrate improvement in subjective measures of olfaction following turbinate reduction, the data on objective measures are mixed. 1441,1443 Although turbinate reduction is generally

performed in patients with AR who have nasal congestion refractory to medical therapy, no recommendation can be made for patients with AR-related OD because of the paucity of available evidence. ESS is effective in treating OD related to CRS in patients who have failed medical therapy alone. Surgery should be part of a multimodal regimen that includes maintenance intranasal corticosteroids. Benefits are most notable for patients with CRSwNP and those with poor preoperative