xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX.25 (Continued) Author

Year LOE Study design

Study groups

Clinical end point Follow-up: 6 months UPSIT R

Conclusions

Nguyenand Patel 1522

2018 2

RCT

Population: 66 treated/67 controls All non-CRS or rhinitis causes, duration of loss: > 6months Severity of smell loss: NA Treatment Budesonide 0.5 mg/2 mL twice daily nasal rinses + OT Saline rinses + OT Population: 73 non-CRS causes Severity of smell loss: mixed, details NA Duration of loss: 2 to 520 months (mean 55 months) Treatment: All patients treated with beclomethasone 15 mg everyday × 20-day taper After 12 weeks, patients treated with topical budesonide 1.5 mg twice daily or budesonide + neomycin 7.5 mg every day

43.9% significant

improvement in budesonide rinses + olfactory training vs 26.9% improvement in saline + olfactory training ( P = 0.039) Younger age and shorter duration of olfactory loss were significant Oral steroids improved mean TDI from 15.5 to 18.7 ( P < 0.001) 27% had clinically meaningful improvement of TDI by at least 6 points Topical treatment did not further improve TDI overall (18.7 to 18.9 points), but 12% had clinically meaningful improvement in TDI No change with topical antibiotics predictors of improvement ( P < 0.0001 for both)

Stenner

2008 4

Retrospective Case series

Follow-up: 12 weeks SS-TDI

et al 1518

Follow-up: 12 weeks SS-TDI

CCCRC = Connecticut Chemosensory Clinical Research Center; CRS = chronic rhinosinusitis; EBRR = evidence-based review with recommendation; LOE = level of evidence; NA = not available; OT = olfactory training; RCT = randomized controlled trial; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination; TDI = threshold, discrimination, identification; URI = upper respiratory infection.

Harm : No adverse effects have been reported in these particular studies with systemic steroids; however, side effects and potential adverse events associated with this therapy are well known and must be considered on a case by-case basis. Topical steroids have a well-established and well tolerated low side-effect profile. Cost : Cost of steroid treatment options. Benefits-harm assessment : There are no reported adverse effects with the use of topical or systemic steroids for nonsinonasal disease–related anosmia. However, side effects of systemic steroids are well known and must be considered on a case-by-case basis. Value judgments : Steroid irrigations and systemic steroids may help improve nonsinonasal inflammatory– related anosmia.

Policy level : Systemic steroids are an option for treat ment of OD. Topical steroid irrigation is recommended in patients with OD. There is no recommendation for use of topical corticosteroid sprays or drops. There is no recom mendation for optimal head position. Intervention : The use of steroid irrigations, and poten tially systemic steroids, should be considered for treatment of patients with OD in an informed discussion between the patient and the provider. 2 Olfactory training OT is performed by smelling specific sets of odors twice daily for an extended period of time. Hummel et al, in a landmark study, first reported benefit from OT in