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

592

INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-27 (Continued) Author

Year LOE Study design Study groups

Clinical end point Conclusions

4 of 34 (11.8%) improved with steroid vs 1 of 37 improved (2.7%) in the no treatment group (not statistically significant) Younger patients more likely to improve ( P = 0.007) clinically significant improvement ( ≥ 6TDI patients), mean TDI improvement 3.25 points Idiopathic etiology: 12.1% clinically significant, meanTDI improvement 1.0 point URI etiology: 29.6% clinically significant improvement, mean TDI improvement 4.5 points Oral steroids improved mean TDI from 15.5 to 18.7 ( P < 0.001), 27% had clinically meaningful improvement ( ≥ 6TDI patients) Topical treatment did not further improve TDI overall 18.7 to 18.9 patients, but 12% had clinically meaningful improvement TDI No change with topical antibiotics All causes 26.6%

Follow-up: 3 to 15.5 months (mean 5.6

RCT

Population: trauma, 34 treat/37 controls Severity of smell loss: all anosmic Duration of loss: 0.5 to 180 months Treatment: Prednisolone (1 mg/kg per day taper for 2 weeks) No treatment Zinc Zinc with prednisolone Population: N = 204: idiopathic (n = 157),URI (n = 27), trauma and other (n = 20) Severity of smell loss: Mixed Duration of loss: mean 67 ± 76months Treatment: 40 mg methylprednisolone × 14 days with taper Population: 73 all 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 oral 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 Follow-up: 20 days (after oral steroids only) Olfactory measurement: SS

Jiang

2015 2

et al 1350

( < 80%

months) PEA threshold test

follow up)

Schriever et al 1535

2012 4

Retrospective case series

Follow-up: 2 visits SS-TDI

Follow-up: 20 days (after oral steroids only) SS-TDI

Stenner

2008 4

Retrospective case series

et al# 1518

*Also included in Table 1, studies included both topical and systemic steroid use. #Also included in Table 1, patients were treated first with systemic steroids then topical steroids.

CRS = chronic rhinosinusitis; EBRR = evidence-based review with recommendation; LOE = level of evidence; NA = not available; OD = olfactory dysfunction; PEA = phenylethyl alcohol; RCT = randomized controlled trial; SS = Sniffin’ Sticks; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination; T&T = Toyoda and Takagi; TDI = threshold, discrimination, and identification; UPSIT R = University of Pennsylvania Smell Identification Test; URI = upper respiratory infection; VAS = visual analog scale.