xRead - Olfactory Disorders (September 2023)

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600

INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-31 Use of omega-3 to treat OD Study Year LOE Study design

Study groups

Clinical end point

Conclusions

Postoperative UPSIT R at: 6weeks

Omega-3 protective

Yan

2020 1b

RCT

87 patients with sellar/parasellar tumors randomized to: Nasal saline irrigation (n = 41) Nasal saline irrigation and omega-3 supplementation (n = 46) 117 children with autism spectrum disorder randomized to:

et al 1564

against olfactory loss 6 months following sellar/parasellar surgery (odds ratio, 0.005; 95% CI, 0.003–0.81 [ P = 0.03]) polyunsaturated fatty acids with vitamin D is not shown to impact subjective smell and taste in children with autism spectrum disorder, (score change, − 2.3, 95% CI, − 4.7 to0.1 [ P = 0.06]) consumption of nuts and fish had reduced odds of olfactory impairment, independent of potential confounding. (adjusted odds ratio, 0.66; 95% CI, 0.44–0.97)

3months 6months

Mazahery et al 1566

2019 3*

RCT

Sensory Processing Measure

Omega-3 long-chain

taste/smell at baseline and 12-month follow-up

vitamin D (n = 31) omega-3 (n = 29) both (n = 28) placebo (n = 29)

Gopinath et al 1565

SDOIT baseline and 5-year follow-up

Adults aged > 60years with the highest

667 suburban Australians with cross-sectional

2015

3

Population-based observational cohort

dietary and olfaction data collected from FFQ and SDOIT olfactory test

*Level of evidence (LOE) downgraded because of differences in population (pediatric autism) and differences in outcome measures. FFQ = Food Frequency Questionnaire; OD = olfactory dysfunction; RCT = randomized controlled trial; SDOIT = San Diego Odor Identification Test; UPSIT R = University of Pennsylvania Smell Identification Test.

Harm : Mild side effects, if any, including unpleasant taste, headache, GI symptoms. Should not be used in patients with underlying bleeding disorders or taking other blood-thinning agents, as can also decrease clotting ability. Cost : Generally low-cost pharmacotherapy. Benefits-harm assessment : There is a benefit over placebo in protection from olfactory loss in patients who undergo endoscopic resection of sellar and parasellar masses as long as patients do not have underlying bleed ing disorders, are taking other blood-thinning agents, or cannot tolerate other minor side effects. Value judgments : It remains uncertain whether omega-3 supplementation may be beneficial in other causes of olfactory loss other than endoscopic resection of sellar and parasellar masses. Policy level : Recommendation for use of omega-3 in treating OD seen after endoscopic skull base surgery. It remains an option for treating other causes of OD. Intervention : Omega-3 supplementation can be used to treat OD in patients after endoscopic skull base surgery

and is an option for possible protection against other causes of olfactory loss. Additional RCTs with expanded causes of olfactory loss are warranted to prospectively eval uate clinical efficacy and treatment regimens. b. Zinc Zinc is involved in cell proliferation and is potentially an important element in maintaining OF. 452 Zinc sulphate was studied by Aiba et al 450 and Quint et al 1567 in patients with PVOD. Aiba et al showed that there was no subjec tive difference between their treatment arms. No objective measure was used, follow-up interval was not reported, and adverse reactions were not discussed. Similarly, Quint et al did not find a significant improvement. The response rates are in keeping with placebo or spontaneous recovery, highlighting the lack of evidence supporting the use of zinc sulphate. 450,452,458,1349,1350,1567 Lyckholm et al 452 foundzinc ineffective, and potentially with an adverse impact, when treating postchemotherapy anosmia in a small placebo controlled RCT. Jiang et al 1350 found in posttraumatic