xRead - Olfactory Disorders (September 2023)

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603

PATEL et al.

TABLE IX-32 (Continued) Study Year

LOE Study design

Study groups

Clinical end point Conclusions

No statistically

6months Forced-choice,

Henkin

1976

3

Double-blinded, crossover

Patient cohort: variety of causative factors for olfactory loss (N = 106) Crossover between placebo and zinc gluconate

et al 1349

significant effects of zinc on either taste or smell function were found

3-stimulus sniff test

LOE = level of evidence; OD = olfactory dysfunction; OF = olfactory function; PVOD = postviral olfactory dysfunction; SS = Sniffin’ Sticks; SS-ID = Sniffin’ Sticks identification only; SS-TDI = Sniffin’ Sticks threshold, discrimination, identification combination.

TABLE IX-33 Useof α -lipoic acid to treat OD

Clinical end point

Study

Year 2002

LOE Study design

Study groups

Conclusions

Hummel et al 1569 35% had an increase in TDI score by at least 5.5 Threshold only subscore to reach significance Negative correlation with age and improvement LOE = level of evidence; OD = olfactory dysfunction; TDI = threshold, discrimination, and identification; SS-TDI = threshold, discrimination, and identification. 4 Prospective observational study (n = 23) Anosmia α -lipoic acid 600 mg daily Hyposmia α -lipoic acid 600 mg daily Median follow-up 4 months (3–11) SS-TDI

and different causes of olfactory loss (ie, postinfectious, posttraumatic, and sinonasal) (ClinicalTrials.gov Identi fier: NCT03574701). 1573 Use of vitamin A treatment for OD Aggregate grade of evidence : C (Level 2: one study; Level 4: four studies). Benefit : Local topical vitamin A application led to an improvement in OF in patients with postinfectious smell loss, but these are low-evidence studies. The effect was less pronounced in posttraumatic patients, but also present. No benefit was seen for systemic vitamin A. Harm : Potential local irritation. Potential for vitamin toxicity if taken systemically. (Contraindication for people with peanut allergy when Benefits-harm assessment : Potential benefit of local vitamin A treatment for OD likely outweighs potential for local irritation in nasal cavity. No benefit for systemic vita minA. Value judgments : In contrast to the potential added value of local vitamin A treatment in OD, the evidence does not support even potential benefit for systemic treat ment (three case series and noncontrolled studies and evi dence of a lack of effectiveness in one RCT), so this modal ity holds no value. Policy level : Use of local application of vitamin A is an option in patients with postinfectious and PTOD. Use of systemic vitamin A is recommended against. using peanut oil as an additive). Cost : Very low therapy costs.

Intervention : The potential benefit of topical vitamin A and the potential for local irritation can be discussed with the patient and if the shared decision-making process leads to choosing this option for treatment, it can be adminis tered intranasally with the patient in the Kaiteki position at a dose of 10,000 IU once daily for 8 weeks. e. Toki-shakuyaku-san TSS, a traditional Japanese herbal drug (combination of six medical plants: Japanese angelicae root, peony root, cnid ium rhizoma, aractylodes lanceae rhizoma, alismatis rhi zome, and pria sclerotium), has been widely used in Japan for the treatment of patients with gynecological disorders, including climacteric disturbance, menstrual irregularity, dysmenorrhea, and infertility. It has also been approved for the above diseases by the Japanese Ministry of Health, Labour and Welfare. In recent years, TSS has also been pre scribed in Japan for patients with PIOD and has shown efficacy in improving OF, although the studies all have a low LOE. Recent clinical practice guidelines 449 published by the Japanese Rhinologic Society stated that TSS may be effective for the treatment of PIOD, but placebo-controlled studies are necessary to accurately evaluate the effect of these drugs on PIOD. Miwa et al 1347 reported that the treat ment of PIOD with TSS resulted in a greater improvement in OF than that seen with intranasal steroid treatment. Uchida et al 1574 treated patients with PIOD who had not responded to intranasal steroids with TSS or Ninjin’yoeito, another Japanese herbal medicine, and the improvement rate was 43% and 36%, respectively. Ogawa et al 1575 also