xRead - Olfactory Disorders (September 2023)

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605

PATEL et al.

TABLE IX-35 Use of TSS for the treatment of OD

Study design

Study groups

Study Miwa

Year 2005

LOE Drug

Clinical end point Conclusions

T&T olfactometer

TSS resulted in a greater improvement in OF than that seen with intranasal steroid treatment 43% of PIOD patients who had not responded to The improvement rate of patients who received treatment with intranasal steroid treatment alone, TSS oral administration alone, or a combination of steroids and TSS, for 3 months, was 29%, 55%, and 60%, respectively Cumulative olfactory recovery rate at 6, 12, and 24 were 47.3%, 62.7%, and intranasal steroids improved with TSS

4

TSS

Case series

60 patients

et al 1347

withPIOD andPTOD

Uchida

2009

4

TSS

Case series

31 patients withOD

T&T olfactometer

et al 1574

Ogawa

2010

4

TSS

Case series

30 patients

T&T olfactometer

et al 1575

withPIOD

Ogawa

2020

4

TSS

Case series

82 patients

T&T olfactometer

et al 1326

withPIOD

77.3%, respectively; cumulative olfactory cured rate in the same periods were 23.6%, 33.7%, and 61.0%, respectively; residual OF and younger age were prognostic factors LOE = level of evidence; OD = olfactory dysfunction; OF = olfactory function; PIOD = postinfectious olfactory dysfunction; PTOD = posttraumatic olfactory dysfunction; T&T = Toyoda and Takagi; TSS = Toki-shakuyaku-san.

5 Minocycline Minocycline is a second-generation tetracycline antibi otic that has been in use for over 30 years, primarily for the management of acne vulgaris and sexually trans mitted diseases. 1576 Minocycline, and the related drug doxycycline, exhibits mechanisms of action beyond their antibacterial effects including anti-inflammatory, anti apoptotic, and immunomodulatory effects, suggesting a potential role in the clinical management of dermatitis, periodontitis, rheumatoid arthritis, inflammatory bowel disease, allergic asthma, atherosclerosis, and CRS. 1577,1578 Both drugs are well tolerated with a low side-effect pro file enabling their long-term use in chronic disorders. 1579 Minocycline is also particularly lipophilic with excellent penetration of the CNS; hence, the potential for treat ment of neurologic disorders ranging from trauma to neu rodegenerative diseases. 1580 These properties suggest that minocycline could play a role in the management of olfac tory disorders as well.

populations, and validated assessment tools limit the inter pretability of results. Harm : There was no adverse event reported in these specific studies. An unknown frequency of the following symptoms has been reported in relation with general use of TSS: loss of appetite, stomach discomfort, nausea, vomit ing, abdominal pain, diarrhea, rash, skin itching, and liver function abnormality. Cost : Low. Benefits-harm Assessment : Inconclusive benefits with limited, but potential, harm. Value judgments : Although preliminary studies sug gest the benefit of TSS for POID, a higher LOE with con trolled studies is needed to accurately evaluate the effect of this medication. Policy level : No recommendation can be made at this time regarding the use of TSS for OD. Intervention : Well-designed studies using timing restriction for enrollment, controls, and validated mea sures to obtain higher a LOE is needed.