xRead - Olfactory Disorders (September 2023)

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INTERNATIONAL CONSENSUS ON OLFACTION

TABLE IX-41 Phantosmia/parosmia surgical treatment options

Clinical end point

Study

Year LOE Study design Study groups

Conclusions

OC-blocking procedure is a novel, simple, safe, and effective procedure for patients with long-term peripheral parosmia Two studies looking at surgical intervention were included 1613,18 10 of 11 patients had resolution of symptoms Given the lack of strong evidence to date and risks associated with OC procedures, surgery should not be viewed as a definitive clinical tool but rather as an option within the All patients had resolution of phantosmia after surgical resection of olfactory neuroepithelium No patients experienced a CSF leak All experienced unilateral anosmia on the operated side 7 of 8 patients had complete and permanent resolution of their phantosmia Surgical excision is an effective and safe method to relieve phantosmia, but the procedure is technically challenging and carries the risk of CSF leak Resolution of phantosmia and return of OF research paradigm for managing phantosmia

Resolution of parosmia Preoperative and postoperative OF Resolution of phantosmia

Liu

2020 4

Case report

1 patient with peripheral parosmia underwent OC blocking

et al 1623

Saltagi

2018 4

Systematic review of retrospective case series

11 patients with phantosmia

et al 1314

undergoing medical and/or surgical treatment

Morrissey et al 1613

Resolution of phantosmia

2016 4

Retrospective case series

3 patients with

peripheral phantosmia who failed a 3-month trial of haloperidol underwent endoscopic resection of olfactory neuroepithelium

Leopold et al 18

2002 4

Retrospective case series

8 patients with phantosmia

Resolution of phantosmia Preoperative and postoperative OF Histologic findings Resolution of phantosmia Preoperative and postoperative OF Histologic findings

underwent intranasal excision of the OE

Leopold

1991 4

Case report

1 patient with unilateral phantosmia underwent intranasal excision of OE

et al 1622

CSF = cerebrospinal fluid; LOE = level of evidence; OC = olfactory cleft; OE = olfactory epithelium; OF = olfactory function.

OD, treatment of platelet-rich fibrin (second-generation PRP) during septoplasty demonstrated improved olfac tory outcomes in the early postoperative period com pared with no treatment, with no differences seen at 6 weeks, possibly reflecting the anti-inflammatory effects of PRP. 1612 PRP has very preliminary potential to improve treatment-resistant OD, particularly for patients with hyposmia. Further research in PRP’s biological effects on olfactory nerve regeneration as well as large, ran domized controlled clinical trials evaluating clinical

safety and efficacy are warranted, and a multicenter RCT examining multiple injections of PRP versus saline to treat PVOD is currently underway in the United States (NCT04406584). 1612 Use of PRP injections for treatment of OD. Aggregate grade of evidence : D (Level 2b: one study; Level 4: two studies). Benefit : PRP injection represents a safe treatment for OD with early but not well-elucidated potential, particu larly for hyposmic patients with persistent smell loss.