Abstract
Introduction: There are limited treatment options for postinfectious olfactory dysfunction (PIOD). Olfactory training has recently been used in clinical practice, but no medical treatment is widely accepted. Although there is weak evidence for their value, some physicians use oral corticosteroids as first-line treatment. The aim of this study was to compare combined oral methylprednisolone and olfactory training with olfactory training alone in the management of PIOD. Methods: This prospective cohort study included 131 patients with PIOD over a 2-year period before the COVID-19 pandemic. Seventy-eight patients who were treated with oral methylprednisolone and olfactory training (group A) were compared with 53 patients who were treated with olfactory training only (group B). Olfactory function was evaluated with “Sniffin’ Sticks” at baseline and 2, 8, and 16 weeks after initial assessment. Patients who improved after steroid treatment underwent magnetic resonance imaging of the paranasal sinuses, skin prick tests, lung spirometry, and sputum eosinophil assessment. Results: Oral steroids improved 19.23% of patients (n = 15) of group A. History, clinical evaluation, imaging, and laboratory tests identified an inflammatory background in half of them (n = 8). The remaining 7 had no findings of nasal inflammation, and all had a short history of olfactory dysfunction. Both groups significantly improved in olfactory testing results at the end of the olfactory training scheme without significant difference between them. Conclusions: The percentage of improved patients after oral methylprednisolone was relatively low to suggest it as first-line treatment. Half of the improved patients had an underlying upper airway inflammatory condition not related to the infection that caused the acute loss of olfactory function.
References
1.
Landis
BN
, Konnerth
CG
, Hummel
T
. A study on the frequency of olfactory dysfunction
. Laryngoscope
. 2004 Oct
;114
(10
):1764
–9
. .2.
Hummel
T
, Whitcroft
KL
, Andrews
P
, Altundag
A
, Cinghi
C
, Costanzo
RM
, Position paper on olfactory dysfunction
. Rhinol Suppl
. 2017 Mar
;54
(26
):1
–30
. .3.
Reden
J
, Mueller
A
, Mueller
C
, Konstantinidis
I
, Frasnelli
J
, Landis
BN
, Recovery of olfactory function following closed head injury or infections of the upper respiratory tract
. Arch Otolaryngol Head Neck Surg
. 2006 Mar
;132
(3
):265
–9
. .4.
Seo
BS
, Lee
HJ
, Mo
JH
, Lee
CH
, Rhee
CS
, Kim
JW
. Treatment of postviral olfactory loss with glucocorticoids, Ginkgo biloba, and mometasone nasal spray
. Arch Otolaryngol Head Neck Surg
. 2009 Oct
;135
(10
):1000
–4
. .5.
Kim
DH
, Kim
SW
, Hwang
SH
, Kim
BG
, Kang
JM
, Cho
JH
, Prognosis of olfactory dysfunction according to etiology and timing of treatment
. Otolaryngol Head Neck Surg
. 2017 Feb
;156
(2
):371
–7
. .6.
Fleiner
F
, Lau
L
, Goktas
O
. Active olfactory training for the treatment of smelling disorders
. Ear Nose Throat J
. 2012 May
;91
:198
–215
. .7.
Nguyen
TP
, Patel
ZM
. Budesonide irrigation with olfactory training improves outcomes compared with olfactory training alone in patients with olfactory loss
. Int Forum Allergy Rhinol
. 2018 Sep
;8
(9
):977
–81
. .8.
Konstantinidis
I
, Printza
A
, Genetzaki
S
, Mamali
K
, Kekes
G
, Constantinidis
J
. Cultural adaptation of an olfactory identification test: the Greek version of Sniffin’ Sticks
. Rhinology
. 2008 Dec
;46
(4
):292
–6
..9.
Oleszkiewicz
A
, Schriever
VA
, Croy
I
, Hähner
A
, Hummel
T
. Updated Sniffin’ Sticks normative data based on an extended sample of 9,139 subjects
. Eur Arch Otorhinolaryngol
. 2019 Mar
;276
(3
):719
–28
. .10.
Gudziol
V
, Lötsch
J
, Hähner
A
, Zahnert
T
, Hummel
T
. Clinical significance of results from olfactory testing
. Laryngoscope
. 2006 Oct
;116
(10
):1858
–63
. .11.
Haynes
JM
. Basic spirometry testing and interpretation for the primary care provider
. Can J Respir Ther
. 2018 Winter
;54
(4
). .12.
Demarche
SF
, Schleich
FN
, Paulus
VA
, Henket
MA
, Van Hees
TJ
, Louis
RE
. Asthma control and sputum eosinophils: a longitudinal study in daily practice
. J Allergy Clin Immunol Pract
. 2017 Sep–Oct
;5
(5
):1335
–e5
. .13.
Global Initiative for Asthma
. Global strategy for asthma management and prevention
. 2020
. Available from: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_04-1-wms.pdf Accessed 2020 Jul 11.14.
Bousquet
J
, Khaltaev
N
, Cruz
AA
, Denburg
J
, Fokkens
WJ
, Togias
A
, Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)
. Allergy
. 2008 Apr
;63
(Suppl 86
):8
–160
. .15.
16.
Hummel
T
, Rissom
K
, Reden
J
, Hahner
A
, Weidenbecher
M
, Huttenbrink
KB
. Effects of olfactory training in patients with olfactory loss
. Laryngoscope
. 2009 Mar
;119
:496
–9
. .17.
Damm
M
, Pikart
LK
, Reimann
H
, Bukert
S
, Goktas
O
, Haxel
B
, Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study
. Laryngoscope
. 2014 Apr
;124
:826
–31
. .18.
Yan
CH
, Overdevest
JB
, Patel
ZM
. Therapeutic use of steroids in non-chronic rhinosinusitis olfactory dysfunction: a systematic evidence-based review with recommendations
. Int Forum Allergy Rhinol
. 2019 Feb
;9
(2
):165
–76
. .19.
Hura
N
, Xie
DX
, Choby
GW
, Schlosser
RJ
, Orlov
CP
, Seal
SM
, Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations
. Int Forum Allergy Rhinol
. 2020 Sep
;10
(9
):1065
–86
. .20.
Ikeda
K
, Sakurada
T
, Suzaki
Y
, Takasaka
T
. Efficacy of systemic corticosteroid treatment for anosmia with nasal and paranasal sinus disease
. Rhinology
. 1995 Sep
;33
(3
):162
–5
.21.
Heilmann
S
, Huettenbrink
KB
, Hummel
T
. Local and systemic administration of corticosteroids in the treatment of olfactory loss
. Am J Rhinol
. 2004 Jan–Feb
;18
(1
):29
–33
. .22.
Stenner
M
, Vent
J
, Hüttenbrink
KB
, Hummel
T
, Damm
M
. Topical therapy in anosmia: relevance of steroid-responsiveness
. Laryngoscope
. 2008 Sep
;118
(9
):1681
–6
. .23.
Schriever
VA
, Merkonidis
C
, Gupta
N
, Hummel
C
, Hummel
T
. Treatment of smell loss with systemic methylprednisolone
. Rhinology
. 2012 Sep
;50
(3
):284
–9
. .24.
Kim
DH
, Kim
SW
, Hwang
SH
, Kim
BG
, Kang
JM
, Cho
JH
, Prognosis of olfactory dysfunction according to etiology and timing of treatment
. Otolaryngol Head Neck Surg
. 2017 Feb
;156
(2
):371
–7
. .25.
Lam
K
, Tan
BK
, Lavin
JM
, Meen
E
, Conley
DB
. Comparison of nasal sprays and irrigations in the delivery of topical agents to the olfactory mucosa
. Laryngoscope
. 2013 Dec
;123
(12
):2950
–7
. .26.
Shu
CH
, Lee
PL
, Shiao
AS
, Chen
KT
, Lan
MY
. Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid-dependent olfactory impairment
. Laryngoscope
. 2012 Apr
;122
(4
):747
–50
. .27.
Mori
E
, Merkonidis
C
, Cuevas
M
, Gudziol
V
, Matsuwaki
Y
, Hummel
T
. The administration of nasal drops in the “Kaiteki” position allows for delivery of the drug to the olfactory cleft: a pilot study in healthy subjects
. Eur Arch Otorhinolaryngol
. 2016 Apr
;273
(4
):939
–43
. .28.
Kanemitsu
Y
, Kurokawa
R
, Ono
J
, Fukumitsu
K
, Takeda
N
, Fukuda
S
, Increased serum periostin levels and eosinophils in nasal polyps are associated with the preventive effect of endoscopic sinus surgery for asthma exacerbations in chronic rhinosinusitis patients
. Int Arch Allergy Immunol
. 2020
;181
(11
):862
–70
. .29.
Guilemany
JM
, Mariño-Sánchez
FS
, Angrill
J
, Alobid
I
, Centellas
S
, Pujols
L
, The importance of smell in patients with bronchiectasis
. Respir Med
. 2011 Jan
;105
(1
):44
–9
. .30.
Seiden
AM
. Postviral olfactory loss
. Otolaryngol Clin North Am
. 2004 Dec
;37
:1159
–66
. .31.
Jafek
BW
, Murrow
B
, Michaels
R
, Restrepo
D
, Linschoten
M
. Biopsies of human olfactory epithelium
. Chem Senses
. 2002 Sep
;27
(7
):623
–8
. .32.
Nishimura
T
, Teranishi
S
, Kawashima
A
, Ishimaru
T
, Miwa
T
, Furukawa
M
. Glucocorticoid enhances Na(+)/K(+) ATPase mRNA expression in rat olfactory mucosa during regeneration: a possible mechanism for recovery from olfactory disturbance
. Chem Senses
. 2002 Jan
;27
(1
):13
–21
. .33.
Takanosawa
M
, Nishino
H
, Ohta
Y
, Ichimura
K
. Glucocorticoids enhance regeneration of murine olfactory epithelium
. Acta Otolaryngol
. 2009 Sep
;129
(9
):1002
–9
. .34.
Choi
R
, Goldstein
B
. Olfactory epithelium: cells, clinical disorders, and insights from an adult stemm cell niche
. Laryngoscope Investig Otolaryngol
. 2018 Feb
;3
(1
):35
–42
.35.
Haehner
A
, Draf
J
, Dräger
S
, de With
K
, Hummel
T
. Predictive value of sudden olfactory loss in the diagnosis of COVID-19
. ORL J Otorhinolaryngol Relat Spec
. 2020
;82
(4
):175
–80
. .36.
WHO
. Corticosterids for COVID-19: Living guidance
. 2020 Sep 2
. Available from: https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Corticosteroids-2020.1 Assessed 2020 Sep 14.37.
Addison
AB
, Wong
B
, Ahmed
T
, Macchi
A
, Konstantinidis
I
, Huart
C
, Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction
. J Allergy Clin Immunol
. 2021 Jan 13
;S0091-6749
(21
):00004
–X
.© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
