The use of platelet-rich plasma in treatment of olfactory dysfunction: A pilot study

Carol H Yan, David C Mundy, Zara M Patel, Carol H Yan, David C Mundy, Zara M Patel

Abstract

Background: Olfactory dysfunction is a prevalent problem with a significant impact on quality of life and increased mortality. Limited effective therapies exist. Platelet-rich plasma (PRP) is an autologous biologic product with anti-inflammatory and neuroprotective effects. This novel pilot study evaluated the role of PRP on olfactory neuroregeneration in patients with hyposmia.

Methods: Seven patients who had olfactory loss greater than 6 months in duration, no evidence of sinonasal inflammatory disease, and no improvement with olfactory training and budesonide topical rinses were enrolled in this preliminary study. Patients received a single intranasal injection of PRP into the mucosa of the olfactory cleft. The Sniffin' Sticks olfactory test consisting of threshold, discrimination, and identification measurements (TDI) was administered at the beginning of the study and at 1 and 3 months.

Results: All patients reported a subjective improvement of their smell shortly after injection but then stabilized. At 3-month post-treatment, two patients with functional anosmia (TDI < 16) did not improve significantly. Five patients with hyposmia (TDI > 16 but <30) showed an improvement with 60% achieving normosmia (TDI > 30) at 3-month follow-up. On average, patients with baseline TDI > 16 improved by 5.85 points with the most significant improvement in the threshold subcomponent. There were no adverse outcomes from intranasal PRP injections.

Conclusion: PRP appears safe for use in the treatment of olfactory loss, and preliminary data suggest possible efficacy, especially for those with moderate yet persistent loss. Further studies will help determine optimal frequency and duration of use.

Keywords: hyposmia; olfaction; platelet‐rich plasma; postviral; smell loss.

Conflict of interest statement

The authors declare no potential conflict of interest.

© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.

Figures

Figure 1
Figure 1
Endoscopic view of the right olfactory epithelium with the sites of PRP injection depicted by the two asterisks. A 1‐mL PRP was injected on each side of the nasal cavity and was split into two injections, first along the superior septum just posterior to the head of the middle turbinate and then again about 1 cm posteriorly into the septum across from the leading edge of the superior turbinate
Figure 2
Figure 2
Total TDI scores at baseline, 1 and 3 months post‐PRP. Among the entire group, mean TDI scores increased from 19.5 at baseline to 23.6 points at 3 months, statistically significant at P = .026

References

    1. Croy I, Nordin S, Hummel T. Olfactory disorders and quality of life: an updated review. Chem Senses. 2014;39(3):185‐194.
    1. Nordin S, Brämerson A. Complaints of olfactory disorders: epidemiology, assessment and clinical implications. Curr Opin Allergy Clin Immunol. 2008;8(1):10‐15.
    1. Landis BN, Konnerth CG, Hummel T. A study on the frequency of olfactory dysfunction. Laryngoscope. 2004;114(10):1764‐1769.
    1. Cavazzana A, Larsson M, Münch M, Hähner A, Hummel T. Postinfectious olfactory loss: a retrospective study on 791 patients. Laryngoscope. 2018;128(1):10‐15.
    1. Kim DH, Kim SW, Hwang SH, et al. Prognosis of olfactory dysfunction according to etiology and timing of treatment. Otolaryngol—Head Neck Surg. 2017;156(2):371‐377.
    1. 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;9(2):165‐176.
    1. 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;8(9):977‐981.
    1. Damm M, Pikart LK, Reimann H, et al. Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study. Laryngoscope. 2014;124(4):826‐831.
    1. Pekala K, Chandra RK, Turner JH. Efficacy of olfactory training in patients with olfactory loss: a systematic review and meta‐analysis. Int Forum Allergy Rhinol. 2016;6(3):299‐307.
    1. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet‐rich plasma. Am J Sports Med. 2011;39(10):2135‐2140.
    1. Anjayani S, Wirohadidjojo YW, Adam AM, Suwandi D, Seweng A, Amiruddin MD. Sensory improvement of leprosy peripheral neuropathy in patients treated with perineural injection of platelet‐rich plasma. Int J Dermatol. 2014;53(1):109‐113.
    1. Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L. Safety and efficacy of platelet‐rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):49.
    1. Sánchez M, Yoshioka T, Ortega M, Delgado D, Anitua E. Ultrasound‐guided platelet‐rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):1084‐1089.
    1. Ikumi A, Hara Y, Yoshioka T, Kanamori A, Yamazaki M. Effect of local administration of platelet‐rich plasma (PRP) on peripheral nerve regeneration: An experimental study in the rabbit model. Microsurgery. 2018;38(3):300‐309.
    1. Sariguney Y, Yavuzer R, Elmas C, Yenicesu I, Bolay H, Atabay K. Effect of platelet‐rich plasma on peripheral nerve regeneration. J Reconstr Microsurg. 2008;24(3):159‐167.
    1. Zheng C, Zhu Q, Liu X, et al. Effect of platelet‐rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cells in vitro. J Tissue Eng Regen Med. 2016;10(5):428‐436.
    1. Farrag TY, Lehar M, Verhaegen P, Carson KA, Byrne PJ. Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model. Laryngoscope. 2007;117(1):157‐165.
    1. Yasak AG, Yigit O, Araz Server E, Durna Dastan S, Gul M. The effectiveness of platelet‐rich plasma in an anosmia‐induced mice model. Laryngoscope. 2018;128(5):E157‐E162.
    1. Mavrogeni P, Kanakopoulos A, Maihoub S, Krasznai M, Szirmai A. Anosmia treatment by platelet rich plasma injection. Int Tinnitus J. 2017;20(2):102‐105.
    1. Hummel T, Sekinger B, Wolf SR, Pauli E, Kobal G. Sniffin' sticks: olfactory performance assessed by the combined testing of odour identification, odor discrimination and olfactory threshold. Chem Senses. 1997;22(1):39‐52.
    1. Rumeau C, Nguyen DT, Jankowski R. How to assess olfactory performance with the Sniffin' sticks test(®). Eur Ann Otorhinolaryngol Head Neck Dis. 2016;133(3):203‐206.
    1. Oleszkiewicz A, Schriever VA, Croy I, Hähner A, Hummel T. Updated Sniffin’ Sticks normative data based on an extended sample of 9139 subjects. Eur Arch Otorhinolaryngol. 2019;276(3):719‐728.
    1. Gudziol V, Lötsch J, Hähner A, Zahnert T, Hummel T. Clinical significance of results from olfactory testing. Laryngoscope. 2006;116(10):1858‐1863.
    1. Menorca RMG, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin. 2013;29(3):317‐330.
    1. Lee DY, Lee WH, Wee JH, Kim J‐W. Prognosis of postviral olfactory loss: follow‐up study for longer than one year. Am J Rhinol Allergy. 2014;28(5):419‐422.
    1. Temmel AFP, Quint C, Schickinger‐Fischer B, Klimek L, Stoller E, Hummel T. Characteristics of olfactory disorders in relation to major causes of olfactory loss. Arch Otolaryngol Neck Surg. 2002;128(6):635‐641.
    1. Noel J, Habib A‐RR, Thamboo A, Patel ZM. Variables associated with olfactory disorders in adults: a U.S. population‐based analysis. World J Otorhinolaryngol—Head Neck Surg. 2017;3(1):9‐16.
    1. Elterman KG, Mallampati SR, Kaye AD, Urman RD. Postoperative alterations in taste and smell. Anesthesiol Pain Med. 2014;4(4):e18527.
    1. do Amaral RJFC, da Silva NP, Haddad NF, et al. Platelet‐rich plasma obtained with different anticoagulants and their effect on platelet numbers and mesenchymal stromal cells behavior in vitro. Stem Cells Int. 2016;2016:1‐11.
    1. Whitcroft KL, Ezzat M, Cuevas M, Andrews P, Hummel T. The effect of intranasal sodium citrate on olfaction in post‐infectious loss: results from a prospective, placebo‐controlled trial in 49 patients. Clin Otolaryngol. 2017;42(3):557‐563.
    1. Braun HJ, Kim HJ, Chu CR, Dragoo JL. The effect of platelet‐rich plasma formulations and blood products on human synoviocytes: implications for intra‐articular injury and therapy. Am J Sports Med. 2014;42(5):1204‐1210.

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