Efficacy and safety of oral corticosteroids and olfactory training in the management of COVID-19-related loss of smell

Serge-Daniel Le Bon, Deborah Konopnicki, Nathalie Pisarski, Léa Prunier, Jérôme R Lechien, Mihaela Horoi, Serge-Daniel Le Bon, Deborah Konopnicki, Nathalie Pisarski, Léa Prunier, Jérôme R Lechien, Mihaela Horoi

Abstract

Purpose: As the COVID-19 pandemic continues, an increasing number of patients are afflicted by olfactory loss, a now well-recognized symptom of the disease. Though many patients seem to recover their sense of smell after a few weeks, a certain proportion of them seem to develop long-lasting olfactory disorder. Yet, as of October 2020, there is no recommended standardized treatment to reduce the risk of developing long-term olfactory disorder. In this pilot study, we investigated the efficacy and the safety of oral corticosteroids and olfactory training as a treatment for patients with persistent olfactory dysfunction as a result of COVID-19.

Methods: Non-hospitalized patients with a sudden loss of smell and a confirmed COVID-19 diagnosis were recruited by hospital call from February to April 2020. These participants were submitted to an extensive psychophysical testing in order to identify those with persistent dysosmia. Dysosmic patients were then treated either by a 10-day course of oral corticosteroids combined with olfactory training, or by olfactory training alone. All participants were subject to a second olfactory test after a mean of 10 weeks.

Results: 72 subjects with documented COVID-19 infection performed the initial olfactory test, on average 5 weeks after losing their sense of smell. Amongst them, 27 (37.5%) patients showed persistent dysosmia and were all included in this study. Nine participants received oral corticosteroids and performed olfactory training (OCS + OT), while 18 performed olfactory training (OT) only. Only participants in the OCS + OT group had significantly improved their olfactory score and did so above the minimal clinically important difference for subjective improvement of smell (p = 0.007). Three of the participants who received oral corticosteroids reported minimal and transient side effects.

Conclusion: This pilot study may suggest the combination of a short course of oral corticosteroids and olfactory training is safe and may be beneficial in helping patients with enduring dysosmia recover from olfactory loss due to COVID-19. There is a crucial need for further investigation with larger cohorts to corroborate these findings.

Keywords: Anosmia; COVID-19; Loss of smell; Olfactory training; Oral corticosteroids.

Conflict of interest statement

The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Evolution of olfactory loss due to COVID-19 for two treatment protocols. Comparison of the evolution of olfactory function (TDI score) between April and July 2020 in dysosmic patients depending on their treatment group: oral corticosteroids and olfactory training (OCS + OT; n = 9; left) versus olfactory training alone (OT; n = 18; right). TDI score = threshold–discrimination–identification score

References

    1. Boscolo-Rizzo P, Borsetto D, Fabbris C, et al. Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19. JAMA Otolaryngol Neck Surg. 2020 doi: 10.1001/jamaoto.2020.1379.
    1. Le Bon S-D, Pisarski N, Verbeke J, et al. Psychophysical evaluation of chemosensory functions 5 weeks after olfactory loss due to COVID-19: a prospective cohort study on 72 patients. Eur Arch Oto-Rhino-Laryngol. 2020 doi: 10.1007/s00405-020-06267-2.
    1. Vaira LA, Hopkins C, Petrocelli M, et al. Smell and taste recovery in coronavirus disease 2019 patients: a 60-day objective and prospective study. J Laryngol Otol. 2020 doi: 10.1017/S0022215120001826.
    1. Huart C, Philpott C, Konstantinidis I, et al. Comparison of COVID-19 and common cold chemosensory dysfunction. Rhinology. 2020 doi: 10.4193/Rhin20.251.
    1. Suzuki M, Saito K, Min W-P, et al. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007;117:272–277. doi: 10.1097/01.mlg.0000249922.37381.1e.
    1. Hura N, Xie DX, Choby GW, et al. Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2020;10:1065–1086. doi: 10.1002/alr.22624.
    1. Pinto JM, Wroblewski KE, Kern DW, et al. Olfactory dysfunction predicts 5-year mortality in older adults. PLoS ONE. 2014;9(10):e107541. doi: 10.1371/journal.pone.0107541.
    1. Whitcroft KL, Hummel T. Olfactory dysfunction in COVID-19. JAMA. 2020;323:2512. doi: 10.1001/jama.2020.8391.
    1. The RECOVERY Collaborative Group (2020) Dexamethasone in hospitalized patients with Covid-19: preliminary report. N Engl J Med NEJMoa2021436
    1. Sterne JAC, Murthy S, Diaz JV, et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19. JAMA. 2020 doi: 10.1001/jama.2020.17023.
    1. Mattos-Silva P, Felix NS, Silva PL, et al. Pros and cons of corticosteroid therapy for COVID-19 patients. Respir Physiol Neurobiol. 2020;280:103492. doi: 10.1016/j.resp.2020.103492.
    1. Ikeda K, Sakurada T, Suzaki Y, Takasaka T. Efficacy of systemic corticosteroid treatment for anosmia with nasal and paranasal sinus disease. Rhinology. 1995;33:162–165.
    1. Heilmann S, Huettenbrink K-B, Hummel T. Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol. 2004;18:29–33. doi: 10.1177/194589240401800107.
    1. Miwa T, Ikeda K, Ishibashi T, et al. Clinical practice guidelines for the management of olfactory dysfunction: secondary publication. Auris Nasus Larynx. 2019;46:653–662. doi: 10.1016/j.anl.2019.04.002.
    1. Oleszkiewicz A, Schriever VA, Croy I, et al. Updated Sniffin’ Sticks normative data based on an extended sample of 9139 subjects. Eur Arch Oto-Rhino-Laryngol. 2019;276:719–728. doi: 10.1007/s00405-018-5248-1.
    1. Damm M, Pikart LK, Reimann H, et al. Olfactory training is helpful in postinfectious olfactory loss: a randomized, controlled, multicenter study. Laryngoscope. 2014;124:826–831. doi: 10.1002/lary.24340.
    1. Kim B-Y, Park JY, Kim E. Differences in mechanisms of steroid therapy and olfactory training for olfactory loss in mice. Am J Rhinol Allergy. 2020;34:810–821. doi: 10.1177/1945892420930945.
    1. Altundag A, Yıldırım D, Tekcan Sanli DE, et al. Olfactory cleft measurements and COVID-19–related anosmia. Otolaryngol Neck Surg. 2020 doi: 10.1177/0194599820965920.
    1. Eliezer M, Hautefort C. MRI evaluation of the olfactory clefts in patients with SARS-CoV-2 infection revealed an unexpected mechanism for olfactory function loss. Acad Radiol. 2020;27:1191. doi: 10.1016/j.acra.2020.05.013.
    1. Gudziol V, Lötsch J, Hähner A, et al. Clinical significance of results from olfactory testing. Laryngoscope. 2006;116:1858–1863. doi: 10.1097/01.mlg.0000234915.51189.cb.
    1. Touisserkani SK, Ayatollahi A. Oral corticosteroid relieves post-COVID-19 anosmia in a 35-year-old patient. Case Rep Otolaryngol. 2020;2020:1–2. doi: 10.1155/2020/5892047.
    1. Saatci O, Altundag A, Duz OA, Hummel T. Olfactory training ball improves adherence and olfactory outcomes in post-infectious olfactory dysfunction. Eur Arch Oto-Rhino-Laryngology. 2020;277:2125–2132. doi: 10.1007/s00405-020-05939-3.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner