Treatment of post-viral olfactory dysfunction: an evidence-based review with recommendations

Nanki Hura, Deborah X Xie, Garret W Choby, Rodney J Schlosser, Cinthia P Orlov, Stella M Seal, Nicholas R Rowan, Nanki Hura, Deborah X Xie, Garret W Choby, Rodney J Schlosser, Cinthia P Orlov, Stella M Seal, Nicholas R Rowan

Abstract

Background: Post-viral olfactory dysfunction (PVOD) is one of the most common causes of olfactory loss. Despite its prevalence, optimal treatment strategies remain unclear. This article provides a comprehensive review of PVOD treatment options and provides evidence-based recommendations for their use.

Methods: A systematic review of the Medline, Embase, Cochrane, Web of Science, Scopus, and Google Scholar databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies with defined olfactory outcomes of patients treated for PVOD following medical, surgical, acupuncture, or olfactory training interventions were included. The Clinical Practice Guideline Development Manual and Conference on Guideline Standardization (COGS) instrument recommendations were followed in accordance with a previously described, rigorous, iterative process to create an evidence-based review with recommendations.

Results: From 552 initial candidate articles, 36 studies with data for 2183 patients with PVOD were ultimately included. The most common method to assess olfactory outcomes was Sniffin' Sticks. Broad treatment categories included: olfactory training, systemic steroids, topical therapies, a variety of heterogeneous non-steroidal oral medications, and acupuncture.

Conclusion: Based on the available evidence, olfactory training is a recommendation for the treatment of PVOD. The use of short-term systemic and/or topical steroids is an option in select patients after careful consideration of potential risks of oral steroids. Though some pharmacological investigations offer promising preliminary results for systemic and topical medications alike, a paucity of high-quality studies limits the ability to make meaningful evidence-based recommendations for the use of these therapies for the treatment of PVOD.

Keywords: budesonide; evidence-based medicine; olfaction disorders; olfactory training; smell; viral infection.

© 2020 ARS-AAOA, LLC.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram. PRISMA = Preferred Reporting Items for Systematic Reviews and Metaanalyses.

References

    1. Van Regemorter V, Hummel T, Rosenzweig F, et al. Mechanisms linking olfactory impairment and risk of mortality. Front Neurosci. 2020;14:140
    1. Kohli P, Soler ZM, Nguyen SA, et al. The association between olfaction and depression: a systematic review. Chem Senses. 2016;41(6):479‐486.
    1. Pinto JM, Wroblewski KE, Kern DW, et al. Olfactory dysfunction predicts 5‐year mortality in older adults. PLoS One. 2014;9(10):e107541.
    1. Hummel T, Whitcroft KL, Andrews P, et al. Position paper on olfactory dysfunction. Rhinology. 2017;54:1‐30.
    1. Deems DA, Doty RL, Settle G, et al. Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center. Arch Otolaryngol Neck Surg. 1991;117(5):519‐528.
    1. Doty R. Handbook of Olfaction and Gustation. 3rd ed. Wiley‐Blackwell, Malden, MA, 2015.
    1. Suzuki M, Saito K, Min W, et al. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007;117(2):272‐277.
    1. Klopfenstein T, Kadiane‐Oussou NJ, Toko L, et al. Features of anosmia in COVID‐19. Médecine Mal Infect. 2020. 10.1016/j.medmal.2020.04.006
    1. Moein ST, Hashemian SMR, Mansourafshar B, et al. Smell dysfunction: a biomarker for COVID‐19. Int Forum Allergy Rhinol. 2020:alr.22587. 10.1002/alr.22587
    1. Lechien JR, Chiesa‐Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild‐to‐moderate forms of the coronavirus disease (COVID‐19): a multicenter European study. Eur Arch Oto‐Rhino‐Laryngology. 2020. 10.1007/s00405-020-05965-1
    1. Reden J, Mueller A, Mueller C, et al. Recovery of olfactory function following closed head injury or infections of the upper respiratory tract. Arch Otolaryngol Neck Surg. 2006;132(3):265‐269.
    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. Rosenfeld RM, Shiffman RN, Robertson P. Clinical practice guideline development manual, third edition: a quality‐driven approach for translating evidence into action. Otolaryngol ‐ Head Neck Surg. 2013;148(Suppl 1):S1‐55.
    1. Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines: a proposal from the conference on guideline standardization. Ann Intern Med. 2003;139(6):493‐498.
    1. Rudmik L, Smith TL. Development of an evidence‐based review with recommendations using an online iterative process. Int Forum Allergy Rhinol. 2011;1(6):431‐437.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
    1. OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2.
    1. Savović J, Weeks L, Sterne JAC, et al. Evaluation of the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Syst Rev. 2014;3(1):37.
    1. Wells G, Shea B, O'Connell D, et al. The Newcastle‐Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta‐analyses. 2019.
    1. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874‐877.
    1. Seo BS, Lee HJ, Mo JH, et al. Treatment of postviral olfactory loss with glucocorticoids, Ginkgo biloba, and mometasone nasal spray. Arch Otolaryngol ‐ Head Neck Surg. 2009;135(10):1000‐1004.
    1. Kim DH, Kim SW, Hwang SH, et al. Prognosis of olfactory dysfunction according to etiology and timing of treatment. Otolaryngol ‐ Head Neck Surg (United States). 2017;156(2):371‐377.
    1. Schriever VA, Merkonidis C, Gupta N, et al. Treatment of smell loss with systemic methylprednisolone. Rhinology. 2012;50(3):284‐289.
    1. Heilmann S, Huettenbrink KB, Hummel T. Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol. 2004;18(1):29‐33.
    1. Stenner M, Vent J, Hüttenbrink KB, et al. Topical therapy in anosmia: relevance of steroid‐responsiveness. Laryngoscope. 2008;118(9):1681‐1686.
    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(3):162‐165.
    1. Gudziol V, Lötsch J, Hähner A, et al. Clinical significance of results from olfactory testing. Laryngoscope. 2006;116(10):1858‐1863.
    1. Mori J, Aiba T, Sugiura M, et al. Clinical study of olfactory disturbance. Acta Otolaryngol Suppl. 1998;538:197‐201.
    1. Blomqvist EH, Lundblad L, Bergstedt H, Stj̈arne P. Placebo‐controlled, randomized, double‐blind study evaluating the efficacy of fluticasone propionate nasal spray for the treatment of patients with hyposmia/anosmia. Acta Otolaryngol. 2003;123(7):862‐868.
    1. Fukazawa K. A local steroid injection method for olfactory loss due to upper respiratory infection. Chem Senses. 2005;30(suppl 1):212‐213.
    1. Fleiner F, Goktas O. Topical beclomethasone in the therapy of smelling disorders—a new application technique. Indian J Otolaryngol Head Neck Surg. 2011;63(1):5‐9.
    1. Philpott CM, Erskine SE, Clark A, et al. A randomised controlled trial of sodium citrate spray for non‐conductive olfactory disorders. Clin Otolaryngol. 2017;42(6):1295‐1302.
    1. Whitcroft KL, Merkonidis C, Cuevas M, et al. Intranasal sodium citrate solution improves olfaction in post‐viral hyposmia. Rhinology. 2016;54(4):368‐374.
    1. Whitcroft KL, Ezzat M, Cuevas M, et al. 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. Schöpf V, Kollndorfer K, Pollak M, et al. Intranasal insulin influences the olfactory performance of patients with smell loss, dependent on the body mass index: a pilot study. Rhinology. 2015;53(4):371‐378.
    1. Reden J, Herting B, Lill K, et al. Treatment of postinfectious olfactory disorders with minocycline: a double‐blind, placebo‐controlled study. Laryngoscope. 2011;121(3):679‐682.
    1. Wang J‐J, Chen J, Doty RL. Impact of antibiotics on smell dysfunction. World J Otorhinolaryngol ‐ Head Neck Surg. 2018;4(1):33‐38.
    1. Henkin RI, Velicu I, Schmidt L. An open‐label controlled trial of theophylline for treatment of patients with hyposmia. Am J Med Sci. 2009;337(6):396‐406.
    1. Henkin RI, Hosein S, Stateman WA, et al. Improved smell function with increased nasal mucus sonic hedgehog in hyposmic patients after treatment with oral theophylline. Am J Otolaryngol. 2017;38(2):143‐147.
    1. Henkin RI, Schecter PJ, Friedewald WT, et al. A double blind study of the effects of zinc sulfate on taste and smell dysfunction. Am J Med Sci. 1976;272(3):285‐299.
    1. Aiba T, Sugiura M, Mori J, et al. Effect of zinc sulfate on sensorineural olfactory disorder. Acta Otolaryngol. 1998;118(538):202‐204.
    1. Quint C, Temmel AFP, Hummel T, Ehrenberger K. The quinoxaline derivative caroverine in the treatment of sensorineural smell disorders: a proof‐of‐concept study. Acta Otolaryngol. 2002;122(8):877‐881.
    1. Duncan RB, Briggs M. Treatment of uncomplicated anosmia by vitamin A. Arch Otolaryngol. 1962;75(2):116‐124.
    1. Reden J, Lill K, Zahnert T, et al. Olfactory function in patients with postinfectious and posttraumatic smell disorders before and after treatment with vitamin A: a double‐blind, placebo‐controlled, randomized clinical trial. Laryngoscope. 2012;122(9):1906‐1909.
    1. Hummel T, Heilmann S, Hüttenbriuk KB. Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract. Laryngoscope. 2002;112(11):2076‐2080.
    1. Hummel T, Rissom K, Reden J, et al. Effects of olfactory training in patients with olfactory loss. Laryngoscope. 2009;119(3):496‐499.
    1. Fleiner F, Lau L, Ö Göktas. Active olfactory training for the treatment of smelling disorders. Ear Nose Throat J. 2012;91(5):198‐215.
    1. Konstantinidis I, Tsakiropoulou E, Bekiaridou P, et al. Use of olfactory training in post‐traumatic and postinfectious olfactory dysfunction. Laryngoscope. 2013;123(12):85‐90.
    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. Geißler K, Reimann H, Gudziol H, et al. Olfactory training for patients with olfactory loss after upper respiratory tract infections. Eur Arch Oto‐Rhino‐Laryngology. 2014;271(6):1557‐1562.
    1. Altundag A, Cayonu M, Kayabasoglu G, et al. Modified olfactory training in patients with postinfectious olfactory loss. Laryngoscope. 2015;125(8):1763‐1766.
    1. Konstantinidis I, Tsakiropoulou E, Constantinidis J. Long term effects of olfactory training in patients with post‐infectious olfactory loss. Rhinology. 2016;54(2):170‐175.
    1. Poletti SC, Michel E, Hummel T. Olfactory training using heavy and light weight molecule odors. Perception. 2017;46(3‐4):343‐351.
    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. Kollndorfer K, Kowalczyk K, Hoche E, et al. Recovery of olfactory function induces neuroplasticity effects in patients with smell loss. Neural Plast. 2014;2014:1‐7.
    1. Dai Q, Pang Z, Yu H. Recovery of olfactory function in postviral olfactory dysfunction patients after acupuncture treatment. Evidence‐Based Complement Altern Med. 2016;2016:4986034.
    1. Vent J, Wang D‐W, Damm M. Effects of traditional Chinese acupuncture in post‐viral olfactory dysfunction. Otolaryngol Neck Surg. 2010;142(4):505‐509.
    1. Schriever VA, Lehmann S, Prange J, Hummel T. Preventing olfactory deterioration: olfactory training may be of help in older people. J Am Geriatr Soc. 2014;62(2):384‐386.
    1. Harless L, Liang J. Pharmacologic treatment for postviral olfactory dysfunction: a systematic review. Int Forum Allergy Rhinol. 2016;6(7):760‐767.
    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. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019‐nCoV lung injury. Lancet. 2020;395(10223):473‐475.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться