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Journal of Allergy and Clinical Immunology

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Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction - 05/05/21

Doi : 10.1016/j.jaci.2020.12.641 
Alfred B. Addison, MRCS a, Billy Wong, FRCS (ORL-HNS) a, Tanzime Ahmed, MBChB a, Alberto Macchi, MD b, ∗, Iordanis Konstantinidis, MD, PhD c, ∗, Caroline Huart, MD, PhD d, e, ∗, Johannes Frasnelli, MD f, g, ∗, Alexander W. Fjaeldstad, MD, PhD h, i, ∗, Vijay R. Ramakrishnan, MD j, k, ∗, Philippe Rombaux, MD, PhD d, e, ∗, Katherine L. Whitcroft, MBChB (Hons), BSc, MRCS, DOHNS l, m, ∗, Eric H. Holbrook, MD, MS n, ∗, Sophia C. Poletti, MD o, ∗, Julien W. Hsieh p, ∗, Basile N. Landis, MD p, ∗, James Boardman, BSc q, Antje Welge-Lüssen, MD, MAS Insurance Medicine r, ∗, Devina Maru, MBChB, MSc, DRCOG, FInstLM s, Thomas Hummel, MD t, ∗, Carl M. Philpott, MBChB, FRCS (ORL-HNS), MD PGCME q, u, v, ∗⁎
a East Sussex North Essex Foundation Trust, Ipswich, United Kingdom 
b ENT University of Insubria, Italian Academy of Rhinology, Varese, Italy 
c Smell and Taste Clinic, 2nd ORL University Department, Aristotle University, Thessaloniki, Greece 
d Department of Otorhinolaryngology, Cliniques Universitaires Saint-Luc, Brussels, Belgium 
e Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium 
f Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada 
g Research Center, Sacré-Coeur Hospital Montréal, Montréal, Québec, Canada 
h Flavour Clinic, ENT Department, Regional Hospital West Jutland, Holstebro, Denmark 
i Flavour Institute, Aarhus University, Aarhus, Denmark 
j Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, Colo 
k Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colo 
l Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, London, United Kingdom 
m South Yorkshire Deanery, Yorkshire and Humber School of Surgery, Yorkshire, United Kingdom 
n Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass 
o Department of Otorhinolaryngology – Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 
p Rhinology-Olfactology Unit, Department of Otorhinolaryngology, University Hospitals of Geneva, Geneva, Switzerland 
q Fifth Sense, Barrow-in-Furness, United Kingdom 
r Department of Otorhinolaryngology, University Hospital Basel, University of Basel, Basel, Switzerland 
s Royal College of General Practitioners, London, United Kingdom 
t Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany 
u Norfolk Smell and Taste Clinic, James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom 
v Norwich Medical School, University of East Anglia, Norwich, United Kingdom 

∗Corresponding author: Carl Philpott, MBChB, FRCS (ORL-HNS), MD PGCME, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK.Norwich Medical SchoolUniversity of East AngliaNorwichNR4 7TJUK

Abstract

Background

Respiratory tract viruses are the second most common cause of olfactory dysfunction. As we learn more about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the recognition that olfactory dysfunction is a key symptom of this disease process, there is a greater need than ever for evidence-based management of postinfectious olfactory dysfunction (PIOD).

Objective

Our aim was to provide an evidence-based practical guide to the management of PIOD (including post–coronavirus 2019 cases) for both primary care practitioners and hospital specialists.

Methods

A systematic review of the treatment options available for the management of PIOD was performed. The written systematic review was then circulated among the members of the Clinical Olfactory Working Group for their perusal before roundtable expert discussion of the treatment options. The group also undertook a survey to determine their current clinical practice with regard to treatment of PIOD.

Results

The search resulted in 467 citations, of which 107 articles were fully reviewed and analyzed for eligibility; 40 citations fulfilled the inclusion criteria, 11 of which were randomized controlled trials. In total, 15 of the articles specifically looked at PIOD whereas the other 25 included other etiologies for olfactory dysfunction.

Conclusions

The Clinical Olfactory Working Group members made an overwhelming recommendation for olfactory training; none recommended monocycline antibiotics. The diagnostic role of oral steroids was discussed; some group members were in favor of vitamin A drops. Further research is needed to confirm the place of other therapeutic options.

Le texte complet de cet article est disponible en PDF.

Key words : Olfaction, olfactory disorders, viral infections, hyposmia, anosmia, parosmia therapy, COVID-19

Abbreviations used : ALA, COVID-19, ENT, MRI, OB, OT, PIOD, PTOL, RCT, TDI, T&T, SARS-CoV-2, VAS


Plan


 Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.


© 2021  American Academy of Allergy, Asthma & Immunology. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 147 - N° 5

P. 1704-1719 - mai 2021 Retour au numéro
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