Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid‐dependent olfactory impairment

Shu, Chih Hung; Lee, Po Lei; Shiao, An Suey; Chen, Kee Tak; Lan, Min‐Yu

doi:10.1002/lary.23212

Cited by 28 publications

(23 citation statements)

References 15 publications

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“…Our results are in accordance with previous studies on nasal spray, which show a poor delivery onto the olfactory epithelium and no effect on olfactory dysfunction in many patients with olfactory loss and sinonasal disease . Oral administration of prednisolone (the most commonly used steroid without specific dose regimen) improved olfactory function, as shown in previous studies . With regard to sonic nebulization, our results are in accordance with studies on the effect of topical corticosteroids application through pressure‐pulsed inhalation or transnasal nebulization as a treatment option for CRS.…”

Section: Discussionsupporting

confidence: 92%

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

et al. 2014

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In vitro differences in drug deposition pattern between both intranasal modalities were demonstrated. Threshold discrimination identification and RNT were similar between three groups at baseline. Threshold discrimination identification improved by 5.5, 5.8, and -1.1 for sonic nebulization, oral, and nasal spray groups, respectively (P = 0.010). This improvement was clinically relevant for oral and nebulized administration. It was similar between oral and nebulized administration but significantly higher than nasal spray administration. Retronasal psychophysical olfactory tests improved similarly for the three groups (P = 0.231) CONCLUSION: Effectiveness of sonic nebulized and oral administration is demonstrated on orthonasal olfactory. The clinical benefit is better than with nasal spray.

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Section: Discussionsupporting

confidence: 92%

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

et al. 2014

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“…If direct OC mucosal inflammation is driving olfactory loss, then the efficacy of these medications will vary in part based on their ability to adequately reach the OC mucosa. Devices or techniques that can deliver anti‐inflammatory medications effectively into the olfactory cleft could offer therapeutic advantage from an olfactory standpoint …”

Section: Discussionmentioning

confidence: 99%

“…Devices or techniques that can deliver anti-inflammatory medications effectively into the olfactory cleft could offer therapeutic advantage from an olfactory standpoint. 6,[24][25][26][27][28] Anti-inflammatory medications delivered systemically would theoretically reach the inflamed OC mucosa directly via the bloodstream. The ability of systemic corticosteroids to improve olfaction in CRSwNP has been known for decades and is recommended as a treatment option in evidence-based reviews.…”

Section: Discussionmentioning

confidence: 99%

Correlation of mucus inflammatory proteins and olfaction in chronic rhinosinusitis

Soler

Yoo

Schlosser

et al. 2019

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis (CRS) is one of the most common causes of olfactory loss, but the pathophysiology underlying olfactory dysfunction in CRS has not been fully elucidated. Previous studies found correlations between olfactory cleft (OC) inflammatory cytokines/chemokines and olfaction in CRS. The purpose of this study was to evaluate the relationship between OC mucus inflammatory proteins and olfaction in a multi‐institutional cohort. Methods Adults with CRS were prospectively recruited. Demographics, comorbidities, olfactory assessment (Sniffin’ Sticks), computed tomography (CT), and OC mucus for protein analysis were collected. Statistical analysis was performed to determine associations between olfactory function, OC mucus protein concentrations, and CT opacification. Results Sixty‐two patients were enrolled in the study, with an average age of 48.2 (standard deviation, 16.2) years, and 56.5% were female and 59.7% were classified as CRS with nasal polyps (CRSwNP). Ten of 26 OC mucus proteins were significantly correlated with threshold, discrimination, and identification (TDI) scores and OC opacification. Subgroup analysis by polyp status revealed that, within the CRSwNP group, C‐C motif ligand 2 (CCL2), interleukin‐5 (IL‐5), IL‐6, IL‐13, IL‐10, IL‐9, tumor necrosis factor‐α (TNF‐α), CCL5, and CCL11 were significantly correlated with olfaction. For CRS without nasal polyps (CRSsNP), only C‐X‐C ligand 5 (CXCL5) showed a correlation. In CRSwNP, IL‐6, IL‐10, vascular endothelial growth factor‐A, and immunoglobulin E (IgE) correlated with OC opacification, whereas, in CRSsNP, only CXCL5 showed a correlation. OC mucus proteins and Lund‐Mackay score correlated only in the CRSsNP group (CXCL5, IL‐5, IL‐13, IgE). Conclusion Several OC mucus proteins have been found to correlate with olfactory function and OC opacification. The profile of OC mucus proteins differs between CRSsNP and CRSwNP subgroups, suggesting different mechanisms between groups, but further study is required.

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“…Corticosteroids are the most frequently prescribed drugs used to treat olfactory dysfunction [3]. An intranasal corticosteroid application produces fewer side effects than do oral corticosteroids [4]. However, a conventional intranasal corticosteroid application has been considered as having little effect on olfactory dysfunction due to the inability of topical corticosteroids to reach the OC [3,5].…”

Section: Introductionmentioning

confidence: 99%

“…erefore, several modified modalities of delivery have been recommended in order to help improve the access of topical corticosteroids to the OC [3][4][5]. When the OC is obstructed by a local inflammation of mucosa with a stagnation of secretion, the olfactory function is often nonresponsive to medical treatment [1].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Endoscopic Olfactory Cleft Opening on Obstructed Olfactory Cleft Disease

Jiang

Liang

2020

International Journal of Otolaryngology

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Purpose. This study was conducted to evaluate the effect of endoscopic olfactory cleft (OC) opening on olfaction in patients with obstructed OC disease. Materials and Methods. Patients with obstructed OC disease who underwent endoscopic OC opening for treatment were enrolled. The endoscopic olfactory cleft opening was performed under local anesthesia. Under an endoscopy, the middle and superior turbinates were gently lateralized to open the OC using an elevator. The phenyl ethyl alcohol threshold test was performed to evaluate the olfactory function both before and after surgery. Results. An endoscopic OC opening was performed on 42 patients. Amongst them, the etiology of OC obstruction revealed anatomic anomalies in 14 patients, inflammatory process in 14, and anatomic anomalies as well as inflammatory process in 14. The phenyl ethyl alcohol threshold levels improved in 32 (76.2%) of the patients after surgery. The olfactory function was better improved in patients experiencing OC obstructed by inflammatory process than those by anatomic anomalies. Conclusions. This study showed that endoscopic OC opening seemed to be effective in treating olfactory dysfunction in patients with obstructed OC disease caused by inflammatory process.

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Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid‐dependent olfactory impairment

Cited by 28 publications

References 15 publications

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

Effect of three-drug delivery modalities on olfactory function in chronic sinusitis

Correlation of mucus inflammatory proteins and olfaction in chronic rhinosinusitis

The Effect of Endoscopic Olfactory Cleft Opening on Obstructed Olfactory Cleft Disease

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