Adjuvant Oral, Nasal Steroids Found to Improve Olfactory Function in CRS With Nasal Polyps

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) exhibited significant improvement in olfactory function when treated with a combination treatment of oral and nasal steroids vs nasal steroids alone after 24 weeks. Results were published in European Annals of Otorhinolaryngology, Head and Neck Diseases.

Cited by patients with CRSwNP as the most prominent symptom they wish to restore, olfactory dysfunction is estimated to occur in 60% to 80% of those with the condition. Despite the availability of several interventions in the management of CRSwNP, researchers note that there is no consensus regarding the optimal medical approach to ensure adequate and long-term disease control for patients with smell impairment as the dominant symptom.

“Olfactory impairment is caused by mucosal inflammation, as well as mechanical obstruction of the olfactory cleft by polyps,” explained the study authors. “Medical treatment options for nasal polyps include topical and systemic steroids, short and long-term antibiotics, and additional care with antihistamines, antileukotrienes, antimycotics, capsaicin, and nasal douching.”

With several trials showing a positive effect of oral steroids on olfactory outcomes in patients with CRSwNP, they sought to explore the effects of oral dexamethasone plus intranasal steroids (INCS) vs INCS alone.

In the prospective randomized nonblinded study, patients with CRSwNP experiencing hyposmia (N = 140; 53.4% men) were recruited from the Outpatient Clinic and the Allergy and Endoscopy Clinic of the Otorhinolaryngology Department of Chania General Hospital in Greece.

Participants were divided into 2 groups, in which group A (n = 20) received a 7-day course of oral steroids with a 12-week course of nasal steroids and douching, and group B (n = 70) received a 12-week course of nasal steroids and douching.

The main objective of the study was to compare the olfactory effect of the different therapies in group A and group B at 2, 12, and 24 weeks, measured via Sniffin’ Sticks identification test and visual analogue scale score for olfaction (VASsmell). Several secondary objectives were also explored:

• Evaluate the therapy effects on endoscopic appearance score (EAS), visual analogue scale score for discomfort (VASdis), and Sinonasal Outcome Test-22, Greek-version (SNOT22- Gr) between groups
• Assess the duration of the therapeutic result within the groups
• Investigate the presence of correlation between the evaluated parameters

After 2 weeks, a statistically significant difference was observed between groups A and B for all parameters except VASdis (P < .001). Moreover, olfactory outcomes (Sniffin’ Sticks and VASsmell scale scores) were significantly improved in group A vs group B at the 24-week evaluation (P < .001).

Regarding effect duration within the groups, the therapeutic result remained stable between the 12-week and 24-week evaluations (P > .05). The Sniffin’ Sticks identification test score further showed a signficant correlation at the 12-week evaluation with the endoscopic appearance score system (rho = 0.58; P < .001), but not with SNOT22-Gr (rho = 0.3; P = .012).

“According to our exclusion criteria, in carefully selected and strictly instructed patients with CRSwNP, a low-dose 7-day course of oral dexamethasone may achieve a favorable outcome regarding olfaction and health-related quality of life for at least half a year,” concluded the study authors.

Reference

Papadakis CE, Chimona TS, Chaidas K, Ladias A, Zisoglou M, Proimos EK. Effect of oral steroids on olfactory function in chronic rhinosinusitis with nasal polyps. Eur Ann Otorhinolaryngol Head Neck Dis. 2021;138(5):343-348. doi:10.1016/j.anorl.2020.06.028