Abstract
Background: The objective of this study was to investigate the efficacy and safety of early administration of oral corticosteroids (OC) or nasal corticosteroids (NC) as an add-on to olfactory training (OT) versus OT alone in patients with olfactory dysfunction (OD) related to coronavirus disease 2019 (COVID-19). Methods: Patients with a positive diagnosis of COVID-19 and OD were prospectively recruited from March 22 to December 15, 2020 from 4 European hospitals. Patients had confirmed OD on psychophysical testing. All patients undertook OT, with add-on 10 days of OC (group 1: OC + OT), or 1 month of NC (group 2: NC + OT) or olfactory training alone (group 3: OT). Olfactory evaluations (Sniffin’Sticks tests) were carried out at the time of inclusion, 1 and 2 months after the start of the therapeutic course. Results: A total of 152 hyposmic or anosmic patients completed the study. Group 1, 2 and 3 included 59, 22 and 71 patients, respectively and all patient groups were comparable regarding baseline Sniffin’Sticks tests. The median Sniffin’Sticks test values significantly improved from pre- to post-intervention in all groups. The increase of Sniffin’Sticks test values was higher in group 1 (OC + OT) compared with groups 2 and 3 (p < 0.001) at one month after treatment but did not remain so at 2 months. Groups 1, 2 and 3, respectively, presented parosmia in 20/71 (28.2%), 9/22 (40.9%) and 42/71 (59.2%) patients. This difference was statistically significant between group 1 and 3 (p < 0.001). There were no patients with a worsening of the disease or an increase of the severity of the COVID-19 symptoms. Conclusions: The use of OCs in patients with OD related to mild COVID-19 is generally well-tolerated without any case of deterioration of symptoms. OC is associated with greater improvement in psychophysical olfactory evaluations at 1-month post-treatment but there was no difference at 2 months. Parosmia may be reduced following treatment with OC and NC. On the basis of these preliminary results, it is possible to state that considering the 2 months efficacy of OC and NC with respect to the OT alone and the risk-benefit ratio, the benefit to start a specific treatment of COVID-19 related OD cannot be demonstrated and there is a need for a randomised controlled trial to assess this further.
Highlights
Coronavirus disease 2019 (COVID-19) has affected 123 million people worldwide and resulted in over two and a half million deaths [1]
The potential benefits of adding oral corticosteroids (OC) to olfactory training (OT) in COVID-19 patients with olfactory loss was recently suggested by two small studies [24,25], which differ from the present report regarding the time of administration of OC, the patient profiles and the number of included individuals
Our results suggest lower rates of parosmia reported in patients receiving oral or nasal steroids
Summary
Coronavirus disease 2019 (COVID-19) has affected 123 million people worldwide and resulted in over two and a half million deaths [1]. The first studies with 6-month follow-up reported that 5% to 11.7% of patients presented severe long-term OD and GD, meaning that we can expect have a high number of patients with disabling disorders in the few years [9,10,11,12,13] This data must be interpreted with caution as there are significant differences based on the assessment methodology [14] (e.g., objective versus subjective tests) and in no study it is possible to exclude that patients unknowingly presented an OD before COVID-19 [15]. Many otolaryngological conditions attributed to viral infection are commonly treated by OC, which may improve the recovery of nerve function through a reduction of the post-infectious inflammatory reaction [18,19]
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