Heilmann Stefan, Huettenbrink Karl-Bernd, Hummel Thomas
Department of Otorhinolaryngology, Smell and Taste Clinic, University of Dresden Medical School, Dresden, Germany.
Am J Rhinol. 2004 Jan-Feb;18(1):29-33.
The aim of this study was to evaluate the benefit of patients with olfactory dysfunction from local (group A) or systemic (group B) administration of corticosteroids.
This unblinded study was conducted at a smell and taste outpatient clinic of an institutional referral center. Patients with olfactory loss after infections of the upper respiratory tract, patients with apparent sinonasal disease, and patients suffering from "idiopathic" smell loss were included. Effects of mometasone nasal spray, administered for 1-3 months, were studied in 37 patients. In addition, effects of oral prednisolone were analyzed in 55 patients who received decreasing doses over 21 days, starting with a dose of 40 mg. Olfactory function before and after treatment was measured.
Although odor identification scores tended to increase (p = 0.05), mometasone nasal spray did not significantly improve olfactory function, when looking at the entire group of patients or when analyzing the three diagnostic categories separately. In contrast, after systemic administration of corticosteroids, improvement of olfactory function was seen over all diagnostic categories (p < 0.001). Interestingly, olfactory function also improved in patients diagnosed with olfactory loss after upper respiratory tract infection (p = 0.05) and in patients initially diagnosed with "idiopathic," olfactory dysfunction (p = 0.008).
In many patients, local application of corticosteroids appears to have little or no positive effect on olfactory dysfunction, especially when considering long-term changes. Duration of disease, the patient's age/sex, or the presence of parosmia does not appear to predict the response to therapy with corticosteroids.
本研究的目的是评估局部（A组）或全身（B组）使用皮质类固醇对嗅觉功能障碍患者的益处。
这项非盲法研究在一家机构转诊中心的嗅觉和味觉门诊进行。纳入了上呼吸道感染后嗅觉丧失的患者、明显鼻窦疾病患者以及患有“特发性”嗅觉丧失的患者。对37例患者使用莫米松鼻喷雾剂治疗1 - 3个月的效果进行了研究。此外，对55例患者口服泼尼松龙的效果进行了分析，这些患者在21天内剂量递减，起始剂量为40毫克。测量了治疗前后的嗅觉功能。
尽管气味识别评分有上升趋势（p = 0.05），但从整个患者群体来看，或者分别分析三个诊断类别时，莫米松鼻喷雾剂并未显著改善嗅觉功能。相比之下，全身使用皮质类固醇后，所有诊断类别患者的嗅觉功能均有改善（p < 0.001）。有趣的是，上呼吸道感染后被诊断为嗅觉丧失的患者（p = 0.05）以及最初被诊断为“特发性”嗅觉功能障碍的患者（p = 0.008）的嗅觉功能也有所改善。
在许多患者中，局部应用皮质类固醇对嗅觉功能障碍似乎几乎没有积极作用，尤其是考虑到长期变化时。疾病持续时间、患者的年龄/性别或嗅觉倒错的存在似乎并不能预测对皮质类固醇治疗的反应。
