Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
Ann Otol Rhinol Laryngol. 2023 Jul;132(7):806-817. doi: 10.1177/00034894221118186. Epub 2022 Aug 12.
Anosmia and hyposmia significantly affect patients' quality of life and have many etiologies, including trauma, inflammatory conditions including chronic rhinosinusitis, neoplasm, and viral infections, such as rhinovirus and SARS-CoV-2.
Our purpose was to establish whether a consensus exists regarding optimal management of olfactory dysfunction and to provide insight into the treatment of anosmia in the current climate of increased prevalence secondary to COVID-19. Thus, we aimed to systematically review the literature on the management of non-Chronic-rhinosinusitis- related anosmia/hyposmia.
PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating management of anosmia and hyposmia written in the English language, with original data, a minimum of 3 months of follow-up except for COVID-related studies, at least 2 patients, and well-defined and measurable outcomes.
A total of 3013 unique titles were returned upon the initial search. Of these, 297 abstracts were examined, yielding 19 full texts meeting inclusion criteria (8 with level 1 evidence, 3 with level 2, 1 with level 3, and 7 with level 4). The studies included a total of 1522 subjects, with follow up ranging from 3 to 72 months, with an exception for COVID related studies. Endpoints were based on clinically significant improvements of olfactory functions as measured through validated smell tests. Treatments with the most robust data were intranasal corticosteroids and olfactory training.
The literature on the treatment of anosmia and hyposmia includes randomized trials showing the efficacy of a few modalities. While further research is needed to expand therapeutic options for this debilitating condition, the current literature supports the use of olfactory training and topical corticosteroids.
嗅觉丧失和嗅觉减退会显著影响患者的生活质量，其病因很多，包括创伤、慢性鼻-鼻窦炎等炎症性疾病、肿瘤，以及病毒感染，如鼻病毒和 SARS-CoV-2。
我们旨在确定在当前 COVID-19 发病率增加的情况下，对于嗅觉功能障碍的最佳治疗方法是否存在共识，并深入了解治疗嗅觉丧失的方法。因此，我们旨在系统地综述非慢性鼻-鼻窦炎相关嗅觉丧失/减退的治疗方法文献。
通过结合医学主题词（MeSH），从 PubMed、EMBASE 和 Cochrane 数据库中检索自 1990 年 1 月以来发表的文章。我们纳入了评估嗅觉丧失和嗅觉减退治疗的文章，这些文章使用英文撰写，具有原始数据，除了与 COVID 相关的研究外，随访时间至少为 3 个月，至少有 2 名患者，以及定义明确和可衡量的结局。
初步检索共返回 3013 个唯一标题。其中，297 篇摘要进行了检查，19 篇全文符合纳入标准（8 篇为 1 级证据，3 篇为 2 级，1 篇为 3 级，7 篇为 4 级）。这些研究共纳入了 1522 名患者，随访时间从 3 到 72 个月不等，与 COVID 相关的研究除外。终点是通过经过验证的嗅觉测试衡量的嗅觉功能的临床显著改善。具有最可靠数据的治疗方法是鼻内皮质类固醇和嗅觉训练。
关于嗅觉丧失和嗅觉减退治疗的文献包括显示几种方法疗效的随机试验。虽然需要进一步研究来扩大这种使人衰弱的疾病的治疗选择，但目前的文献支持使用嗅觉训练和局部皮质类固醇。
