Departement of ENT Practice, ENT Center, HNO Zentrum am Kudamm, Berlin, Germany.
Ear Nose Throat J. 2024 Jun;103(1_suppl):48S-53S. doi: 10.1177/01455613231168487. Epub 2023 Mar 28.
The benefit of a nasal corticosteroid in the treatment of persistent post-infectious smell disorders is not as clear in previous studies as is assumed for olfactory training. This study would therefore like to describe the treatment strategies using the example of a persistent olfactory dysfunction as a result of a proven infection with SARS-CoViD-2-virus.
Twenty patients (average age of 33.9 ± 11.9 years) with hyposmia were included in this study from December 2020 to July 2021. Every second patient received additionally a nasal corticosteroid. The two resulting randomized groups of equal size were screened with the TDI test, a 20-item taste powder test for the assessment of retronasal olfaction and otorhinolaryngological examination. The patients were asked to train twice daily using a standardized odor training kit and followed up after 2 months and 3 months, respectively.
We documented a significant overall improvement in olfactory ability over the investigation period in both groups. While the TDI score steadily increased on average under the combination therapy, the rise under olfactory training alone was initially steeper. This short-term interaction effect over mean two months was not statistically significant. According to Cohen, however, a moderate effect (eta = 0.055, Cohen`s = 0.5) can still be assumed. This effect could be explained by a possibly higher compliance at the beginning of the sole olfactory training due to the lack of further drug treatment offers. When the training intensity decreases, the recovery of the sense of smell stagnates. Adjunctive therapy ultimately outweighs this short-term benefit.
The results reinforce the recommendation of early and consistent olfactory training on patients with dysosmia due to COVID-19. For continuous improvement of the sense of smell, an accompanying topical treatment seems at least to be worth consideration. The results should be optimized with larger cohorts and using new objective olfactometric methods.
与嗅觉训练相比，先前的研究对于鼻用皮质类固醇在治疗持续性感染后嗅觉障碍方面的益处并不明确。因此，本研究将通过 SARS-CoV2 病毒感染后证实的持续性嗅觉功能障碍为例，描述治疗策略。
2020 年 12 月至 2021 年 7 月期间，本研究纳入了 20 名（平均年龄 33.9±11.9 岁）嗅觉减退的患者。每 2 名患者中就有 1 名接受鼻用皮质类固醇治疗。这两组患者随机分为两组，每组 10 名，大小相等。两组患者均采用 TDI 测试、20 项味觉粉末测试评估鼻后嗅觉和耳鼻喉科检查进行筛查。患者被要求使用标准化的嗅觉训练包每天训练两次，并分别在 2 个月和 3 个月后进行随访。
我们记录了两组患者在整个研究期间嗅觉能力的显著整体改善。在联合治疗下，TDI 评分平均持续升高，而单独嗅觉训练下的升高起初更为陡峭。这种在平均两个月的短期交互作用在统计学上并不显著。然而，根据科恩的说法，仍可以假设一个中等效应（eta=0.055，Cohen`s=0.5）。这种效应可以通过单独嗅觉训练开始时由于缺乏进一步的药物治疗而导致的更高依从性来解释。当训练强度降低时，嗅觉恢复停滞。辅助治疗最终超过了这种短期获益。
这些结果强化了对 COVID-19 后嗅觉障碍患者进行早期和持续嗅觉训练的建议。为了持续改善嗅觉，伴随的局部治疗似乎至少值得考虑。应使用更大的队列和新的客观嗅觉测量方法来优化结果。
