Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA.
Int Forum Allergy Rhinol. 2024 Jun;14(6):1088-1096. doi: 10.1002/alr.23314. Epub 2024 Jan 16.
Post-COVID parosmia may be due to dysautonomia and sympathetic hyperresponsiveness, which can be attenuated by stellate ganglion block (SGB). This study evaluates SGB as a treatment for post-COVID olfactory dysfunction (OD).
Retrospective case series with prospective data of patients with post-COVID OD undergoing unilateral (UL) or bilateral (BL) SGB. Patients completed Brief Smell Identification Tests (BSIT) (12 points maximum) and post-procedure surveys including parosmia severity scores on a scale of 1 (absent) to 10 (severe). Scores were compared from before treatment (pre-SGB) to after first (SGB1) or second (SGB2) treatments in overall, UL, and BL cohorts.
Forty-seven patients with post-COVID OD underwent SGB, including 23 UL and 24 BL. Twenty patients completed pre- and post-SGB BSITs (eight UL and 12 BL). Twenty-eight patients completed postprocedure surveys (11 UL and 17 BL). There were no differences in BSIT scores from pre-SGB to post-SGB1 or post-SGB2 for the overall (p = 0.098), UL (p = 0.168), or BL (p = 0.230) cohorts. Parosmia severity for the overall cohort improved from pre-SGB (8.82 ± 1.28) to post-SGB1 (6.79 ± 2.38) and post-SGB2 (5.41 ± 2.35), with significant differences from pre-SGB to post-SGB1 (p < 0.001) and pre-SGB to post-SGB2 (p < 0.001), but not post-SGB1 to post-SGB2 (p = 0.130). Number of parosmia triggers decreased for overall (p = 0.002), UL (p = 0.030) and BL (p = 0.024) cohorts. Quality of life (QOL) improved for all cohorts regarding food enjoyment, meal preparation, and socialization (p < 0.05).
SGB may improve subjective parosmia and QOL for patients with post-COVID OD, however it may not affect odor identification. Further placebo-controlled studies are warranted.
新冠后幻嗅可能是由于自主神经功能紊乱和交感神经过度反应引起的，而星状神经节阻滞（SGB）可以减轻这种情况。本研究评估了 SGB 作为治疗新冠后嗅觉障碍（OD）的一种方法。
这是一项回顾性病例系列研究，前瞻性纳入了接受单侧（UL）或双侧（BL）SGB 的新冠后 OD 患者。患者完成简短嗅觉识别测试（BSIT）（最高 12 分）和治疗后调查，包括幻嗅严重程度评分（范围 1 分[不存在]至 10 分[严重]）。在总体、UL 和 BL 队列中，分别比较治疗前（SGB 前）与第一次（SGB1）或第二次（SGB2）治疗后的评分。
47 例新冠后 OD 患者接受了 SGB，其中 23 例接受 UL，24 例接受 BL。20 例患者完成了 SGB 前后的 BSIT（8 例 UL，12 例 BL）。28 例患者完成了治疗后调查（11 例 UL，17 例 BL）。总体（p=0.098）、UL（p=0.168）或 BL（p=0.230）队列中，BSIT 评分从 SGB 前到 SGB1 或 SGB2 后均无差异。总体队列的幻嗅严重程度从 SGB 前（8.82±1.28）改善至 SGB1 后（6.79±2.38）和 SGB2 后（5.41±2.35），与 SGB 前相比差异有统计学意义（p<0.001）和 SGB 前相比差异有统计学意义（p<0.001），但 SGB1 后与 SGB2 后差异无统计学意义（p=0.130）。幻嗅触发次数总体（p=0.002）、UL（p=0.030）和 BL（p=0.024）队列均减少。所有队列的食物享受、膳食准备和社交方面的生活质量（QOL）均有所改善（p<0.05）。
SGB 可能改善新冠后 OD 患者的主观幻嗅和 QOL，但可能不影响嗅觉识别。需要进一步开展安慰剂对照研究。
