Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid-dependent olfactory impairment.
ABSTRACT Oral corticosteroids may restore conductive olfactory dysfunction that has been defined as steroid-dependent olfactory loss, but the effect may be temporary. This study was designed to evaluate whether applying topical corticosteroids with a squirt system was more effective than using a nasal spray to maintain olfactory improvement following oral corticosteroids.
Prospective randomized trial enrolling 32 patients.
Patients were enrolled if they had suffered from olfactory dysfunction for more than 3 months, and if their composite scores of odor threshold, discrimination, and identification scores in Sniffin' Sticks olfactory tests increased by more than six points after 1 week of oral corticosteroid treatment. A total of 32 patients were enrolled and randomized into two groups. All patients were treated with topical corticosteroids for 2 months using either the spray or squirt system, respectively.
Both measured and self-rated olfactory functions after 1 and 2 months of topical corticosteroid treatment were better in the squirt group than in the spray group. However, 2 months of topical corticosteroid treatment with the squirt system only partially maintained olfactory improvement.
The application of topical corticosteroids with a squirt system was more effective than with a spray in maintaining olfactory improvement with oral corticosteroid treatment. Nevertheless, it only partially maintained the improvement so that topical corticosteroid treatment using a squirt system needs to be combined with intervals of short-term oral corticosteroids to treat steroid-dependent olfactory loss while avoiding the side effects of long-term oral corticosteroid use.
Article: Steroid-dependent anosmia.[show abstract] [hide abstract]
ABSTRACT: To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy. A prospective study of 24 patients with nasal and sinus polyps who were anosmic prior to endoscopic nasal and sinus surgery. Those who remained anosmic after surgery were treated with steroids. Most patients had asthma, allergic rhinitis, or both. A few had aspirin sensitivity. All 24 patients had testing of their sense of smell before and after surgery. Those who remained anosmic postoperatively were first treated with topical nasal and then oral steroids and then tested again. Twelve of the 24 remained anosmic after surgery and were found to be unresponsive to nasal steroids, but oral steroids were found to restore the sense of smell to normal in most patients. Few patients continued to take the medication for long periods of time mainly because of a fear of side effects. Recent studies have suggested the role of systemic steroids in olfactory secretion, which may explain the mechanism for this response. Patients who remain anosmic after the removal of nasal and sinus polyps can be treated with oral steroids resulting in improvement of their sense of smell. Further research is needed on a molecular level to determine the reason for this and also why oral but not nasal steroids are helpful in these patients.The Laryngoscope 03/2001; 111(2):200-3. · 1.98 Impact Factor
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ABSTRACT: The delivery of nasal drugs specifically to the middle meatus is of critical importance in the medical treatment of rhinosinusitis. In this respect, topical nasal drug administration by drops has generally been perceived to be superior to nasal sprays, although there is a lack of evidence to support this notion. This study aims to compare the intranasal delivery of nasal sprays and drops to the middle meatus in vivo, using a novel quantitative method. A surgical patty was placed in the middle meatus. Radio-labelled topical nasal drops and aqueous sprays were administered in a standardized fashion in normal volunteers (10 nasal cavities). The subsequent absorption of administered radio-labelled saline on the patty was measured using a gamma counter. A randomized prospective crossover design was used for the study. The mean percentage (range) of absorbed administered saline on the swab was 8.7 (0.3-39.5) and 9.7 (0.03-20.4) for the spray and drop administration techniques respectively (p = 0.8). Thus, there is wide variation in the delivery of topical nasal drugs and the perceived superiority of nasal drop administration, in terms of delivery to the middle meatus, may be incorrect.The Journal of Laryngology & Otology 02/2002; 116(1):10-3. · 0.68 Impact Factor
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ABSTRACT: "Sniffin' Sticks" is a test of nasal chemosensory performance that is based on penlike odor-dispensing devices. It is comprised of three tests of olfactory function: tests for odor threshold, discrimination and identification. Previous work has already established its test-retest reliability and validity in comparison to established measures of olfactory sensitivity. The results of this test are presented as a composite TDI score--i.e., the sum of results obtained for threshold, discrimination and identification measures. The present multicenter investigation aimed at providing normative values in relation to different age groups. To this end, 966 patients were investigated in 11 centers. An additional study tried to establish values for the identification of anosmic patients, with 70 anosmics investigated in five specialized centers where the presence of anosmia was confirmed by means of olfactory evoked potentials. For healthy subjects, the TDI score at the 10th percentile was 24.5 in subjects younger than 15 years, 30.3 for ages from 16 to 35 years, 28.8 for ages from 36 to 55 years and 27.5 for subjects older than 55 years. While these data can be used to estimate individual olfactory abilities in relation to a subject's age, hyposmia was defined as the 10th percentile score of 16- to 35-year-old subjects. Our latter study revealed that none of 70 anosmics reached a TDI score higher than 15. This score of 15 is regarded as the cut-off value for functional anosmia. These results provide the basis for the routine clinical evaluation of patients with olfactory disorders using "Sniffin' Sticks."Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/2000; 257(4):205-11. · 1.46 Impact Factor