Topical corticosteroids applied with a squirt system are more effective than a nasal spray for steroid-dependent olfactory impairment

Authors

  • Chih-Hung Shu MD,

    Corresponding author
    1. Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei
    • Department of Otolaryngology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan 11217, R.O.C
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  • Po-Lei Lee PhD,

    1. the Department of Electrical Engineering, National Central University, Jhongli, Taiwan
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  • An-Suey Shiao MD,

    1. Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei
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  • Kee-Tak Chen MD,

    1. Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei
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  • Ming-Ying Lan MD

    1. Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei
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  • The study was supported by Taipei Veterans General Hospital (Grant V100C-156). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

Prospective randomized trial enrolling 32 patients.

Methods:

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.

Results:

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.

Conclusions:

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. Laryngoscope, 2012

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