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


METHODS
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.
Department of Otolaryngology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei. chshu@vghtpe.gov.tw
Chih-Hung
CH
Shu
Po-Lei
PL
Lee
An-Suey
AS
Shiao
Kee-Tak
KT
Chen
Ming-Ying
MY
Lan
D000281:Administration, Intranasal; D000284:Administration, Oral; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa; D059085:Nasal Sprays; D000857:Olfaction Disorders / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D012903:Smell / Q000187:drug effects*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D059085:Nasal Sprays