Olfactory outcomes in chronic rhinosinusitis with nasal polyposis after medical treatments: a systematic review and meta-analysis.
BACKGROUND
Olfactory dysfunction is common among patients with chronic rhinosinusitis and has a negative impact upon quality of life. Olfactory dysfunction can be both subjective and objective and appears to be more predominant in patients with concomitant nasal polyposis. The efficacy of medical interventions on olfaction among patients with CRS with nasal polyposis (CRSwNP) is not well known. Our aim was to perform a systematic review with meta-analysis of the efficacy of medical therapies on objective and subjective hyposmia among patients with CRSwNP.


METHODS
Olfaction specific outcomes from randomized controlled trials evaluating medical interventions on patients with CRSwNP were evaluated. Interventions included corticosteroids, antibacterials, antifungals, diuretics, herbals and anti-immunoglobulin E (IgE) medications.


RESULTS
A total of 28 randomized control trials evaluation olfaction in CRSwNP was identified and systematically reviewed. Sufficient data for meta-analysis was retrieved for 5 trials. In the meta-analysis, oral steroids showed significant improvement in subjective olfaction scores compared to placebo (standardized mean difference [SMD] -2.22; 95% confidence interval [CI], -3.94 to -0.49). Oral steroids also showed significant improvement in objective olfaction scores compared to placebo (SMD 0.65; 95% CI, 0.28 to 1.01). In the systematic review, both topical steroids and combined topical and oral steroid groups showed overall improvement in subjective olfaction outcomes. Antibacterials, antifungals, herbals, and anti-IgE medications had no impact on overall olfaction scores.


CONCLUSIONS
The results of this meta-analysis demonstrated that oral and topical steroids significantly improve olfaction in patients suffering from CRSwNP.
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
Sarfaraz M
SM
Banglawala
Samuel L
SL
Oyer
Shivangi
S
Lohia
Alkis J
AJ
Psaltis
Zachary M
ZM
Soler
Rodney J
RJ
Schlosser
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000906:Antibodies / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004333:Drug Administration Routes; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy*; D000857:Olfaction Disorders / Q000209:etiology / Q000517:prevention & control*; D008517:Phytotherapy; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy*; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy*; D012903:Smell / Q000187:drug effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000906:Antibodies; D000935:Antifungal Agents; D004232:Diuretics; D007073:Immunoglobulin E
chronic rhinosinusitis; disease severity; eosinophilic rhinitis and nasal polyposis; evidence-based medicine; olfaction; olfactory test; steroid therapy