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Prednisone and sense of smell. Doctors Identify The Best Treatment For COVID-19 Smell Loss, And It's Not Steroids
A group of olfactory experts are advising against the use of steroids to treat a lingering loss of smell caused by COVID Instead, they suggest you try re-training your nose to sniff out certain scents. It'll take time, possibly months, but if you try to get a whiff of at least four different aromas twice a day, it could help you recover faster and more fully, without any unwanted side effects.
The recommendation is based on a systematic evidence-based review, which concluded corticosteroids should not be the first treatment option for smell loss due to COVID These drugs are commonly prescribed to those with congested or inflamed noses, but this doesn't seem to be what's causing olfactory dysfunction in those with COVID, so it might not work. Smell training, on the other hand, is a more evidence-based way to get your sniffer back up to snuff after a viral infection.
Moreover, it is the only available treatment… supported by a robust evidence base. It's hard to compare steroids and smell training treatments for COVID olfactory dysfunction specifically, as no controlled studies have been done.
That said, the idea of smell training has been around for a while. It's even been used with great success to help treat smell loss from other infections. Today, we might need to implement this practice on a scale never before seen.
Around 60 percent of those who contract COVID experience a disturbance in smell, while about 10 percent have persistent symptoms lasting for weeks, even months. Luckily, it seems most people do get better, and smell training might have something to do with that. At the start of , a study of 1, coronavirus patients with olfactory dysfunction found 95 percent of patients recovered their sense of smell after six months. These patients were advised to undertake two smell training sessions a day at home, although it was unclear how many people actually did this.
Corticosteroids have also been considered as a treatment option, but this medication isn't harmless. It can come with many unwanted side effects, including fluid retention, high blood pressure, and mood swings.
Plus, it might not even help. We just don't have enough evidence to say for sure. While some case reports suggest steroids may help people recover their lost sense of smell from COVID, without a control, it's unclear if these patients would have gotten better on their own - as, indeed, it seems many patients do.
Based on the current evidence, the authors join numerous other experts in calling for caution. Until randomized, placebo-controlled trials can be undertaken we should start with smell training, they say, and not steroids.
This requires time, and not everyone is going to get better at the same rate. Older people, for instance, might take longer to get their sense of smell back as they have fewer olfactory receptor neurons.
Traditionally speaking, smell training relies on four odors: clove, rose, lemon and eucalyptus, but it really doesn't matter what you choose. There might even be a benefit to focusing on familiar smells, like perfumes, lemon rinds, vanilla or ground coffee , and reflecting on memories while you sniff them.
For the best results, you should change the four smells every 12 weeks. If you're interested in learning more, Philpott suggests checking out the charity website Fifth Sense. About Us Our Team. Follow Us. Daily Newsletter. Contact Privacy Accessibility Terms.
❿Prednisone and sense of smell
Around 60 percent of those who contract COVID experience a disturbance in smell, while about 10 percent have persistent symptoms lasting for weeks, even months. Luckily, it seems most people do get better, and smell training might have something to do with that. At the start of , a study of 1, coronavirus patients with olfactory dysfunction found 95 percent of patients recovered their sense of smell after six months.
These patients were advised to undertake two smell training sessions a day at home, although it was unclear how many people actually did this. Corticosteroids have also been considered as a treatment option, but this medication isn't harmless. It can come with many unwanted side effects, including fluid retention, high blood pressure, and mood swings.
Plus, it might not even help. We just don't have enough evidence to say for sure. While some case reports suggest steroids may help people recover their lost sense of smell from COVID, without a control, it's unclear if these patients would have gotten better on their own - as, indeed, it seems many patients do.
Based on the current evidence, the authors join numerous other experts in calling for caution. Until randomized, placebo-controlled trials can be undertaken we should start with smell training, they say, and not steroids.
This requires time, and not everyone is going to get better at the same rate. Older people, for instance, might take longer to get their sense of smell back as they have fewer olfactory receptor neurons. Traditionally speaking, smell training relies on four odors: clove, rose, lemon and eucalyptus, but it really doesn't matter what you choose. There might even be a benefit to focusing on familiar smells, like perfumes, lemon rinds, vanilla or ground coffee , and reflecting on memories while you sniff them.
For the best results, you should change the four smells every 12 weeks. However, because of the side effects of prolonged use, we try to minimize the use of oral steroids for loss of smell. We prefer to use other medications that are less likely to cause side effects- but these also are often less effective.
We use oral and nasal antihistamines if one is allergic- we would suggest other medications such as singulair- and allergy desensitization if you are allergic. There is the possibility that there are further polyps to be removed surgically- and this should be evaluated. Lastly, some patients and their sinus doctors will use the smallest dose of oral prednisone from time to time that works judiciously- balancing against the potential for long term side effects.
I have one such patient who chooses to take a small dose of steroids once or twice a year, before his vacations. In your case, I would try to use all of the more conservative measures on a regular basis first before relying on steroids for loss of smell.
We have found Budesinide rinses and nasal nebulizer treatments to be two of the more promising topical treatments that are often overlooked. I would speak to your sinus specialist and explain your concerns and come up with a regimen that works for you and your life style. To request an appointment at NYOG by email, please give us your contact information in the form below and we will get back to you shortly with available dates. We take most insurance plans. Please call the office to see if we accept yours.
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❾-50%}Prednisone and sense of smell -
When we remove polyps from the nose, we usually cannot remove all of the swelling around the smell fibers as they are quite close to the thin wall separating the nose from the brain cribiform plate. In any case, whatever causes the polyps in the first place, is likely to continue to cause the nasal and sinus lining to be swollen after surgery. Oral steroids, such as medrol or prednisone, are the most effective medications we have in shrinking down polyps and in your case are effective enough to bring back your sense of smell.
However, because of the side effects of prolonged use, we try to minimize the use of oral steroids for loss of smell. We prefer to use other medications that are less likely to cause side effects- but these also are often less effective. We use oral and nasal antihistamines if one is allergic- we would suggest other medications such as singulair- and allergy desensitization if you are allergic.
There is the possibility that there are further polyps to be removed surgically- and this should be evaluated. Lastly, some patients and their sinus doctors will use the smallest dose of oral prednisone from time to time that works judiciously- balancing against the potential for long term side effects. I have one such patient who chooses to take a small dose of steroids once or twice a year, before his vacations. In your case, I would try to use all of the more conservative measures on a regular basis first before relying on steroids for loss of smell.
Treatment measures included topical steroids, systemic steroids, classical olfactory training COT , and modified olfactory training MOT. COT was defined as the regimen firstly described by Hummel et al. Seventeen out of the 20 included articles had control groups and all articles were statistically analyzed. Four trials used oral steroids with other control treatments and two trials used topical steroids alone Table 1 Heilmann et al.
Of these trials following systemic steroids, two studies evaluated patients with PVOD and demonstrated a significant improvement of olfactory score and recovery rate after systemic steroids therapy alone Heilmann et al. Similarly, another study by Schriever et al. Table 1. Summary of topical and systemic steroid studies included in the systematic review.
About the local steroids, nasal spray and injection to the olfactory cleft were included. Four studies evaluated the effect of nasal spray or injection alone on the olfaction in patients with PVOD Heilmann et al. A retrospective study by Heilmann et al. Fukazawa et al. Two studies used steroids in combination with other drugs Seo et al.
The novel therapy about systemic steroids and nasal irrigation with betamethasone, ambroxol, and prednisolone in patients with COVID had been explored by Vaira et al. Compared with the no treatment group, the experimental group showed significant olfactory improvement in which the mean CCCRC score was from 10 to Another retrospective case series trial by Stenner et al.
The administered regimen included beclomethasone at 3 mg daily for 20 days and then patients were randomly assigned to budesonide spray 1. After the experiment, there was no difference in recovery rate with additional antibiotics compared with topical treatment.
In summary, the routine use of nasal steroid spray alone during the management of PVOD without combination with other treatments is not recommended. However, direct injection of steroid or nasal steroid spray into the olfactory cleft has been proved to be a promising therapy, which needed further studies. Although early evidence suggests that systemic steroids are more effective than intranasal steroid spray in patients with olfactory loss due to varied etiologies Kim et al.
More RCTs are required before a recommendation on medical treatment can be provided. COT was firstly described by Hummel et al. Patients usually smell each odorant for 10 s or longer twice daily until they have finished the entire set Hummel et al.
Table 2. Summary of classical olfactory training studies included in the systematic review. Even for a short period of 12 weeks, the COT group provided relatively higher scores than to placebo which did not receive training Hummel et al.
Another study by Konstantinidis et al. The mean TDI scores significantly changed from A prospective, randomized controlled clinical trial by Konstantinidis et al. Patients with PVOD were exposed to four odors twice daily for 16 weeks short-term group or 56 weeks long-term group and compared with the no treatment group. Figure 2. In summary, short-term olfactory training results in sustainable olfactory improvement greater than that of the natural course of the disease. Furthermore, olfactory function sustained a fast recovery period and a second slower period after long-term olfactory training.
Four randomized controlled and one pseudorandomized study used modifications of the COT, including different concentrations of odorants, different molecular odorants, various odorants, and olfactory balls Table 3 Damm et al. Two RCTs without a placebo group compared two different types of olfactory training with COT for weeks and all the treatment groups showed significant olfactory improvement after olfactory training Qiao et al. A study by Qiao et al.
Another study by Saatci et al. Table 3. Summary of modified olfactory training studies included in the systematic review. Another prospective, randomized, controlled clinical trial by Altundag et al. Both the modified olfactory training and COT groups reached better scores than controls in terms of odor discrimination and odor identification.
Besides, changing the types of odors periodically during olfactory training can enhance the likelihood of success of this olfactory therapy. Another two prospective studies explored the effect of different odor concentrations and molecular weight odorants on the olfactory function in patients with PVOD Damm et al.
Heavy-weight molecules were associated with a larger improvement in threshold score at 5 months. Except for the threshold, there were no differences between light molecular weight odorants and heavy molecular weight odorants. Damm et al. The use of odors at higher concentrations was more beneficial to PVOD than low concentrations of odorants within 12 months.
At 18 weeks, However, only In either the high There was no significant difference in the recovery rate with prolonged treatment.
Figure 3. In summary, a recommendation supports the use of modified olfactory training for patients with PVOD. On the other hand, they are more helpful for the recovery of olfactory dysfunction on an earlier and prolonged start.
Five trials studied combined therapy of olfactory training and steroid vs. The treatment details involved exposure to four odors twice daily and budesonide 0. Another study by Nguyen and Patel examined the effect of adding budesonide irrigation to olfactory training on patients with olfactory loss Nguyen and Patel, ; Patients in the COT and steroids group had improved their olfactory score by 7. Table 4.
Summary of combination with olfactory training and steroid studies included in the systematic review. In summary, olfactory training with steroids exhibits clinical significance in the improvement of the Sniffin' Sticks score. Although some studies showed there were no differences between a combination of nasal spray and olfactory training and olfactory training only, the use of steroid irrigation and oral corticosteroids in addition to COT could be beneficial in accelerating the recovery of PVOD.
A combination of steroids and olfactory training is more efficient than olfactory training only in managing olfactory dysfunction from PVOD. This is the first systematic review summarizing the evidence for steroids, olfactory training, or both interventions in the treatment of PVOD and revealed the improvement and optimization of treatment modalities.
For steroid treatment, direct injection of steroid or nasal steroid spray into the olfactory cleft significantly improved the olfactory function in patients with PVOD and nasal steroid spray alone is not recommended Heilmann et al.
These studies indicated that direct alleviation of the lesions in the olfactory cleft facilitated the olfactory improvement in patients with PVOD. It has been reported that nasal steroid sprays deliver medication to the restricted areas including the anterior and inferior parts of the nasal cavity and the deposition of steroids in the superior and posterior of the nasal passages is relatively limited Djupesland and Skretting, ; Lam et al.
That might explain why local steroids direct into the olfactory cleft demonstrated exact treatment effect in patients with PVOD. Similarly, head positions including Kaiteki and Mygind positions delivered the nasal drops effectively to the olfactory epithelium, and further studies should evaluate the effect of nasal steroid drops with these two head positions in patients with PVOD Mori et al.
It should be pointed out that current evidence supporting systemic steroids over nasal steroids spray in patients with PVOD is limited and more studies are needed Heilmann et al. We next systematically reviewed the efficiency of different olfactory training modalities in patients with PVOD from the perspective of olfactory recovery rate. Recent meta-analyses found a beneficial effect from olfactory training on a range of etiologies including PVOD for olfactory dysfunction, although characterized by a high level of heterogeneity among included studies Pekala et al.
Although there is growing evidence supporting the efficiency of COT in patients with PVOD, the exact effect of modification of the COT including treatment duration, various odorants, olfactory training device olfactory training ball , changing the types of odors periodically, different molecular odorants, and different concentrations of odorants on patients with PVOD is not systematically reviewed.
It can be inferred that long-term olfactory training provided sustainable improvement of at least 56 weeks and the training effect consistently modulated the olfactory system. Recent fMRI studies on patients with PVOD showed that olfactory training reorganized functional connectivity networks, especially within the visual cortex Kollndorfer et al. An extended period of odor exposure maintained the olfactory training effect at a sustainable high level.
However, the mechanism accounting for the difference between short-term and long-term effects is still unknown. As for the types of odorant, MOT with four different odors essential balm, vinegar, alcohol, and rose perfume was not superior to COT regarding the difference in TDI improvements Qiao et al. This study demonstrated that different types of olfactory agents which irritated the olfactory system and nasal trigeminal system functioned similarly in improving olfaction.
A new olfactory training device called olfactory training ball increased adherence to the training process, which was associated with better olfactory outcomes than COT Saatci et al. Furthermore, continuing olfactory training with four different odors after 12 and 24 weeks produced better results in terms of odor discrimination and odor identification scores as compared with COT throughout the entire study. Previous studies showed that it was odor discrimination and odor identification and not odor thresholds that correlated significantly with tests of executive function and semantic memory which is highly associated with central processing and cognitive function Nasreddine et al.
We speculated that changing the odors with prolonged olfactory training produced cognitive improvement, which further leads to improved olfactory perception. As for the different molecular weight odorant and odor concentrations, heavy-weight molecules were associated with a larger improvement in threshold score, and more patients with PVOD would achieve MCID in the high-concentration training group than that in the low-concentration training group Damm et al.
A recent meta-analysis showed that it was the odor discrimination and odor identification but not odor thresholds that improved after olfactory training among patients with olfactory loss due to varied etiologies Pekala et al. It seems that changes in molecular weight odorant during olfactory training would facilitate the improvement of odor thresholds, which provided a new strategy to comprehensively improve olfactory function in patients with PVOD.
A thorough discussion on whether a combination of steroids and olfactory training is better than monotherapy has not been reported. It is imperative to confirm the efficacy of steroids and olfactory training on patients with PVOD. Fleiner et al. It can be inferred that the addition of steroids including nasal steroid spray or steroid irrigation to COT could significantly improve the efficiency of COT within 8 months.
Presumably, local steroids could suppress inflammation within sinonasal cavities that caused anosmia and promote proper neuronal regeneration at the same time to enhance the effect of COT Nguyen and Patel, Luckily, it seems most people do get better, and smell training might have something to do with that. At the start of , a study of 1, coronavirus patients with olfactory dysfunction found 95 percent of patients recovered their sense of smell after six months.
These patients were advised to undertake two smell training sessions a day at home, although it was unclear how many people actually did this. Corticosteroids have also been considered as a treatment option, but this medication isn't harmless.
It can come with many unwanted side effects, including fluid retention, high blood pressure, and mood swings. Plus, it might not even help. We just don't have enough evidence to say for sure. While some case reports suggest steroids may help people recover their lost sense of smell from COVID, without a control, it's unclear if these patients would have gotten better on their own - as, indeed, it seems many patients do. Based on the current evidence, the authors join numerous other experts in calling for caution.
Until randomized, placebo-controlled trials can be undertaken we should start with smell training, they say, and not steroids.
Background: Postviral olfactory dysfunction PVOD is a clinical challenge due to limited therapeutic options and poor prognosis. Both steroids and olfactory training have been proved to be effective for olfactory dysfunction with varied etiologies. We sought to perform a systematic review to summarize the evidence of steroids or olfactory training for patients with PVOD.
Methods: A systematic literature review using PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies assessing olfactory change in patients with PVOD receiving steroid or olfactory training. Results: Of the initial abstracts reviewed, 20 articles with data from 2, patients with PVOD were included.
Treatments including topical steroids, systemic steroids, classical olfactory training COTmodified olfactory training MOTand olfactory training with steroid were analyzed. Both psychophysical olfactory testing and subjective symptom scores were utilized to assess the olfactory function.
The routine use of nasal steroid spray alone during the management of PVOD seems to have no positive effect on olfactory dysfunction. Direct injection of steroid or nasal steroid spray into the olfactory cleft significantly improved the olfactory function in patients with PVOD. Olfactory improvement is greater than that of the natural course of the disease with short-term COT.
Treatment duration, various odorants, olfactory training devices, changing the types of odors periodically, different molecular odorants, and different concentrations of odorants tended to increase the efficiency of MOT. From week 24 to week 36, both COT and MOT groups reached the maximum therapeutic effect regarding the number of participants achieving clinically significant improvement.
A combination of local or oral steroids with olfactory training is more efficient than COT only. Olfaction, together with vision, hearing, taste, and touch, constitutes the special sensory function of human beings, which has the effects of discriminating odors, increasing appetite, and warning, and is the primary tool for human understanding and cognition of the outside world like vision and hearing.
There are numerous etiologies of olfactory dysfunction. This pandemic has regained interest in PVOD and the related treatment. A variety of drugs were reported in the literature for the treatment of PVOD, which were confirmed to affect including corticosteroids, vitamin A, Ginkgo biloba extract, and sodium citrate Seo et al.
Both oral and intranasal corticosteroids significantly improve olfactory function in patients with olfactory dysfunction with varied etiologies Schriever et al.
Meanwhile, olfactory training is currently the non-medical treatment supported by level 1A evidence which was proved to have a significant improvement on olfactory function in patients with olfactory disorders Hummel et al. These treatments gained widespread acceptance and were included in treatment guidelines for PVOD Sorokowska et al.
The objective of this systematic review was to summarize the current evidence of steroids or olfactory training in PVOD, especially a combination of steroids and olfactory training. Two investigators F. A combination of the following search algorithm was used in this review: postviral olfactory dysfunction, postviral anosmia, post-infectious olfactory dysfunction, post-infectious olfactory loss, or postviral olfactory disorder and olfactory therapy, olfactory training, smell training, smell therapy, steroid, systemic steroid, topical steroid, or local steroid.
The search strategy is illustrated in Figure 1. The systematic search was not restricted to any specific study or publication type to ensure a thorough evaluation of the literature. Figure 1. The article selection process for systematic review. URTI, upper respiratory tract infection. Studies exploring the effects of steroids, olfactory training, or both interventions on olfaction in patients with PVOD were included.
Changes in olfactory scores or rates of patients with treatment response should be reported and abstracts containing subjects with postviral olfactory dysfunction and other etiologies of olfactory dysfunction were also included.
Exclusion criteria included non-English language and patient populations composed exclusively of those with olfactory dysfunction secondary to etiologies other than viral infection e.
Studies without a defined intervention were excluded. In addition, case reports, letters to the editor, abstracts, and book chapters were not included. Two reviewers F. Extracted data included descriptive baseline characteristics, intervention data regimen and durationfollow-up, and olfactory outcomes.
Summary tables were developed after the extraction of articles. Our search identified studies that met the inclusion criteria through the initial literature Figure 1. After the removal of duplicates and abstract screening, articles were excluded.
Finally, 20 articles were included in the systematic review. A total of 2, patients with olfactory dysfunction were included and The severity of olfactory dysfunction ranged from hyposmia to anosmia. The length of follow-up varied from half a month to 12 months. Treatment measures included topical steroids, systemic steroids, classical olfactory training COTand modified olfactory training MOT.
COT was defined as the regimen firstly described by Hummel et al. Seventeen out of the 20 included articles had control groups and all articles were statistically analyzed. Four trials used oral steroids with other control treatments and two trials used topical steroids alone Table 1 Heilmann et al.
Of these trials following systemic steroids, two studies evaluated patients with PVOD and demonstrated a significant improvement of olfactory score and recovery rate after systemic steroids therapy alone Heilmann et al. Similarly, another study by Schriever et al.
Table 1. Summary of topical and systemic steroid studies included in the systematic review. About the local steroids, nasal spray and injection to the olfactory cleft were included. Four studies evaluated the effect of nasal spray or injection alone on the olfaction in patients with PVOD Heilmann et al. A retrospective study by Heilmann et al.
Fukazawa et al. Two studies used steroids in combination with other drugs Seo et al. The novel therapy about systemic steroids and nasal irrigation with betamethasone, ambroxol, and prednisolone in patients with COVID had been explored by Vaira et al. Compared with the no treatment group, the experimental group showed significant olfactory improvement in which the mean CCCRC score was from 10 to Another retrospective case series trial by Stenner et al.
The administered regimen included beclomethasone at 3 mg daily for 20 days and then patients were randomly assigned to budesonide spray 1.
After the experiment, there was no difference in recovery rate with additional antibiotics compared with topical treatment. In summary, the routine use of nasal steroid spray alone during the management of PVOD without combination with other treatments is not recommended.
However, direct injection of steroid or nasal steroid spray into the olfactory cleft has been proved to be a promising therapy, which needed further studies. Although early evidence suggests that systemic steroids are more effective than intranasal steroid spray in patients with olfactory loss due to varied etiologies Kim et al. More RCTs are required before a recommendation on medical treatment can be provided. COT was firstly described by Hummel et al.
Patients usually smell each odorant for 10 s or longer twice daily until they have finished the entire set Hummel et al. Table 2. Summary of classical olfactory training studies included in the systematic review.
Even for a short period of 12 weeks, the COT group provided relatively higher scores than to placebo which did not receive training Hummel et al. Another study by Konstantinidis et al. The mean TDI scores significantly changed from A prospective, randomized controlled clinical trial by Konstantinidis et al. Patients with PVOD were exposed to four odors twice daily for 16 weeks short-term group or 56 weeks long-term group and compared with the no treatment group.
Figure 2. In summary, short-term olfactory training results in sustainable olfactory improvement greater than that of the natural course of the disease. Furthermore, olfactory function sustained a fast recovery period and a second slower period after long-term olfactory training. Four randomized controlled and one pseudorandomized study used modifications of the COT, including different concentrations of odorants, different molecular odorants, various odorants, and olfactory balls Table 3 Damm et al.
Two RCTs without a placebo group compared two different types of olfactory training with COT for weeks and all the treatment groups showed significant olfactory improvement after olfactory training Qiao et al. A study by Qiao et al. Another study by Saatci et al. Table 3. Summary of modified olfactory training studies included in the systematic review.
Another prospective, randomized, controlled clinical trial by Altundag et al. Both the modified olfactory training and COT groups reached better scores than controls in terms of odor discrimination and odor identification. Besides, changing the types of odors periodically during olfactory training can enhance the likelihood of success of this olfactory therapy.
Another two prospective studies explored the effect of different odor concentrations and molecular weight odorants on the olfactory function in patients with PVOD Damm et al. Heavy-weight molecules were associated with a larger improvement in threshold score at 5 months. Except for the threshold, there were no differences between light molecular weight odorants and heavy molecular weight odorants.
Damm et al. The use of odors at higher concentrations was more beneficial to PVOD than low concentrations of odorants within 12 months. At 18 weeks, However, only In either the high There was no significant difference in the recovery rate with prolonged treatment. Figure 3. In summary, a recommendation supports the use of modified olfactory training for patients with PVOD.
On the other hand, they are more helpful for the recovery of olfactory dysfunction on an earlier and prolonged start. Five trials studied combined therapy of olfactory training and steroid vs.
The treatment details involved exposure to four odors twice daily and budesonide 0.
Although the benefit of steroids for post-URTI olfactory loss is not entirely clear, physicians still commonly use them as first-line treatment. Some authors. In steroid-dependent anosmia (nasal polyps, inhalant allergy, anosmia), high doses of steroids will temporarily restore the sense of smell, a diagnostic. However, treating patients with oral steroids that suppress the immune system can bring back the sense of smell temporarily, suggesting that. Most patients regain a normal sense of smell within 4 weeks, but in % the sense of smell does not fully recover. These persistent smell disorders greatly. Systemic steroids may enhance recovery from loss of smell and taste in hospitalized coronavirus disease (COVID) patients: an. Clinical effects of two combinations of olfactory agents on olfactory dysfunction after upper respiratory tract infection during olfactory training. Both oral and intranasal corticosteroids significantly improve olfactory function in patients with olfactory dysfunction with varied etiologies Schriever et al.I recently May 14 had sinus surgery to remove polyps. The question nobody can answer is that when I am on steroids for a sinus infection my smell and taste return and once done with the steroid or as it tapers off I lose them again.
Do you recommend steroids for loss of smell? While we tend not to think of smell and taste as important as our other senses, clearly its loss can interfere with the enjoyment of life-and our safety. Taste fibers are on the bottom of our tongue, and not really affected by nasal and sinus disease. But since smell is such a large part of what we perceive as taste, we perceive the loss of taste as well.
Smell fibers are located in the top of the nose- and extend directly into the brain from there. We all have noticed the loss of the ability to smell when we are congested with a cold or bad allergies.
Nerve damage is often permanent. Loss from nasal obstruction may be transient. If the sense of smell returns at times, this is not a permanent loss. In your case, it is likely the congestion of the nasal lining around the smell fibers that obstructs your sense of smell. When we remove polyps from the nose, we usually cannot remove all of the swelling around the smell fibers as they are quite close to the thin wall separating the nose from the brain cribiform plate.
In any case, whatever causes the polyps in the first place, is likely to continue to cause the nasal and sinus lining to be swollen after surgery. Oral steroids, such as medrol or prednisone, are the most effective medications we have in shrinking down polyps and in your case are effective enough to bring back your sense of smell. However, because of the side effects of prolonged use, we try to minimize the use of oral steroids for loss of smell.
We prefer to use other medications that are less likely to cause side effects- but these also are often less effective. We use oral and nasal antihistamines if one is allergic- we would suggest other medications such as singulair- and allergy desensitization if you are allergic.
There is the possibility that there are further polyps to be removed surgically- and this should be evaluated. Lastly, some patients and their sinus doctors will use the smallest dose of oral prednisone from time to time that works judiciously- balancing against the potential for long term side effects. I have one such patient who chooses to take a small dose of steroids once or twice a year, before his vacations. In your case, I would try to use all of the more conservative measures on a regular basis first before relying on steroids for loss of smell.
We have found Budesinide rinses and nasal nebulizer treatments to be two of the more promising topical treatments that are often overlooked. I would speak to your sinus specialist and explain your concerns and come up with a regimen that works for you and your life style. To request an appointment at NYOG by email, please give us your contact information in the form below and we will get back to you shortly with available dates.
We take most insurance plans. Please call the office to see if we accept yours. Meet our Doctors. Footer Column 1. Home Doctors Events Contact. Locations Midtown Upper West Side.
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