Abstract
Limited olfactory improvement after topical steroid therapy in chronic rhinosinusitis (CRS) patients might result from restricted drug access to the olfactory cleft. The aim of our study was to investigate the difference between two methods to topically administer steroids with respect to olfaction: (1) conventional nasal spray and (2) a device using pressure and vibration to distribute steroid aerosol endonasally. A prospective study was performed in patients with olfactory impairment due to chronic rhinosinusitis with and without nasal polyps. While the first group used the conventional dexamethasone nasal spray, the second group used the device over a period of 12 days. Olfactory testing was done at 0, 2, and 8 weeks using Sniffin’ Sticks test. A significant olfactory improvement was found after 2 weeks of treatment with either steroid (p = 0.005). However, there was no significant difference between the different methods of steroid application. There is a significant olfactory improvement in CRS patients following topical dexamethasone therapy, but no obvious superiority of one of the two ways to administer the steroid.
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References
Litvack JR, Fong K, Mace J, James KE, Smith TL (2009) NIH Public Access 118(12):2225–2230
Jiang RS, Lu FJ, Liang KL et al (2008) Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery. Am J Rhinol 4:445–448
Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:1–298
Heilmann S, Huettenbrink K-B, Hummel T (2004) Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol 18(1):29–33
Alobid I, Benítez P, Cardelús S et al (2014) Oral plus nasal corticosteroids improve smell, nasal congestion, and inflammation in sino-nasal polyposis. Laryngoscope 124(1):50–56
Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B (2011) Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med 154(5):293–302
Keith P, Nieminen J, Hollingworth K, Dolovich J (2000) Efficacy and tolerability of fluticasone propionate nasal drops 400 mcg daily compared with placebo for the treatment of bilateral polyposis in adults. Clin Exp Allergy 30(10):1460–1468
Friedman M, Hamilton C, Samuelson CG et al (2012) Dead Sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis: a randomized, prospective double-blind study. Int Forum Allergy Rhinol 2(3):252–257
Leopold DA, Hummel T, Schwob JE, Hong SC, Knecht M, Kobal G (2000) Anterior distribution of human olfactory epithelium. Laryngoscope 110(3 Pt 1):417–421
Dilisio MF (2014) Osteonecrosis following short-term, low-dose oral corticosteroids: a population-based study of 24 million patients. Orthopedics 37(7):e631–e636
Mori E, Merkonidis C, Cuevas M, Gudziol V, Matsuwaki Y, Hummel T (2015) The administration of nasal drops in the “Kaiteki” position allows for delivery of the drug to the olfactory cleft: a pilot study in healthy subjects. Eur Arch Oto-Rhino-Laryngol 273(4):1–5
Scheibe M, Bethge C, Witt M, Hummel T, Article O (2008) Intranasal administration of drugs. Arch Otolaryngol Head Neck Surg 134(6):643–646
Kayarkar R, Clifton NJ, Woolford TJ (2002) An evaluation of the best head position for instillation of steroid nose drops. Clin Otolaryngol Allied Sci 27(1):18–21
http://www.schumacher-medizintechnik.de/html/druckstoss.html. Accessed 8 Oct 2016
Goektas O, Lau L, Olze H (2013) Treatment of chronic rhinosinusitis with pressure-pulsed corticosteroid inhalation. Indian J Otolaryngol Head Neck Surg. 65(SUPPL2):402–405
Hummel T, Sekinger B, Wolf SR, Pauli E, Kobal G (1997) “Sniffin” sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 22(1):39–52
Kobal G, Klimek L, Wolfensberger M et al (2000) Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds. Eur Arch Otorhinolaryngol 257(4):205–211
Penttilä M, Poulsen P, Hollingworth K, Holmström M (2000) Dose-related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polyposis: a placebo-controlled randomized study in adult patients. Clin Exp Allergy 30(1):94–102
Gudziol V, Lötsch J, Hähner A, Zahnert T, Hummel T (2006) Clinical significance of results from olfactory testing. Laryngoscope 116(10):1858–1863
Reychler G, Colbrant C, Huart C et al (2015) Effect of three-drug delivery modalities on olfactory function in chronic sinusitis. Laryngoscope 125(3):549–555
Doty RL, Mishra A (2001) Olfaction and its alteration by nasal obstruction, rhinitis, and rhinosinusitis. Laryngoscope 111(3):409–423
Klimek L, Eggers G (1997) Olfactory dysfunction in allergic rhinitis is related to nasal eosinophilic inflammation. J Allergy Clin Immunol 100(2):158–164
Weber R, Keerl R, Radziwill R et al (1999) Videoendoscopic analysis of nasal steroid distribution. Rhinology 37(2):69–73
Bateman ND, Whymark AD, Clifton NJ, Woolford TJ (2002) A study of intranasal distribution of azelastine hydrochloride aqueous nasal spray with different spray techniques. Clin Otolaryngol Allied Sci 27(5):327–330
Fowler PD, Gazis AG, Page SR, Jones NS (2002) A randomized double-blind study to compare the effects of nasal fluticasone and betamethasone on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis. Clin Otolaryngol Allied Sci 27(6):489–493
Croy I, Nordin S, Hummel T (2014) Olfactory disorders and quality of life-an updated review. Chem Senses 39(3):185–194
Fardet L, Kassar A, Cabane J, Flahault A (2007) Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf 30(10):861–881
Acknowledgments
This work was supported by a grant from the Deutsche Forschungsgemeinschaft to TH (DFG HU441/18-1). SCP was supported by the Dresden Junior Fellowship Program (Exzellenzinitiative) of the “Technische Universität” (TU) Dresden. We also would like to thank Schumacher and Partner GmbH, Dausenau, Germany, for providing us with an AMSA® device to conduct this study.
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Poletti, S.C., Batashev, I., Reden, J. et al. Olfaction in chronic rhinosinusitis: comparing two different endonasal steroid application methods. Eur Arch Otorhinolaryngol 274, 1431–1435 (2017). https://doi.org/10.1007/s00405-016-4341-6
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DOI: https://doi.org/10.1007/s00405-016-4341-6