Management of new onset loss of sense of smell during the COVID‐19 pandemic ‐ BRS Consensus Guidelines

Abstract

Objectives The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smellduring the COVID‐19 pandemic Design After undertaking a literature review, we used the RAND/UCLA methodology with a multi‐step process to reach consensus about treatment options, onward referral andimaging. Setting and participants An expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. Main outcome measures The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID‐19 pandemic.Using a 9‐point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. Results Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A Drops. Alpha lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made. Conclusion This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID‐19 related loss of sense of smell. The guideline may evolve as our experience of COVID‐19 develops.

Course of symptoms for loss of sense of smell and taste over time in one thousand forty‐one healthcare workers during the Covid‐19 pandemic: Our experience

“…The reported persistence of smell/taste disturbances requires improved management guidelines, and points to the need for more treatments to be evaluated through clinical trials. At present, guidelines published by ENT UK/British Rhinological Society recommend those with recent loss of smell and Covid‐19 infection are managed by their GP with treatments suggested, which may include oral steroids after the initial 2 weeks 5 . Further guidance can be found on supportive resources such as those available through Fifth Sense (http://www.fifthsense.org.uk).…”

Smell disorders in COVID-19 patients: role of olfactory training

“…[ 31 , 32 ] Since coronavirus is one of the triggers of PVOD, the effective treatment of PVOD is of great reference value for studying the treatment of smell disorders in COVID-19. [ 9 , 15 ] Present study shows that OT, as an emerging nonpharmacologic therapy option, has shown promise in the treatment of PVOD. [ 33 , 34 ] An increasing body of preclinical and clinical evidence supported the beneficial effects of OT in smell disorders.…”

“…[ 24 ] Research from Dr Borsetto D and Dr Hopkins C shows a high rate of early recovery, at 4 to 6 weeks after onset, approximately 90% patients have experienced recovery. [ 8 , 9 ] Dr Yan XG's study also suggests in patients with less than a year of smell disorders, the olfactory function improved obviously. [ 24 ] In addition, long-term OT seems to be associated with better results in patients with smell disorders than a short-term scheme.…”

“…[ 7 ] A previously published systematic review suggests a prevalence of self-reported smell disorders in 50% of patients with COVID-19. [ 8 , 9 ] As of December 20, there have been over 75 million cases since the start of the pandemic. [ 10 ] According to the ratio, there have been more than 35 million of them suffering from smell disorders.…”

“…However, since Post-viral olfactory dysfunction (PVOD) is the most common cause of smell disorders and since coronaviruses are one of many pathogens, it is reasonable to deem the smell disorders in COVID-19 as a classification of PVOD. [ 9 , 15 , 16 ] Thus, evaluating the effective treatment for PVOD is of great significance. A wide range of treatment modalities including olfactory training (OT), corticosteroid, theophylline, budesonide (nasal irrigation), intranasal calcium buffers, and antibiotics have been attempted to treat PVOD.…”