Stellate Ganglion Block for the Treatment of COVID‐19‐Induced Olfactory Dysfunction: A Prospective Pilot Study

Abstract

ObjectiveThe objective of this study was to explore the safety and feasibility of stellate ganglion blocks (SGBs) to treat persistent COVID‐19‐induced olfactory dysfunction (OD). Secondarily, the goal was to determine effect sizes to plan a future randomized clinical trial.Study DesignProspective case series.SettingQuaternary Care Academic Medical Center.MethodsIn this single‐arm pilot trial, adult participants with a COVID‐19 diagnosis ≥ 12 months prior to enrollment with OD underwent bilateral SGBs. Subjects were followed for 1 month after completion of SGB. The primary outcome measure was the change in the Clinical Global Impression‐Improvement Scale for smell loss. Secondary outcome measures included changes in the University of Pennsylvania Smell Identification Test (UPSIT) and Olfactory Dysfunction Outcomes Rating (ODOR).ResultsTwenty participants were enrolled with a mean (SD) age of 46 (11) years and a mean (SD) duration of OD of 21 (5) months. At 1 month, 10 (50%) participants experienced at least slight subjective improvement in their OD, 11 (55%) attained a clinically meaningful improvement in smell identification using the UPSIT, and 7 (35%) achieved a clinically meaningful improvement in olfactory‐specific quality of life (QoL) measured by the ODOR. The median difference between UPSIT scores at baseline and 1 month was 6 (95% confidence interval: 3‐11), exceeding the minimal clinically important difference of 4. There were no serious adverse events.ConclusionSequential SGBs for COVID‐19‐associated OD were safe and associated with modest improvements in subjective olfaction, odor identification, and olfactory‐specific QoL. A placebo‐controlled trial is warranted to determine the efficacy of SGBs for COVID‐19‐associated OD.

Stellate ganglion block for treating post‐COVID‐19 parosmia

“…However, they did not report if overall changes in the UPSIT scores or parosmia severity scores were statistically significant. 33 In this current study, interestingly, while SGB demonstrated a significant impact on subjective parosmia severity and QOL metrics, there was no significant improvement in odor identification from pre-to post-SGB as measured through the BSIT for the overall, UL, and BL cohorts (Table 3). Additionally, in the comparison of the overall SGB cohort to the general COVID-19 OD cohort, patients undergoing SGB presented clinically with significantly higher baseline BSIT scores than patients with COVID-19 OD (Table 2).…”

“…One study of 20 participants undergoing BL SGB found that at 1 month after treatment, 55% of patients achieved a clinically meaningful improvement of 4 points or greater on the University of Pennsylvania Smell Identification Test (UPSIT), an objective olfactory function test, and 50% reported improvement in parosmia. However, they did not report if overall changes in the UPSIT scores or parosmia severity scores were statistically significant 33 …”

Reply to “A Review of Stellate Ganglion Block for the Treatment of COVID‐19‐Induced Olfactory Dysfunction”

“…To the Editor, Duckett et al deserve admiration for their comprehensive meta-analysis and systemic review of the prevalence of postoperative radiotherapy (PORT) delay and assessment of variations among care delivery settings in head and neck cancer (HNC) patients. 1 The present systematic review comprised 36 studies, while the metaanalysis covered 14 studies. The meta-analysis revealed that nearly half of patients (48.6%) underwent PORT after a lapse of >6 weeks following surgery.…”

“…Reply to "A Review of Stellate Ganglion Block for the Treatment of COVID-19-Induced Olfactory Dysfunction" DOI: 10.1002/ohn.700 Thank you to Youssef et al for your commentary regarding our manuscript titled, "Stellate Ganglion Block for the Treatment of COVID-19-Induced Olfactory Dysfunction: A Prospective Pilot Study." 1 We appreciate your review of our study and would like to offer further information on some of the points raised in the commentary.…”

A Review of Stellate Ganglion Block for the Treatment of COVID‐19‐Induced Olfactory Dysfunction

“…We read with pleasure the article by Peterson et al, 1 titled "Stellate Ganglion Block for the Treatment of COVID-19-Induced Olfactory Dysfunction: A Prospective Pilot Study." We offer additional commentary on the extrapolated conclusions and hope these perspectives may provide insight into areas that may require further research.…”