Topical Administration of Mometasone Is Not Helpful in Post-COVID-19 Olfactory Dysfunction

Abstract

Persistent olfactory dysfunction is a major concern post-COVID-19, affecting up to 5% of all patients. Different therapeutic options, including mometasone nasal spray, have been recommended, only some of which have been validated for post-COVID-19 olfactory dysfunction. In this study we psychophysically assessed the effect of intranasally applied mometasone furoate on the recovery of olfaction. The spray was applied with a long applicator so that the olfactory cleft could be reached effectively. After olfactory dysfunction had been confirmed psychophysically using Sniffin’ Sticks, patients were randomly assigned to two different treatment arms: the study group (n = 40) underwent olfactory training and intranasal administration of mometasone furoate twice daily, whereas the control group (n = 46) performed olfactory training only. After a study duration of three months, psychophysical testing of olfaction was repeated using Sniffin’ Sticks. We found no benefit of an additional topical administration of mometasone furoate compared to olfactory training alone. These results psychophysically confirm two previous studies which were based on patients’ subjective self-ratings. Our findings are in contrast to current recommendations for the management of olfactory dysfunction post-COVID-19, which might have to be adapted accordingly.

Therapies for COVID-19-Related Persistent Olfactory Disorders: One of the Good Fruits of the Pandemic

“…Rashid et al [ 24 ], in their randomized double-blind placebo-controlled study including 276 COVID-19 patients with anosmia did not find a significant benefit of topically administering betamethasone in terms of the speed of recovery of olfactory function. Kasiri et al [ 26 ] and Hintschich et al [ 27 ] treated patients with persistent ODs after SARS-CoV-2 infection with mometasone furoate as in our study without detecting significant benefits. This was confirmed by the recent meta-analysis of Kim et al [ 30 ] and is likely related to poor delivery of the corticosteroid spray to the olfactory epithelium [ 31 , 32 ].…”

“…However, the results of larger randomized trials that included subjects with persistent ODs did not give concordant or negative results [ 24 , 25 , 26 , 27 , 28 , 29 ]. Rashid et al [ 24 ], in their randomized double-blind placebo-controlled study including 276 COVID-19 patients with anosmia did not find a significant benefit of topically administering betamethasone in terms of the speed of recovery of olfactory function.…”

Riechen und Riechstörungen

“…Bezüglich der COVID19-OD zeigten Hintschich und Kollegen [327] in einer kontrollierten Studie keinen Vorteil hinsichtlich des SDI-Wertes für die Behandlung von Mometason-Nasenspray (Applikation zur Riechspalte mit extra langem Applikator) zusammen mit Riechtraining gegenüber der alleinigen Behandlung mit Riechtraining. Ebenfalls bei Patient:innen mit COVID19-OD führten Kasiri und Kollegen eine doppelt verblindete, randomisierte, kontrollierte Studie durch, in der intranasales Mometasonfuroat-Spray/Riechtraining (n = 39) mit intranasalem Natriumchlorid/Riechtraining (n = 38) verglichen wurde [328].…”

Odorat et virus respiratoires :une relation révélée par la Covid-19

“…Selon le temps de résolution de l'inflammation et la bonne réintégration dans le réseau des neurones olfactifs néoformés, les perturbations olfactives pourraient alors être plus ou moins prolongées. Les traitements visant à rétablir l'olfaction sont peu nombreux : 1) les traitements par anti-inflammatoires de type stéroïdien, mais leur efficacité semble limitée [45], probablement parce que ces traitements sont débutés très tard après l'apparition de l'anosmie, ou uniquement utilisés localement, ce qui ne permet pas une bonne irrigation de la fente olfactive qui est située très haut dans la cavité nasale ; 2) l'entraînement olfactif, qui, comme pour les autres sens, devrait permettre de stabiliser plus rapidement le réseau de traitement de l'information. Reste à avoir un minimum de sensation olfactive pour démarrer ce type de thérapie, dont des protocoles 5 sont facilement applicables chez soi.…”