Systemic corticosteroids in coronavirus disease 2019 (COVID-19)-related smell dysfunction: an international view.

The frequent association between coronavirus disease 2019 (COVID-19) and olfactory dysfunction is creating an unprecedented demand for a treatment of the olfactory loss. Systemic corticosteroids have been considered as a therapeutic option. However, based on current literature, we call for caution using these treatments in early COVID-19-related olfactory dysfunction because: (1) evidence supporting their usefulness is weak; (2) the rate of spontaneous recovery of COVID-19-related olfactory dysfunction is high; and (3) corticosteroids have well-known potential adverse effects. We encourage randomized placebo-controlled trials investigating the efficacy of systemic steroids in this indication and strongly emphasize to initially consider smell training, which is supported by a robust evidence base and has no known side effects.

Evaluating the clinical usefulness of structured questions in parosmia assessment.

OBJECTIVES/HYPOTHESIS: Parosmia and phantosmia relate to distorted odor perceptions. Little is known about their clinical significance. Measuring phantosmia and parosmia is still not possible. Today, assessment of parosmia or phantosmia relies mainly upon the patient's interview and the physician's experience. Therefore, we investigated the clinical usefulness of four structured questions in comparison to the patient's history regarding their accuracy in terms of the presence of odor distortions. STUDY DESIGN: Tertiary care center outpatient clinic analyses. METHODS: Responses from 193 patients were analyzed. All patients underwent full olfactory work-up (ear, nose, and throat examination, Sniffin' Sticks testing, structural brain imaging) and filled in a questionnaire with four parosmia questions and six questions regarding characteristics and severity of the parosmia. These responses formed the bases of a numerical parosmia score. RESULTS: Patients with parosmia showed significantly lower parosmia scores (P <.001) when compared to either patients with phantosmia or patients without odor distortions. Two questions could be identified that showed a high association to the presence or absence of parosmia. CONCLUSIONS: The present results confirm reports on the high frequency of parosmia and phantosmia among patients suffering from olfactory disorders. A parosmia score could be established that distinguishes between patients with or without odor distortions. The score provides valuable information regarding the presence or absence of parosmia, thus helping the physician during the patient's evaluation.