COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Abdelalim AA, Mohamady AA, Elsayed RA, et al. Corticosteroid nasal spray for recovery of smell sensation in COVID-19 patients: A randomized controlled trial. Am J Otolaryngol. 2021 Mar-Apr;42(2):102884. doi: 10.1016/j.amjoto.2020.102884. Epub 2021 Jan 4.
Abstract

OBJECTIVES: To evaluate the role of the topical corticosteroid, mometasone furoate, nasal spray in the treatment of post COVID-19 anosmia.

METHODS: A prospective, randomized, controlled trial was conducted among patients with post COVID-19 anosmia. One hundred patients were randomly assigned to two groups; group I included 50 patients received mometasone furoate nasal spray in an appropriate dose of 2 puff (100 µg) once daily in each nostril for 3 weeks with olfactory training, group II included 50 patients were advised to keep on olfactory training only. The assessment of smell was done using (Visual Analog Scale from 0 to 10). All patients were initially evaluated after their recovery from COVID-19 and followed up for 3 weeks. The smell scores were recorded weekly and the duration of smell loss was recorded from the onset of anosmia till the full recovery.

RESULTS: In both groups, the smell scores significantly improved by the end of the third week (P < 0.001). By comparing smell scores between both groups after 1 week, 2 weeks, and 3 weeks of treatment, there were no statistically significant differences between both groups. In group I, (62%) of patients completely recovered their sense of smell after 3 weeks of treatment, compared to (52%) of patients in group II (P = 0.31).

CONCLUSION: The results suggested that using mometasone furoate nasal spray as a topical corticosteroid in the treatment of post COVID-19 anosmia offers no superiority benefits over the olfactory training, regarding smell scores, duration of anosmia, and recovery rates.

TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04484493.

Ratings
Discipline / Specialty Area Score
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

By now, it is clear that there is no effective treatment for the anosmia caused by COVID. This article again shows that nasal steroids are ineffective for the treatment of COVID-related anosmia over 3 weeks. It is a randomized but not blinded study and the outcome is subjective and included using a visual analogue scale. Despite that, the study did not show any efficacy of nasal steroids.

Hospital Doctor/Hospitalists rater

This is an excellent prospective RCT on studying the use of corticosteroid (CS) nasal spray in the management of COVID-19 induced anosmia. Even though the authors concluded there is no statistical significance between both groups, it is important new data to add to the body of knowledge in managing post-COVID-19 syndrome. I appreciate the authors invested the time to research the use of CS nasal spray in this setting.

Infectious Disease rater

Anosmia is an interesting aspect of COVID-19 infection. Although it is a minor symptom, it is one that is distressing to patients and we are often asked about possible treatments. This makes the article newsworthy. Although this was a small study, there was no benefit from topical steroids; it's good to know this when patients ask about using topical steroids.