TOPICAL CORTICOSTEROID TREATMENT OF ANOSMIA ASSOCIATED WITH NASAL ANDSINUS DISEASE

Objective: To establish the efficacy of topical corticosteroid nasal s pray treatment of severe olfactory loss associated with severe nasal a nd sinus disease. Design: Efficacy before and after open-label trial o f topical corticosteroid nasal spray used exclusively in the head-down -forward position. Setting: Taste and smell clinic of a university tea ching hospital and research facility. Patients: Taste and smell clinic patients with anosmia or severe hyposmia associated with paranasal si nus disease and nasal polyposis including 39 of 45 patients recruited from 1988 to 1994 who completed the topical corticosteroid treatment c ourse and returned for subsequent testing. Intervention: At least 8 we eks of treatment with flunisolide (Nasalide), 2 sprays in each nostril twice a day, with concurrent antibiotic treatment of any bacterial in fection. Main Outcome Measures: Subjective olfactory symptoms, objecti ve olfactory function tests, and otolaryngological evaluation (includi ng endoscopic examination). Results: Olfactory scores significantly im proved following treatment (P < .001); signs of nasal and sinus diseas e significantly decreased (P < .001); and 26 (66%) of the patients rep orted a subjective improvement in their sense of smell. Conclusion: To pical corticosteroid nasal spray administered in a head-down-forward p osition is an effective treatment of severe olfactory loss associated with severe nasal and sinus disease.