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October 01, 2020

Treatment guidelines

Doctors publish guidelines for smell loss treatment

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The British Rhinological Society (BRS) represents the group of doctors that look after your nose and sinuses. They’ve been working flat out over the last few months to understand the best response to Covid-19 related anosmia.

An expert panel of 15 members, including our own Chrissi Kelly, got together to review all the available evidence about the best way to manage patients who lost smell during the Covid-19 pandemic. They recognised that the majority of referrals would be because of Covid-19, but also that anosmia occurs for other reasons and they needed to understand how best to care for these patients when resources are stretched. In particular, they wanted to agree the best treatment options, when a patient should be referred for more treatment, and when to use MRI images.

They considered all the evidence by ranking against an agreed scale and reached consensus on most of the evidence after just two rounds. For treating Covid-19 smell loss they agreed that:

  • No recommendation could be made about using Vitamin A drops.
  • Alpha lipoic acid was not recommended.
  • Olfactory training was recommended for all patients with persistent smell loss of longer than two weeks.
  • Oral steroids, steroid rinses and omega-3 supplements could be considered on an individual basis.

A referral to Ear Nose and Throat (ENT) specialists after three months should only be considered for patients where it could be established that Covid-19 was not a possible cause of their problem. 

The way a patient should be supported is laid out in five key points highlighted by the report. The panel considered the best course of treatment for all causes of smell loss was to recommend smell training, and that the GP should care for the patient for the first three months. If the GP felt a consultation with an ENT specialist was necessary, that would be most likely be done by phone or video call. The panel agreed an MRI brain scan was not appropriate in any case where Covid-19 was the cause of loss of smell. 

What next

The BRS turned to AbScent to ask for their support in providing a resource that would turn this advice into practical help, particularly for Covid-19 patients. The result is NoseWell, based entirely on best medical advice and endorsed by the BRS and ENT UK. 

Chrissi Kelly who represented the patients’ experience on behalf of AbScent said, “It’s good to have clear guidelines agreed. I know some people who contact us despair that the doctors don’t seem to know or do anything about their condition. In fact, there is a whole team of experts working out what’s best and the patient is at the heart of everything. There is no medicine to recover smell, but there are a lot of positive things you can do to manage your recovery.”

The authors end the report by saying: “We hope that the newfound spotlight on loss of sense of smell and taste will drive clinical research and lead to the development of novel treatment options for patients with post-viral loss, and that greater understanding exists for those who do not recover.” AbScent whole-heartedly agree!

You can read the whole report here https://onlinelibrary.wiley.com/doi/10.1111/coa.13636

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