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Effect of different therapeutic strategies on olfactory outcomes in patients with chronic rhinosinusitis with nasal polyps: a systematic review

Alobid I1,2, Barroso B3,4, Calvo C5, Ferrario MG6, Sastre J3,4

1Skull Base Unit, ENT Department, Hospital Clinic, IDIBAPS, CIBERES, Barcelona University. Barcelona, Spain
2Unidad Alergo-Rino, Centro Médico Teknon, Barcelona, Spain
3Department of Allergy, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
4Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. CIBERES, Instituto de Salud Carlos III, Spain
5Rhinology and sleep apnea unit, Otolaryngology department, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
6Medical Science Consulting, Valencia, Spain 

J Investig Allergol Clin Immunol 2024; Vol. 34(4)
doi: 10.18176/jiaci.0987

Introduction: Olfactory impairment is one of the cardinal symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), yet the effect of the currently available therapeutic options on the recovery of the sense of smell is not well defined. The aim of this systematic review was to compile the evidence on the impact of medical, surgical, and biological therapies on the olfactory outcomes in patients with CRSwNP.
Methods: This review was conducted by two reviewers, according to the Preferred Reporting Items for Systematic Reviews and meta-Analyses (PRISMA) guidelines. The quality of evidence of all studies included in the qualitative synthesis was evaluated using the Critical Appraisal Skills Programme (CASP).
Results: Forty-four studies were included in the qualitative synthesis (assessing sinonasal surgery [n = 23], biologics [n =15], and conventional medical treatment [n = 6]); most had moderate-to-high methodological quality. Overall, significant improvements in the sense of smell were detected with all analyzed interventions measured by either an objective or a subjective tool (or both). However, most studies used different outcome measurements, hindering comparisons between interventions, and data on clinically relevant changes were missing.
Conclusion: Oral corticosteroids, biologics and sinonasal surgery improve olfactory impairment associated with CRSwNP, but the high variability among existing studies does not allow accurate comparisons. 

Key words: CRSwNP, Olfaction, Impairment, Biologics, Surgery, Corticosteroids