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April E. Mott, MD; William S. Cain, PhD; Denis Lafreniere, MD; Gerald Leonard, MD; Janneane F. Gent, PhD; Marion E. Frank, PhD

Arch Otolaryngol Head Neck Surg. 1997;123(4):367-372.

Abstract
Objective
To establish the efficacy of topical corticosteroid nasal spray treatment of severe olfactory loss associated with severe nasal and sinus disease.

Design
Efficacy before and after open-label trial of topical corticosteroid nasal spray used exclusively in the headdown-forward position.

Setting
Taste and smell clinic of a university teaching hospital and research facility.

Patients
Taste and smell clinic patients with anosmia or severe hyposmia associated with paranasal sinus disease and nasal polyposis including 39 of 45 patients recruited from 1988 to 1994 who completed the topical corticosteroid treatment course and returned for subsequent testing.

Intervention
At least 8 weeks of treatment with flunisolide (Nasalide), 2 sprays in each nostril twice a day, with concurrent antibiotic treatment of any bacterial infection.

Main Outcome Measures
Subjective olfactory symptoms, objective olfactory function tests, and otolaryngological evaluation (including endoscopic examination).

Results
Olfactory scores significantly improved following treatment (P<.001); signs of nasal and sinus disease significantly decreased (P<.001); and 26 (66%) of the patients reported a subjective improvement in their sense of smell.

Conclusion
Topical corticosteroid nasal spray administered in a head-down-forward position is an effective treatment of severe olfactory loss associated with severe nasal and sinus disease.

Arch Otolaryngol Head Neck Surg. 1997;123:367-372

Author Affiliations
From the Departments of Medicine (Dr Mott), Surgery (Drs Lafreniere and Leonard), and Biostructure and Function, School of Dental Medicine (Drs Gent and Frank), University of Connecticut Health Center, Farmington; and Department of Surgery, University of California, San Diego, La Jolla (Dr Cain).

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