Management of new onset anosmia during the COVID pandemic - BRS
Consensus Guidelines Running title
BRS Consensus guidelines for COVID anosmia
Abstract
Objectives
The primary aim of the study is to provide recommendations for the
investigation and management of patients with new onset anosmia during
the COVID-19 pandemic
Design
After undertaking a literature review, we used the RAND/UCLA methodology
with a multi-step process to reach consensus about treatment options,
onward referral
imaging.
Setting and participants
An expert panel consistent of 15 members was assembled. A literature
review was undertaken prior to the study and evidence was summarised for
the panellists.
Main outcome measures
The panel undertook a process of ranking and classifying appropriateness
of different investigations and treatment options for new onset anosmia
during the COVID-19 pandemic. Using a 9-point Likert scale, panellists
scored whether a treatment was: Not recommended, optional, or
recommended. Consensus was achieved when more than 70% of responses
fell into the category defined by the mean.
Results
Consensus was reached on the majority of statements after 2 rounds of
ranking. Disagreement meant no recommendation was made regarding one
treatment, using Vitamin A Drops. Alpha lipoic acid was not recommended,
olfactory training was recommended for all patients with persistent
anosmia of more than 2 weeks duration, and oral steroids, steroid rinses
and omega 3 supplements may be considered on an individual basis.
Recommendations have been made regarding the need for referral and
investigation have been made.
Conclusion
This study identified the appropriateness of olfactory training,
different medical treatment options, referral guidelines and imaging for
patients with COVID-19 related anosmia. The guideline may evolve as our
experience of COVID-19 develops.
Keywords
COVID-19, corona virus, anosmia, olfactory training, RAND/UCLA
Five succinct key points.
- If the COVID status is unknown, serology should be performed for all
patients with new onset smell loss
- Patients with Isolated loss of smell for less than three months may be
managed by their GP.
- When ENT referral is necessary, remote ENT consultation may be offered
instead of a face-to-face consultation depending on duration of
symptoms and associated nasal symptoms
- An MRI brain is not recommended for patients with COVID infection
regardless of LOS duration.
- Olfactory training is recommended to patients with LOS more than 2
weeks.