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.
  1. If the COVID status is unknown, serology should be performed for all patients with new onset smell loss
  2. Patients with Isolated loss of smell for less than three months may be managed by their GP.
  3. 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
  4. An MRI brain is not recommended for patients with COVID infection regardless of LOS duration.
  5. Olfactory training is recommended to patients with LOS more than 2 weeks.