Material and Methods
An expert panel of 15 members was assembled, comprising of members of the BRS Council, members of an ENTUK taskforce charged with developing guidance for outpatient practice in ENT and representatives of the Global Consortium of Chemosensory Research.
A comprehensive literature review has been undertaken, by CH and MA, using Medline, Cochrane databases, and MEdRxIv, and preprint server. Evidence was summarised for the panellists (Appendix 1), and where a systematic review had been performed this was circulated in full. Studies were considered if they included any patients with post-viral olfactory loss, or idiopathic loss. Some treatments identified by the literature review were excluded if the evidence base showed that there were infective, or if the mode of administration could not be supported during the pandemic (for example, repeated intravenous administration), or if regularly face to face contact was required for administration or monitoring (Appendix 2). We used the RAND/UCLA methodology with a multi-step process. Our expert panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options. Using a 9-point -Likert scale, panellists scored whether a treatment was:
Not recommended: should not be undertaken or prescribed based on current evidence base as risks outweigh likely benefits (1 -3),
Optional: could be undertaken or prescribed based on discussion with individual patient based on likely risks versus benefits (4-6),
Recommended: should be undertaken or prescribed in all patients unless there are contraindications as benefits outweigh likely risks (7-9)
Free text comments were encouraged if greater context was required, if question were ambiguous or if anything had been overlooked
Specific combinations of treatment were not considered as the evidence base does not currently have sufficient data to evaluate for any enhanced effectiveness when used in combination. However multiple options could be considered and recommended, and none of the treatments would be considered a contra-indication to use of any others.
Upon receiving the results, the classification of recommendation was based on the mean ranking scores collated from each clinical scenario provided that there was consensus.
Consensus was defined as the requirement for more than 70% of responses to fall into the category defined by the mean, and when the mean score sits in ‘recommended’, less than 15% of responses fall into not recommended, and vice versa. Where consencus was not reached items were reconsidered in a further round.
Disagreement was declared if more than 30% responses fell in both recommended and not recommended; in this setting no recommendation could be given.
Panellists were given 72 hours to return their answers. The scores at the end of round 1 were analysed and represented to the group, with each individual receiving a copy of their own initial evaluation. The panel was then asked to repeat the scoring for any items where consensus had not been reached. After the second round, any remaining items that had not reached consensus were further reviewed.