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.