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 head-down-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.