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Rhinology/Allergy

(331) Neuromodulators for Treatment of Post-Viral Parosmia

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Katarzyna Resler, MD

    assistant
    Wroclaw Medical University, Department of Otolaryngology, Head and Neck Surgery
    Wroclaw, Dolnoslaskie, Poland

    • Co-Author(s)

  • BC

    Bruna Castro Silva, MD

    Stanford University School of Medicine, United States

    • Senior Author(s)

  • ZP

    Zara M. Patel, MD

    Professor, Director of Endoscopic Skull Base Surgery
    Stanford University
    Stanford, CA, United States

Disclosure(s):
Katarzyna Resler, MD: No relevant relationships to disclose.


Introduction: The recent coronavirus 19 (COVID-19) pandemic has drawn attention to post-viral smell distortion, or parosmia. Parosmia has been poorly studied to date, but neuromodulators have been suggested as a potential treatment option. The aim of this study was to evaluate neuromodulator treatment in patients with post-viral parosmia.

Methods: In this retrospective analysis, patients presenting to a tertiary care academic smell center with post-viral parosmia that had been treated with a neuromodulating agent (PwN) between June 2015 and December 2022 were compared to a cohort of patients with post-viral parosmia who had not been treated with a neuromodulating agent (PsN). Duration of parosmia prior to presentation, demographics, medical co-morbidities, UPSIT and SNOT-22 were recorded at presentation. Follow up was at least 6 months for all patients, and a Visual Analog Scale (VAS) was utilized to assess for subjective score and change over time of smell distortion.

Results: Of 21 patient identified in the PwN group, 18 completed follow up VAS. 18 patients in a controlled, matched cohort of PsN also then completed VAS. Follow up was at least 6 months with a range of 6-24 months.
VAS started at an average of 7.61 in both the PwN group and the PsN, (range 3-10). VAS on follow-up was an average of 5.55 in the PwN group and 4.89 in the PsN group, (range 0-9). 7 patients of the PwN group and 6 patients of the PsN group had a >5 point improvement in the VAS. There was no significant difference between VAS scores between the two groups (p = 0.51), or in duration of parosmia prior to presentation, time to follow-up, co-morbidities, or demographic data.

Conclusions: Direct retrospective comparison of post-viral parosmia treated with and without neuromodulators did not show a significant effect on the outcome of smell distortion. Limitations of this study are its small number and retrospective nature, and the question will have to be answered in a larger scale randomized controlled trial. Until then, there does not appear to be good evidence supporting use of neuromodulators, such as gabapentin, pregabalin or amitriptyline to treat post-viral parosmia.