Journal Reading

Dr. Novirianty Tutor : Dr. Puspa Zuleika, Sp.THT-KL,M.Kes

Treatment of Postviral Olfactory Loss With Glucocorticoids, Ginkgo biloba, and Mometasone Nasal Spray

Beom Seok Seo,Hyun Jong Lee, Ji-Hun Moo,Chul Hee Lee, Chae-Seo Rhee,Jeong-Whun Kim

Background

Olfactory disorder mechanism is not clearly understood Which viruses cause postviral olfactory loss is unknown The role of the olfactory neural system in postviral olfactory loss is unknown

Questions

Does treatment using prednisolone plus ginkgo biloba significanly improved for postviral olfactory loss?

The Purpose

To analyze the efficacy of treating postviral olfactory loss with glucocorticoid, Ginkgo biloba and mometasone nasal spary

Hypotesis

There is significant difference between the ginkgo biloba and non ginkgo biloba group of treating postviral olfactory loss.

Material and method

Design
Place Time

RCT ( Randomized Controlled Trial

Chemosensory Outpatient Clinic of Seoul National University Bundang Hospital, Seongmnam, Korea

July 1,2007 through June 30,2008

Inclusion criteria

Exclusion criteria

History of upper

History of olfactory loss

respiratory tract infection

immediately before post viral olfactory loss Sudden onset of postviral olfactory loss

History of head trauma

History of oral or nasal corticosteroid use Concurrent memory loss

Inclusion criteria
A visit within 12 month after onset of postviral

exclusion criteria
Presence of nasal discharge

olfactory loss
No evidence of sinus Inflammation on computed tomographic osteomeatal or paranasal sinus view

Allergic rhinitis
Chronis rhinosinusitis

Procedure

Male 10 monotherapy Female 18

71 patient Male 10 Combination therapy

Female 33

monotherapy

Combination therapy

Oral prednisolon for 2 weeks

Oral prednisolon 2 weeks and G biloba 4 weeks

Monometasone furoat nasal spray 2 puff pernostril twice daily for 4 weeks

Result
After treatment ( score change) BTT CCSIT Monotherapy 2.2 1.7 Combination therapy 2.9 (P=.22) 2.7 (P=.11)

Result
After Therapy ( the Monotherapy threatment respon) Modification Therapy

BTT Therpy

32% (9 from 28)

37% ( 16 fom 43) ( P=0,66) 33% ( 14 from 43) (P= 0,08)

CCSIT

14% ( 4 from 28)

Odds ratio: 2,89( 95% Confidence interval 0,84-9,97)

Discussion

This study to analyze the efficacy of treating postviral olfactory loss with glucocorticoids, Ginkgo biloba and mometasone furoate nasal spray All patient underwent olfactory function test such BTT, CCSIT Postviral olfactory loss were treated with oral prednisolon,Ginkgo biloba and mometasone furoate nasal spray

Critical apraisal
1. Is an estimate of the treatment effect given ? yes 2. Is it of clinical importance ? yes

3. Is the estimate of threatment effect sufficiently precise ? yes

4. Was the spectrum of patients well defined? yes

5. Was the diagnosis of the disease well defined? no

6. Were eligibility criteria suitably narrow ? yes

7. Was assignment to treatments stated to be random? yes

8. Was the method of randomized explained? no

9 Were all patient accounted for after randomization? no

10. Were loses to follow-up low ? yes 11. Were the treatment groups similar in important factor's at the start of the trial? yes

12. Were all patients otherwise treated alike? yes

13. Were patients, health care workers and investigator 'blind' to treatment? no 14.Was assessment of outcome 'blind'? no

15. Was the main analysis on 'intention to treat'? Yes 16. Were appropriate statistical methods used? Yes

Conclusion

The study is valid and can be applied in clinical practice

Thank you