Data collection:
Patients were identified from the regional multidisciplinary team (MDT)
database, which includes all patients recovered from
COVID-19 infection.
Recovery of COVID-19 infection confirmed by 2 consecutive negative
polymerase chain reaction (PCR) swabs. All patients were submitted for
detailed endoscopic nasal examination.
The study depended on baseline visits at the outpatient clinic of ENT
and follow up for 4 weeks. Patients age, sex, olfactory dysfunction
onset and duration, severity of COVID infection, isolation place,
hospitalization, medication used, medical history, date of confirmed
positive and negative COVID swabs and potential risk factors as obesity,
hypertension, diabetes mellitus, tobacco smoking and asthma were taken
in consideration.
Patients allocated into four groups each group 30 patients:
- 1st group (group A): Control group-
received isotonic saline nasal irrigation in each nostril twice daily.
- 2nd group (group B): received mometazone
furoate nasal spray 2 puff ̵̸100mg per each nostril once daily.
- 3rd group (group C): received vitamin A
nasal drops 2drops 10.000IU per each nostril once daily (vi-tadral,
Aristo pharma Gmbh, Berlin, Germany).
- 4th group (group D): received nasal
theophylline 400mg theophylline tablet diluted in 240 mL isotonic
nasal saline in sinus rinse bottle, irrigation per each nostril twice
daily.
All enrolled participants received medications for 4 weeks in addition
to olfactory training in the form of sniffing of 4 different scents
typically phenylethyl alcohol (rose), citronella (lemon), eugenol(clove)
and eucalyptol (eucalyptus), each odorant for 15 seconds, with10 seconds
rest between odorant twice daily for one month.
Olfactory function evaluation (normal smell, anosmia, hyposmia) based on
patient subjective senses, visual analog scale (VAS)-smell score. This
was used with familiar nonirritant substances with a distinctive odor
like mint, coffee, and garlic. Score from 0 to 10, 0 means do not
recognize it at all (total loss of smell) and 10 means fully recognize
it (complete normal smell). This test was done before starting
medications and every week for one month for all participants.
Smell loss duration was considered from the onset of olfactory
dysfunction to complete recovery of the smell sensation.
Statistical analysis:
The data were recorded on an “Investigation report form”. These data
were tabulated, coded then analyzed using the computer program SPSS
(Statistical package for social science) version 26. Descriptive
statistics were calculated for the data in the form of mean and standard
deviation (±SD), Median and interquartile range (IQR) and Number and
percent. In the statistical comparison between the different groups, the
significance of difference was tested using student’s t -test to
compare between mean of two groups of numerical data, for continuous
non- parametric data, Mann-Whitney U- test was used for
inter-group analysis, Anova to compare between mean of more than two
groups of numerical data, for continuous non- parametric data, Kruskal
Wallis test was used for inter-group analysis Inter-group comparison of
categorical data was performed by using chi square test
(X2- value). P value <0.05 was
considered statistically significant.
Results:
Patient characteristics:
A total of 120 patients met the iclusion criteria of the study allocated
into four groups of 30 patients. Among the total included and analyzed
120 adult patients, 52 patients were male (43.3%) and 68 were female
(56.6%). Patient ages ranged from 18 to 62 years; the median age was
38.5 years (IQR 24.75). 38 patients (36.3%) were managed in hospital
while 82 patients (68.3%) were home isolated. severity: to COVID-19
illness severity; 87 patients (72.5%) were mild, 25 patients (20.83%)
were moderate, and 8 patients (6.67%) suffered severe illness. The
study included 23 diabetic patients (19.1%) and 41 patients (34.2%)
were hypertensive. 20 patients (16.7%) were suffering from obesity and
18 patients (15%) were asthmatic and 37 patients (30.8%) were smokers.
Regarding age and sex, all groups showed non-significant differences.
There were no statistically significant differences between all groups
as regards prognostic factors such as place of management, severity of
COVID-19 illness, obesity as shown in (15) .
We found a high signigant
association between other prognostic factors as; diabetes
(P-Value=<0.001***) ,
hypertension(P-Value=<0.001***) , smoking
(P-Value=<0.001***) , and asthma
( P-Value=<0.001***)
as shown in (15) .
Also, there were no statistically significant differences between the
studied groups as regards the duration of COVID-19 illness
(P-Value =0.5) and the duration of anosmia/hyposmia
before recovery/discharge
(P-Value =0.2) .
There is signigant difference between the studied groups as regards
Duration of anosmia/hyposmia till complete recovery
(P-Value=<0.02*) . [Table 2]
Duration of anosmia/hyposmia and smell scores of the studied
groups:
As regards duration of anosmia/hyposmia till complete recovery, the
comparison between studied groups showed statistically significant
difference as the average time (Mean ± SD) for complete recovery of
smell in group A was 28.97± 4.29 days and was 25.70± 9.20 days among
group B and 24.80±6.67among group C and was 23.50± 7.13 days among group
D (P value <0.02*) . [Table 2]
Recovery of anosmia/hyposmia:
Regarding smell scores at recovery/discharge at the initial assessment,
there was no statistically significant difference between the studied
groups, (P value = 0.2) . On comparing smell scores
after1 week, 2 weeks and 3 weeks of treatment, there were high
statistically significant differences between the studied groups
(P-values <0.001*) . But there is no
significant difference after the fourth week of treatment
(p value =0.6) as shown in [Table 3 ].
In group A, 17 out of 30 patients (56.6%) had their sense of smell
completely recovered by the end of the fourth week, compared to 18 out
of 30 patients (60%) in group B and 21 out of 30 patients (70%) in
groups C and D.
Table 2 : Comparison between the studied groups.