Regarding Use of Topical Steroids in Patients With COVID-19–Associated Olfactory Loss | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Comment & Response
November 19, 2020

Regarding Use of Topical Steroids in Patients With COVID-19–Associated Olfactory Loss

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2021;147(1):110. doi:10.1001/jamaoto.2020.4275

To the Editor We read with interest the recent Invited Commentary by our friend and colleague, Dr Joshua Levy, on the treatment of postviral olfactory dysfunction titled “Treatment Recommendations for Persistent Smell and Taste Dysfunction following COVID-19—the Coming Deluge.”1

Although we agree with Dr Levy that there is a frustrating dearth of interventions that can help everyone who suffers from postviral or postinfectious olfactory loss, we cannot help but completely disagree with his discussion surrounding the use of oral and topical corticosteroids in this patient population.

He asserts that there is a lack of demonstrated efficacy of topical steroids for this patient population. We would direct him to our recent randomized clinical trial (RCT), followed by a systematic review of the evidence, addressing this very topic.2,3

We first demonstrated in our RCT2 that placing a topical steroid, in particular budesonide, in a rinse formulation, used along with olfactory training, added significant benefit to patients with idiopathic or postviral olfactory dysfunction.

In addition, in our systematic review,3 we confirmed that topical steroid nasal sprays should not be used in this patient population because there is good evidence showing no benefit, while also examining the conflicting data regarding oral corticosteroid use in this patient population.

Topical steroid sprays should not be used to treat patients with postviral olfactory dysfunction, coronavirus disease 2019 (COVID-19) related or otherwise, because it will not help them. Alternatively, rinsing with a topical steroid irrigation can be helpful for these patients. Finally, we simply do not have enough data currently to advise or recommend for or against use of oral corticosteroids in this patient population, although a cohort study is currently underway to answer this particular question in patients with COVID-19.

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Article Information

Corresponding Author: Zara M. Patel, MD, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA 94305 (

Published Online: November 19, 2020. doi:10.1001/jamaoto.2020.4275

Conflict of Interest Disclosures: Dr Patel reported being a consultant for Medtronic, Stryker, and Optinose.

Levy  JM.  Treatment recommendations for persistent smell and taste dysfunction following COVID-19—the coming deluge.   JAMA Otolaryngol Head Neck Surg. Published online July 2, 2020. doi:10.1001/jamaoto.2020.1378PubMedGoogle Scholar
Nguyen  TP, Patel  ZM.  Budesonide irrigation with olfactory training improves outcomes compared with olfactory training alone in patients with olfactory loss.   Int Forum Allergy Rhinol. 2018;8(9):977-981. doi:10.1002/alr.22140PubMedGoogle ScholarCrossref
Yan  CH, Overdevest  JB, Patel  ZM.  Therapeutic use of steroids in non-chronic rhinosinusitis olfactory dysfunction: a systematic evidence-based review with recommendations.   Int Forum Allergy Rhinol. 2019;9(2):165-176. doi:10.1002/alr.22240PubMedGoogle ScholarCrossref
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