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Loss of smell (LOS) is a debilitating symptom with increasing interest for the medical community due to its high prevalence in COVID-19. In the present paper, a team of 15 experts provide recommendations for the investigation and management of patients with new onset LOS during the COVID-19 pandemic. After conducting a systematic review of the literature, they used the RAND/UCLA methodology to reach consensus. Using a nine-point Likert scale, panellists classified the investigations and treatment modalities under consideration as ‘recommended’, ‘optional’ or ‘not recommended’. Consensus was reached in most items when more than 70% of the board supported the category defined by the mean. The authors advised for an ENT referral for the patients with isolated LOS, after a four-to-six-week period if no association with COVID-19 was made, or after three months if COVID-19 was diagnosed. Initially GPs can manage these patients and ENT can later review via remote consultation. Patients presenting with other nasal symptoms should have a face-to-face consultation for nasendoscopy and further investigation planning. Imaging studies are recommended in the cases of isolated LOS in the absence of COVID-19 and LOS with persistent nasal symptoms, when nasendoscopy is normal. MRI brain scan should be first-line investigation in case of LOS along with other neurological symptoms. The authors recommend olfactory training and support to all patients with LOS for more than two weeks. While intranasal steroid sprays are recommended for persistent symptoms of more than two weeks, the use of nasal drops or oral steroids is optional. Similarly optional is the use of Omega-3 vitamin, whereas Vitamin A drops are not recommended. Although this is a united effort to guide the medical community on patients with LOS during the pandemic, we should expect the guidelines to shift, as our experience of COVID-19 infection grows.

Management of new onset loss of sense of smell during the COVID-19 pandemic - BRS Consensus Guidelines.
Hopkins C, Alanin M, Philpott C, et al.
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Dimitrios Spinos

NHS West Midlands, UK.

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