Improving olfactory function and sinonasal manifestations in patients with granulomatosis with polyangiitis (GPA) - a prospective intervention study

BACKGROUND: No guidelines exist and very few papers are written suggesting how to treat chronic rhinosinusitis (CRS) in granulomatosis with polyangiitis (GPA) patients.

AIMS AND OBJECTIVES: We conducted this prospective non-randomized intervention study to define the disease burden in GPA and to optimize the CRS treatment attempting to alleviate the symptoms with a special focus on whether the olfactory function could be improved.

MATERIALS AND METHODS: We included 30 participants with GPA, who underwent olfactory training therapy combined with nasal corticosteroids twice a day for six months. At the first and second out-patient visits, the following data were collected: patients' CRS symptom were scored using a Visual Analog Scale (VAS), Sinonasal Outcome Test 22 (SNOT-22), Kennedy-Lund endoscopic score, and an olfactory threshold, discrimination, and identification (TDI) test.

RESULTS: The patients with few crusts and high compliance improved their olfactory function significantly. The total cohort improved their SNOT-22 score and the facial pain subdomain significantly. No significant improvements were made regarding the VAS score.

CONCLUSIONS AND SIGNIFICANCE: This study identified that GPA patients' CRS symptoms can be alleviated, using nasal corticosteroids and smell training therapy. Nevertheless, patients with GPA still have a high CRS-disease burden, mostly suffering from nasal crusting.