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

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

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.

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.

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.

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.