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ORIGINAL ARTICLE

Intranasal Theophylline Treatment of Hyposmia

and Hypogeusia

A Pilot Study

Robert I. Henkin, MD, PhD; Michael Schultz, RPh; Laura Minnick-Poppe, PharmD

Objective

To determine whether intranasal theophyl-

line methylpropyl paraben can correct hyposmia and hy-

pogeusia.

Design

We performed an open-label pilot study in pa-

tients with hyposmia and hypogeusia under the follow-

ing 3 conditions: (1) before treatment, (2) after oral the-

ophylline anhydrous treatment, and (3) after intranasal

theophylline treatment. Under each condition, we per-

formed subjective evaluations of taste and smell func-

tions, quantitative measurements of taste (gustometry)

and smell (olfactometry), and measurements of serum

theophylline level and body weight.

Setting

The Taste and Smell Clinic inWashington, DC.

Patients

Ten patients with hyposmia and hypogeusia

clinically related to the effects of viral illness, allergic rhi-

nitis, traumatic brain injury, congenital hyposmia, and

other chronic disease processes were selected.

Interventions

Oral theophylline anhydrous, 200 to 800

mg/d for 2 to 12 months, was administered to each pa-

tient. This treatment was discontinued for 3 weeks to 4

months when intranasal theophylline methylpropyl para-

ben, 20 µg/d in each naris, was administered for 4 weeks.

Main OutcomeMeasures

At termination of each con-

dition, taste and smell function was determined subjec-

tively, by means of gustometry and olfactometry, with

measurement of serum theophylline levels and body

weight.

Results

Oral theophylline treatment improved taste and

smell acuity in 6 patients after 2 to 12 months of treat-

ment. Intranasal theophylline treatment improved taste

and smell acuity in 8 patients after 4 weeks, with im-

provement greater than after oral administration. No ad-

verse effects accompanied intranasal drug use. Bodyweight

increased with each treatment but was greater after in-

tranasal than after oral administration.

Conclusions

Intranasal theophylline treatment is safer

and more effective in improving hyposmia and hypo-

geusia than oral theophylline anhydrous treatment.

Arch Otolaryngol Head Neck Surg. 2012;138(11):1064-1070

OSS OF SMELL

(

HYPOSMIA

)

and taste (hypogeusia) are

common symptoms that

affect many thousands of pa-

tients in the United States, as

reported by several investigators.

1-4

Effec-

tive treatment for these symptoms has been

demonstrated only recently and has not

been formally established.

Before effective treatment to correct loss

of smell and taste can be established, a bio-

chemical basis for the cause of these symp-

toms is necessary. To accomplish this, we

determined that these symptoms are com-

monly caused by decreased secretion of

several growth factors in the saliva and na-

sal mucus. The growth factors act on stem

cells in taste buds and olfactory epithelial

cells to generate the elegant repertoire of

cellular components in these sensory or-

gans.

5-11

Growth factor stimulation of these

sensory organs is thought to maintain nor-

mal taste and smell function.

5-11

If these

growth factors were diminished by any of

several diseases and pathological condi-

tions, then hyposmia and hypogeusia oc-

cur.

5,12,13

These conditions and diseases in-

clude trace metal deficiencies

; vitamin

deficiencies

15,16

; liver disease

; diabetes

mellitus

; other metabolic,

12,13

otolaryn-

gological,

19,20

and neurodegenerative dis-

orders, including multiple sclerosis,

21-23

Parkinson disease,

24-28

and Alzheimer dis-

ease

29-32

; and other neurological disor-

ders.

Effective treatment to increase se-

cretion of these growth factors is therefore

Author Affi

and Smell C

Molecular

Sensory Dis

DC (Dr Hen

Care, Earth

(Mr Schultz

College of P

Missouri (D

Author Affiliations:

The Taste

and Smell Clinic, Center for

Molecular Nutrition and

Sensory Disorders, Washington,

DC (Dr Henkin); Foundation

Care, Earth City, Missouri

(Mr Schultz); and St Louis

College of Pharmacy, St Louis,

Missouri (Dr Minnick-Poppe).

ARCH OTOLARYNGOL HEAD NECK SURG/VOL 138 (NO. 11), NOV 2012

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Reprinted by permission of Arch Otolaryngol Head Neck Surg. 2012; 138(11):1064-1070.