Please select the eligibility criteria that correspond to the clinical trial below.
Title: Determinants of Olfactory Dysfunction in Chronic Rhinosinusitis
Brief Summary: Olfactory dysfunction is a cardinal symptom of chronic rhinosinusitis, a disease which affects 12.5% of the adult population across all racial and ethnic groups. Previous research has documented olfactory deficit in 68% of patients with chronic rhinosinusitis and 20% with complete anosmia, suggesting that olfactory dysfunction affects over 25 million individuals in the United States with chronic rhinosinusitis. This proposed investigation will be used to predict olfactory outcomes following treatments for chronic rhinosinusitis and gain insights into mechanisms of olfactory dysfunction in this population.


Options:
A: Inclusion Criteria:

* Adults (18 years of age or older) with self-reported new-onset olfactory dysfunction
* Positive COVID-19 diagnosis will be deemed eligible for inclusion.

Exclusion Criteria:

* Patients \<18 years of age
* Patients who are unable to provide informed consent
* Patients without a positive COVID-19 PCR result obtained through nasopharyngeal swab - Patients with a COVID-19 diagnosis but without self-reported anosmia
* Patients with severe COVID-19 disease as defined by the Mouth Sinai Health System Treatment Guidelines for SARS-COV-2 (requiring high flow nasal cannula, non-rebreather, CPAP/BIPAP, or mechanical ventilation OR patients requiring pressor medication OR patients with evidence of end organ damage)
* Patients with pre-existing self-reported olfactory dysfunction
* Patients with a history of chronic nasal/sinus infections (rhinosinusitis) or history of endoscopic sinus surgery
* Patients using nasal steroid sprays or irrigations for any reason
* Patients who are prisoners of the state
* Patients who have psychiatric or developmental disorder conditions that may impair ability to provide informed consent
* Patients will also be excluded if they have an allergy to fish or an omega-3 supplement, or do not eat fish or fish- containing substances for any reason
B: Inclusion Criteria:

* Adult ( \> 18 years of age)
* A diagnosis of medical recalcitrant CRS as defined by 2015 Adult Sinusitis Guidelines outlined by the American Academy of Otolaryngology
* Provide written informed consent and authorization.
* Study participants must be able to complete consent, all study evaluations, olfactory testing, and study-related health questionnaires written in the English language.
* Patients must self-select subsequent treatment option (endoscopic sinus surgery or continued medical therapy) to be dictated by the disease process and judgment and preferences of each individual, following counseling for each treatment option.
* Present to the enrolling site with indication for a CT scan or a CT scan completed, off-site, from another provider
* Complete appropriate standardized medical treatment by the Interim Assessment, 6-week follow-up period including, but not limited to, at least one course of either topical corticosteroids (\>21-days) or a 5-day course of oral corticosteroid therapy, and at least one course (\>14-days) of culture-directed or broad spectrum antibiotic therapy.

Exclusion Criteria:

* Children (\< 18 years of age)
* Any patient unable and/or unwilling to complete questionnaires or clinical testing or cooperate with all study protocols.
* Non-English speaking / English translation services required
* Unwilling or unable to provide informed, written consent.
* Contra-indications for any type of continued medical therapy required for treatment of symptoms related to CRS
* Patients who have not undergone previous prescribed medical therapy as described in Inclusion Criteria.
* Individuals of any vulnerable population including: children, pregnant women, neonates, decisionally impaired adults, or prisoners.
C: Inclusion Criteria:

* Patient over 18 years of age;
* Patient with a suspected SARS-CoV-2 infection in a epidemic context, whether or not confirmed by PCR, or contact close to a PCR-confirmed case, typical chest CT scan (unsystematized frosted glass areas predominantly sub-pleural, and at a later stage of alveolar condensation with no excavations neither nodules nor masses) or positive serology ;
* Patient with isolated acute hyposmia persisting at D30. of the onset of signs of CA-MRSA-CoV-2 infection;
* Absence of PCR-confirmed SARS-CoV-2 portage at the time of inclusion

Exclusion Criteria:

* Known hypersensitivity to budesonide or to any of the excipients of the medicine;
* Hemostasis disorder, or epistaxis;
* Oromo-oral-nasal and ophthalmic herpes virus infection;
* Long-term corticosteroid treatment;
* Treatment with potent CYP3A4 inhibitors (e.g., CYP3A4 inhibitors); ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV proteases) ;
* Forms of CoV-2-SARS with respiratory signs or other than anosmia persisting at 30 days from the onset of symptoms;
* Hyposmia persisting for more than 90 days after onset of symptoms;
* Other causes of hyposmia revealed on interrogation or an MRI;
D: Inclusion Criteria:

* adults 18 yrs or older patients
* confirmed case (+ve PCR),
* recovered/discharged (2 -ve PCR),
* suffered from sudden recent anosmia or hyposmia

Exclusion Criteria:

* patients already on nasal steroid
* with previous chronic rhinological pathologies,
* patients on systemic steroid for previous systemic disease,
* anosmia improved before COVID19 recovery,
* pregnancy
* patients who will not complete the follow up period.

Answer: B