Long and smelly covid: how to get the treatment you need


It’s been months since your ability to taste and smell disappeared after a Covid-19 infection. You’ve tried to make an appointment with a specialist—if you could find one—only to discover waiting lists. six months or more.

“There was this explosion of patient calls after the pandemic started, and we couldn’t see 10 percent of the patients who wanted to come to the clinic,” said Dr. Justin Turner. Associate professor of otolaryngology and head and neck surgery at Vanderbilt University Medical Center in Nashville.

Unfortunately, that’s still the case, with many who have not recovered their sense of smell and taste struggling to find help, said Dr. Zara Patel, a nose and sinus surgeon.

“One of the big problems we realized at the beginning of the pandemic is that almost only a few specialists knew anything about smell loss and how to diagnose or treat it,” said Patel, professor and head of Otolaryngology. neck surgery at Stanford University School of Medicine in California.

Stanford and Vanderbilt have been established olfactory loss treatment and research clinics, two of a handful in the united states

“The saddest and most common thing I hear from patients in my clinic who have seen multiple doctors before coming to me is, ‘There’s nothing you can do.’ You just have to see if your smell comes back over time,'” Patel said.

“In reality, the sooner you start definitive intervention, the more likely you are to be able to restore your sense of smell.”

To address the issue, Patel said he brought together 50 experts to create a more than 600-page consensus that combined proven scientific knowledge about smell loss with medical best practices.

“It’s the first peer-reviewed conviction of its kind on smell,” Patel said. “And it’s open access, not just for doctors, but for patients, so anyone can read it.”

Guidelines published in the journal International Forum of Allergy & Rhinology are outlined An action plan for GPs on how to assess, diagnose and treat smell loss – including when to refer to a specialist.

Patel encourages people with smell loss to print out the clinical assessment (see below) and take it to their doctor.

“We wrote this as a resource for patients to advocate for themselves, and for doctors who have no training or education in this area,” Patel said. “They don’t just have to say, ‘Oh, there’s nothing you can do.’ They can use that and learn about different treatment options.’

Clinical assessment determines the recommended order for diagnosing smell loss of any cause, not just Covid-19.

Patient history: The doctor should take a detailed history of the patient, according to the guidelines. It will include questions about the onset, severity, and psychological impact of the loss of smell, with culprits such as exposure to toxic chemicals, head or nose injuries, or surgery and cancer radiation.

Headaches, chronic sinus problems, autoimmune disorders, certain medications, and vitamin or mineral deficiencies can all be associated with and even loss of smell. common cold, flu and other viral diseases such as Covid-19.

Age can also play a factor: we all partially lose our sense of smell as more olfactory nerves fail to regenerate. People with Parkinson’s disease, Alzheimer’s disease and multiple sclerosis often experience a loss of smell due to the disease’s effect on the brain.

Smell test: A doctor-verified smell test should be performed. However, keep in mind that some tests may not be sensitive enough to pick up subtle nuances in smell loss, possibly leading doctors to say that nothing is wrong.

Some patients had this experience early in the pandemic, when about 60 percent of people with the Alpha and Delta variants complained of loss of smell and taste, Turner said.

“When they started objectively testing those patients, that positivity rate went way up — about 80 percent or 90 percent of the patients had some kind of dysfunction if they actually tested them,” Turner said.

It can also work in reverse, as many people are unaware of the nuances of smell recovery, said Dr. Eric Holbrook, associate professor of otolaryngology and head and neck surgery at Harvard Medical School in Boston.

“The paper shows that humans have difficulty evaluating gradual changes in smell,” Holbrook said. “It can make the test a little different, and for some people it can be encouraging to see that there has been a change.”

Physical training: A complete physical examination should be performed, including nasal endoscopy and cranial nerve examination. If the patient’s history shows evidence of a neurological disorder or chronic sinus inflammation, further tests should be ordered, the guidelines say.

If the tests are positive, the patient should be referred to a specialist to treat that specific disorder. For example, a person with chronic sinusitis would be referred to a rhinologist

If a specialist is needed, Patel suggested using the American Rhinologic Society’s website to find one near you.

The guidelines recommend various treatments, depending on the cause of the loss of smell.

The underlying disorder: If the loss of smell is due to an underlying condition, such as chronic sinusitis or a neurological condition, the guidelines suggest that doctors refer the patient to a specialist and offer treatment options.

Surgery and trauma: If the loss is due to cranial surgery, treatment with omega-3 fatty acids is recommended. If trauma such as a car accident is the cause, oral zinc and topical vitamin A are options.

Using the term ‘possibilities’ means either there’s very low-level data that might help,” Patel said, “or there’s conflicting research where some help and some don’t, but there’s no data to suggest harm. ”

Viral infections: If the loss of smell is due to a viral infection such as Covid-19 or the flu, the recommended treatment is olfactory training, a process in which patients practice smelling smells twice a day for at least six months.

“We start with four odors in different olfactory categories that stimulate different types of olfactory receptor neurons in the nose: lemon, rose, eucalyptus, and clove,” Patel said.

Another recommendation is to use steroids through a squeeze bottle nasal irrigation device similar to a neti pot, Patel said. Steroid nasal sprays do not reach far enough up the nose to reach the olfactory nerves.

“We add a topical steroid to the saline water and that allows you to bathe the neurons in your nose with a powerful anti-inflammatory medication,” he said.

Safety studies on the use of steroids for chronic sinusitis patients have shown that they are absorbed by the body That way, he adds, “So you don’t have all these side effects that people get when they take steroids systemically orally or by injection.”

Other treatment options (not fully supported by research) for viral-induced smell loss may include topical vitamin A and omega-3 fatty oil supplements, the guidelines note.

The consensus also specifies which medications and treatments have little or no science to support their use, such as systemic vitamin A, oral or nasal zinc, oral steroids or steroid nasal sprays, and platelet-rich plasma nasal injections.

People who lose their sense of smell may suddenly begin to smell foul odors: Food and drink smell rotten, putrid, metallic, or chemically sour. Doctors call the condition parosmia, which occurs when the olfactory receptors do not provide accurate information to the brain. Distorted smell can occur after head trauma, neurological conditions or viral infections such as Covid-19.

“Parosmia is something we’ve always seen with post-viral olfactory loss,” Patel said, “but not to the same extent we see with olfactory problems associated with Covid-19.”

The good news is that experts believe that parosmia is a sign of recovery. Guidelines include olfactory training and certain medications as treatment options.

“Some people may respond to what we call neuromodulators (gabapentin, pregabalin, amitriptyline) or drugs that rewire the nerve signal to the brain,” Patel said.

Finally, the guidelines state that your doctor should discuss the emotional impact of smell loss and offer referrals to therapists or specialists if needed.

Some people get along without the smell, Patel said. For others, it can lead to depression and malnutrition, especially if the smell is distorted.

“Imagine you went out to eat and the food smelled and tasted like rotting meat,” Patel said. “People have wild spikes where they lose a bit of weight, then gain a lot of weight by finding bland but high-fat or starchy foods. that is safe for them.’

Groups like Fifth Sense and the Smell and Taste Association of North America have mobilized to help, offering affirmation and hope, tips on how to train your sense of smell, and even recipes to boost your appetite.

“A lot of how we enjoy our environment is through our sense of smell,” Turner said. “Simple things like the smell of spring flowers, the smell of your child and your spouse or partner are embedded in our minds.”