Ongoing Patient Impact
A sudden loss of or distortion of smell may not be as thoroughly life changing as a loss of or distortion of hearing or sight, but it can still be debilitating.
Explore This IssueAugust 2021
“Persistent olfactory dysfunction is very disturbing for those who experience it,” Dr. Villwock said. “It can have a significant negative impact on quality of life—especially related to nutrition and food enjoyment—and have significant safety implications in terms of hazard detection.”
As with other debilitating conditions, patients with COVID-19 related OD are taking solace in sharing information and experiences with each other. A Facebook COVID-19 Anosmia/Parosmia Support Group created in August 2020 now has more than 30,000 members, with more than 2,600 posts during the month of June 2021. Another group on Facebook called Parosmia/Phantosmia Support Group has more than 8,000 members.
Patients are notoriously bad at predicting their degree of smell loss. They often underpredict it or fail to recognize it. —Carol H. Yan, MD
Complicating OD, when patients have parosmia, they can also have dysgeusia, a distortion of taste that can make things taste sweet, bitter, sour, or metallic. This is often described as far worse than smell loss and can lead to significant dietary and nutrition concerns that can be traumatizing. “I had a patient who was unable to eat and had to be hospitalized with a feeding tube,” Dr. Yan said.
Smell Recovery Treatments
While there have been several studies published on treatments for post-viral smell loss, it’s too early to know which may specifically benefit COVID-19-related OD. There are some treatment options currently in use or in research:
Olfactory training. Although not specifically developed for COVID-19 smell loss, there is evidence that olfactory training can help patients with COVID-19-related OD. Typically, this consists of sniffing four different odors twice daily over at least 24 weeks (Olfactory Training. StatPearls Publishing. Updated 2020 December 24, 2020). “Olfactory training is a staple for any chemosensory or smell disorder, whether it’s smell loss, parosmia, or phantosmia,” Dr. Yan said.
Other therapies. When it comes to COVID-19 olfactory training, however, Dr. Yan combines it with other therapies. While she doesn’t recommend oral steroids due to the many possible side effects, she does prescribe budesonide, a topical steroid rinse that was shown to improve smell loss in a pre-COVID-19 randomized control trial, compared to just olfactory training and saline rinses alone (Int Forum Allergy Rhinol. 2018;8:977-981). “The theory is that we are decreasing any localized inflammation that may be isolated to the olfactory cleft and not visible during endoscopy,” she said.
Other possible therapies under consideration include: