CNN
—
It’s been months since I lost my sense of taste and smell after Covid-19.Attempted to schedule an appointment with a specialist — even if a specialist could be found — only to find a waiting list Over 6 months.
Dr. Justin Turner said, “After the pandemic started, we had an explosion of calls from patients and we didn’t see the 10% of patients who wanted to come to our clinic.” Associate Professor of Otolaryngology and Head and Neck Surgery at Vanderbilt University Medical Center in Nashville, Tennessee.
Unfortunately, it still is, and many people who have not yet regained their sense of smell and taste find help, says rhinologist Dr. Zara Patel, a surgeon focused on treating the nose and sinuses. I’m having a hard time.
“One of the big problems we recognized early in the pandemic was that, with the exception of a few experts, almost no one knew anything about smell loss and how to diagnose or treat it.”Stanford University School of Medicine, California underwent neck surgery.
Founded by both Stanford and Vanderbilt Two of a handful of clinics to treat and study the loss of smell in the United States.
“The saddest and most common thing I hear from patients who have seen multiple doctors before coming to my office is to be told, ‘There’s really nothing you can do.’ We’ll have to see if the smell comes back over time,” Patel said.
“In practice, the sooner decisive intervention is initiated, the more likely it is that the smell can be reversed.”
To address this issue, Patel brought together 50 experts to develop a 600-plus page consensus that combines vetted scientific knowledge with medical best practices for smell loss.
“This is the first peer-reviewed compendium of its kind on the sense of smell,” said Patel. “And it’s open access. Anyone can read it, not just doctors, but patients.”
guidelines, Published in International Forum of Allergy & Rhinologylayout An action plan for general practitioners on how to test, diagnose and treat smell loss, including when to refer to a specialist.
Patel recommends people with anosmia print out a clinical assessment (see below) and take it with them to their doctor.
“We wrote this as a resource for patients to advocate for themselves and for physicians who do not have training or expertise in this area.” They can use it to learn about different treatment options.”
Clinical evaluation outlines a recommended sequence for the diagnosis of smell loss due to all causes, not just Covid-19.
Medical history: Physicians should follow guidelines and take a detailed patient history. This includes questions about the onset, severity, and psychological impact of loss of smell and possible causes such as exposure to toxic chemicals, head or nose injury or surgery, and cancer radiation.
Headaches, chronic sinus problems, autoimmune diseases, some medications, and vitamin and mineral deficiencies can be associated with loss of smell. Common colds, flu, and other viral illnesses such as Covid-19.
Age may also play a role. We all partially lose our sense of smell because our olfactory nerves stop regenerating. People with Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis often lose their sense of smell due to the effects the disease has on the brain.
Smell test: Your doctor should perform a validated smell test. Be aware, however, that some tests may not be sensitive enough to detect subtle nuances of smell loss, and your doctor may decide there’s nothing wrong.
Early in the pandemic, Turner said some patients complained of loss of smell and taste, about 60% of those who had the alpha and delta variants.
“Once those patients were tested objectively, the positive rate increased significantly. When actually tested, about 80% or 90% had some form of impairment. said Turner.
It can also work the other way around, says Dr. Eric Holbrook, associate professor of otolaryngology and head and neck surgery at Harvard Medical School in Boston, and many people are unaware of the nuances of odor restoration. .
“There are papers showing that humans have difficulty assessing gradual changes in olfactory perception,” says Holbrook. “It will give us a little bit of differentiation in the test and some people will be encouraged to see that there has been a change.”
Physical examination: A complete physical examination should be performed, including a nasal endoscopy and cranial nerve examination. If a patient’s medical history shows evidence of neurological impairment or chronic sinusitis, further testing should be ordered, the guidelines say.
If the test is positive, the patient should be referred to a specialist to treat that particular disease.For example, people with chronic sinusitis are referred to to a rhinologist.
If you need an expert, Patel can American Rhinological Society website Find it in your area.
Guidelines recommend different treatments, depending on the cause of the loss of smell.
Underlying disease: If the loss of smell is due to an underlying medical condition such as chronic sinusitis or a neurological condition, the guidelines suggest that doctors refer patients to specialists to offer treatment options.
Surgery and Trauma: If the loss is due to skull surgery, treatment with omega-3 fatty acids is recommended. Oral zinc and topical vitamin A are options if trauma is the cause, such as a car accident.
“Using the term ‘optional’ means that there is very low-level data that might be useful,” Patel said. ”
Viral infection: If the loss of smell is the result of a viral infection such as COVID-19 or influenza, the recommended treatment is smell training. This is a process in which patients practice sniffing twice daily for at least six months.
“We start with four odors belonging to different categories of odors to stimulate different types of olfactory receptor neurons in the nose: lemon, rose, eucalyptus and clove,” says Patel.
Another recommendation is the use of steroids via a squeeze bottle nasal irrigation device similar to a neti pot.
“We add topical steroids to the salt water rinse so that we can bathe the nerve cells in the nose with powerful anti-inflammatory drugs,” she said.
Safety studies on steroid use in patients with chronic sinusitis show the body absorbs She added that she rarely uses steroids in this way.
Other treatment options for virus-induced odor loss (not fully supported by research) may include topical administration of vitamin A or omega-3 fatty oil supplements, the guidelines say. increase.
Consensus also specifies medications and treatments for which there is little or no science to support their use, such as systemic vitamin A, oral or nasal zinc, oral steroids or nasal steroid sprays, and intranasal platelet-rich plasma injections. increase.
A person who has lost his sense of smell may suddenly begin to smell vulgar. Food and drink smell rotten, rancid, metallic, or chemically pungent. Doctors call parosmia, a condition caused by the inability of the olfactory receptors to convey accurate information to the brain. Distorted odors can occur after head trauma, neurological conditions, or viral infections such as Covid-19.
“Parosmia is always seen in postviral odor loss, but not to the extent that it is seen in Covid-19-related odor problems.”
Fortunately, experts consider parosmia to be a sign of recovery. The guidelines consider smell training and certain medications as treatment options.
“Some people may respond to drugs that we call neuromodulators — gabapentin, pregabalin, amitriptyline — drugs that modulate nerve signals back to the brain,” Patel said. .
Finally, the guidelines state that physicians should discuss the emotional impact that loss of smell may have and provide referrals to therapists and specialists if necessary.
Some people don’t mind having no sense of smell, says Patel. For others, it can lead to depression and malnutrition, especially if the smell is distorted.
“Imagine you went out to eat and it smelled and tasted like rotten meat,” Patel said. , find bland high-fat or starchy foods to gain a lot of weight. It’s safe for them. ”
groups such as five senses and the North American Smell and Taste Association Have mobilized to helpRecruitment positive and hope, Olfactory training tips and even recipe to increase appetite.
“Our enjoyment of the environment is actually through our sense of smell,” Turner said. “Simple things like the smell of spring flowers, the smell of children, spouses and loved ones permeate our minds.”
