Treating COVID-19 patients with smell loss in the otolaryngology clinic: Approach, management and prognosis

ABSTRACT

A full year has passed since patients were first seen in their medical and otolaryngology clinics with reported acute onset and often profound smell and taste loss that were soon linked to the SARS-CoV-2 virus. While studies vary in their prevalence, roughly 50% of patients with COVID-19 are estimated to suffer from viral-induced chemosensory dysfunction with approximately 5-25% experiences some extent of persistent smell and/or taste loss. The widespread screening of COVID-19 has allowed for a heightened clinical awareness in the early onset of one's olfactory dysfunction with a known viral etiology. Despite the high spontaneous recovery rate, persistent smell loss and qualitative olfactory dysfunctions such as parosmias have developed in an unfortunate subset of COVID-19 patients. Thus, consideration for early onset therapy may be appropriate and physicians have the opportunity to recommend treatment options for acute and chronic COVID-19 associated olfactory loss. Preliminary studies have suggested efficacy with the use of olfactory training as well as topical and oral steroids for olfactory loss, and topical sodium citrate for qualitative olfactory symptoms. Early longitudinal data have also suggested that the increased severity of smell dysfunction and the female gender may predispose to long term olfactory loss. Perhaps equally as important as the therapeutic management of smell loss is the counseling provided and the understanding of the impacts of olfactory dysfunction on quality of life and mental health. In this symposium talk, we will review the literature and discuss the approach and management that an otolaryngologist might provide to patients suffering from acute and chronic COVID-19 related olfactory loss.