Olfactory training in long COVID-19 patients with lasting symptoms including olfactory dysfunction.

INTRODUCTION: Two-thirds of patients with COVID-19 developed smell and taste dysfunction, of whom half experienced improvement within the first month. After six months, 5-15% still suffered from significant olfactory dysfunction (OD). Before COVID-19, olfactory training (OT) was proved to be effective in patients with post-infectious OD. Therefore, the present study aimed to investigate the progress of olfactory recovery with and without OT in patients with long COVID-19. METHODS: Consecutive patients with long COVID-19 referred to the Flavour Clinic at Gødstrup Regional Hospital, Denmark, were enrolled. The diagnostic set-up at the first visit and follow-up included smell and taste tests, questionnaires, ENT examination and instructions in OT. RESULTS: From January 2021 to April 2022, 52 patients were included due to long COVID-19-related OD. The majority of patients complained of distorted sensory quality, in particular, parosmia. Two-thirds of the patients reported a subjective improvement of their sense of smell and taste along with a significant decline in the negative impact on quality of life (p = 0.0001). Retesting at follow-up demonstrated a significant increase in smell scores (p = 0.023) where a minimal clinically important difference (MCID) in smell scores was found in 23% of patients. Full training compliance was significantly associated with the probability of MCID improvement (OR = 8.13; p = 0.04). CONCLUSIONS: The average effect of OT is modest; however, full training compliance was significantly associated with an increased probability of a clinically relevant olfactory improvement. FUNDING: none. TRIAL REGISTRATION: not relevant.

[The nose can be the focus of treatment and prophylactic approaches against COVID-19].

Infection with SARS-CoV-2 frequently commences in the nasal cavity, yet knowledge about this initial virus-host interaction is sparse. In this review, we update our current understanding of SARS-CoV-2 infection via the nasal epithelium and the associated local immune response. Furthermore, we present considerations to how this interaction may influence the clinical course of COVID-19 and the systemic immune response, and lastly touch upon the potential for intranasal vaccination, intranasal antiviral therapies and immunomodulatory approaches.