Another study, with a prospective cohort of 150 adult men ages 27 to 45, found that the HPV vaccine generated a durable immune response (Vaccine. 2019;37:2864-2869). “The potential benefits of increasing vaccine uptake far outweigh the limited risks,” Dr. St. John said.
Explore This Issue
June 2022Olfactory Training Following Infection
Ralph Metson, MD, a professor of otolaryngology– head and neck surgery at Harvard Medical School in Boston, said that evidence supports the use of olfactory training to help with loss of smell after an infection.
Patients report a loss of smell in 50% to 60% of COVID-19 cases. In 85% of those cases, their sense of smell returns after about four weeks. But in 5% to 10% of these cases, the loss of the sense of smell can go on for three months or longer, and an estimated 700,000 to 1.6 million people have chronic problems with smell because of COVID-19, Dr. Metson said.
A pioneering study in 2009 was the first to report the usefulness of olfactory training for smell loss after infection. In the prospective study, 24 patients underwent the training, while 11 controls did not. The training consisted of smelling four different scents for about 10 seconds at a time, twice a day for three months. Improvement in detecting scents, telling the difference between scents, and identifying scents at three months was seen in 21% of the treatment group, but in just 6% of the controls (Laryngoscope. 2009;119:496-499).
In another, more recent study, 70 subjects underwent training with therapeutic concentrations of scents, while 74 were exposed to concentrations that were diluted and not considered therapeutic. At four months, 26% of those in the therapeutic group showed significant improvement, while just 11% in the other group showed significant improvement. Those who’d had loss of their sense of smell for less than 12 months were more likely to improve than those who had suffered smell loss for a longer period (Laryngoscope. 2014;124:826-831).
“Olfactory training should be offered to patients who complain of postinfection smell loss,” said Dr. Metson. “It’s low cost and low risk. It makes patients feel good, and it makes you [as a physician] feel good.”
The approach that has been shown to work well for many patients involves deliberate sniffing of each of a floral, citrus, spice, and fresh or effervescent scent—most commonly rose, lemon, clove, and eucalyptus—for about 20 seconds each, twice a day for three months or more. This should not be started within one month of the loss of the sense of smell because the problem so often resolves naturally within the first month, Dr. Metson said. Subglottic Stenosis Management Mona Abaza, MD, MS, a professor of otolaryngology–head and neck surgery