Otolaryngologists and primary care providers report seeing more patients with smell loss or a distorted sense of smell than ever before. Chronic fatigue and headaches are common; some patients also report tinnitus, hearing loss, “brain fog,” persistent cough, and heart palpitations.
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May 2023“There are patients who come in after a year or two and ask, ‘How can you help me?’” said Alfred Marc Iloreta, Jr., MD, an assistant professor of otolaryngology and director of skull base surgery at The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai Hospital in New York City.
Otolaryngologists and researchers are still looking for answers to that question. Here is what’s currently known.
Rhinologic Manifestations
Anosmia and hyposmia appear more common in long COVID patients who also report headache, mental clouding, or both, according to a cross-sectional study of patients with olfactory dysfunction (Brain Sci. 2022;12:154). Cognitive impairment and headache were associated with more severe olfactory loss in the cohort of adult patients experiencing persistent smell alterations—a finding the researchers noted is “consistent with neuroinflammatory mechanisms mediating a variety of long COVID symptoms.”
A recent study in Communications Medicine implicated the coronavirus in hearing and balance disorders. It provided putative evidence that the SARS-CoV-2 virus can directly infect the inner ear. —Michael Brenner, MD
The Brain Sciences study and others report a higher rate of olfactory dysfunction in female COVID-19 survivors, though it isn’t yet entirely clear whether this difference has a biological underpinning or is perhaps related to sociological differences.
“We saw a significantly higher predominance of parosmia in female patients, but it may just be because male patients aren’t coming in when they experience a change in smell,” Dr. Iloreta said.
Although a 2021 study of 231 patients with COVID-related olfactory dysfunction found that “a majority of patients sought treatment” for olfactory challenges, anecdotal evidence suggests that many patients aren’t getting medical help for anosmia, parosmia, and phantosmia (Laryngoscope. 2022;132:633–639). Dishner told her primary care physician about her continued olfactory dysfunction, but “he did not have suggestions,” she said.
Patients and physicians alike have been frustrated by the lack of proven, well-tolerated, efficacious medical interventions for smell loss. Pre-pandemic, “the mainstays for treating post-viral smell loss were olfactory training and high-volume steroid irrigations,” said Zara M. Patel, MD, director of endoscopic skull base surgery and a professor of otolaryngology–head and neck surgery at Stanford University Medical Center in Stanford, Calif. Both interventions have since proven helpful for many patients with long COVID olfactory dysfunction.