Monday, December 11, 2023

The Management of Post-Covid Anosmia

 

Here’s a piece of information sent to me by a friend of mine, Professor Dr Charles Andrew Gomez, a Senior Consultant ENT Surgeon on:

 Overcoming Post-COVID-19 Long-Lasting Olfactory Issues written by Dr  Antonio Segovia


Exploring the Impact of COVID-19 on Smell and Taste, Its Repercussions on Daily Life, and Advances in Innovative Treatments


The COVID-19 pandemic has messed up millions of lives in all sorts of ways.

Even my wife wasn’t spared and had to deal with weird stuff like losing her sense of smell, everything smelling foul, and taste changes when she got infected.

Fortunately, in her case, these symptoms were temporary, lasting about 15 days.

However, in my line of work as a medical doctor, I have seen many patients still struggling with these changes that mess up their quality of life and mood, particularly those who find joy and healing through cooking.

 The Extent of Post-COVID-19 Anosmia in the US

Post-COVID-19 anosmia  statistics in the United States reveal a worrying picture.

According to the World Health Organization (WHO), as of November 2023, 103,436,829 cases of COVID-19 have been reported in the US, with 1,138,309 deaths.

World meter updated these figures to 109,378,312 cases with 1,182,614 deaths as of November 2023.

Olfactory disorder is common among COVID-19 patients, with approximately  70% experiencing loss of smell during the illness  and 65% having olfactory dysfunction 18 months later.

This 2022 paper on MDPI found that:

24.2% of mildly symptomatic patients still experienced chemosensory (responsive to chemical stimuli) dysfunction one year after infection, with 45.1% presenting with dysfunction after 12 months and 35.9% suffering from parosmia (abnormality in the sense of smell.)

Recent studies suggest that up to 20% of all COVID-19 patients experience long-term olfactory disorders.

 Mechanism of Loss of Smell and Taste in COVID-19

Anosmia (temporary loss of smell) is one of the primary neurological symptoms and one of the most common and earliest indicators of COVID-19.


Interestingly, the sensory neurons that detect and transmit smell to the brain are not among the cell types most vulnerable to SARS-CoV-2 infection.

Studies led by neuroscientists at Harvard Medical School have identified that
 the virus primarily affects cells that supply metabolic and structural support to olfactory sensory neurons and  specific populations of stem cells and blood vessel cells.

Cells contain the receptor, which SARS-CoV-2 uses to enter human cells.

It implies  that in most cases, SARS-CoV-2 infection is unlikely to damage olfactory neural circuits permanently and lead to persistent anosmia.

Accompanying symptoms and causes

Patients with post-COVID-19 anosmia
 not only lose their sense of smell, but may also suffer from parosmia and other related symptoms.

Parosmia is a condition where our sense of smell is distorted, causing us to perceive smells differently from how they are.

People with parosmia *may experience odours that are unpleasant or different from their true nature. All these sequelae cause:


Mood disturbances,

 Weight loss,  and a decreased quality of life  caused by damage to sensory neurons or brain areas responsible for the smell.

 Work-Life and Mental Health After the Pandemic

The COVID-19 pandemic has destroyed part of the work and private lives of many people, as well as employees' mental well-being and self-rated health.

About 30% of employees reported that their work and personal lives had worsened, while about 10% reported improvements at work and 13% in private life.

The negative perception of the impact of the crisis is enormously strengthened by lower mental well-being and self-rated health.

 Conventional Treatments and New Options

Although there are pharmacological and topical treatments for anosmia, their effectiveness is limited, especially in cases of parosmia.

It is where hope arises with A CT-guided stellate ganglion block (SGB) to treat post-COVID parosmia.


With this technique, an aesthetic and a depot steroid are injected into the stellate ganglion under the guidance of computed tomography.

A recent study indicated that most patients treated with this technique experienced a significant improvement in their symptoms.

This technique helped a bunch of patients who hadn’t gotten relief before. But patients got even more relief when they had the treatment on both sides. The good old CT-guided stellate ganglion block (SGB)is a promising new way to help those dealing with long-term smell issues after COVID-19.

The advancements are exciting, as this technique offers hope to those facing persistent smell disorders post-COVID. However, microsurgery is a minimally invasive new option that gives hope to those with long-lasting loss of smell after COVID.

 Conclusions

From my own experience and medical practice, I’ve noticed that not only does losing your sense of smell after COVID-19 mess with daily life and enjoyment, but it can also really hit mental health and job performance hard.

The roll-out of treatments such as the CT-guided stellate ganglion block is like a light at the end of the tunnel for folks grappling with these lingering disorders.

As you can see, the news is excellent for the many people still facing long-term COVID-19 symptoms.

Overcoming anosmia and parosmia after COVID-19 is not just about regaining smell; it’s about reclaiming mental well-being in daily life.

To truly get into the weeds on this topic, there’s a detailed research piece you should look at in the Radiological Society of North America (RSNA).

You might find the “Analysis of Prevalence and Predictive Factors of Long-Lasting Olfactory and Gustatory Dysfunction in COVID-19 Patients” in PubMed.

Here is some additional information on “Impact of the COVID-19 crisis on work and private life, mental well-being” on BMC Public Health

Here’s my reply to my friend, Professor Charles Andrew Gomez, who sent me the above article someone else wrote about anosmia (loss of smell) from post-Covid effect:

…………………………………………………..

Thank you, Professor Andrew, for this post Covid olfactory dysfunction information.

I am not surprised because this virus affects the nose first as Covid is a respiratory infection

I am unsure the mechanisms in which this virus paralyzes the olfactory sensation to the brain, but my feeling is, the effect may be temporary even without all those elaborate, expensive, harmful radiation CT guided stellate ganglion block treatment,  whatever it is

The virus is not going to stay unchallenged by the immune system forever

Once the virus is overwhelmed, I believe as in most cases of repair systems by the body, the olfactory cells and  nerves will automatically regenerate, and the patient will and must recover from loss of smell.

One very cheap and natural way to deal with this anosmia is to stimulate the olfactory cells by steam inhalation  with antivirus eucalyptus oil alone or in combination with tea tree oil. The strong stimulating smell from the hot vapour of this anti-viral oil will excite the olfactory cells and nerves.

See details here:


https://taionn.blogspot.com/2021/05/recommendations-of-steam-inhalation.html


This is physiologically logical and is my take. There is no need for all those high end, highly expensive and time-consuming CT guided therapy which would be inaccessible to a large population of people with post-Covid symptoms. Imagine if we have 5 billion people world-wide, especially in poor countries like India, Indonesia, Yemen or in rural areas of African countries with Long Covid symptoms. How are they going to get CT-guided stellate ganglion block therapy? Doctors who devise and recommend such expensive out-of-reach methods of treatment that benefit only a few elite and rich patients will not get a Nobel Prize in medicine or in physiology. Clinicians and scientists need to find the cheapest and highly effective method that would benefit tens of hundreds of millions of people world-wide who shall be eligible for the prestigious Nobel Prize in medicine or in physiology

In the practice of medicine do it the easiest, cheapest, most effective and most convenient and natural way for the patient

That is good and ethical medicine

Thank you

Jb 

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