After COVID-19: Will I get my sense of smell back?

For those suffering from anosmia, there are no quick treatments but most eventually recover

It’s a lingering COVID-19 symptom that, at first glance, might not seem as alarming as other long-term effects, like heart or lung problems. But for those who suffer from it, the loss of smell can be devastating — and even dangerous.

The loss of smell also affects the ability to taste and enjoy foods. As a result, those who’ve experienced it know the condition can lead to a lack of appetite and nutrition deficiencies, as well as depression, anxiety and overall decreased quality of life. It can also be a health hazard for those whose nose can’t alert them to dangers such as spoiled food, a natural gas leak or smoke from a fire.

“Losing the sense of smell can be very disorienting because smell connects us with the world around us,” says Jay Piccirillo, MD, a Washington University otolaryngologist at Barnes-Jewish Hospital.

Dr. Piccirillo and a team of researchers at Washington University School of Medicine estimate that 700,000 to 1.6 million people in the United States who have recovered from COVID-19 have experienced an impaired sense of smell — also called chronic olfactory dysfunction or anosmia — for six months or longer.

And the true number may be even higher, they noted, calling the loss of smell an emerging public health concern in urgent need of research.

Dr. Piccirillo explains what happens during COVID-19 infection that causes the loss of smell.

“The cells in the nose, called supporting cells, near the olfactory (smell) nerves become infected and stop working during the acute infection. During this time, the nerve cells become affected because the supporting cells aren’t working properly. This leads to the distortion of smell,” Dr. Piccirillo says.

Dr. Piccirillo says most of those who suffer the loss of smell, loss of taste or both during COVID-19 infection quickly regain it. But, for those whose sense of smell hasn’t returned after six months or longer — generally 5% to 10% of those who initially suffered the loss — Dr. Piccirillo says there are no easy answers.

“We don’t know for sure why it takes longer for some people to regain their sense of smell, which also affects the ability to detect flavor. The best guess is that, like all viral infections, some infections can be more severe and cause more damage to the affected nerves.

“In the case of longer return to normal, or failure to return sense of smell to normal, the supporting cells may have become more damaged and, thus, the olfactory nerves are also more damaged,” he says. “In this case, the sense of smell may not come back or, if it does, it comes back in a distorted way.”

A distorted sense of smell, Dr. Piccirillo says, can be even more debilitating for patients than the loss of smell. Called parosmia, the condition can cause typically pleasant scents to smell terrible — or vice versa. For example, certain once-loved foods can smell like garbage, or the scent of a skunk might smell like flowers to someone with parosmia.

“Food tastes and smells rancid to these patients, and it’s very unpleasant,” he says. “It really decreases the quality of life — even more than lack of smell or reduced smell.”

Sometimes, the sense of smell never returns. In those cases, Dr. Piccirillo says, patients are typically older and initially suffered a more severe COVID-19 infection.

“We’ve found that the older you are and the longer you’ve had the loss of sense of smell, the less likely it is to return,” he adds.

For those who are suffering from ongoing loss of smell and taste, Dr. Piccirillo recommends making an appointment for a nasal examination.

“There isn’t a lot we can do at this point with regard to treatment,” he says. “But it’s important to rule out other causes of olfactory dysfunction, such as a tumor, a nasal polyp or allergies.”

He also proposes using a nasal saline lavage, like Netipot, a treatment that’s commonly suggested for patients with allergies and that he recommends for everyone as part of good nasal hygiene. For patients with anosmia, he recommends adding a prescription steroid medication to daily nasal saline lavage treatments.

“That’s one of the few treatments that shows possible effectiveness,” he says. “After several weeks of nasal lavage with steroids, a few patients have reported that their sense of smell has improved.”

He adds, however, that it’s difficult to say whether those patients recovered their sense of smell because of the treatment or because of time.

“If that’s cause and effect, I can’t say for sure — because, over time, Mother Nature heals,” he says. “Over time, many people will recover their sense of smell anyway.”

He notes that he and his fellow physicians at Washington University are researching other potential treatments for the loss of smell.

“Washington University physicians have several different avenues of research currently,” he says. “We are actively researching this — because it’s such a public health issue.”

If you’ve lost your sense of smell or sense of taste after COVID-19 infection, and it hasn’t returned after several weeks or months, schedule an appointment with your primary care physician or an ear, nose and throat/ENT specialist.