Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: I’m an 82-year-old, very healthy woman. In February 2020, just as the COVID-19 pandemic was starting to appear in North America, I had a viral infection that was relatively mild (a bit of coughing, runny nose, itchy throat) and lasted for a few days only, although I felt tired for a bit longer. One unusual symptom was that I lost my sense of taste and smell. At that time, it was not known that COVID-19 caused this in many people, nor did we have tests to determine if I had COVID-19.
My lack of smell and taste was unusual because I had always had a very acute sense of smell. A few months later, a blood test as part of a study I was in revealed that I had not had the SARS-CoV-2 virus. When I asked why I had not recovered my chemical senses, the reply was that other viruses can cause those symptoms, too.
Almost three years in, I consulted an ENT about something else and asked about my problem. He was quite dismissive, also stating that other viruses can cause a lack of taste and smell, and told me I’d recover them eventually. I asked if after three years with no progress he still thought that was possible, and he responded in the affirmative.
Do you agree with his assertion? I know that nerves regenerate, and it can take a long time, but I think I should have seen at least some partial recovery of these senses. Besides, it might be a nervous system problem, not a peripheral issue. Until now, I’ve been patient, but my quality of life is suffering greatly. I cannot taste anything except the four basic tastes (salty, sweet, bitter and sour), which reappeared shortly after my viral infection. Food is only enjoyable by texture and memory.
I’ve tried to stimulate my sense of smell by smelling perfumes that I like, cinnamon, or anything that has a strong smell, but this has not resulted in a reappearance of the sense of smell. As someone who enjoys cooking, it’s very disconcerting to remember how the house smelled, sometimes for days, after cooking certain dishes, and now I can’t smell it at all. This makes me very sad. — E.R.H.
ANSWER: I cannot say for certain whether that initial infection was COVID-19 or some other virus, but during that time, the dominant infection was certainly SARS-CoV-2, and the loss of sense of smell is so characteristic of the virus at the time that it is hard to believe the blood testing you had. (Blood tests are not perfect.)
Studies on people who lost their sense of smell due to COVID show that 96% of people recovered sense of smell by eight months. I don’t know of any data that show what happened to the 4% of people who didn’t, and while I agree with the ENT doctor who said it was possible that your sense of smell could return, I have never seen a person who lost their sense of smell for as long as you have in those who have subsequently recovered it.
Sensory retraining using perfumes and other strong odors (also called “olfactory training”) has been recommended to help recovery. Some have suggested a trial of a nasal steroid such as budesonide as well. But I honestly do not think it is likely you will recover. I am very sorry. I’ve seen so many cases of people with long-term symptoms from COVID infection.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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