When COVID-19-related olfactory disturbances improve spontaneously, specific treatment may not be necessary. However, when the impairment persists beyond 2 weeks, it may be reasonable to consider treatment. The efficacy of available treatments for patients with COVID-19-related olfactory disorders is unknown, although treatments targeting postinfectious olfactory disorders may be potentially useful for COVID-19.
Olfactory training involves repeated, deliberate sniffing of a set of odors (corresponding to the primary odors) for 20 seconds each at least twice daily for at least 3 months (or longer if possible). Studies have shown improved sense of smell in patients with postinfectious olfactory disorders after olfactory training. Olfactory training may be considered for patients with persistent olfactory complaints related to COVID-19 infection because this therapy has low cost and negligible adverse effects.
Oral and intranasal corticosteroids have been used to rule out an inflammatory component in patients with postinfectious olfactory disorders. However, corticosteroids are not currently recommended for individuals with postinfectious olfactory disorders because evidence of benefit is lacking and there is a potential risk of harm. Because of safety concerns, the administration of systemic corticosteroids for the routine management of acute COVID-19 is not recommended. In the absence of demonstrable inflammatory disease observed by endoscopy or imaging, initiation of corticosteroid treatment is unlikely to benefit post-COVID-19 olfactory complaints, as it does for other causes of post-infectious olfactory complaints. However, for patients who were using intranasal steroids before developing COVID-19 (e.g., for allergic rhinitis), such medication should be continued.
Other drugs that have shown promise in postinfectious olfactory disorders include intranasal sodium citrate, which is thought to modulate olfactory receptor transduction cascades; intranasal vitamin A, which may act to promote olfactory neurogenesis; and systemic omega-3s, which may act through neuroregenerative or anti-inflammatory means. The latter 2 drugs may serve as adjuvant therapies in olfactory training. However, to date, there is no evidence that these therapies are effective in patients with COVID-19-related olfactory disorders.
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