Anosmia: five minutes with . . . ENT consultant Claire HopkinsBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2095 (Published 26 May 2020) Cite this as: BMJ 2020;369:m2095
“Postviral smell loss is relatively common, though in a typical month I would usually see only one or perhaps two patients with the condition.
“People with covid-19 lose their sense of smell because the virus injures the nerve endings in the olfactory epithelium and damages the olfactory bulb. It’s a neurotropic virus so can travel along nerves and cause damage to those nerves.
“The British Rhinological Society and ENT UK published guidelines on treating patients with anosmia to coincide with the announcement that it is a recognised symptom of covid-19.
“The advice for GPs is essentially to try to establish the covid status of the patient. If the patient has been shown to have covid-19 and they have no other neurological or nasal symptoms, then they do not need further investigation of other causes of loss of smell, so they don’t need to be referred to ENT.
“What we’re seeing is that around 90% of patients improve spontaneously in the first two to three weeks, so no active treatment is required for the majority of patients. For the 10% of patients who have ongoing symptoms we have made recommendations for treatment options.
“The evidence for any treatment for postviral smell loss is actually very poor, but there is something called smell training that is essentially repeated stimulation of the olfactory nerves to try to get them working again. There are a small number of other treatments that might be considered on an individual basis, but largely it’s supportive measures.
“For the group who have still lost their sense of smell at around two months, on the basis of what we know in general about postviral loss there is still a reasonable chance that they will recover spontaneously, but it’s likely to take months. Around a third will recover within six months, and two thirds will have recovered at 18 months.
“But we will still be left with some people who will never get their sense of smell and taste back. My back of the envelope calculation at the moment is that there will probably be around 100 000 patients in the UK who will have long lasting loss of sense of smell from covid-19.
“In terms of support, there are two very good charities: Fifth Sense (fifthsense.org.uk) and Abscent (abscent.org). They can advise patients on how to do smell training and give them access to support groups. Losing your sense of smell is isolating and has a high risk of associated depression. None of your friends and family can empathise; it’s almost impossible to imagine how it feels to have lost your sense of smell.
“These patients need support, and primary care doctors don’t have the resources to do that, but these two charities do. The British Rhinological Society is working with them to try to get more funding to raise awareness and develop e-modules for patients and GPs to help give them more information.”
Addendum: On 28 May we amended this article to clarify the text in paragraphs 4 and 7.
Claire Hopkins is president of the British Rhinological Society, professor of rhinology at King’s College, London, and a consultant ENT surgeon at Guy’s and St Thomas’ Hospitals in London.
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