Time to Smell the Roses: Anosmia in the Covid-19 Era

Anosmia = loss of the sense of smell Marc and I had an interesting experience last week, which started the New Year off on an unexpected note. A woman came into the apothecary and explained that while she was almost fully recovered from Covid-19, she had still not regained her sense of smell. She had just started using a technique designed to utilize pure essential oils to reestablish the brain’s connection to aromas and restore this vital sense. Our customer spent quite some time at our 100-unit essential oil tester bar, sampling a wide range of aromatic oils, including herbal, woody, spicy, floral and citrus oils. It took some time, but finally she lit up when sampling cold-pressed lime oil from Mexico. It was the first thing that she had actually been able to smell since contracting Covid, and she was thrilled! She headed out with a handful of essential oils, ready to work with all of them. Naturally, we were very interested to learn about the technique she was using, and we’ve outlined it here. If you, or anyone you know, has experienced this Covid-19 side effect, this article is for you! Covid-19 has changed the way we perceive the world around us in many ways. Some of the side effects of the SARS-CoV-2 virus have been baffling and intriguing to the scientific community, who have scrambled to address them and provide beneficial outcomes to Covid patients. One of the more unusual side effects that the scientific community has documented is total loss of smell (anosmia) or partial loss of smell (hyposmia) often accompanied by total loss of taste (aguesia) or partial loss of taste (hypoguesia). The Centers for Disease Control (CDC) has weighed in on this situation, calling ‘new’ loss of smell or taste “the most common side effect of Covid-19.” These disturbing conditions impair quality of life and can create fear in patients who have not experienced them before Covid, and don’t know how to deal with this new phenomenon. Research suggests that loss of the sense of smell affects 77% of Covid-positive people --- a staggering number. One study found that, even two months after the virus, 24% of people had still not found their full sense of smell restored. This is a more concerning side effect than many imagine, since our sense of smell is vital to us for detecting potentially dangerous situations such as fire, smoke or a gas leak, or for discerning if the food we are about to consume is safe to eat or is spoiled or rotten. As smell is intrinsically linked to taste, appetite, food enjoyment, memories and emotions, loss of this sense can be devastating, and lead to increased stress, anxiety and depression in Covid sufferers. Scientists don’t yet know why this symptom is so prevalent in Covid patients. Typically, if someone contracts flu or even a bad cold, loss of the sense of smell can occur as respiratory viruses result in sinus congestion and inflammation, physically blocking smells from reaching the upper nasal cavities. In this situation, the sense of smell returns very quickly once the flu or cold is over. This is not the case with Covid-19. “The loss of smell observed in Covid-19 infections is thought to be caused by direct viral injury to the chemosensory system, which is different from the mechanism seen in a typical cold or upper respiratory infection (URI),” states Lauren T. Roland, MD, head and neck surgeon at the University of California at San Francisco’s Otolaryngology Department, and head of three new studies of Covid-19 patients with olfactory loss. “In contract to the typical temporary loss of smell we see with URI, many people with Covid-19 report sudden loss of smell without nasal obstruction and congestion” adds Patricia Loftus, MD, rhinologist, surgeon and co-author of the studies. “Histological studies have shown that SARS-CoV-2 attacks the sustentacular cells --- the cells that support the olfactory nerves in the nose. SARS-CoV-2 targets the ACE2 receptor found on the sustentacular cells but not on the olfactory neurons. If the supporting cells are compromised, the olfactory neurons are unable to function correctly.” The UCSF team maintains a focus on patient care-related research for those with olfactory loss. One area of focus is a ‘retraining method’ designed to help patients learn how to again detect commonly encountered aromas. This scientifically-approved technique is now known as ‘Olfactory Training.’ So, what exactly is olfactory training? Olfactory training, or smell training, is a specific rehabilitative protocol that helps people to regain their sense of smell after an illness or injury. It is not random, occasional sniffing or smelling, but a structured protocol that is believed to strengthen the connection between the olfactory nerves and the brain. Olfactory training increases the sensitivity of the smell identification function and leads to an overall increase in olfactory function. In the original olfactory training protocol, four essential oils were used: rose, eucalyptus, lemon and clove. The reason that these particular essential oils were selected is that essential oils from plant sources typically have a strong, singular dominant aroma that can be identified with the plant they are derived from, whereas perfumes and fragrances are complex combinations of chemical constituents that are not as easily identified by the brain. Other essential oils can be useful in the olfactory training process. It is helpful if they are distinctive and each selected from the major families of plant aromas – fruity, spicy, woodsy, herbal and floral. While some studies utilize only the dominant terpenes found in the four ideal plant aromas mentioned above, smelling the entire essential oil in its natural state is preferred for best results.

This science-based practice is easy and pleasant to perform and can be done in the privacy and comfort of your home. Following is a step-by-step description of the protocol: 1. Sprinkle 2 – 3 drops of the first oil onto a cotton pad and wait for a couple of moments for the oil to diffuse through the pad.

2. Bring the pad to your nose and inhale the aroma for 20 – 30 seconds, using a series of short, quick inhalations. As you do this, visualize and conjure up memories associated with the aroma. For example, while inhaling lemon, immerse yourself in your personal experience with the aroma of lemon --- clean, fresh laundry, lemonade, lemon meringue pie – fully experiencing the aroma and letting your mind play with images that come up. 3. Pause for 30 seconds, inhale and exhale deeply several times while resting and meditating briefly on the experience. 4. Repeat steps 1 – 3 with the other three essential oils, concentrating on their subjective, unique message to you, affirming that your body and brain are enjoying this aromatic experience, and that your olfactory nerves are healing as you repeat the process. In scientific studies, patients repeated this process twice a day (first thing in the morning and later in the evening) for three to four months, or until their sense of smell was satisfactorily reestablished. The structured nature of the technique helps the olfactory neurons to repair and the brain to rewire in the most positive and effective manner. In certain studies, after the initial three month period, patients switched to a different set of four aromas to continue the olfactory rehabilitative process. In classical olfactory training (COT) the patients used four aromas, whereas in modified olfactory training (MOT) the patients used three sets of four aromas sequentially. The patients that participated in the COT and MOT techniques fared considerably better than those who did not participate in the olfactory training at all, who found their olfactory function remained basically unchanged. Fortunately, with essential oils, there are many to choose from, so it is always possible to work with your favorites! Olfactory training is not a quick fix, so do not be disappointed if you don’t experience much progress in a matter of days or even a few weeks, but continue the technique until you begin to see results. Experts state that the best results are seen if one starts the training within one year of experiencing Covid symptoms. It’s also a good idea to keep a dairy or journal so that you can track your progress, add positive changes and stay motivated. If you, or someone you know, has experienced this Covid-19 symptom, please pass this article along to them. In the majority of cases, anosmia sufferers have found their sense of smell to be completed restored in six to twelve months or even much sooner using olfactory training. It’s time to smell the roses again!