Treatment Options & Evidence
Olfactory Training
With abundant high-level evidence now proving the efficacy of this intervention, it should be offered as first line therapy for anyone with loss of smell. Unfortunately, patients are often not counseled appropriately about how exactly to perform this structured smelling protocol and for how long they need to do it to see benefit, wasting precious time and delaying recovery. Dr. Patel takes care to go through these details during each patient visit.
Although there are now many websites and companies that claim to sell the perfect protocol, these are often taken directly from Dr. Patel’s own research, as she ran the first ever randomized controlled trial on olfactory training in the United States, using the protocol that is now considered the standard regimen.
Read these publications for more detailed information:
High Volume Steroid Irrigations
Due to her long experience as a sinus surgeon and physician, Dr. Patel knew that adding a potent anti-inflammatory medication to a salt water rinse and having patients rinse their nose and sinus cavity could be extremely helpful in bringing down inflammation and bringing back smelling ability in patients with chronic sinusitis. This topical application is much safer than oral, inhaled or injected steroids, and most patients can utilize this without concern over systemic absorption, although Dr. Patel does test each patient to ensure this does not happen if they use it for a long time.
She then ran a study examining if this could also help patients with smell loss that did not have any sinus issues, as often the underlying etiology of smell loss is associated with inflammation at a microscopic level at the olfactory epithelium from viruses/trauma/toxins/etc., and it was effective for that patient population as well.
Read this study:
For those patients whose smell and taste loss is associated with chronic sinusitis with or without nasal polyps, both medical and surgical therapies are available. High volume steroid irrigations, as noted above, are one part of that.
How to rinse the nose and sinuses with salt water
Endoscopic Sinus Surgery
All faculty rhinologists with the Stanford Sinus Center can help patients with smell loss related to sinusitis. Dr. Patel has performed over 6,000 sinus surgeries with excellent success, and has performed research in these areas as well, proving the efficacy of these treatment options in improving smelling ability along with alleviating many other sinus symptoms.
Learn more about Dr. Patel’s research evaluating sinus treatment options for smell specific outcomes:
- Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis
- Association Between Smell Loss, Disease Burden, and Dupilumab Efficacy in Chronic Rhinosinusitis with Nasal Polyps
- EDS-FLU efficacy in patients with chronic rhinosinusitis with or without prior sinus surgery in ReOpen1 and ReOpen2 randomized controlled trials
High Dose Omega-3
In addition to being an expert in smell disorders, Dr. Patel is also Director of Endoscopic Skull Base Surgery for the ENT department. She noted about a decade ago that a significant portion of those patients were having difficulty with smelling ability after those surgeries, even when great care was taken to preserve the olfactory structures – likely because of the high level of inflammation in the nose during the healing period of those surgeries
She ran a randomized controlled trial evaluating if high dose omega-3 could help, after reading how it was being used in other areas of neurology for nerve regeneration, and indeed it significantly decreased the number of patients with long term issues. Her same protocol was then replicated in a COVID-19 patient population with smell loss in Germany with promising results as well.
As this is simply providing the body with the building blocks of nerve regeneration and decreasing systemic inflammation, this is an option for patients with smell loss from all etiologies, keeping in mind that we are extrapolating from the data learned in these specific patient populations when using it in others.
This supplement can thin the blood, so patients with bleeding disorders or who are on other blood thinning medications should avoid this option. Please also keep in mind that vitamins and supplements are not regulated by the Food and Drug Administration (FDA) in this country , and thus care should be taken in choosing a reputable brand. The United States Pharmacopeia (USP) independently tests and verifies these supplements, so look for their seal of approval.
Read more about the study this treatment is based on:
Platelet-Rich Plasma (PRP)
PRP is a therapy utilized for wound healing and tissue regeneration in many fields, including orthopedics, general surgery, and aesthetics, among others. Dr. Patel first became interested in PRP when she saw it being used for nerve regeneration in other neurologic conditions.
The patient’s own blood is drawn and placed in a centrifuge to create the PRP, which is then injected back into the patient, so there are no medication side effects to worry about.
She has run a randomized controlled trial showing success in patients who lost their smell and taste from COVID-19, as well as a long term follow up cohort study which included all post-viral smell loss. She has seen success with this therapy with some patients who have smell loss even from other etiologies, thus she has now opened this up as a treatment option for all patients with smell loss, regardless of etiology.
